scholarly journals Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity

2021 ◽  
Vol 18 (15) ◽  
pp. 7899
Author(s):  
Tiffany Jessop ◽  
Carmelle Peisah
Keyword(s):  
Human Rights ◽  
Aged Care ◽  
Care Quality ◽  
Royal Commission ◽  
Active Player ◽  
Chemical Restraint ◽  
People With Dementia ◽  
Educational Engagement ◽  
Care System

The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. To be powerful advocates for themselves and others, people with dementia and the wider community with vested interests in quality aged care must be informed about their rights and what should be expected from the system. Prior to the Australian Royal Commission into Aged Care Quality and Safety, the Empowered Project was established to empower and raise awareness amongst people with dementia and their families about changed behaviours, chemical restraint, consent, end of life care, and security of tenure. A primary care-embedded health media campaign and national seminar tour were undertaken to meet the project aims of awareness-raising and empowerment, based on 10 Essential Facts about changed behaviours and rights for people with dementia, established as part of the project. Knowledge translation was assessed to examine the need and potential benefit of such seminars. We demonstrated that this brief educational engagement improved community knowledge of these issues and provided attendees with the information and confidence to question the nature and quality of care provision. With the completion of the Royal Commission and corresponding recommendations with government, we believe the community is ready to be an active player in reframing Australia’s aged care system with a human rights approach.

Progressing Towards a Freer Market in Australian Residential Aged Care

2021 ◽  
pp. 1-25
Author(s):  
Susan F Cochrane ◽  
Alice L Holmes ◽  
Joseph E Ibrahim
Keyword(s):  
Current System ◽  
Aged Care ◽  
Care Quality ◽  
Cultural Safety ◽  
Residential Aged Care ◽  
Royal Commission ◽  
Care Providers ◽  
Fit For Purpose ◽  
Market Driven ◽  
Care System

The Royal Commission into Aged Care Quality and Safety has again focussed attention on the failings of the Australian aged care system. Residential aged care in Australia has become increasingly market-driven since the major reforms of 1997. The aims of increased marketisation include providing residents with greater choice, higher quality services, and increasing providers’ efficiency and innovation. However, marketisation is not meeting these aims, predominantly due to asymmetries of knowledge and power between residents and aged care providers. These asymmetries arise from inadequate provision of information, geographic disparities, urgency for care as needs arise acutely, and issues surrounding safety, including cultural safety. We propose a human rights framework, supported by responsive regulation, to overcome the failings of the current system and deliver an improved aged care system which is fit for purpose.

scholarly journals Women, work and industrial relations in Australia in 2019

2020 ◽  
Vol 62 (3) ◽  
pp. 365-379 ◽  
Author(s):  
Meraiah Foley ◽  
Sue Williamson ◽  
Sarah Mosseri
Keyword(s):  
Gender Equality ◽  
Labour Force ◽  
Industrial Relations ◽  
Labour Force Participation ◽  
Aged Care ◽  
Economic Security ◽  
Care Quality ◽  
Royal Commission ◽  
Political Agenda ◽  
Annual Review

Interest in women’s labour force participation, economic security and pay equity received substantial media and public policy attention throughout 2019, largely attributable to the federal election and the Australian Labor Party platform, which included a comprehensive suite of policies aimed at advancing workplace gender equality. Following the Australian Labor Party’s unexpected loss at the polls, however, workplace gender equality largely faded from the political agenda. In this annual review, we cover key gender equality indicators in Australia, examine key election promises made by both major parties, discuss the implications of the Royal Commission into Aged Care Quality and Safety for the female-dominated aged care workforce, and provide a gendered analysis on recent debates and developments surrounding the ‘future of work’ in Australia.

The essence, content and characteristics of medical services’ quality

2021 ◽  
pp. 40-43
Author(s):  
Constantin Etco ◽  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care System ◽  
Health Care Quality ◽  
Services Quality ◽  
Care Quality ◽  
Medical Services ◽  
Total Quality ◽  
Care System

One of the priorities of the health care system in Moldova is the medical services’ quality improvement. Th is article presents various defi nitions for health care quality and the principles connected with quality improvement. An important part in this article is allocated to the structure and main principles of total quality management in the health care system. Th is part reveals the problems of the commissions that are studying the quality of medical services in healthcare establishments.

scholarly journals A cross-country comparison of family carers experiences with residential aged care facilities during the COVID-19 pandemic

2021 ◽  
Vol 33 (S1) ◽  
pp. 26-26
Author(s):  
Katarzyna M Lion ◽  
Clarissa Giebel ◽  
Ilaria Chirico ◽  
Monica Cations ◽  
Rabih Chattat ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Aged Care ◽  
Care Quality ◽  
Residential Aged Care ◽  
Care Provision ◽  
Family Carers ◽  
Country Comparison ◽  
People With Dementia ◽  
Cross Country ◽  
The Uk

Background:The number of research projects into residential aged care (RAC) during the COVID-19 pandemic is increasing, however there are limited data on the cross-country comparison of experiences residents living with dementia and their families. Our study aimed to 1) give an overview of the RAC restrictions and changes (visiting policy, governmental & health authorities’ advice, service delivery) implemented during the pandemic in Australia, Italy and the UK and 2) and their impact on people with dementia in RAC facilities and their families.Methods:A total of 56 informal family carers of people with dementia residing in RAC took part in semi- structured interviews over the telephone or via Skype in Australia (n=6), Italy (n=25) and the UK (n=26) between July 2020 and March 2021. The interviews were recorded and translated verbatim. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.Results:Inductive thematic analysis identified four overarching themes: 1) Adaptations implemented in RAC facilities due to the COVID-19 pandemic in Australia, Italy and the UK; 2) means of communication between RAC facility personnel, people with dementia living in RAC and family members; 3) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on people with dementia in RAC facilities and 4) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on families of people with dementia in RAC facilities. While differences between countries and facilities were identified, the restrictions and changes within the residential care system impacted families’ well-being, increased their worries about care quality and safety of people with dementia. The consequences of a lack or modified services for people with dementia included noticeable physical and mental health changes. Although the majority of the facilities implemented some form of video-communication between families and residents, those solutions were unable to replace face-to-face contact.Conclusions:These findings demonstrate the need for implementing safe solutions which might facilitate more frequent in-person contact between families and residents with dementia preventing consequences in mental and physical health in both groups.

Quality of life measurement in community-based aged care – understanding variation between clients and between care service providers

2021 ◽  
Author(s):  
Joyce Siette ◽  
Mikaela L. Jorgensen ◽  
Andrew Georgiou ◽  
Laura Dodds ◽  
Tom McClean ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Participation ◽  
Service Providers ◽  
Care Service ◽  
Aged Care ◽  
Care Quality ◽  
Care Providers ◽  
Community Based ◽  
Care Services

Abstract Background Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets.Methods A retrospective sample of 1141 Australians aged ≥ 60 years receiving community-based care services from a large service provider within 19 service outlets. Clients’ QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e.sociodemographic, social participation and service use) were extracted from clients’ electronic records and examined using multivariable regression.Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets.Results Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0–1, SD = 0.15). After accounting for other factors, being older (p < 0.01), having lower-level care needs (p < 0.01), receiving services which met needs for assistance with activities of daily living (p < 0.01), and having higher levels of social participation (p < 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% (n = 4) had lower mean risk-adjusted QoL scores than expected (< 95% control limits) and 16% (n = 3) had higher mean scores than expected.Conclusion Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support.Trial registration: Australian and New Zealand clinical trial registry number: ACTRN12617001212347. Registered 18/08/2017

scholarly journals The “CHROME criteria”: Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia

2019 ◽  
Vol 32 (3) ◽  
pp. 315-324 ◽  
Author(s):  
Ruben Muñiz ◽  
Alia I. Pérez-Wehbe ◽  
Francisco Couto ◽  
María Pérez ◽  
Noemí Ramírez ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Quality Care ◽  
Primary Study ◽  
Physical Restraints ◽  
Prospective Longitudinal Study ◽  
Legal Standards ◽  
Chemical Restraint ◽  
People With Dementia ◽  
Prospective Longitudinal

AbstractObjective:Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.Design:Observational prospective longitudinal study.Setting:Single nursing home in Las Palmas de Gran Canaria, Spain.Participants:288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.Intervention:Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.Measurements:Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).Results:For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).Conclusions:Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

scholarly journals PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia

2014 ◽  
Vol 26 (7) ◽  
pp. 1147-1160 ◽  
Author(s):  
Lynn Chenoweth ◽  
Ian Forbes ◽  
Richard Fleming ◽  
Madeleine T. King ◽  
Jane Stein-Parbury ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intervention Group ◽  
Emotional Responses ◽  
Care Quality ◽  
Residential Aged Care ◽  
Interaction Quality ◽  
Positive Effects ◽  
People With Dementia

ABSTRACTBackground:There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE.Methods:38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality.Results:From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%.Conclusion:The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369.

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