Australians are living longer
and the overall percentage of the Australian population is aging. Australia’s
population is projected to increase to 38 million by 2060 (an increase of 15
million from 2012). In terms of health Australians have a longer life
expectancy and are generally healthier than previous generations. However, older
people access health services proportionally more often than other age groups.
In living longer, older Australians also have a high incidence of living with
chronic disease, 49% of people 65-75 years had five or more chronic health
conditions. This increases to 70% for people over 85 years. (AIHW 2013)
As
at July 2013 there were 2718 residential aged care services across Australia
with 186 278 resident places and aged care workers made up approximately 68% of
the care workforce. (ANMF 2014)
With higher level
acuity and health complexity of older people requiring residential aged care
services and the expanding costs of care, staffing models of care in
residential aged care facilities (RACFs) requires significant review and
restructure.
Aged care services need to be
provided by knowledgeable competent practitioners but are challenged by staff
shortages, sufficiently skilled workforce to meet complex health care needs and
ongoing reduction in staff/resident ratio (indeed there is no legislated
mandatory minimum staff/resident ration in aged care faculties in Australia).
ACWs should be acknowledged and for
the important role they play in providing direct care. ACWs assist with Activities
of Daily Living (ADLs) and personal care needs such as toileting, washing,
dressing, eating and drinking, mobility etc. The
ACW role may further include carrying out some (indirectly) supervised health
tasks (eg routine wound dressings, administration of routine medications).
What is increasingly
overlooked (and poorly acknowledged) is that the capacity of ACWs to provide
safe and appropriate care is fundamentally dependent on the level
of individualised nursing assessment of the older person undertaken by a
registered nurse.
To
ensure safe, quality care, ACWs must have the knowledge and understanding of
different health conditions, ability and awareness to recognise, identity and
promptly report often, subtle changes in physical and/or mental health that may
indicate deteriorating health status such as increased discomfort, loss of
mobility, hearing or sight loss, signs of depression or anxiety.
The important role of registered nurses in RACFs is to
provide comprehensive health assessments, determine and develop plans of care,
to identify individual clients at risk, to assess and intervene early for
clients with deteriorating health and to ensure than clients with high level
acuity and complex care and clients with high acuity are cared for by qualified
registered nurses.
I am not advocating, nor do I believe that only nurses should (or are
able) to provide care. This is not necessarily addressed by increasing the number of registered
nurses to provide direct hands on care, although the important role of
registered nurses in reducing morbidity and mortality across a broad spectrum
of health conditions is well documented. It best lies in ensuring nursing roles
are positioned to encompass greater emphasis and resources on case management,
clinical assessment, risk management and early intervention.
Registered nursing roles in aged should emphasise
·
Client-centred
assessment, care planning and case management
·
Preventative
management strategies
·
Safety/risk
management strategies
·
Maintenance of
self-care ability independence
·
Maintenance of
adequate nutrition, physical activity
·
Facilitating
client and family health literacy
·
Referral and access
to interdisciplinary health care team
·
Liaison with
other health services (eg acute care)
·
Staff
(enrolled nurse and ACW) training and education (including competency based assessment and review
