New directions in aged care in Australia

Flinders University researchers are advocating a better quality of life for residents in aged care facilities.

A new Flinders University study has found that living within home-like, clustered models of residential aged care can lead to better quality of life and lower hospitalisation and emergency department presentation rates when compared with standard Australian care models.

The results, after adjusting for differences in the complexity of the residents, show improved outcomes for the residents were achieved with no increment in whole-of-system costs.

Overall, such alternative models of care such as the US Green House approach are delivering better outcomes for a comparable cost.

Overall the new research found that the running costs for the smaller residential care facilities were not higher and might be even lower than current models, when weighing up differences between the people living in the different facility types.

Approaches to ensuring quality in aged care have been heavily debated in Australia.

While there has been considerable focus on reviewing regulatory approaches to quality assessment, internationally there is growing interest in the effects of various physical environments and models of care on the quality of life of residents – and particularly those living with dementia.

Novel approaches such as the US Green House Model provide a home-like, clustered model of care, where residents live within small-scale living units that are designed to look and feel more like a home.

The Flinders University INvestigating Services Provided in the Residential care Environment for Dementia (INSPIRED) study compared patient-reported outcomes and resource use for over 500 residents of 17 facilities across four Australian states.

In 2016 there were approximately 180,000 people living in permanent residential aged care in Australia, an increase of over 10% in the last five years.

The average age of a person living in residential aged care is 84 with 52% of these living with a diagnosis of dementia.

Dr Suzanne Dyer, left, and Professor Maria Crotty, right, and Flinders research fellow Dr Stephanie Harrison conducted extensive interviews with older Australians as part of their national investigation.

In Australia’s major cities the standard model of residential aged care has been buildings of more than 60 beds and this size is increasing. However, there is growing evidence from around the world that more home-like models provide better quality of life for aged care residents.

The study found that living within home-like, clustered models of residential aged care  – with limited number of people, for example 12-15 – can lead to better quality of life and lower hospitalisation and emergency department presentation rates when compared with standard Australian care models.

The results, after adjusting for differences in the complexity of the residents, show improved outcomes for the residents were achieved with no increment in whole-of-system costs. Overall, these models are delivering better outcomes for a comparable cost.

The staff and physical environments support resident choice and flexibility in activities and provide access to the outdoors, for example residents can have more involvement in domestic duties such as meal preparation.

Residents of the home-like models of care were also 52% less likely to be prescribed a potentially inappropriate medication (such as antipsychotics or benzodiazepines), which have been associated with adverse health effects such as falls or strokes in older adults.

Residents of the home-like models of care had a lower rate of hospitalisation admissions and emergency department presentations, after adjustments for other differences were taken into account.

The study lead, Professor Maria Crotty, from the Rehabilitation, Aged and Extended Care research group at the College of Medicine and Public Health at Flinders University, says other overseas studies have demonstrated that these models of care perform better in quality of care indicators such as re-hospitalisations, catheter use and pressure ulcers.

“But ours is the first study to examine such a range of outcomes, including resident-reported quality of life, health care, medication and aged care resource use,” Professor Crotty says.

The lead author on the study, Dr Suzanne Dyer, says this latest research – with partners including the NHMRC Cognitive Decline Partnership Centre (CDPC) at Sydney University – found smaller, home-like units with a person-centred care approach were associated with better outcomes for older people living in care and comparable or lower older aged care costs.

“There is a need for further research to explore these potential benefits and future research should be directed toward longitudinal projects, applying a more comprehensive method of measuring facility running costs such as a ‘bottom up’ analysis,” Dr Dyer says.

The study was been conducted as part of the work of the NHMRC CDPC. This partnership includes Dementia Australia, three leading aged care provider organisations Helping Hand Australia, Brightwater Care Group and HammondCare, eight universities and health-care organisations.

Professor Crotty says the aged care partners and consumers involved in the study “set the research agenda and priorities, including the people with dementia”.

“We needed 411 proxy consents because of the high level of participation of people with dementia and their aged care partners did the heavy lifting and provided amazing support with the residents and families,” she says.

“The issue of quality in aged care is always close to the community’s heart and this study suggests there should be increases access to alternative models of residential aged care, particularly those that have evidence of better outcomes for the residents.”

While the aged care providers did not provide funding for this study, the model allows aged care providers to have input into research priorities.

Results of the study have been published in the Medical Journal of Australia.

The INSPIRED project is funded as part of the NHMRC Cognitive Decline Partnership Centre (CDPC).

Read more at The Conversation – ‘Caring for by elderly Australians in a home-like setting can reduce hospital visits’ – by Dr Sue Dyer and Dr Stephanie Harrison) here

The study, entitled Cluster models of residential aged care are associated with fewer hospitalisations and better quality of life: An Australian cross-sectional study’, Suzanne M Dyer, Enwu Liu, Emmanuel S Gnanamanickam, Rachel Milte, Tiffany Easton, Stephanie L Harrison, Clare E Bradley, Julie Ratcliffe and Maria Crotty Med J Aust 2018; 208 (10): 433-438. || doi: 10.5694/mja17.00861, and Costs of potentially inappropriate medication use in residential aged care facilities’ can be read in Geriatrics.

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