Residential Aged Care in Australia, Article Critique Example

Introduction

De Bellis wrote an article on Australian Residential Aged Care and the Quality of Nursing Care Provision. This article focuses on three highly dependent aged individuals in an aged nursing care. The author shows that in Australia, after reforms on aged care in 1987 and implementation in 1997, there have been problems in the aged care-nursing field. The study employed the use of interviews on the relatives who participated in providing nursing care for patients. The individuals were two elderly women suffering from Alzheimer’s disease, Ruby and Anna and Cynthia, 32, a woman who had a terminal astrocytoma, obesity, seizures and expressive dysphasia. This case study is as crucial to the nursing practice in Australia as it points out the concerns of clients receiving aged care. The field has suffered neglect due to the system and policy failures governing the field. The article also shows unethical issues within the nursing centres and the fact that anybody including the unqualified can provide care for the elderly. Again, the article is of high importance to a society witnessing increasing people who need care at old age. De Bellis shows that about 5-7% of elderly people in Australia live in residential aged care centres (De Bellis, 2010). He further shows that 208,079 or 10.4% people received residential aged care in Australia in the year 2008. We learn from this article that residential aged care in the country is in want, and policy reconsideration should occur in order to salvage the situation of the population.

Howe et al. (2007) wrote on the Australian residential aged care dynamics: 8-year trends in separation, dependency and admission. The paper aimed to analyse the changes in residents’ dependency in residential aged care centres as a consequent to coming into force of the Commonwealth Aged Care Act, which was in 1997. The paper also sought to establish resultant changes extent in the residential aged care dynamics. This article is relevant to nursing because it gives the impact of the Commonwealth Act of 1997 on the practice of nursing. The authors assert that legislation on residential care specifies the care to the residents and those deserving admission into care homes. Thus, a change in legislation leads to changes in aspects or traits of aged care homes’ residents. The paper deals with a review so comprehensive about separations and admissions through Resident Classification Scale (RSC) starting 1999 to 2006.

Discussion

De Bellis article had an aim to construct the practice of nursing in Australia. This was by the use of a residential aged care with accreditation and access to participants who were highly dependent. The residents and relatives’ perspectives, the coreworkers’ (CW), registered nurses’ (RNs) perspectives, and non-participant observation were crucial for the nursing practice analysis. The research was qualitative used a discourse analysis and case study method in collecting and analyzing data about nursing care for the three women.

De Bellis gives a discourse of broadly by terming as “an environment of neglect” the situation in which the three women in care underwent. The author tells of ‘indecent haste’. The amount of time required to attend to a resident had been a basis of describing the residents. For instance, Anna liked drinking, and since it was easy attending to her, they said her drinking was ‘good’. This could mean that there were ‘bad drinkers’ and they could not receive careful attention because of limited time. The staff always complained of ‘busyness’ and this became a problem according to the relatives. In Cynthia’s case, it was hard to have enough staffs to attend to her needs because her situation being complex required 4-5 people assisting at a time. The data about Cynthia showed hurriedly and rushed ethos at the facility and the problems this had on the provision of nursing care and the residents. In the discourses, there were no any clues about the palliative nature of nursing needs for Cynthia.

There were also notable risky existence including negligent practices and unsafe nursing practices. Negligent practices included Ruby’s and Anna’s untreated hypertension, Anna’s untreated and chronic conjunctivitis and urinary tract infection (UTI), medication errors and undiagnosed deep vein thrombosis (DVT) in Cynthia.

De Bellis is of the opinion that the government had failed in its promise to assure quality of life via adequate funding, residents’ rights and complaint mechanisms and accreditation (De Bellis, 2010). This according to De Bellis is evident in the fact that nursing provision took place under insufficient resources and untrained, unskilled and uneducated non-nurses delivered the services in rush ethos. Thus, the nursing care was a substandard one, detrimental to the health and the quality of life of the residents. There has been normalization of the permeation of principles governing the quality of life as means to assessing the inadequacy of the nursing process and nursing standards. Therefore, provision of quality care cannot occur in a system with low numbers of qualified nursing staff. De Bellis argues that understaffed nursing homes have hidden costs and provide low quality care unlike those with a higher number of staff. Hurried and rushed nursing care provision in Australia to nursing and resident outcomes detriment occurs because of limited human resources in aged care facilities.

Howe and colleagues analyzed data from Residential Aged Care Statistical Overviews annually published by Australian Institute of Health and Welfare, which were from 1998-99 to 2005-06. The researchers compared the trends in the dependency distribution across the eight categories of RCS for admissions, separations and residents.  Recording of separations is when a resident leaves the system through discharge to another setting or death. Exceptions included residents moved to an acute hospital, but who returned to the same home, thus covered by provisions of hospital leave (Howe et al, 2007).

The authors in the article note crucial changes, which came with the change of legislation on the aged residential care. They cite the first change as the replacement of the Personal Care Assessment Instrument used in hostels and the Resident Classification Instrument used in nursing homes with a single Resident Classification scale (RSC) (Howe et al, 2007). The second changes involved allowing residents’ “ageing-in-place” whose care needs had increased and were under admission to a hostel. From RCS piloting, hostel residents were just as dependent as nursing home residents were and they had equal care needs. The RCS funded all residents according to the category of RCS instead of facility type, in which they lived while addressing the overlap. Ageing-in-place meant that residents with increasing dependency remained in the same home. This was unlike previously where they moved to nursing homes for higher funding in tandem their needs of care. A third change, which arose, was in the separations and admissions way of recording. Residents who aged-in-place in same care facility did have a single stay and those admitted to one facility at any RSC level and then transferred to another facility of care, regardless of the care level, did also have their recording as one admission to the aged care residential system for consistency purposes.

The authors in their analysis high dependency in the population of residential aged care thus pointing to increasingly dependent people admitted to residential care. Changes in both the aged population and the aged care system are factors contributing to this increasing selectivity. There have been efforts aiming to provide appropriate, supported accommodation forms for young people in aged care homes thus their number has reduced over time. Community care services have expanded against the fall in bed supply. The increase in Community Aged Care Packages (CACPs) has extended the community care capacity to delay admission to low care, in addition to the steady growth, of the Home and Community Care Program. The growth of residential, respite care has also resulted in delays of residential admissions to the aged care facilities.

Comparison of the two articles

The study by De Bellis seems specific, and we can say that it is one of the effects that resulted from the legislation change in the year 1997 (De Bellis, 2010). The study by Howe et al is broad and shows the various ways in which then aged care system changed with the passing of new legislation. Both articles agree in the premise that a change in legislation led to a change of aged care nursing provision. The study by De Bellis shows the specifics of the aged care status because of legislative changes. However, it is worth noting that the two articles differ in that the study by De Bellis was a case study specific to three women in a nursing care while the one by Howe and colleagues reviews all aged care facilities in terms of separations and admissions by using RSC scale (Howe et al, 2007). Howe’s article is more a broader study than that of De Bellis. Howe’s is a quantitative research while De Bellis’ is qualitative.

Conclusions

De Bellis shows the risks borne by three residents in an aged care. Nursing care has become a menace in Australia with the change in legislation. The care was under discretion by non-nurses with limited time and limited knowledge base (De Bellis, 2010). Although the study focused on only three individuals, the study could be used to depict the state of aged care in several other facilities, in Australia.

Howe’s et al (2007) shows residential aged care dynamics with clear increasing proportion trends of admissions, separations and residents at progressive high categories of RCS over the period of 8 years. Their findings did not support the hypothesis; increasing dependency leads to an overall reduction in Length of Stay (LOS). The aged care system changes have a relation to associated changes, which have reduced individual admission likelihoods on one hand, and restricting admission of those with high dependency, on the other hand. The findings by the researchers evoke various implications for future funding and planning of residential care. Thus, the use of population aged 70 and above to plan does not auger well with the prevailing situation and the balance of high and low care places used in planning no longer works with diminishing separations and admissions share taken by low care homes.

References

De Bellis, A. (2010). Australian Residential Aged Care and the Quality of Nursing Care Provision. Contemporary Nurse: A Journal For The Australian Nursing Profession, 35(1), 100.

Howe, A., Robinson, A., & Andrews-Hall, S. (2007). The dynamics of residential aged care in Australia: 8-year trends in admission, separations and dependency. Australian Health Review, 31(4), 611.