How do health and allied health practitioners perceive excellence in residential aged care? An exploratory qualitative study.

OBJECTIVE: To identify factors that health and allied health practitioners consider central to excellence in residential aged care facilities (RACFs) with the objective of supporting improvements in monitoring, accountability and service delivery within the sector. METHODS: In a qualitative, exploratory designed study, interviews were undertaken with seventeen participants from 10 health and allied health disciplines (general practice, dentistry, pharmacy, psychiatry, psychology, neuropsychology, physiotherapy, speech pathology, occupational therapy and palliative care) with experience of working in Victorian RACFs. The interviews focused on how practitioners perceived excellence within RACFs. Data were analysed thematically. RESULTS: Thematic analysis yielded five themes, which correspond with different dimensions or ways of understanding excellence, including resident well-being, residences as a true home, good practice models, effective management and skilled staff, and unmet needs. Under each of these themes, participants referred to issues closely related to the concerns of their particular professions as well as those more general in nature. CONCLUSIONS: The diversity in issues to which participants drew attention highlights the importance of obtaining the perspectives of a broad range of practitioners providing services to RACF residents to achieving excellence in the sector. Commonalities in their responses indicate the potential for a greater level of collaboration among the health and allied health professions.

Loss, Unresolved Trauma and Gaps in Staff Knowledge: A Qualitative Study on Older Adults Living in Residential Aged Care.

Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.

Minority Stress for Care Experienced Young Queer People: A Case Study.

Young people who are placed in out-of-home care are amongst the most vulnerable in our community. Removed from or rejected by their families, they must learn to live with carers who may be strangers. They may have experienced the trauma of abuse or neglect. Post care, they may experience further social isolation and marginalisation due to limited social capital. These challenges are compounded for queer young people placed in out-of-home care. This study adopted a case study approach to explore the lived experience of two young adults growing up queer in and out of out-of-home care in Australia. Our investigation was framed by two complementary theoretical frameworks. The first, a model of minority stress, is informed by queer perspectives and enabled an exploration into the adverse impact of enduring stigma and prejudice associated with homophobia and transphobia on young people's capacity to thrive. The model of social capital was then employed to inform an analysis of relationships between queer young people in out-of-home care and trustworthy adults. The findings suggest that queer young people growing up in out-of-home care experience minoritised stress, with lasting negative implications. The presence however, of trustworthy adults who challenge dominant heteronormative assumptions and work to support queer young people can be experienced as stabilising and restorative.

Challenges faced by residential aged care staff in decision-making for residents with dementia.

Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015-2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents' decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents' rights and inconsistent treatment by staff, placing residents' wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents' self-determination and their own need for greater organisational support.

Indigenous Children and Young People in Residential Care: A Systematic Scoping Review.

In Australia and internationally, Indigenous children are seriously overrepresented in the child welfare system. This article provides an overview of literature investigating the needs of Indigenous children in residential care facilities. The provision of culturally safe and trauma-informed therapeutic care to Indigenous children and young people in residential care recognizes that the trauma and violence that they have experienced is exacerbated by their Indigeneity due to the colonial histories presenting. Utilizing a systematic scoping review methodology, the study returned a total of 637 peer-reviewed articles that were identified and reviewed for inclusion. The process of exclusion resulted in the inclusion of eight peer-reviewed studies and 51 reports and discussion papers sourced from gray literature. Findings from this study, though dearth, indicate that trauma-informed and culturally safe interventions play a significant role in Indigenous children's health and well-being while in care. Their experiences of abuse and neglect transcend individual trauma and include intergenerational pain and suffering resulting from long-lasting impacts of colonization, displacement from culture and country, genocidal policies, racism, and the overall systemic disadvantage. As such, a therapeutic response, embedded within Indigenous cultural frameworks and knowledges of trauma, is not only important but absolutely necessary and aims to acknowledge the intersectionality between the needs of Indigenous children in care and the complex systemic disadvantage impacting them.

How Residential Care Staff Conceptualize the Identities of Residents With Dementia and Its Relevance for Decision Making.

The ways in which residential aged care staff conceptualize the identities of residents with dementia has significance for how they support them to make decisions and make decisions on their behalf. This article aims to further understand how staff in residential aged care facilities comprehend who residents "are." METHODS: This qualitative study draws on individual and group interview data with aged care staff from two Australian states concerning decision making for individuals with dementia. It identifies themes relevant to how staff refer to identity in relation to such residents. RESULTS: Staff possess disparate ideas about what things comprise residents' identities and, accordingly, which sources of knowledge are most relevant to learning about residents. DISCUSSION: This article argues for the application of a multidimensional and temporally inclusive understanding of identity by those who provide care to people with dementia.

How do care staff in residential aged care facilities conceptualise their non-verbal interactions with residents with dementia and what relevance has this for how residents' preferences and capacity for decision-making are understood?

This paper considers the significance of how staff in residential aged care facilities interpret the non-verbal communication and behaviour of residents vis-a-vis their assessments of residents' preferences and ability to participate in decision-making. It highlights the risks associated with staff members' failure to interpret residents' non-verbal communication and behaviour with reference to residents' backgrounds and prior experiences. It also considers how non-verbal communication implemented by staff may impact residents' emotional state and, as a consequence, decision-making abilities. Drawing on interview data with aged care staff from Queensland and Victoria, it demonstrates that care staff in residential facilities appear to rely heavily on non-verbal signals in assessing the decision-making capacity and preferences of residents with dementia. It also indicates that many staff fail to consider residents' non-verbal communication and behaviour with due consideration of residents' individual histories.

Identifying conceptualizations and theories of change embedded in interventions to facilitate community participation for people with intellectual disability: A scoping review.

BACKGROUND: Little progress has been made towards community participation of people with intellectual disability despite it being a policy aim since the 1980s. We aimed to identify the features of programmes designed to support community participation. METHOD: A scoping review was conducted of peer-reviewed literature between 2000 and 2015, about interventions to support community participation for adults with intellectual disability. RESULTS: A small body of evidence relates to the design and effectiveness of interventions to enhance community participation. Seventeen studies reported programmes reflecting three conceptualizations of community participation (as social relationships, as convivial encounter and as belonging) that used strategies such as active mentoring, facilitative support worker practice and arts-based programmes. CONCLUSIONS: Studies showed the diverse and person-centred nature of community participation and demonstrated the need for larger-scale studies of promising interventions that include details of costs, and strategies to guide implementation of policies to support community participation.