tag:theconversation.com,2011:/global/topics/aged-care-staff-90361/articlesAged care staff – The Conversation2023-05-03T12:46:24Ztag:theconversation.com,2011:article/2049192023-05-03T12:46:24Z2023-05-03T12:46:24ZGovernment to spend $11.3 billion over four years to fund 15% pay rise for aged care workers<p>Tuesday’s budget will include $11.3 billion over four years to fund the 15% pay rise aged care workers will receive from July 1.</p>
<p>The rise was awarded by the Fair Work Commission. Labor committed at last year’s election to fully fund a rise in pay for this sector. </p>
<p>Given acute staff shortages, it is hoped that the higher wages will attract more workers.</p>
<p>The pay rises will benefit more than 250,000 people.</p>
<p>A registered nurse on a level 2.3 award wage will receive an extra $196.08 a week – more than $10,000 a year. </p>
<p>A personal care worker on a level 4 (aged care award) or a home care worker on a level 3.1 (social, community, home care and disability services award) will get an extra $141.10 weekly – more than $7300 annually. </p>
<p>Recreational officers and chefs in the sector also are in line for increases. </p>
<p>Treasurer Jim Chalmers said that “for too long, those working in aged care have been asked to work harder for longer without enough reward, but with this budget that changes”. </p>
<p>Aged Care Minister Anika Wells said that “fair wages play a major role in attracting and retaining workers”. </p>
<p>Aged care is now the fifth-largest area of federal government spending.
This financial year the cost of aged care will increase from $24.8 billion to an estimated $29.6 billion (23%).</p>
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<p>There are about 1.5 million recipients of aged care in Australia, with growing pressures on the system ahead as the population ages.</p>
<p>In a round of Wednesday media appearances, Chalmers reiterated next week’s budget would contain “substantial cost-of-living relief”. </p>
<p>“It’ll prioritise the most vulnerable. It won’t just be limited by age, and it will be responsible.”</p>
<p>Chalmers said the budget would forecast the economy slowing considerably but not going into recession. </p>
<p>“The budget will be a difficult balancing act, between providing the cost-of-living relief that people need, being conscious of the pressures on the budget and all of that debt that we inherited, but also making sure that we can grow our way out of this slowing economy by investing in things like energy and laying some of these foundations for growth in our economy.”</p>
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<p>Chalmers said the budget would also contain efforts “to get people into work if they want to work, including in communities where there has been for too long entrenched disadvantage”. </p>
<p>“We’ve got colleagues working on the job agency system to make sure that if people want to work, they can grab the opportunities of an economy that’s got unemployment currently running at three and a half per cent.”</p><img src="https://counter.theconversation.com/content/204919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Treasurer Jim Chalmers said that “for too long, those working in aged care have been asked to work harder for longer without enough reward, but with this budget that changes”Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1901472022-09-13T03:39:00Z2022-09-13T03:39:00ZWhat do aged care residents do all day? We tracked their time use to find out<figure><img src="https://images.theconversation.com/files/483173/original/file-20220907-20-97eqmm.jpg?ixlib=rb-1.1.0&rect=17%2C26%2C5809%2C3852&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/an-elderly-man-opening-a-window-curtain-8860207/">Photo by cottonbro/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>What’s the daily routine like for older people in residential aged care facilities? </p>
<p>To find out, we spent 312 hours observing 39 residents at six Australian aged care facilities to learn how and where they spend their time across the day. We wanted to know how socially engaged residents actually were and how this could affect their wellbeing. </p>
<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273412">Our study</a>, published in the journal PLOS One, highlights some long-standing issues in aged care but also provides promise. </p>
<p>Residents were largely active, both in terms of communicating with other people in the centre and in terms of doing activities. But there’s more we can do to create opportunities for socialising.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There’s more we can do to create opportunities for socialising in residential aged care.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Humans are a social species</h2>
<p>Transitioning from life at home to life in aged care can be challenging, often <a href="https://pubmed.ncbi.nlm.nih.gov/17444984/">linked with</a> loss of independence, loss of identity, and loss of control. </p>
<p>Many also associate moving into aged care with a decline in their <a href="https://www.academia.edu/16621669/Daily_life_in_a_nursing_home_Has_it_changed_in_25_years">social lives</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28804359">overall physical health</a>. </p>
<p>So it’s no surprise people living in aged care homes suffer from generally <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02254-2">low levels of wellbeing</a>.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/26155723/">Previous research</a> has found residents hardly attend activities in their facility. The conversations they do have are often with care staff – these are very rare, short, and mainly about their physical care. </p>
<p>However, previous studies often fail to capture critical aspects of how and where socialisation occurs in aged care.</p>
<p>We know humans are a social creatures and that we’re <a href="https://www.nature.com/articles/s41562-018-0389-1">wired to connect</a>, with more social connections boosting our overall wellbeing. </p>
<p>That’s why we decided to take a closer look at how aged care residents spend their time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older woman looks at a friend's phone." src="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Having good evidence on how people spend their time in aged care centres helps identify gaps so we can address them.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/TeWwYARfcM4">Photo by Georg Arthur Pflueger on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>What we found</h2>
<p>During the 312 hours we spent observing 39 residents, we found a day in the life of a resident looks something like this:</p>
<ul>
<li><p>waking up in the morning and getting ready for the day (with the help of personal care staff if necessary)</p></li>
<li><p>attending the dining room for breakfast and spending most of the morning in the common area or lounge room – perhaps participating in an activity run by the lifestyle staff at the facility – before returning to the dining room for lunch</p></li>
<li><p>after that, depending on whether there is an activity being organised, most will go back to their own rooms to recuperate before coming back to the dining room for dinner in the early evening.</p></li>
</ul>
<p>We found social interactions peak at breakfast, lunch and dinner.</p>
<p>Across the day, residents</p>
<ul>
<li><p>spent the greatest proportion of time (45%) in their own room </p></li>
<li><p>were alone 47.9% of the time </p></li>
<li><p>were inactive 25.6% of the time</p></li>
<li><p>were most likely to chat with other residents, followed by staff, then family</p></li>
<li><p>outside of meal times, residents had conversations in the common area or in their own rooms.</p></li>
</ul>
<p>Overall, residents spent more than half their time being socially and physically active.</p>
<p>Over a third of their time was spent with another resident. Spending time with other residents was most likely to be associated with a higher quality of life.</p>
<p>We also found spending time with staff or too much time alone was linked to poorer quality of life.</p>
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<a href="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older people play a board game." src="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Spending time with other aged care residents tends to be associated with a higher quality of life.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/elderly-game">Photo by Singapore Stock Photos on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Creating opportunities for socially active lives</h2>
<p>Based on our research, here are three things aged care providers and governments can do to improve older Australians’ wellbeing:</p>
<p><strong>1. Improve staffing</strong></p>
<p><a href="https://agedcare.royalcommission.gov.au/system/files/2020-06/RCD.9999.0256.0017.pdf">Staff shortages and time pressures</a> are key reasons why residents spend little time with staff. </p>
<p>Including more activities chosen and assisted by residents in aged care facilities could help create new social opportunities between residents and strengthen existing ones.</p>
<p><strong>2. Tailor <a href="https://montessorifordementia.com.au/">Montessori programs</a> to the aged care environment</strong></p>
<p>Montessori programs create a collaborative approach filled with self-directed activities with <a href="https://dementiashop.com.au/product-tag/aged-care-activities/">hands-on learning</a> and play. Activities include things like sorting and recognising objects, completing puzzles, and practising opening locks.</p>
<p>Montessori programs in small groups or led by family members would suit the smaller staff to resident ratios in many aged care centres. They would also help residents (including those with dementia) regain some independence, feel less bored or isolated and have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600589/">sense of purpose</a>.</p>
<p><strong>3. Change the physical environment and offer more afternoon activities</strong></p>
<p>Changing the physical environment to accommodate for more social spaces would go a long way to help.</p>
<p>Increasing the number of activities in the afternoon would mean residents have more opportunities to socialise with each other, especially those who are busy with personal care routines in the mornings.</p>
<h2>Doing residential aged care differently</h2>
<p>After <a href="https://www.abc.net.au/4corners/who-cares/10258290">media reports</a> and a <a href="https://agedcare.royalcommission.gov.au/publications/final-report">royal commission</a> highlighted the failings of Australia’s aged care system, it’s time to think differently about aged care.</p>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273412">study</a> reveals residents can and do socialise, and that it can significantly improve people’s quality of life.</p>
<p>We must now find ways to change aged care environments and practices to create more social opportunities.</p>
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<img src="https://counter.theconversation.com/content/190147/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joyce Siette is affiliated with the Australian Association of Gerontology.</span></em></p><p class="fine-print"><em><span>Laura Dodds receives funding from Macquarie University. </span></em></p>We spent 312 hours observing 39 residents at six Australian aged care facilities to find out how and where they spend their time across the day.Joyce Siette, Research Fellow, Western Sydney UniversityLaura Dodds, Research assistant, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848292022-08-11T23:18:12Z2022-08-11T23:18:12ZGetting more men into nursing means a rethink of gender roles, pay and recognition. But we need them urgently<figure><img src="https://images.theconversation.com/files/474236/original/file-20220715-11-w83sqo.jpg?ixlib=rb-1.1.0&rect=0%2C70%2C6720%2C4396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Demand for health care is soaring as the population ages, medical treatments become more widely available and more people live with chronic and complex illnesses.</p>
<p>However, there is global <a href="https://www.who.int/health-topics/health-workforce#tab=tab_1">shortage of health professionals</a> – and the pandemic has only accentuated the trend. Overwork, burnout and stress are causing nurses to <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce">leave in droves</a>. </p>
<p>The World Health Organization <a href="https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery">estimates</a> we’ll need a further 9 million nurses worldwide by 2030. According to the International Council of Nurses, the figure is closer to <a href="https://www.icn.ch/sites/default/files/inline-files/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention_0.pdf">13 million</a>.</p>
<p>Part of the solution is to recruit and retain more men in nursing. This would help address workforce shortages and could, over time, reduce the industry gender pay gap as the existence of men in nursing becomes more normalised. </p>
<p>And as jobs dry up in traditionally male-focused industries – such as mining and manufacturing – work in health care should be an <a href="https://nurse.org/articles/Male-Nurses-And-The-Profession/">attractive option</a> for men, providing job security, career opportunities and salary. </p>
<p>But attracting men to the profession won’t be without its challenges. It will require a serious society-wide rethink around gender roles, compensation and recognition for the importance of nursing work.</p>
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<a href="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The reasons for the low number of men in nursing are complex and multifaceted.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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Read more:
<a href="https://theconversation.com/fixing-the-aged-care-crisis-wont-be-easy-with-just-5-of-nursing-homes-above-next-years-mandatory-staffing-targets-184238">'Fixing the aged care crisis' won't be easy, with just 5% of nursing homes above next year's mandatory staffing targets</a>
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<h2>Why are there so few men in nursing?</h2>
<p>Caregiving is <a href="https://link.springer.com/article/10.1186/s12960-019-0406-0">feminised</a> in society and health care, and the nursing profession has strong female foundations. This has established a trajectory and a culture that has kept the representation of men to <a href="https://www.acn.edu.au/nurseclick/men-in-nursing-why-its-okay-for-men-to-care">around</a> <a href="https://www.bbc.com/news/uk-scotland-48125231">10%</a> in many high income countries.</p>
<p>This is despite fervent efforts by many in the industry to achieve the <a href="https://www.bls.gov/cps/cpsaat11.htm">equity of gender representation</a> you see in most professions. </p>
<p>The reasons are complex and multifaceted. Men in nursing are often portrayed negatively in <a href="https://www.truthaboutnursing.org/media/films/meet_the_parents.html#gsc.tab=0">media and movies</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/24001311/">Stereotypes</a> abound. </p>
<p>And some men in nursing face <a href="https://journals.lww.com/ajnonline/Citation/2006/02000/Men_in_Nursing__Still_Too_Few__Discrimination_and.16.aspx">discrimination</a> from patients and staff, underpinned by false assumptions women are better suited to the role. Many people still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228905/">underestimate</a> the capacity of men to undertake personal care tasks.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/nuf.12504?casa_token=0fSzo6BonEQAAAAA%3AuEbtIqONQ7FdzpbrezYLGoIEKLH37CbOan7R0n33MG4vBGplDO0PlJ4kcjEIHhp1hXlxKlEqCgEd">Research</a> also shows low male participation can stem from reticence by career counsellors to recommend nursing as a career.</p>
<p>A recent Australian <a href="https://www.health.gov.au/sites/default/files/documents/2019/12/topic-2-nursing-as-a-career-choice.pdf">report</a> shows the dominance of women in the nursing workforce may hinder some men from considering nursing as a career, particularly those for whom masculinity is central to their identity. So we must work to undo the perception nursing is a feminine job – it is not.</p>
<p>Negative perceptions around the prestige of nursing and its perceived status in the community may hinder some men’s interest in nursing as a career.</p>
<p>Good role modelling is important. Many educational institutions and supporters such as <a href="https://nursing.jnj.com/">Johnson & Johnson</a> are working hard to in present <a href="https://nursing.gwu.edu/improving-mens-health-battling-stereotypes">positive images</a> of men in nursing and normalise that men can be great nurses too.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WikQz4J9B7U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Source: JHU.</span></figcaption>
</figure>
<h2>Retaining men in the workforce and addressing the ‘glass escalator’</h2>
<p>Many <a href="https://www.who.int/publications/i/item/9789240003279">regulatory</a> and professional bodies are monitoring the participation of men in nursing. Some organisations offer incentives. For example, <a href="https://www.aamn.org/">The American Association for Men in Nursing</a> offers scholarships, awards and training to attract and retain men in the profession.</p>
<p>It is important to recognise some barriers for men come from within the nursing profession itself. </p>
<p>Some in the nursing workforce perceive that men are on a career “<a href="https://journals.lww.com/naqjournal/Abstract/2021/10000/Going_Up___Exploring_the_Phenomenon_of_the_Glass.6.aspx#:%7E:text=The%20%E2%80%9Cglass%20escalator%E2%80%9D%20refers%20to,to%20upper%20levels%20of%20leadership">glass escalator</a>”. Unlike a “glass ceiling”, which inhibits career progression, the “glass escalator” allows men to be fast-tracked up the nursing workforce to higher positions in an effort to retain them.</p>
<p>This can cause some to <a href="https://journals.lww.com/naqjournal/Abstract/2021/10000/Going_Up___Exploring_the_Phenomenon_of_the_Glass.6.aspx#:%7E:text=The%20%E2%80%9Cglass%20escalator%E2%80%9D%20refers%20to,to%20upper%20levels%20of%20leadership">perceive</a> male participation in nursing as a negative, which reduces inclusion. </p>
<p>But this glass escalator phenomenon, which can occur in <a href="https://www.spglobal.com/esg/csa/yearbook/articles/gender-equality-workplace-going-beyond-women-on-the-board">other industries</a> too, can only be overcome if male participation in the workforce is normalised. </p>
<p>And it is critically important to look at the structural, gender-driven factors that inhibit women embracing leadership roles. </p>
<p>It’s also worth noting women in the health and caregiving sector face a larger gender pay gap than in other economic sectors. A joint report by the International Labour Organization and the World Health Organization found: </p>
<blockquote>
<p>Women in the health and care sector face a larger gender pay gap than in other economic sectors, earning on average of 24% less than peers who are men […] Within countries, gender pay gaps tend to be wider in higher pay categories, where men are over-represented. Women are over-represented in the lower pay categories.</p>
</blockquote>
<p>Although this differential is not easily explained, it does reflect the value society ascribes to caregiving. If women are over-represented in the lower pay categories (which tend to focus more on personal care tasks) that suggests society ascribes low value to caregiving tasks, and over-representation of women in caregiving helps to further “feminise” caregiving.</p>
<p>It is highly likely these factors conspire to dissuade men and boys from getting started in nursing and undertaking caregiving roles within the profession.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We urgently need more men in nursing.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Time for action</h2>
<p>We urgently need more men in nursing. </p>
<p>Not only does this make good sense for health care, as it presents opportunities for engagement with men, but also good sense for our society and economic productivity. Investment in education and job creation in the health and social sectors <a href="https://www.who.int/teams/high-level-commission-on-health-employment-and-economic-growth/recommendations">could improve</a> health outcomes, shore up global health security, and boost inclusive economic growth.</p>
<p>Perhaps most importantly, robust health care systems should be representative of the populations they serve. The workforce in any industry should be drawn from a range of perspectives, including gender and culture. </p>
<p><hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-saints-or-monsters-pop-cultures-limited-view-of-nurses-107696">Friday essay: saints or monsters, pop culture's limited view of nurses</a>
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</em>
</p>
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</p><img src="https://counter.theconversation.com/content/184829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Davidson is Vice Chancellor and President of the University of Wollongong and is Dean Emerita at the Johns Hopkins School of Nursing. She has previously received funding from the National Health & Medical Research Council, Australian Research Council, National Heart Foundation, NSW Cancer Institute and National Institutes for Health in the United States. </span></em></p><p class="fine-print"><em><span>Caleb Ferguson works for the School of Nursing, University of Wollongong, NSW, Australia. He receives funding from the National Health & Medical Research Council, and has received funding from the Stroke Foundation and Heart Foundation.
</span></em></p><p class="fine-print"><em><span>Jason Farley works for Johns Hopkins University School of Nursing. He receives funding from the National Institutes of Health, Baltimore City Health Department, and the Centers for Disease Control and Prevention. </span></em></p>Research shows low male participation in the nursing workforce can stem from many sources, including reticence by career counsellors to recommend nursing as a career.Patricia Davidson, Vice-Chancellor, University of WollongongCaleb Ferguson, Associate Professor, University of WollongongJason Farley, Professor, Infectious Disease-Trained Epidemiologist and Nurse Practitioner, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1882152022-08-05T05:10:24Z2022-08-05T05:10:24ZCould ‘virtual nurses’ be the answer to aged care staffing woes? Dream on<figure><img src="https://images.theconversation.com/files/477796/original/file-20220805-19484-yd4qm5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-senior-man-patient-medical-consultation-1502513540">Shutterstock</a></span></figcaption></figure><p>Former Health Department Chief Martin Bowles has <a href="https://www.theguardian.com/australia-news/2022/aug/03/virtual-nurses-may-be-needed-to-meet-247-aged-care-staff-mandate-top-health-executive-says">reportedly proposed</a> “virtual nurses” could help address the shortage of nurses in aged care. </p>
<p>This might involve remote, possibly artificial intelligence-assisted, virtual care, rather than physical nurse presence, to assist nursing homes to meet new legislative requirements to have a registered nurse present 24/7.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1554528496915025922"}"></div></p>
<p>There are clear opportunities for technological innovations to improve the care, health, and wellbeing of older people. However, substitution of face-to-face nursing and human interaction with remote care is not the answer. </p>
<p>This seriously risks perpetuating the status quo where <a href="https://www.hrw.org/news/2021/03/03/australia-urgently-address-aged-care-abuse#:%7E:text=%E2%80%9CMultiple%20investigations%20and%20reports%20have,human%20rights%20of%20older%20people.%E2%80%9D">many older people suffer</a> from isolation, neglect and lack of human engagement. </p>
<p>Eroding requirements to properly staff nursing homes with registered nurses could make it even harder to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685779/">attract and keep</a> staff.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-ailing-aged-care-system-shows-you-cant-skimp-on-nursing-care-115565">Our ailing aged care system shows you can't skimp on nursing care</a>
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</p>
<hr>
<h2>What are ‘virtual nurses’?</h2>
<p>“<a href="https://www.nature.com/articles/d41586-022-00072-z">Robot nurses</a>” already exist in some contexts, helping to move patients, take vital signs (such as blood pressure), carry medicines and laundry, and even engage with patients.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"602223483687317504"}"></div></p>
<p>However, “virtual nursing” likely refers to more familiar technology where a real nurse provides a limited range of care via <a href="https://www.sciencedirect.com/science/article/pii/S1541461219303866?casa_token=4QuZ-seF5i4AAAAA:0QtENxksLvBDzKsrvWXuPNcgrPcKf6XhaVTbOVJfsnE8nL-XVQypjCq9XZGXp_KJ51ekYUQn">telehealth</a> (by phone and/or video). </p>
<p>While some might appreciate when robots can assist with <a href="https://www.nursingworld.org/%7E494055/globalassets/innovation/robotics-and-the-impact-on-nursing-practice_print_12-2-2020-pdf-1.pdf">certain tasks</a>, much of what nurses do cannot and should not be performed remotely (or by robots). </p>
<p>Indeed, older people, their loved ones, and staff are <a href="https://www.theguardian.com/australia-news/2022/feb/05/yelling-out-for-help-the-atrocious-conditions-inside-australias-aged-care-homes">calling out for</a> more physically present staff and more time to care and interact, not virtual interfaces and remote consultations.</p>
<p>The benefits of technology in health care are unquestionable and many innovations have improved care for older people. Artificial intelligence shows promise in helping <a href="https://www.nature.com/articles/s41598-021-81115-9">prevent and detect falls</a>, and socially assistive robots such as <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1244-6">PARO</a> (a baby harp seal), have been shown to reduce stress, anxiety and antipsychotic use in people with dementia.</p>
<p>Technology should not, however, be introduced at the <a href="https://www.sciencedirect.com/science/article/pii/S1322769620301438?via%3Dihub">expense of care quality</a> or supporting and sustaining a suitably sized and skilled aged care workforce. We still need to adequately staff nursing homes to provide <a href="https://www.sciencedirect.com/science/article/pii/S0020748921000869?via%3Dihub">safe, dignified care</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/before-replacing-a-carer-with-a-robot-we-need-to-assess-the-pros-and-cons-106160">Before replacing a carer with a robot, we need to assess the pros and cons</a>
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</p>
<hr>
<h2>We need adequate staffing</h2>
<p>The <a href="https://agedcare.royalcommission.gov.au/publications/final-report">Royal Commission into Aged Care Quality and Safety</a> heard a vast quantity of evidence regarding insufficient staffing, particularly of nurses who have the education and skills to deliver high quality clinical and personal care. </p>
<p>This expertise is why nurses cannot be replaced with remote care, and why the Commission recommended 24/7 registered nurse presence; this has now been <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r6874">legislated</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fixing-the-aged-care-crisis-wont-be-easy-with-just-5-of-nursing-homes-above-next-years-mandatory-staffing-targets-184238">'Fixing the aged care crisis' won't be easy, with just 5% of nursing homes above next year's mandatory staffing targets</a>
</strong>
</em>
</p>
<hr>
<p>More than half of Australian aged care residents live in nursing homes with <a href="https://ro.uow.edu.au/ahsri/1073/">unacceptably low levels of staffing</a> and <a href="https://www.health.gov.au/resources/publications/2020-aged-care-workforce-census">around 20%</a> do not have a registered nurse onsite overnight. </p>
<p>Insufficient staffing results in workers <a href="https://www.anmfsa.org.au/Web/News/2022/The_grim_reality_of_what_happens_in_a_nursing_home_that_doesn_t_have_registered_nurses_24_7.aspx">not having time to interact</a> with residents meaningfully and compassionately and also contributes to avoidable hospitalisations, worse quality care and outcomes, and poor working conditions for staff. </p>
<p>As social beings, human interaction is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/">fundamental to health</a>, wellbeing, and best practice care. This is particularly true for <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12173?casa_token=l5Y_-r6rvt8AAAAA%3Awpp7P9Q9CUncyK60XOUPgv5ORx_Pi0jyMJ-Yp_kvdL7b5sTYih66Htp7l05J_I0vafKubec91hRL4Q">older people in nursing homes</a> who are less able to engage with others and is especially vital for those living with <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12765">mobility challenges</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28332405/">dementia</a>. </p>
<p>Partly due to nurse low staffing levels, <a href="https://link.springer.com/article/10.1186/s12889-020-8251-6">loneliness, isolation</a> and <a href="https://www.racgp.org.au/getattachment/86cf2c46-46f2-4177-a17b-700bb7cfa3ac/20030705lie.pdf">mental ill health</a> are widespread in aged care and have become more common due to <a href="https://www.apa.org/topics/covid-19/nursing-home-residents">pandemic related restrictions</a> on visitors and staff.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/working-conditions-in-aged-care-homes-are-awful-largely-because-the-work-is-done-by-women-124900">Working conditions in aged care homes are awful, largely because the work is done by women</a>
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</em>
</p>
<hr>
<p>Care experiences are shaped by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382052/">human interaction and contact</a>; the touch of a hand, a smile, eye contact, and being able to take the time to genuinely listen. </p>
<p>These actions are central to how nurses and other staff build effective and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.12862">meaningful relationships</a> with residents. </p>
<p>Seeking to replace human contact with virtual interfaces seems both inconsistent with the Royal Commission’s findings and possibly cruel. </p>
<p>Personal interactions also help staff, as the <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1_0.pdf">Royal Commission</a> highlighted:</p>
<blockquote>
<p>Knowing those they care for helps care staff to understand how someone would like to be cared for and what is important to them. It helps staff to care – and to care in a way that reinforces that person’s sense of self and maintains their dignity. This type of person-centred care takes time.</p>
</blockquote>
<p>Rather than circumventing reforms to ensure more nurses provide face-to-face care in nursing homes, we need to address the range of challenges contributing to widespread and tenacious <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-8462.12427">workforce shortages</a>. </p>
<p>There are clear challenges for growing and retaining a sufficiently sized and skilled aged care workforce. However, government reforms, such as better pay, mandated care time, and greater accountability and transparency regarding the use of funds all work together to make aged care a feasible and attractive sector to work in. </p>
<p>This is one where staff are supported to provide the high quality and safe aged care all Australians deserve and where older people receive best practice, human care.</p><img src="https://counter.theconversation.com/content/188215/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Micah DJ Peters works for and is affiliated with the Australian Nursing and Midwifery Federation (ANMF) Federal Office.</span></em></p>Many people in nursing homes already suffer from isolation, neglect and lack of human engagement. They need the human touch – in person.Micah DJ Peters, Senior Research Fellow / Director - Australian Nursing and Midwifery Federation (ANMF) National Policy Research Unit (Federal Office), University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1796692022-04-05T20:02:39Z2022-04-05T20:02:39ZServing up choice and dignity in aged care – how meals are enjoyed is about more than what’s on the plate<figure><img src="https://images.theconversation.com/files/456247/original/file-20220405-14-y2m2cu.jpg?ixlib=rb-1.1.0&rect=24%2C18%2C4065%2C2704&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1575467678930-c7acd65d6470?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=3540&q=80">Unsplash/CDC</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Meals are rituals built around pleasures and choices. While what is served at mealtimes in aged care homes has received recent <a href="https://www.abc.net.au/news/2018-09-17/food-in-aged-care/10212880?nw=0&r=HtmlFragment">attention</a> and <a href="https://theconversation.com/labors-budget-reply-goes-big-on-aged-care-similar-on-much-else-180098">Labor has pledged</a> to improve the food offered, new research highlights that how meals are offered is just as important.</p>
<p>More than <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with-dementia/residential-aged-care">50% of aged care residents live with dementia</a>, and outside of mealtimes, spend the majority of their days <a href="https://pubmed.ncbi.nlm.nih.gov/32396600/">alone</a>. Mealtimes are the time of the day when people come together, providing opportunities for social connection, celebration, and <a href="https://www.sciencedirect.com/science/article/pii/S0890406510000046?casa_token=pwOucRx12WUAAAAA:cC0RMR5Oq3T4ly2vFOvuW7_DziNLkHy1QyWoClwfV04zQFLtqm8_7rgQrZ-xhhta_ONxYwsLqY8">honouring</a> individual preferences and culture.</p>
<p>And yet, staffing shortages and insufficient time to help residents eat and drink means mealtimes are frequently highly structured and depersonalised, with the focus being on food intake rather than the dining experience.</p>
<p>Further, current aged care funding <a href="https://theconversation.com/why-is-nursing-home-food-so-bad-some-spend-just-6-08-per-person-a-day-thats-lower-than-prison-120421">does not incentivise quality</a> in food, or mealtime autonomy.</p>
<p>Innovation in mealtime care is needed to turn this around and give aged care residents back their basic rights. One <a href="https://www.sciencedirect.com/science/article/pii/S152586101500643X">proven</a> approach draws on Montessori principles traditionally used within the early childhood field.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/labors-plans-for-aged-care-are-targeted-but-fall-short-of-whats-needed-180497">Labor's plans for aged care are targeted but fall short of what's needed</a>
</strong>
</em>
</p>
<hr>
<h2>Careful planning allows more freedom</h2>
<p>The revolutionary thinking of Italian physician and educator <a href="https://amshq.org/About-Montessori/History-of-Montessori/Who-Was-Maria-Montessori">Maria Montessori</a> has been increasingly applied to dementia care – introduced to the field by psychologist <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600589/">Cameron Camp</a> in the 1990s. The Montessori approach respects the abilities and preferences of the person – young or old – engaging people at their own pace and rhythm.</p>
<p>Montessori methods focus on a carefully prepared environment and work with the retained strengths of a person with dementia to enable <a href="https://www.cambridge.org/core/journals/international-psychogeriatrics/article/randomized-crossover-trial-to-study-the-effect-of-personalized-onetoone-interaction-using-montessoribased-activities-on-agitation-affect-and-engagement-in-nursing-home-residents-with-dementia/0C0011B4FDE4DE33BD4A674738239AA0">engagement</a> and involvement in everyday life. This helps people with dementia reclaim skills, such as the ability to <a href="https://www.sciencedirect.com/science/article/pii/S152586101500643X">eat independently</a>.</p>
<p>The approach can change people’s expectations of what a person with dementia is capable of and promote a sense of community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&rect=8%2C5%2C1846%2C1226&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman chooses cutlery" src="https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&rect=8%2C5%2C1846%2C1226&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456244/original/file-20220405-18-cpyy05.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Residents can play an active role in mealtimes.</span>
<span class="attribution"><span class="source">Author</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://journals.sagepub.com/doi/full/10.1177/14713012211057414">Our study</a> looked at how applying Montessori strategies changed mealtimes for staff and residents in a residential aged care setting. We periodically filmed mealtimes, starting before any changes were made and ending with new practices in place. </p>
<p>Routines, materials, and external aids were established to support memory loss and independence. For example, signage invited residents to help themselves to snacks, and a buffet encouraged residents to serve their own meals.</p>
<p>Extending the duration of the breakfast service enabled residents to eat at their own pace, while the preparation of additional food ensured residents had the opportunity for second or third helpings.</p>
<p>Staff across all levels of the organisation were trained and mentored in the Montessori approach. For example, the Montessori mantra “Everything you do for me; you take away from me” was introduced to staff – transforming the way they thought about empowering residents and their own caring roles.</p>
<p>Care staff were encouraged to involve residents in mealtime routines and create meaningful roles, such as setting the table, filling water jugs or writing up the daily menu.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="women at table eating" src="https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456249/original/file-20220405-20-zak6bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meals are about sharing food and coming together.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/senior-woman-eating-her-lunch-600w-163582757.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/todays-aged-care-falls-well-short-of-how-wed-like-to-be-treated-but-there-is-another-way-177067">Today's aged care falls well short of how we'd like to be treated – but there is another way</a>
</strong>
</em>
</p>
<hr>
<h2>What we saw</h2>
<p>Our observational research evaluated mealtime routines before and after the Montessori model of care was introduced and the findings were promising for everyone involved – residents, families, and staff. We can see this by examining the experience of a resident we’ll call “Marjory”. </p>
<p>Before Montessori, Marjory’s meal was chosen by a staff member and there were no second options should she not like the selection. Marjory’s main meal and dessert were placed together on the bare table, with no explanation as to what they were. She did not choose who she sat with, or which drink was served with her meal. Marjory ate her meal in silence.</p>
<p>We noted this as a familiar pattern, highlighted in <a href="https://www.tandfonline.com/doi/full/10.3109/17549507.2014.987816">previous research</a>, that featured very little social interaction between care staff and residents.</p>
<p>Since Montessori strategies were introduced, Marjory selects what and how much she would like from the labelled buffet. She eats at a table that is beautifully set with a tablecloth, cutlery, and condiments. Marjory can help herself to a second helping if she likes and she socialises during her meal. Afterwards, she helps staff by taking her dishes to the sink.</p>
<p>We watched on as opportunities for choice significantly increased, as did social interaction between staff and residents. Mealtime care had become more respectful and centred around people.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1445373382351114241"}"></div></p>
<h2>Transforming care</h2>
<p>Examples of positive innovation in aged care need to be shared if we are to change public perceptions of dementia and show how more humanistic models of care are possible.</p>
<p>The Montessori approach is an innovative way to transform care – helping aged care staff rethink their role in enabling people with dementia. With mealtimes occurring several times each day, improved mealtime experiences can provide a pathway to person-centred care.</p>
<p><a href="https://academic.oup.com/gerontologist/article/57/5/e94/2852108?login=true">Cultural change</a> isn’t easy and creative strategies and commitment are needed. Care staff require quality training and ongoing support.</p>
<p>The <a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">aged care sector</a> must place greater emphasis on quality outcomes for residents, rewarding providers who enable residents to live well – engaged, involved, and connected.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-choose-a-legal-decision-maker-as-you-get-older-3-things-to-consider-177631">How to choose a legal decision-maker as you get older – 3 things to consider</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/179669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was funded by Catholic Homes Inc. </span></em></p><p class="fine-print"><em><span>Elizabeth Oliver worked for Catholic Homes as the Leader of Care Innovation during the research period. The research was funded by Catholic Homes Inc.</span></em></p><p class="fine-print"><em><span>Anne Whitworth does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When aged care residents are involved with mealtime jobs such as sorting cutlery and laying the table, they are treated like people not task lists.Jade Cartwright, Associate Professor, University of TasmaniaAnne Whitworth, Professor, University of TasmaniaElizabeth Oliver, Sessional Academic, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1804972022-04-02T05:45:34Z2022-04-02T05:45:34ZLabor’s plans for aged care are targeted but fall short of what’s needed<figure><img src="https://images.theconversation.com/files/455725/original/file-20220401-25-bbb91w.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-older-woman-caring-female-doctor-451107376">Shutterstock</a></span></figcaption></figure><p>In his <a href="https://anthonyalbanese.com.au/media-centre/budget-reply-2022">budget reply speech</a> this week, opposition leader Anthony Albanese promised a plan to fix the “crisis in aged care”. </p>
<p>Labor’s aged care package includes 24/7 registered nurses for all residential care facilities, better pay for aged care workers, more care, better food for residents, and greater accountability for providers. </p>
<p>The immediate cost of Labor’s commitments is estimated at <a href="https://theconversation.com/anthony-albanese-offers-2-5-billion-plan-to-fix-crisis-in-aged-care-180419">A$2.5 billion over four years</a>, not including better pay for workers. </p>
<p>That cost is likely to be up to <a href="https://www.smh.com.au/national/we-must-act-aged-care-body-calls-for-4b-annual-wages-injection-20220313-p5a47l.html">A$4 billion per year</a>, depending on the <a href="https://www.fwc.gov.au/hearings-decisions/major-cases/work-value-case-aged-care-industry">Fair Work Commission’s decision</a> later this year. The commission is considering <a href="https://www.theguardian.com/australia-news/2020/nov/12/more-than-200000-aged-care-workers-seek-25-pay-rise-in-landmark-australian-case">aged care worker unions’ case</a> for a 25% pay increase. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1509623059371773962"}"></div></p>
<p>But while Labor’s announcements are worthy initiatives, they stop short of the comprehensive plan we need for reform. </p>
<h2>What’s the problem?</h2>
<p>The Commonwealth <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/agedcarebeds">took responsibility for aged care from the states</a> 25 years ago. </p>
<p>It then centralised, privatised, commodified and marketised it to drive efficiency and manage its spending, but at the cost of quality and accountability.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/quality-costs-more-very-few-aged-care-facilities-deliver-high-quality-care-while-also-making-a-profit-178022">Quality costs more. Very few aged care facilities deliver high quality care while also making a profit</a>
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</em>
</p>
<hr>
<p>The results are there for all to see. Increasingly, larger “big box” institutions are riddled with loneliness, poor quality care and isolation from friends, family and the community. </p>
<p>Those who don’t want to go into residential aged care, face year-long waiting lists for home and community care. </p>
<p>The <a href="https://agedcare.royalcommission.gov.au">Royal Commission into Aged Care Quality and Safety</a> comprehensively documented the problems with the current system. </p>
<h2>Labor’s aged care announcements</h2>
<p>Labor’s initiatives in the budget reply are best seen as a downpayment focused on the problems in residential aged care identified by the commission. </p>
<p>The broader structural directions for policy are yet to be addressed. This includes:</p>
<ul>
<li>the balance between residential and home care, as Australians increasingly choose the latter</li>
<li>market management and stewardship, as too much emphasis falls on cost and profit for providers and not enough on quality and outcomes for residents</li>
<li>the balance between public and private financing, because better care will cost more.</li>
</ul>
<figure class="align-center ">
<img alt="Older man sits in a wheelchair in his bedroom." src="https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older Australians increasingly want to stay in their own home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-sitting-on-wheelchair-alone-1012812838">Shutterstock</a></span>
</figcaption>
</figure>
<p>But Labor’s initiatives for residential care are cleverly targeted.</p>
<p>Staff make up about <a href="https://www.stewartbrown.com.au/images/documents/StewartBrown---FY19-Aged-Care-Financial-Performance-Survey-Report.pdf">70% of residential aged care costs</a>. One way of reducing costs and improving profits is to employ low paid unskilled workers on casual and flexible part time arrangements. </p>
<p>Not surprisingly, this has made aged care unattractive for workers. Quality has suffered and it is increasingly hard to get staff.</p>
<p>Another way to cut costs is to reduce living expenses for aged care residents. On average, one-third of homes <a href="https://theconversation.com/why-is-nursing-home-food-so-bad-some-spend-just-6-08-per-person-a-day-thats-lower-than-prison-120421">still spend under $10 on food</a> for <a href="https://www.smh.com.au/national/report-questions-where-10-a-day-aged-care-food-budget-is-being-spent-20220325-p5a7v9.html">each resident per day</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-is-nursing-home-food-so-bad-some-spend-just-6-08-per-person-a-day-thats-lower-than-prison-120421">Why is nursing home food so bad? Some spend just $6.08 per person a day – that's lower than prison</a>
</strong>
</em>
</p>
<hr>
<p>There is little doubt aged care will struggle without a better paid and more skilled workforce, including <a href="https://theconversation.com/our-ailing-aged-care-system-shows-you-cant-skimp-on-nursing-care-115565">a greater role for nurses</a>. </p>
<p>In 2015, <a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">it was estimated</a> each resident in aged care got about 168 minutes of care a day. </p>
<p>Labor is promising Fair Work wage increases for staff, 215 minutes of care for each resident and round-the-clock nursing support. </p>
<h2>What’s in the budget for aged care?</h2>
<p>The government promised little new for aged care in its 2022 budget, apart from a continuation of its response to the recent royal commission’s recommendations. </p>
<p>However there is a <a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">one-off bonus of A$800</a> and additional funding for training and to embed pharmacists in aged care facilities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-budget-2022-spends-a-little-on-favoured-interest-groups-but-misses-a-chance-for-real-reform-179835">Health budget 2022 spends a little on favoured interest groups but misses a chance for real reform</a>
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</em>
</p>
<hr>
<p>While COTA (Council of the Ageing), which represents older Australians, <a href="https://www.cota.org.au/news-items/reflections-on-the-federal-budget/">largely endorsed the government’s budget</a> and its response to the royal commission, the Australian Aged Care Collaboration, representing major providers, has been <a href="https://lasa.asn.au/news/aged-care-budget-2022-initial-response">much more critical</a>, particularly of the government’s lack of commitment to lift the pay for aged care workers. </p>
<p>In contrast, both <a href="https://www.cota.org.au/news-items/cota-welcomes-labor-commitment-to-aged-care-reform/">consumer</a> and <a href="https://lasa.asn.au/news/aged-care-budget-in-reply-response-2022/">provider</a> organisations have been supportive of Labor’s budget initiatives for aged care.</p>
<p>In general, the aged care sector has <a href="https://www.smh.com.au/politics/federal/hopes-raised-and-dashed-in-aged-care-response-20220216-p59x0w.html">criticised the government’s response</a> to the aged care crisis as anaemic: too little, too slow and too late (particularly in relation to COVID). </p>
<p>Throughout the pandemic, there have been repeated calls for the Aged Care Minister, Richard Colbeck <a href="https://www.smh.com.au/politics/federal/who-is-richard-colbeck-the-low-profile-minister-in-the-middle-of-a-covid-crisis-20200828-p55qdu.html">to be sacked</a>.</p>
<figure class="align-center ">
<img alt="Empty corridor of a large aged care facility." src="https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The government’s response to COVID in aged care was widely criticised.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/corridor-elderly-care-facility-1579445854">Shutterstock</a></span>
</figcaption>
</figure>
<p>None of this was helped by the royal commission’s inability to present a coherent, unified and consistent blueprint. </p>
<p>Not surprisingly, the government cherry-picked an incremental, piecemeal path of least resistance from the commission’s recommendations to shore up, rather than reform, the current system. </p>
<p>A key line in opposition leader’s budget reply speech for aged care was: “we will bring the principle of universal, affordable and quality service to Child Care and to Aged Care”.</p>
<p>Aged care reform remains unfinished business for Labor. It made a start this week but more needs to come. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">When aged care workers earn $22 an hour, a one-off bonus won’t help</a>
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<hr>
<img src="https://counter.theconversation.com/content/180497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hal Swerissen is a non executive director of the Murray PHN</span></em></p>Aged care reform remains unfinished business for Labor. It made a start this week but more needs to come.Hal Swerissen, Emeritus Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1635692021-06-29T11:01:08Z2021-06-29T11:01:08ZEvidence supports mandatory COVID vaccination for aged-care workers. But we need to make it easier too<p>National cabinet yesterday announced it will <a href="https://www.abc.net.au/news/2021-06-29/vaccines-to-become-mandatory-for-aged-care-workers/13423368">mandate COVID-19 vaccination</a> for residential aged-care workers, with the aim to ensure all aged-care staff have received their first dose by mid-September. </p>
<p>A support package worth <a href="https://www.smh.com.au/politics/federal/mandatory-vaccines-for-aged-care-workers-quarantine-to-be-separated-20210628-p5850h.html">A$11 million</a> is intended to facilitate this, by enabling aged-care facilities to provide their staff with paid leave to be vaccinated. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409449712806109188"}"></div></p>
<p>Health department figures released to <a href="https://www.theage.com.au/politics/victoria/two-thirds-of-staff-in-aged-care-homes-not-vaccinated-20210624-p583vv.html">The Age</a> showed two-thirds of Australian aged-care staff were yet to receive one dose as of last week. Of 263,000 workers, just over 88,000 (33.6%) had received their first shot and about 43,000 (16.3%) had received both doses.</p>
<p>Given the current community transmission across parts of Australia, and the low vaccination rates in this crucial group, it’s perhaps not surprising we’ve seen this policy shift. </p>
<h2>Vaccine mandates for Australian health and aged-care workers exist</h2>
<p>In Australia, <a href="https://theconversation.com/mandatory-covid-vaccines-for-aged-and-health-care-workers-could-increase-uptake-but-we-need-to-exhaust-other-options-first-161875">this is not the first time</a> we’ve moved to mandates to improve vaccine uptake among the health- and aged-care sectors. </p>
<p>Many health- and aged-care workers are required to show evidence they’re protected from a range of vaccine-preventable diseases. For example, <a href="https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2020_017.pdf">annual flu vaccines are mandatory</a> for those working in high-risk clinical settings, including staff in NSW Health aged-care facilities. With the introduction of these mandates, we have not documented mass departures of staff. </p>
<p>That said, as <a href="https://www.sbs.com.au/news/all-australian-adults-can-now-ask-their-gp-for-an-astrazeneca-covid-19-vaccine">Prime Minister Scott Morrison</a> correctly pointed out:</p>
<blockquote>
<p>Imposing on a person the requirement to have a vaccine or not be able to work in a particular sector is something that no government would do lightly.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-all-aged-care-residents-with-covid-19-be-moved-to-hospital-probably-but-there-are-drawbacks-too-143826">Should all aged-care residents with COVID-19 be moved to hospital? Probably, but there are drawbacks too</a>
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</em>
</p>
<hr>
<h2>Did we do enough to get to this point?</h2>
<p>While Aged & Community Services Australia, the industry peak body, has welcomed the mandate as “<a href="https://www.theguardian.com/australia-news/2021/jun/29/not-their-fault-aged-care-sector-says-covid-vaccine-mandate-wont-fix-governments-failed-rollout">the right decision</a>”, others are questioning whether the government has made sufficient efforts to ensure on-site or priority off-site access to vaccination for aged-care staff across all states and territories. </p>
<p>To support vaccination access for the sector, the federal government <a href="https://www.theguardian.com/australia-news/2021/may/21/just-three-of-13-promised-vaccine-hubs-for-australias-young-aged-care-workers-have-opened">announced 13 clinics</a> in multiple locations for aged-care staff. But as of May, only three of these pop-up clinics had been established, all of which were in Sydney (in areas covered by the mass vaccination hubs). </p>
<p>Aged care provider <a href="https://www.australianageingagenda.com.au/covid-19/optional-covid-vaccine-under-review-for-aged-care-staff/">peak bodies</a> Leading Age Services Australia and Aged & Community Services Australia had previously called for more on-site vaccination for aged-care staff, as opposed to having staff members seek vaccination appointments via mass clinics or their GP. </p>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S0264410X1831702X">the aged-care sector</a>, the delivery of vaccination is complicated by variations in staff working hours. Providing the COVID vaccine at their place of work can potentially addresses issues around access to vaccination. </p>
<p>Seeing coworkers getting vaccinated may also help build confidence in those who are sitting on the fence. </p>
<p>Studies have found workplace provision of vaccination <a href="https://www.sciencedirect.com/science/article/pii/S0264410X20300086?casa_token=H-hhDEtQfTEAAAAA:QDo4598dJVS9PMAPQ3d5iQ0-sKx2kFBBd3tqmicKuQDUIBCRvppCIE98intFyp22k8ppm5liAGw#b0205">plays an important part</a> in the decision to immunise among aged-care workers, with higher vaccination rates in facilities providing on-site vaccination. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-crucial-we-address-covid-vaccine-hesitancy-among-health-workers-heres-where-to-start-152977">It's crucial we address COVID vaccine hesitancy among health workers. Here's where to start</a>
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</em>
</p>
<hr>
<h2>What we can do alongside the mandate</h2>
<p>To support the introduction of this policy, it’s critical we support conversations within aged-care facilities to ensure staff members understand why the shift in policy has occurred, to address any misinformation and to support them to take up the vaccine. </p>
<p>Importantly, <a href="https://www.sciencedirect.com/science/article/pii/S0264410X20300086">Australia’s aged-care workforce</a> reflects the make-up of the broader Australian population. So English may be a second language for a portion of workers.</p>
<p>While efforts have been made to ensure information sheets are available in other languages, booking systems, including the one used to support the pop-up vaccination clinics in Sydney, <a href="https://www.sonicvaccinations.com.au/">are only available in English</a>.</p>
<p>We need to be mindful to adopt <a href="https://sph.med.unsw.edu.au/sites/default/files/sphcm/News/Enhancing-supporting-COVID-19-vaccination-program.pdf">best practice</a> to support engagement with vaccine services for people from culturally and linguistically diverse communities. Information sessions should be held which allow for questions, and staff should have the opportunity to talk to an immuniser who speaks the same language if needed. </p>
<p><a href="https://www.agedcareinsite.com.au/2012/07/going-back-to-basics/">Previous surveys</a> of aged-care staff have also identified some workers have limited computer skills, which may be a barrier to using online booking systems. Support should be available to assist those staff in booking their appointments. </p>
<figure class="align-center ">
<img alt="An aged-care worker with an elderly woman." src="https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408827/original/file-20210629-14-18y6wk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Research has shown workplace provision of vaccination makes aged-care staff more likely to immunise.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Concerns have also been raised about the level of funding allocated to support staff members to to take leave to have the vaccine. Australian Nursing and Midwifery Federation federal secretary Annie Butler calculated the A$11 million would give each unvaccinated worker <a href="https://www.theguardian.com/australia-news/2021/jun/29/not-their-fault-aged-care-sector-says-covid-vaccine-mandate-wont-fix-governments-failed-rollout">about $A30 per dose</a>. </p>
<p>As Butler noted, this would be nowhere near enough to support time off from work. So this issue needs to be addressed immediately to ensure aged-care workers can take time off if needed to access off-site vaccination appointments, and ideally to recover if they experience any adverse reactions.</p>
<h2>Mandates work</h2>
<p>The introduction of this mandate aligns with what has been <a href="https://www.sciencedirect.com/science/article/pii/S0196655313013035?casa_token=VXWNbmodPd8AAAAA:e2a9yv2WSBDZ0Ltonoxv50aXGFxyaIdmAMOsjac9gUEEgzctzTsoQGlg4wF6jGML6Mg05uqcDg0">recommended previously</a> to improve influenza vaccination of aged-care staff. <a href="https://pubmed.ncbi.nlm.nih.gov/28957042">Internationally</a>, mandates have been shown to increase vaccine coverage for health workers including for influenza. </p>
<p>It also aligns with <a href="https://www.sciencedirect.com/science/article/pii/S0264410X1831702X">our past research</a> on mandatory vaccination of aged-care staff, where we found positive support from stakeholders, including those responsible for developing policy and delivering vaccination programs to aged-care staff. </p>
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<strong>
Read more:
<a href="https://theconversation.com/mandatory-covid-vaccines-for-aged-and-health-care-workers-could-increase-uptake-but-we-need-to-exhaust-other-options-first-161875">Mandatory COVID vaccines for aged- and health-care workers could increase uptake, but we need to exhaust other options first</a>
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<p>Beyond aged care, there may be a need to extend mandatory COVID vaccination policies to other health workers including those working in community or disability care, or to staff in hospitals. </p>
<p>However, it’s critical we understand the coverage levels for each of these groups before moving forward, as other strategies including the opportunity for paid time off to receive a vaccine or incentives may assist here, before we need to consider further mandates.</p><img src="https://counter.theconversation.com/content/163569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on a study funded by NHMRC and has previously received funding for investigator driven research from NSW Ministry of Health, as well as from Sanofi Pasteur and Seqirus. She is the Deputy Chair of the Collaboration on Social Science and Immunisation.</span></em></p>The federal government has announced COVID-19 vaccination will now become mandatory for aged-care workers. This comes amid a slow and troubled rollout in the sector.Holly Seale, Associate professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1431772020-07-23T19:51:41Z2020-07-23T19:51:41Z4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes<figure><img src="https://images.theconversation.com/files/349065/original/file-20200723-31-a62qkh.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C7002%2C4227&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As of <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#at-a-glance">July 22</a>, the total number of COVID-19 infections nationally was 12,896, with 128 deaths. This figure includes 43 aged-care residents.</p>
<p>In Victoria, at least 45 aged-care facilities have now reported <a href="https://www.theweeklysource.com.au/45-covid-19-outbreaks-in-melbourne-aged-care-homes-and-383-positive-cases-as-premier-says-many-of-those-going-to-work-sick-are-aged-care-staff/">outbreaks</a>, with about 383 positive cases in the sector overall (including among staff).</p>
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<p>St Basil’s Home for the Aged in Fawkner and Estia Health in Ardeer have the <a href="https://www.abc.net.au/news/2020-03-17/coronavirus-cases-data-reveals-how-covid-19-spreads-in-australia/12060704?nw=0#clusters">largest number of cases</a>: 73 and 67 respectively.</p>
<p>Although these outbreaks don’t compare to what we’ve seen <a href="https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/">internationally</a>, the rising case numbers within Victorian aged-care homes are of grave national concern.</p>
<p>We’ll need a concerted community effort to arrest this looming disaster.</p>
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Read more:
<a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">Why are older people more at risk of coronavirus?</a>
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<h2>Aged care was in crisis even before COVID-19</h2>
<p>The <a href="https://agedcare.royalcommission.gov.au/publications/interim-report">interim report</a> of the Royal Commission into Aged Care Quality and Safety laid bare the <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja2.50168">system failures</a> in the provision of aged care in Australia.</p>
<p>These deficits include <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja2.50615">workforce</a> and <a href="https://gen-agedcaredata.gov.au/Resources/Reports-and-publications/2017/March/The-aged-care-workforce,-2016">skill</a> shortages. A report on the sector’s performance between October and December 2019 found around 20% of facilities audited <a href="https://www.agedcarequality.gov.au/media/88018">did not meet standards</a> in “safe and effective personal and clinical care”, while 13% fell short on the measure of a “safe, clean and well-maintained service environment”. </p>
<p>This makes aged-care homes highly vulnerable to any external disaster.</p>
<p>Several other factors set the scene for infection transmission in aged care, including its design. Residential aged care is intended to provide a home-like <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja18.00268">physical environment</a>. While this serves an important purpose, it means aged-care homes may be missing some clinical features needed for optimal infection control, such as prominent placement of multiple hand basins.</p>
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<img alt="" src="https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349091/original/file-20200723-29-184ihar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Aged-care homes are designed differently to clinical settings like hospitals.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Communal spaces and a high volume of foot traffic (residents, staff, external contractors and visitors) also increase the risk of infection, while some residents have <a href="https://www.priorityhealthcare.com.au/files/Victorian%20Government%20Aged%20Care%20Brief.pdf">shared rooms</a> and bathrooms.</p>
<p>And residents have a range of cognitive and physical disabilities that can make it difficult to adhere to the fundamental infection control measures of social distancing and handwashing.</p>
<h2>COVID-19 and the elderly</h2>
<p>We had early warning of the catastrophic effects of COVID-19 in aged-care homes in March and April from countries like <a href="https://www.bmj.com/content/bmj/369/bmj.m1554.full.pdf">Spain</a> and <a href="https://www.trtworld.com/magazine/the-massacre-of-italy-s-elderly-nursing-home-residents-35575">Italy</a>, which saw widespread outbreaks and deaths in nursing homes.</p>
<p>While roughly one-third of COVID-19 deaths in Australia so far have been aged-care residents, a <a href="https://ltccovid.org/wp-content/uploads/2020/06/Mortality-associated-with-COVID-among-people-who-use-long-term-care-26-June-1.pdf">review</a> taking in 26 countries found this group has accounted for almost half of coronavirus deaths.</p>
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Read more:
<a href="https://theconversation.com/banning-visitors-to-aged-care-during-coronavirus-raises-several-ethical-questions-with-no-simple-answers-134663">Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers</a>
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<p>Severe illness and death from COVID-19 is <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2002032">more likely</a> in older people because they tend to have lower immunity, less biological reserve and higher rates of chronic conditions such as type-2 diabetes, high blood pressure, heart failure and renal disease.</p>
<p>One study found the case-fatality rate — the proportion of people who get COVID-19 who will die — is <a href="https://pubmed.ncbi.nlm.nih.gov/32220208/">33.7% for aged-care residents</a>.</p>
<h2>Avoiding disaster</h2>
<p>We need a coordinated, standardised, compassionate, supportive response to prevent premature deaths, and to minimise psychological harm to residents, families and staff.</p>
<p>Different aged-care homes will need different strategies to suit their varying circumstances. For example, facilities located in areas without community transmission, such as South Australia, will be different to those where there’s community spread, like in NSW and Victoria. And the needs of those homes with an active outbreak, such as St Basil’s or Estia Health, will be different again.</p>
<p>But broadly speaking, I believe these four key pillars are applicable to all aged-care homes.</p>
<p><strong>1. Stop COVID-19 entering</strong></p>
<p>In areas where there’s community transmission, all aged-care homes should be put into lockdown, with tight controls at entry and exit points. This should be done as humanely as possible, for example by creating teams to keep residents connected to family and community, and with exceptions for essential visitors.</p>
<p>Staff should be tested routinely and counselled about limiting contact with other people outside the workplace. Staff should also only work in one facility, and be allocated the same group of residents (to minimise the number of contacts in the event of a confirmed or suspected infection).</p>
<p>Finally, the development and provision of specific guidance, training and support around the use of personal protective equipment (PPE) is essential. Individual homes should be supported to engage experienced infection control nurses to train staff if possible on site.</p>
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<img alt="" src="https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349092/original/file-20200723-29-krb53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">We’ve known since early in the pandemic that older people are more susceptible to COVID-19.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p><strong>2. Be prepared in case it does</strong></p>
<p>Every aged-care home in Australia should have a “risk and readiness” rating to determine the likelihood of a COVID-19 outbreak and the facility’s ability to prevent and manage an initial infection. </p>
<p>This would include factors such as the experience and size of the aged-care provider, location of the facility, the size and structure of the building, ventilation, access to open spaces, the residents’ profile, staff numbers and skills, and past performance in accreditation audits.</p>
<p>And each home should have designated vacant rooms to be ready for isolation of any suspected cases.</p>
<p>Finally, the government should establish a national rapid response and advisory team dedicated to the management of aged-care homes during COVID-19. This would strengthen existing public health response units and should include clinicians with expertise in aged care.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/our-ailing-aged-care-system-shows-you-cant-skimp-on-nursing-care-115565">Our ailing aged care system shows you can't skimp on nursing care</a>
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<p><strong>3. Respond quickly and decisively when an outbreak occurs</strong></p>
<p>Aged-care homes along with public health units should have protocols for coordination of their on-site response, with clear lines of accountability for action and escalation.</p>
<p>They should rapidly separate residents when an outbreak occurs, rather than relying on a continued usual model of care with the addition of PPE.</p>
<p>Aged-care homes require productive partnerships with hospitals to ensure residents can get the specialised care they need. Wherever possible, all confirmed cases should be sent to a clinical setting such as an acute or sub-acute hospital.</p>
<p>And importantly, all homes should have dedicated communication channels to keep family members informed.</p>
<p><strong>4. Learn from past experience</strong></p>
<p>The two major aged-care outbreaks in NSW, particularly the one in <a href="https://www.smh.com.au/national/nsw/the-perfect-storm-how-covid-19-unleashed-chaos-inside-newmarch-house-20200515-p54t9d.html">Newmarch House</a>, attracted national attention. But we’re still awaiting a public statement from government about the lessons learned.</p>
<p>There are also ongoing inquiries into COVID-19 in aged care by a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/COVID-19/COVID19">senate committee</a> and the <a href="https://agedcare.royalcommission.gov.au/news-and-media/coronavirus-covid-19-and-aged-care-royal-commission">Royal Commission</a>. But neither are due to report for some time.</p>
<p>The government should release interim reports into the investigations of recent outbreaks which might give us valuable information about reducing transmission.</p>
<p>Eliminating COVID-19 outbreaks from aged-care homes reduces community transmission, the need for hospital care and reduces premature death. This benefits the whole nation.</p>
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Read more:
<a href="https://theconversation.com/why-prisons-in-victoria-are-locked-up-and-locked-down-143178">Why prisons in Victoria are locked up and locked down</a>
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<img src="https://counter.theconversation.com/content/143177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Ibrahim has received funding from Commonwealth and State Health Departments for research, education and consultancies. He was an expert witness for the Coroner's Court in South Australia, Victoria and New South Wales and provided evidence to the multiple inquiries into aged care including but not limited to the Royal Commission and those lead by Carnell-Paterson, Senate and, House of Representatives. Joseph featured in The Good Weekend – People Who Mattered 2019 as a leading health contributor. Joseph also has a podcast on aged care and COVID19 available at <a href="https://www.profjoe.com.au/">https://www.profjoe.com.au/</a></span></em></p>Aged care homes need to have protocols in place to prevent COVID-19 infection in the first instance. But in the event an outbreak does occur, they need to be well prepared.Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.