Best Practice in supporting the elderly managing transitions and life changes' Reflections on a deca

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Best Practice in supporting the elderly managing
transitions and life changes. Reflections on a
decade of research in Australia
Julianne Cheek
Professor Atlantis Medical College Oslo Norway
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Background

• Australia has an ageing population like many
  other western countries
• The majority of older people live in the
  community with less than 10 of older people
  living in residential aged care
• There are community care services available to
  enable frail older people to remain living in
  their own homes in the community
• The demand for these aged care services far
  outweighs their availability

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This presentation comprises reflections on

• How to develop and sustain service and supports
  to address transitions and the challenges that
  they pose
• Taking time out to challenge what otherwise might
  be assumed or unexplored planks of our service
  and support provision
• Re-looking at some of the sacred mantras
  independence/dependence, home, and older.

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What is common in these studies is
1.inclusion of older people, their families,
significant others, care and support providers
and policy makers 2.working closely with
consumers, industry and policy makers before,
during and after the actual research building a
community of research and practice 3.research
based recommendations relevant and able to
contribute to best practice service provision at
the local level 4. provision of an evidence
base for current and future discussions on policy
for service provision for older people
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The Research Program that provides the material
for reflection
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How Australian families search for and select an
aged care facility for a family member upon
discharge from an acute care setting A project
funded by the Australian Rotary Health Research
Fund Professor Julianne Cheek, Ms Alison
Ballantyne, and Ms Melanie Tucker
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How older people living in Independent Living
Units decide to enter the acute care system A
project funded by the Australian Research Council
Strategic Partnerships with Industry Research
and Training Grants and ACH Group Professor
Julianne Cheek, Dr Jacqueline Jones, Ms Alison
Ballantyne, and Ms Gerda Roder-Allen
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An exploration of factors influencing the move of
older people from retirement villages to
residential aged care A project funded by the
Australian Research Council Linkage-Projects
Grants and Village Care Ltd. Professor Julianne
Cheek, Ms Alison Ballantyne, and Ms Loretta Byers
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Options, Opportunities and Older People An
exploration of care transitions of older
people A project funded by the Australian
Research Council Linkage-Projects Grants, ACH
Group and Brightwater Collaborative (Brightwater
Care Group, Silver Chain, and Perth Home Care
Services) Professor Julianne Cheek, Ms Alison
Ballantyne, Dr David Gillham, Ms Jane Mussared,
Dr Penny Flett, Dr Gill Lewin, Ms Marita Walker,
and Ms Gerda Roder-Allen
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Reflection One Working with the complexity that
is a transition
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Transition as some form of destablisation in a
persons health and/or support needs. Traditional
/common way of looking at this is in terms of
transition as a point (see Hollander
2001) Funding and services and supports can then
be directed to that point for example the point
of needing to enter a residential aged care
facility
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Our studies reveal transitions as a complex
series of events and choices involving an array
of players and options Thus transition is more
of a process than a specific point
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One implication of this is that if we develop
services and supports around specific points
rather than in relation to the transition as a
process, then we may be losing opportunities to
intervene and assist older people in ways that
are timely and responsive to the unique set of
events that constitute that persons transition.

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A focus on transition as a point may lead to a
menu type of approach with respect to choice of
available services and support. This is a form
of bounded choice that may not optimally meet the
needs of the older person in the complex and
messy reality in which they live. Tailor made but
with the fabric chosen by others!!
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Capturing a transition
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Older person X Significant other B
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Reflection Two Independence and Dependence
Are they mutually exclusive?
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• Independence for older people is a significant
  political platform in Australia as in many
  western countries
• Often equated to the older person living at home
  or the place of their choice for as long as
  possible
• Ageing in place underpins much of Australian aged
  care policy

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But how independent is independent?
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Avoiding simplistic dichotomies

• Questions I ask myself
• Are independence and dependence mutually
  exclusive?
• Is the emphasis on independence necessarily a
  good thing?
• How independent are some older people who live at
  home?

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Avoiding simplistic dichotomies
4. Can an older person be independent in
residential aged care? 5. Could it be that
independence and the desire to maintain it and
support it at all costs, actually works against
the older person retaining independence in the
long term?
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What can we learn from all this?
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The right information at the right time to make
the best decision
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• Accommodation, care, both or
• something else!
• What is it that we are actually
• talking about?

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• How best to plan for any transition that may or
  may not be necessary?
• Who should be involved in that planning?
• Do the service or accommodation providers have
  any role in that planning?

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And just before we think it is all settling
down What about the category of older itself?
What will this mean as demographics change?
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The only certainty Care of older people is a
matter of citizenship, social responsibility and
indeed social sustainability