Working in the Aged Care Industry

Terminology in aged care refers to the specific language and terms used within the aged care industry to describe various concepts, roles, services, and aspects related to the care and support of older adults.

These terms have specific meanings and are commonly used by healthcare professionals, caregivers, and service providers in the aged care sector. Understanding this specialised terminology is essential for effective communication and providing quality care to older individuals.

Some examples of aged care terminology and their meanings include:

• Consumer-Directed Care CDC - Consumer-Directed Care refers to an approach in aged care where older adults have greater control and choice over the care and services they receive. It empowers individuals to make decisions about their care plan, service providers, and how funding is allocated, promoting personalized and tailored care.
• Commonwealth Home Support Programme (CHSP) - The Commonwealth Home Support Programme (CHSP) is a government-funded program that provides entry-level support services to help elderly individuals remain independent and living in their homes for as long as possible
• Home Care Packages(HCP)-Home Care Packages are government-funded packages that provide a range of care and support services to older adults who wish to continue living in their homes. These packages are tailored to individual needs and may include services such as personal care, nursing, domestic assistance, and social support.
• Aged Care Assessment Team (ACAT) - A team of healthcare professionals who assess the care needs of older adults and determine their eligibility for government-funded aged care services.
• Residential Aged Care - Residential Aged Care refers to long-term care provided to older adults who require higher levels of support and cannot live independently in their own homes. It includes accommodation, personal care, meals, and 24-hour nursing and support services in a residential facility.
• Transition Care - Transition Care refers to short-term care and support services provided to older adults after a hospital stay to help them recover and regain independence. It assists individuals in transitioning from hospital to home or an aged care facility.
• Respite Care - Respite Care offers temporary and short-term care services to support carers who need a break from their caregiving responsibilities. It provides temporary relief while ensuring the well-being of the care recipient.
• Palliative Care - Palliative Care is specialized care provided to older adults with life-limiting illnesses to manage symptoms, improve quality of life, and provide emotional and spiritual support for both the individual and their family.
• Advance Care Planning - Advance Care Planning involves discussions and decisions made by older adults about their future care preferences and treatment choices, ensuring that their values and wishes are respected in the event they cannot make decisions themselves.
• Ageing in Place - Ageing in Place refers to the concept of older adults continuing to live in their own homes and communities for as long as possible, with the support of appropriate care and services to meet their changing needs.
• Activities of Daily Living (ADLs) - Everyday tasks that individuals perform to maintain their personal hygiene, grooming, eating, and mobility.
• Reablement - A process that aims to help older adults regain their independence and abilities after an illness or injury.
• Active Ageing - Encouraging older adults to maintain an active and engaged lifestyle to promote overall well-being.

Understanding aged care terminology is crucial for effective communication, collaboration, and the delivery of high-quality care services to older adults in Australia.

Risk Areas for Abuse and Systemic Issues

Aged care in Australia addresses the identification and prevention of abuse in various forms, including physical, emotional, sexual, and financial abuse. Additionally, systemic issues such as inadequate staffing, poor governance, and gaps in oversight are targeted to ensure the safety and well-being of older individuals.

Definition of Abuse and Neglect

Abuse is usually defined as any action that causes intentional harm to a person. Unintentional harm resulting from accidents may be included under the umbrella of ‘neglect’, providing the harm is caused by negligence or failure to provide a safe environment.

Neglect is usually defined as a failure to provide for a person’s needs, whether intentionally or unintentionally, resulting in harm to the person’s wellbeing, for example, failure to meet a person’s physical or survival needs by providing a safe environment, sufficient food or water, shelter and health care. It also includes failure to meet social, psychological and emotional needs, such as not helping the person take part in meaningful activity and interaction with other people and not providing emotional support.

Abuse and neglect are most commonly carried out by people in trusted positions close to the person, such as family members and carers. Almost always, the abuser has more power than the person being. In Australia, the Australian Law Reform Commission (ALRC) defines elder abuse as "a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person." The ALRC includes the same types of abuse as the WHO, as well as systemic abuse, which refers to the mistreatment of older people by organisations or systems (ALRC, 2017).

Forms of Abuse and Neglect Types of Abuse

Aged care support practices focus on preventing and addressing different types of abuse. This includes physical abuse (e.g., assault, improper use of restraints), emotional abuse (e.g., verbal abuse, isolation), sexual abuse, financial abuse, and neglect. Strict policies, training, and reporting mechanisms are in place to safeguard older individuals. Below are the types and forms of abuse:

• Physical Abuse: Physical abuse involves the use of force that results in physical pain, injury, or impairment. It can include actions such as hitting, pushing, restraining, or inappropriate use of medication.
• Emotional or Psychological Abuse: Emotional abuse involves the infliction of mental anguish, emotional distress, or fear through verbal or non-verbal acts. This can include yelling, insults, humiliation, isolation, and threats.
• Sexual Abuse: Sexual abuse involves any non-consensual sexual contact, harassment, or exploitation of an elderly person. This includes unwanted sexual advances, touching, or coerced sexual acts.
• Neglect: Neglect occurs when a caregiver fails to provide adequate care, attention, or support to meet an elderly person's basic needs, resulting in harm or a decline in their physical or mental well-being. This can include neglecting to provide food, medication, personal hygiene assistance, or appropriate medical attention.
• Financial Abuse: Financial abuse refers to the unauthorised or improper use of an elderly person's financial resources. This can include theft, fraud, exploitation, coercing or deceiving the person into providing money or assets or misusing their financial information.

Risk Factors for Abuse and Neglect

Risk factors for being abused or neglected are associated with powerlessness. Risks for people dependent on others for their needs, such as children, people with disabilities, older people and in aged care, are higher than for people who are more able to speak up or defend themselves. In aged care, because of the nature of the disease, can experience significantly higher degrees of risk:

• Communication barriers may make it difficult for them to tell someone what is happening.
• Memory lapses may mean that they might not recall the abuse.
• Confusion may cause them to be unsure about what is real and what is not.
• Social isolation can mean nobody can notice the abuse or support the person to address it.
• Negative stereotypes and assumptions about older people and aged care might affect the person’s credibility and make others less likely to believe them or take their accusations seriously.
• Devaluation may result in discrimination and ill-treatment.
• Hostile behaviours, aggression and personality changes associated with aged care may make others more likely to respond with aggression and ‘lash out’ – the stress of caring for a person in aged care may also cause these reactions in carers.

Other factors that can put a person living in aged care at risk of abuse and neglect include:

• A history of domestic abuse or family violence in the household (including abuse/violence initiated by the person with aged care)
• Substance abuse
• Severity of aged care
• Living in regional or remote areas
• Lack of awareness of rights and support service

Signs and indicators of elder abuse and neglect

Elder abuse and neglect can be difficult to detect, as older people may be hesitant to report abuse or may not be able to do so due to physical or cognitive impairments. However, several signs and indicators may suggest elder abuse or neglect.

Some of these signs and indicators are:

1. Physical abuse: Unexplained bruises, burns, cuts, or injuries; frequent falls or unexplained fractures; restrained or tied up against their will.
2. Emotional abuse: Agitation, fear, anxiety, or withdrawal; lack of interest or participation in activities they used to enjoy; a sudden change in behaviour or mood.
3. Sexual abuse: Unexplained sexually transmitted infections; torn, stained, or bloody underwear; unexplained genital or anal pain.
4. Financial abuse: Unexplained or sudden changes in financial situation; missing money or valuables; forged signatures or coercion to sign documents.
5.  Neglect: Dehydration or malnutrition; untreated medical conditions; poor hygiene or living conditions; bed sores or pressure ulcers.

It's important to note that these signs and indicators may not necessarily indicate abuse or neglect and can also be caused by other factors. However, if these signs and indicators are present, it's important to investigate further to ensure the safety and well-being of older people.

Responding to Abuse and Neglect

As a support worker, you will be on the ‘front line’ for protecting your clients from harm and exploitation, so it is particularly important for you to recognise signs of abuse or neglect and to respond appropriately:

• Take care of any injuries the person has received, either by providing first aid or ensuring that the person receives appropriate medical treatment.
• Reassure the person, help them to feel safe and make sure they are physically comfortable. Collect as much information about what has happened to the person as you can.
• Report the situation as soon as possible to your immediate supervisor. Document your observations and actions accurately and objectively.
• Remember always to follow your organisation’s policies and procedures for responding to the abuse or harm, and reporting harm to your supervisor.

Legislative requirements to report neglect and abuse of elderly

Compulsory reporting requirements of abuse of adults with disabilities or in aged care are also very strictly enforced. In most cases, your manager, such as a nurse or supervisor, is required to report to police or the government department any suspected or actual signs of physical or sexual abuse.

In some states, anyone who sees or suspects signs of physical or sexual abuse has a legal obligation to go directly to the police, or to be satisfied that the police have been contacted. In other states, your legal responsibilities are only to report what you have seen or heard to your direct manager. You may also like to read a link from the Aged Care Quality and Safety Commission.

The department developed the Serious Incident Report Scheme (SIRS), which helps to prevent and reduce incidences of neglect and abuse in residential aged care services by the Australian Government.

For further information regarding SIRS, please click here.

You might also like to read through the National Disability Services information that provides detailed information about understanding, preventing and responding to abuse. You can find the link here.

• Aged Care Act 1997: The Aged Care Act requires approved providers of aged care services to have procedures in place for reporting suspected or alleged cases of abuse or neglect of care recipients. This includes reporting to the Aged Care Quality and Safety Commission and other relevant authorities.
• National Aged Care Mandatory Reporting Scheme: The National Aged Care Mandatory Reporting Scheme requires approved providers and their staff to report specific incidents, including suspected or alleged abuse or neglect of a care recipient, to the Aged Care Quality and Safety Commission. Failure to report such incidents can result in penalties.
• State and Territory Legislation: Each state and territory in Australia has its legislation regarding the reporting of abuse and neglect of vulnerable adults. For example, in New South Wales, the Crimes (Domestic and Personal Violence) Act 2007 requires anyone who suspects an older person is at risk of or experiencing abuse or neglect to report it to the NSW Police or to the NSW Ageing and Disability Commission.
• Aged Care Quality Standards: The Aged Care Quality Standards set out the expected outcomes for care recipients and the requirements for aged care providers to meet those outcomes. Standard 3 requires providers to have systems in place to detect, prevent and respond to abuse and neglect and to promptly and appropriately report any allegations or incidents.
• Criminal Code Act 1995 (Commonwealth): This act makes it an offence to engage in any form of elder abuse, including emotional abuse, that causes harm or distress to an older person. The penalty for the offence can range from fines to imprisonment, depending on the severity of the abuse.
• Elder Abuse Prevention Interim Measures Act 2015 (Victoria): This act provides a framework for responding to and preventing elder abuse in Victoria. It defines elder abuse as any act or omission that causes harm or distress to an older person and includes emotional abuse.

In summary, carers in Australia must follow legislative requirements, including the Aged Care Act, the National Aged Care Mandatory Reporting Scheme, State and Territory Legislation, and the Aged Care Quality Standards to report cases of neglect and abuse of elderly in aged care. These requirements must be followed to ensure the safety and well-being of vulnerable older adults.

1. Read the following article for an overview of reporting procedures for workers in residential aged care services: ‘Reportable Assault Flowchart for Residential Aged Care’ from the Aged Care Quality and Safety Commission'
2. Read the following article to learn about the limitations of Australia’s current laws in protecting older people from abuse: ‘Elder Abuse: Laws and Limitations’ from Ausmed.
3. ‘Subject to decisions by the Federal Parliament, from 1 April 2021 it is expected that compulsory reporting legislative requirements will be repealed and approved providers will be subject to the legislative requirements of the Serious Incident Response Scheme (SIRS). For further information, please download.

Watch

Watch this video from the Aged Care Quality and Safety Commission to learn more about reporting responsibilities in residential aged care: ‘Reportable Incidents Under the Serious Incident Response Scheme (SIRS)

Support practices to prevent abuse in aged care

These support practices in aged care in Australia aim to promote the rights, well-being, and safety of older individuals. They emphasise person-centered approaches, the duty of care, the dignity of risk, abuse prevention, and ensuring appropriate delegation and supervision by healthcare professionals. Support practices organisations can implement to prevent abuse and uphold clients' dignity:

1. Comprehensive Staff Training: Provide thorough training programs to staff members on recognising, preventing, and responding to abuse. This includes education on resident rights, communication skills, conflict resolution, and maintaining a safe and respectful environment.
2. Reporting Mechanisms: Establish precise reporting mechanisms that encourage staff, residents, and family members to report any concerns or suspected cases of abuse. Ensure that reports are taken seriously, investigated promptly, and appropriate actions are taken to address the issue.
3. Collaborative Care Planning: Involve residents, family members, and relevant healthcare professionals in care planning discussions. This collaborative approach ensures that individual needs and preferences are considered, reducing the risk of neglect or abuse.
4. Staff Supervision and Support: Implement regular supervision and support mechanisms for staff members, including ongoing feedback, performance evaluations, and opportunities for professional development. This helps maintain accountability and fosters a positive work culture that prioritises resident well-being.
5. Adequate Staffing Levels: Ensure appropriate staffing levels to meet the needs of residents. Sufficient staffing allows for better supervision, individualised care, and timely identification and intervention in cases of abuse.
6. Resident Empowerment: Promote resident empowerment by encouraging participation in decision-making processes, respecting their choices, and ensuring their voices are heard. Provide information about their rights, available support services, and avenues to raise concerns or complaints.
7. Continuous Quality Improvement: Establish a culture of continuous quality improvement through regular monitoring, evaluation, and feedback mechanisms. Conduct regular audits, satisfaction surveys, and resident/family meetings to identify areas of improvement and address any systemic issues.

By implementing these practices, the aged care sector strives to provide high-quality, compassionate care that upholds the dignity and autonomy of older individuals.

Systemic issues

Systemic issues, also known as structural issues, are problems or challenges within a system that arises from the way the system is designed, organised, or operates. These issues are not isolated incidents or the result of individual actions but rather are embedded within the system itself, affecting its functioning and outcomes. In the context of aged care in Australia, systemic issues can significantly impact the quality of care and services provided to elderly individuals across the sector.

Definition of Systemic Issues in Aged Care

Systemic issues in aged care refer to underlying problems or deficiencies within the aged care system in Australia that affect the delivery of care, support, and services to older adults. These issues can arise from the structure, funding, regulation, or governance of the aged care sector and may lead to widespread and recurring problems affecting residents and aged care workers. Examples of Systemic Issues in Aged Care in Australia:

1. Funding Model Inadequacies: The aged care sector in Australia has faced ongoing challenges related to funding and resource allocation. The funding model may not adequately meet the rising demand for aged care services, leading to limited resources for high-quality care and support.
2. Staffing Shortages and Workforce Issues: Systemic workforce challenges can include difficulties in recruiting and retaining qualified and compassionate aged care staff. Low wages, high workloads, and limited career advancement opportunities may contribute to staffing shortages and impact the quality of care provided to residents.
3. Regulatory Oversight and Compliance: Issues with regulatory oversight and compliance can lead to substandard care in some aged care facilities. Weak enforcement of quality standards or inadequate monitoring of facilities may result in neglect, abuse, or safety breaches.
4. Lack of Person-Centered Care: Some aspects of the aged care system may not thoroughly prioritise person-centred care, where the individual's needs, preferences, and goals are at the forefront of care planning and delivery. A lack of individualised care can lead to a one-size-fits-all approach, potentially neglecting the unique needs of residents.
5. Delayed Access to Home Care Packages: Long waitlists for Home Care Packages can be a systemic issue, resulting in delays for elderly individuals who require care and support in their homes. This delay can adversely affect seniors' health and well-being and may lead to unnecessary admissions to residential aged-care facilities.
6. Fragmented Healthcare Integration: Inadequate coordination and communication between aged care providers and healthcare services can be a systemic issue. This fragmentation may result in challenges in addressing the complex health needs of elderly residents and may lead to inadequate medical care.
7. Insufficient Cultural Competency: Aged care services may not always have sufficient cultural competency to cater to the diverse needs of elderly individuals from different cultural backgrounds. This lack of understanding and sensitivity can negatively impact the overall care experience for residents.

Addressing systemic issues

Addressing systemic issues in aged care requires comprehensive reforms and collaborative efforts from policymakers, industry stakeholders, and the community. Identifying and rectifying these underlying challenges is essential for improving the quality of care and ensuring the well-being of elderly Australians in aged care settings.

1. Conduct regular assessments of staffing levels to ensure an adequate staff-to-resident ratio, considering the needs and acuity of residents. This helps prevent burnout, fatigue, and potential neglect due to understaffing.
2. Providing ongoing training and education for staff members, including topics such as effective communication, resident rights, and person-centred care, to address knowledge gaps and improve the overall quality of care.
3. Improving communication and coordination among staff members through regular team meetings, utilising technology for efficient information sharing, and promoting interdisciplinary collaboration to ensure a holistic approach to resident care.
4. Conduct regular audits and evaluations of policies and procedures to identify areas of improvement, ensuring they align with best practices and promote resident well-being and safety.

An Individual Support Plan (ISP), also known as a Care Plan or Personal Care Plan, is a detailed and personalised document created for an individual receiving support or care services. It outlines the specific needs, preferences, and goals of the person and serves as a roadmap for providing person-centered care. The Individual Support Plan is developed through a collaborative process involving the individual, their family (if appropriate), care providers, and healthcare professionals. It takes into account the person's physical, emotional, social, and cognitive needs, as well as their cultural and personal preferences.

Purpose of individualised plan

The purpose of an individualised plan in the context of aged care is to provide personalised support and care to older individuals based on their unique needs, preferences, and goals. It aims to enhance their quality of life, promote independence, and address any physical, emotional, or cognitive challenges they may be facing.

Key contents commonly found in an individualised plan:

1. Personal Information: This section includes relevant personal details of the elderly individual, such as their name, age, contact information, medical history, and any specific cultural or religious considerations.
2. Health Assessment: An assessment of the individual's current health status, including any chronic conditions, disabilities, or medical needs. This helps in determining appropriate healthcare interventions and support services.
3. Care Goals: Clearly defined goals that the elderly individual aims to achieve with the help of the care plan. These goals may focus on maintaining or improving physical health, managing pain, enhancing mental well-being, promoting social engagement, or any other areas relevant to their overall well-being.
4. Care Needs: Identification of the specific care needs of the individual, including assistance with activities of daily living (ADLs) such as bathing, dressing, eating, mobility, medication management, and any specialised care requirements.
5. Care Services and Interventions: Details of the services and interventions that will be provided to address the individual's care needs. This may include in-home care, nursing services, physical therapy, occupational therapy, social activities, or any other relevant support services.
6. Medication Management: Information about the medications the individual is taking, including dosage, frequency, and any special instructions. This section may also include details about medication administration, monitoring, and potential interactions.
7. Personal Preferences: Consideration of the individual's personal preferences, choices, and routines to ensure that the care plan aligns with their lifestyle and values. This may include food preferences, cultural or religious practices, preferred activities, and social interactions.
8. Communication and Coordination: Details about the communication and coordination processes among the care team members, including family members, healthcare professionals, caregivers, and any other involved parties. Clear lines of communication are crucial for effective implementation and monitoring of the care plan.
9. Safety and Emergency Measures: Protocols and guidelines for ensuring the safety of the elderly individual, including fall prevention strategies, emergency contact information, and instructions for handling medical emergencies or adverse events.
10. Regular Evaluation and Review: A schedule for regular evaluation and review of the care plan to assess its effectiveness, make necessary adjustments, and ensure that it continues to meet the changing needs of the individual over time.

A risk assessment framework refers to a structured and systematic process used to identify, evaluate, and manage potential risks and hazards that may arise in aged care settings. The purpose of the framework is to promote the safety, well-being, and quality of care for older adults, residents, and staff members within aged care facilities or home care settings.

The risk assessment framework involves the following key steps:

1. Identification of Hazards: The framework begins by identifying potential hazards or sources of harm that could pose a risk to the health, safety, or well-being of older adults or staff members. Hazards may include environmental factors, equipment, infection control, and behavioral risks.
2. Risk Evaluation: Once hazards are identified, the next step is to evaluate the likelihood and severity of potential risks associated with each hazard. This involves assessing the probability of an incident occurring and the potential impact it could have.
3. Implementing Control Measures: After evaluating the risks, appropriate control measures are implemented to minimise or eliminate potential hazards. Control measures may include policies, procedures, staff training, equipment maintenance, and infection control protocols.
4. Monitoring and Review: The risk assessment framework emphasises the importance of ongoing monitoring and review to ensure the effectiveness of control measures and to identify any new or changing risks. Regular reviews help ensure that the aged care facility remains proactive in managing potential risks.
5. Involvement of Stakeholders: A comprehensive risk assessment framework involves the active participation and collaboration of various stakeholders, including aged care providers, staff, residents, family members, and external regulators.

The risk assessment framework in aged care aligns with the principles of person-centered care, where individual needs, preferences, and safety are prioritised. It ensures that the aged care environment is safe, conducive to well-being, and responsive to the unique needs of older adults. Compliance with risk assessment frameworks is also essential for aged care facilities to meet regulatory requirements set forth by organisations like the Aged Care Quality and Safety Commission (ACQSC) in Australia.

By adhering to the framework, aged care providers can deliver high-quality, safe, and person-centered care to older adults while minimising potential risks and promoting a culture of safety within the aged care sector.

Let's explore how the risk assessment framework applies to different aspects of aged care:

Risk Assessment Framework - Personal Care Worker Role

1. Identification of Hazards: Personal care workers should identify potential hazards in their role, such as handling equipment, assisting with mobility, administering medications, and managing hygiene.
2. Risk Evaluation: Assess the likelihood and severity of potential risks associated with personal care tasks. Consider factors like the individual's physical condition, cognitive abilities, and any pre-existing medical conditions.
3. Implementing Control Measures: Develop protocols and procedures for safe care practices. Provide personal care workers with proper training and equipment to minimize risks and ensure safe care delivery.
4. Monitoring and Review: Continuously monitor the effectiveness of control measures and update protocols based on feedback and incidents to enhance the safety of care provision.

Risk Assessment Framework - Working in a Person's Home

1. Identification of Hazards: Personal care workers must identify potential hazards in the person's home, such as slippery floors, clutter, and inadequate lighting.
2. Risk Evaluation: Assess the likelihood and severity of potential risks associated with working in the person's home environment. Take into account the accessibility of emergency assistance.
3. Implementing Control Measures: Develop home safety assessment checklists and provide guidance on minimising risks in the person's home. Encourage the use of personal protective equipment when necessary.
4. Monitoring and Review: Regularly review the home environment to ensure safety measures are in place and effectively maintained.

Risk Assessment Framework - Assisting a Person to Engage Outside of Their Regular Setting

1. Identification of Hazards: Identify potential risks associated with outings or activities outside the regular setting, such as environmental hazards or accessibility issues.
2. Risk Evaluation: Assess the likelihood and severity of risks involved in the planned activity, considering the individual's health status and specific needs.
3. Implementing Control Measures: Plan and prepare for the outing, considering the individual's safety requirements and support needs. Ensure access to emergency contacts and contingency plans.
4. Monitoring and Review: Observe and monitor the person during the outing to address any unexpected risks or challenges.

Risk Assessment Framework - Planning an Activity

1. Identification of Hazards: Identify potential risks related to the planned activity, such as physical demands, potential triggers for challenging behaviors, or environmental risks.
2. Risk Evaluation: Assess the likelihood and severity of risks associated with the activity, considering the capabilities and preferences of the individuals involved.
3. Implementing Control Measures: Develop a detailed activity plan, considering safety measures, individual support needs, and emergency protocols.
4. Monitoring and Review: Monitor the activity's progress, assess participant feedback, and identify areas for improvement in future activity planning.

Risk Assessment Framework - Medication Safety

1. Identification of Hazards: Identify potential risks associated with medication administration, such as incorrect dosages, drug interactions, or medication storage.
2. Risk Evaluation: Assess the likelihood and severity of medication-related risks, considering the individual's medical history and medication regimen.
3. Implementing Control Measures: Develop medication administration protocols, provide training on medication safety, and ensure accurate documentation of medication administration.
4. Monitoring and Review: Continuously monitor the individual's response to medications and assess any adverse reactions. Review medication administration practices regularly and update protocols as needed.

In all these scenarios, the risk assessment framework in Australian aged care aims to prevent accidents, injuries, and adverse events, while promoting a culture of safety and person-centered care. It ensures that care workers are equipped to provide high-quality and safe care to older adults in diverse care settings.

Examples and Scenarios for Risk Assessment Framework

Personal Care Worker Role

Scenario: Jane is a personal care worker responsible for assisting Mr. Smith, an elderly resident in a residential aged care facility. Mr. Smith requires assistance with mobility due to his recent hip surgery.

Example of Risk Assessment

• Identification of Hazards: Jane identifies potential hazards, such as slippery floors, unsecured walking aids, and uneven surfaces in Mr. Smith's room.
• Risk Evaluation: Jane assesses the likelihood of falls and the severity of potential injuries based on Mr. Smith's medical condition and history.
• Implementing Control Measures: Jane ensures the floor is dry, walking aids are properly secured, and clear pathways are maintained. She also educates Mr. Smith on using handrails and providing assistance during mobility.
• Monitoring and Review: Jane regularly monitors Mr. Smith's mobility and reviews the effectiveness of control measures to prevent falls and injuries.

Working in a Person's Home

Scenario: Michael is a personal care worker providing home care services to Mrs. Johnson, an elderly woman living independently at home.

Example of Risk Assessment

• Identification of Hazards: Michael identifies potential hazards in Mrs. Johnson's home, such as loose rugs, inadequate lighting, and cluttered walkways.
• Risk Evaluation: Michael assesses the likelihood of accidents and the severity of potential injuries, considering Mrs. Johnson's mobility limitations.
• Implementing Control Measures: Michael assists in removing trip hazards, improves lighting in key areas, and encourages Mrs. Johnson to wear non-slip footwear.
• Monitoring and Review: Michael regularly checks Mrs. Johnson's home environment and reviews the effectiveness of control measures to maintain a safe living space.

Assisting a Person to Engage Outside of Their Regular Setting

Scenario: Sarah, a support worker, is taking a group of older adults from a residential facility on a picnic outing to a nearby park.

Example of Risk Assessment

• Identification of Hazards: Sarah identifies potential hazards during the picnic, such as adverse weather conditions, uneven terrain, and allergic reactions to certain foods.
• Risk Evaluation: Sarah assesses the likelihood of incidents and the severity of potential health issues among the participants, considering their medical histories.
• Implementing Control Measures: Sarah checks weather forecasts, plans for a suitable location with accessible paths, and inquires about any dietary restrictions or allergies.
• Monitoring and Review: Throughout the outing, Sarah keeps a watchful eye on the participants, ensuring their safety and addressing any emerging risks.

In each scenario, the risk assessment framework is essential for ensuring the safety and well-being of older adults in aged care settings. It helps care workers identify and mitigate potential risks, enabling them to provide high-quality and safe care to older individuals.

What are restrictive practices?

Restrictive practices refer to the use of physical, chemical, or environmental restraints to manage challenging behaviours in people with aged care. A restrictive practice is any practice that restricts a person's freedom of movement or choice and can include the use of physical restraints, sedatives, bed rails, or other devices. These practices can negatively affect a person's well-being and quality of life, and, therefore, should be used only as a last resort when all other options have been exhausted.

Here are some examples of restrictive practices in aged care:

1. Physical restraints: This can include bedrails, chair alarms, or other devices to prevent a person with aged care from getting out of bed or chair.
2. Chemical restraints: This involves using medications, such as antipsychotics or sedatives, to control behavior or calm a person in aged care.
3.  Environmental restraints: This can include locked doors or gates to prevent a person with aged care from wandering.
4. Seclusion restraint: also known as involuntary seclusion or physical isolation, is a restrictive practice used in some healthcare settings, including aged care facilities, to separate a person from others against their will. It involves confining an individual to a specific area or room, often alone, with restricted access to others and their surroundings. The purpose of seclusion restraint is typically to manage behaviours that may pose a risk of harm to the individual or others. It's important to note that these practices are generally not recommended in the care of people with aged care, as they can cause physical and psychological harm. Instead, healthcare professionals should use a person-centred approach that focuses on identifying the underlying causes of challenging behaviours and developing individualised strategies to manage them

Legislative, regulatory requirements and ethical considerations for restrictive practices

In Australia, the use of restrictive practices in aged care is governed by legislative and regulatory requirements. These requirements are designed to protect the rights and dignity of people receiving care and to ensure that any use of restrictive practices is necessary and appropriate.

Here are some key legislative and regulatory requirements for restrictive practices in Australia:

1. Aged Care Quality Standards: The Aged Care Quality Standards set out the expectations for quality care and services in residential aged care. Standard 3 requires that providers ensure that the care and services provided are safe and free from abuse and neglect, including the inappropriate use of restrictive practices.
2. Aged Care Act 1997: The Aged Care Act 1997 provides the legislative framework for aged care in Australia. The Act includes provisions that restrict the use of restrictive practices and require providers to have policies and procedures in place to use such practices.
3. National Framework for Action on Aged Care: The National Framework for Action on Aged Care provides a framework for improving the quality of care and support for people with aged care in Australia. The framework emphasises the importance of person-centred care and the need to avoid the inappropriate use of restrictive practices.
4. State and Territory legislation: Each state and territory in Australia has its own legislation and regulations governing the use of restrictive practices in aged care. For example, in Victoria, the Use of Restraints in Residential Aged Care Facilities Policy sets out the requirements for the use of restraints and the need to use them as a last resort.

It's essential for aged care providers and staff to be aware of these legislative and regulatory requirements and to ensure that any use of restrictive practices is necessary and appropriate and in compliance with these requirements.

Ethical considerations

The use of restrictive practices in Australia for aged care raises several ethical considerations. Restrictive practices refer to any intervention restricting an individual's freedom of movement, access to goods or services, or ability to make choices. These practices are often used to manage difficult behaviours in individuals with aged care, such as wandering, aggression, or agitation.

1. One ethical consideration is the potential violation of human rights. Restrictive practices can impede an individual's autonomy and dignity, limiting their ability to make decisions and move freely. People in aged care have the same rights as others, including dignity, privacy, and freedom from abuse or neglect. Restrictive practices must be carefully considered and implemented to ensure these rights are not violated.
2. Another ethical consideration is the potential for harm. Restrictive practices can be physically and emotionally harmful to individuals with aged care. For example, physical restraints can cause pain, injury, and even death. The use of chemical restraints can lead to sedation, confusion, and other adverse effects. These potential harms must be carefully weighed against the benefits of using restrictive practices.
3. Furthermore, there is a risk that restrictive practices may be overused or misused. Sometimes, these practices may be used simply as a convenience for staff or caregivers rather than as a last resort to manage challenging behaviors. It is essential to ensure that restrictive practices are only used when essential and that less restrictive alternatives are considered first.

In conclusion, the use of restrictive practices in Australia for aged care requires careful consideration of ethical principles. The potential violation of human rights, potential harm, and the risk of overuse must all be considered when deciding whether to use restrictive practices. It is essential to ensure that individuals in aged care are treated with dignity, respect, and compassion and that their rights are always protected.

Organizational policies and procedures relating to restrictive practices

Here are common requirements that govern the use of restrictive practices across all jurisdictions in Australia.

1. Informed consent: Before any restrictive practice is applied, the person receiving care must provide their informed consent or the consent of their substitute decision-maker if they are unable to provide consent. This includes being informed of the risks and benefits of the practice, as well as any alternatives.
2. Use of least restrictive alternative: Restrictive practices should only be used when no other alternative is available, and the practice should be the least restrictive alternative that is appropriate for the person's needs.
3. Monitoring and review: Any use of restrictive practices must be closely monitored and regularly reviewed to ensure they are still necessary and appropriate. This includes ensuring that the practice is achieving its intended purpose and that it is not causing harm or distress to the person.
4. Training and education: All staff involved in the use of restrictive practices must receive appropriate training and education on the risks and benefits of these practices, as well as alternatives and how to implement them.
5. Reporting and recording: Any use of restrictive practices must be reported and recorded in the person's medical records, and this information must be accessible to relevant staff and authorities as needed.
6. Rights and advocacy: People receiving care have the right to access advocacy and support services to assist them in making decisions about their care, including decisions about the use of restrictive practices.
7. National guidelines: In addition to state and territory legislation and regulations, there are also national guidelines and codes of practice that provide guidance on the use of restrictive practices in healthcare, such as the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector.

Organisational policies and procedures should reference the above requirements in relation to the use of restrictive practices. Organisational policies and procedures related to restrictive practices should outline the circumstances in which these practices may be used, the types of restrictive practices that may be used, the conditions under which they may be used, and the monitoring and review processes that must be followed.

Conditions for Use

1. A qualified healthcare professional must authorise the use of restrictive practices.
2. The use of restrictive practices must be documented and reviewed regularly.
3. The resident or their representative must be informed of the use of restrictive practices and their right to appeal against their use.
4. All staff and caregivers involved in the use of restrictive practices must be appropriately trained and qualified.

Monitoring and Review

The use of restrictive practices must be regularly reviewed to ensure that they are being used appropriately and that less restrictive alternatives have been considered.

Documentation

Policies and procedures should outline the documentation required when using restrictive practices, including the reasons for their use, the alternative strategies considered, and the ongoing monitoring of their use. This documentation should be kept securely and confidential and available for review by regulatory bodies as required.

Organizations that are carrying out restrictive practices for aged care in Australia are required to keep accurate and up-to-date records to ensure compliance with relevant legislation, standards, and guidelines. Here are some of the documents that may be required:

1. Policy and Procedure Manual: This manual should outline the organisation's policy and procedures relating to the use of restrictive practices. It should include information on the types of restrictive practices that may be used, the conditions under which they may be used, and the monitoring and review processes that must be followed.
2. Consent Forms: Before any restrictive practice is used, the resident or their representative must provide informed consent. Consent forms should be completed and signed by the resident or their representative, and a copy should be kept on file.
3. Risk Assessment and Management Plan: A comprehensive risk assessment and management plan should be completed for each resident who is at risk of exhibiting challenging behavior. The plan should include information on the types of restrictive practices that may be used, the conditions under which they may be used, and the less restrictive alternatives that have been tried. 4. Incident Reports: Any incidents related to the use of restrictive practices, such as falls, injuries, or adverse reactions, should be documented in an incident report. The report should include details of the incident, the date and time, the individuals involved, and any action taken.
4. Medical and Medication Records: Medical records should be kept for each resident, including details of any medications prescribed and administered. This information should be used to monitor the use of chemical restraints and ensure compliance with relevant legislation.
5. Staff Training and Qualification Records: Staff members involved in the use of restrictive practices should be appropriately trained and qualified. Records of staff training and qualifications should be kept on file to ensure compliance with relevant standards.
6. Review and Evaluation Reports: The use of restrictive practices should be regularly reviewed and evaluated to ensure that they are being used appropriately and that less restrictive alternatives have been considered. Review and evaluation reports should be completed and kept on file. These documents should be kept in a secure location and made available for inspection by relevant regulatory bodies. It is essential to ensure that all documentation is accurate, up-to-date, and compliant with relevant legislation, standards, and guidelines.

Implementation of positive strategies

Overall, the goal of using restrictive practices in aged care should always be to ensure the safety and well-being of the individual in aged care and to minimize their use as much as possible through implementing positive strategies. The use of restrictive practices in aged care should only be considered as a last resort and in accordance with strict ethical and legal guidelines. However, in situations where they are deemed necessary, there are positive strategies that can be used to minimise their impact and ensure the safety and well-being of the individual in aged care.

Some positive strategies for the use of restrictive practices in aged care in Australia may include:

1. Developing a comprehensive care plan: A care plan should be developed for each individual with aged care that outlines their specific needs and preferences, as well as any potential triggers that may result in challenging behaviours. This will help to identify appropriate interventions and strategies to prevent and manage challenging behaviors, and to minimise the need for restrictive practices.
2. Implementing non-pharmacological interventions: Non-pharmacological interventions such as sensory stimulation, music therapy, and physical activity can be effective in reducing challenging behaviours and promoting relaxation in individuals in aged care. These strategies should be implemented before considering the use of restrictive practices.
3. Using least restrictive options: When restrictive practices are deemed necessary, it is important to use the least restrictive option possible. For example, instead of using physical restraints, a supportive chair or bed that limits movement may be a better option.
4. Regularly reviewing the use of restrictive practices: The use of restrictive practices should be regularly reviewed to ensure they are still necessary and appropriate. This can help to minimise their use over time and identify alternative strategies to manage challenging behaviours.
5. Providing training and support for staff: Staff working with individuals in aged care should be trained in appropriate communication techniques and strategies for managing challenging behaviours. They should also be provided with ongoing support and supervision to ensure they are using restrictive practices appropriately and ethically.

A rewarding career in Aged Care means caring for some of the most vulnerable people in society. The very nature of caring for our older people can induce high levels of stress if not managed properly. Organisational policies and procedures should have in place ways of managing stress within the workplace. However, it will be up to you to monitor your stress levels and use strategies, including seeking support, to manage your stress. Unmanaged stress can lead to more serious health issues such as diabetes, high blood pressure, heart disease and obesity. Taking a step back and evaluating how you are feeling is an important monitoring tool for stress. A certain level of stress can help with performance. However, by monitoring how you react in certain situations, you

should be able to determine your triggers and your body’s response, including an increased heart rate, sweating, shaking and dry mouth. When stressed, the body releases several hormones into the bloodstream, including cortisol (which increases glucose in the bloodstream) and adrenaline.

Here's some strategies to guide support workers on implementing self-care strategies

Implementing Self-Care Strategies in Aged Care: As a support worker in the aged care industry, it is essential to recognise that caring for others also means taking care of yourself. Providing care to elderly individuals can be emotionally rewarding, but it can also be challenging and stressful at times. To ensure you maintain your well-being and continue delivering compassionate care, it is essential to monitor your stress levels and implement self-care strategies.

Here are some steps to help you achieve this: Monitor Your Stress Level When Working with People Receiving Care

1. Awareness: Take a moment to be mindful of your emotional state before, during, and after interacting with the elderly individuals in your care. Recognize signs of stress, such as feelings of overwhelm, irritability, or fatigue.
2. Regular Check-ins: Perform regular check-ins with yourself throughout your shift. Pause and assess how you are feeling emotionally and physically. This will help you identify any triggers or sources of stress.
3. Seek Feedback: Communicate openly with your colleagues and supervisors. Sharing experiences and seeking feedback can provide insights and support in managing stress effectively.

Use Self-Care Strategies and Seek Support if Required

1. Time Management: Ensure you have a balanced work schedule and avoid overextending yourself. Take breaks when needed, and prioritise tasks to prevent burnout.
2. Engage in Stress-Reducing Activities: Engage in activities outside of work that help you relax and unwind. This can include hobbies, exercise, spending time with loved ones, or practising mindfulness techniques.
3. Utilise Organisational Resources: Familiarise yourself with the self-care resources provided by your organisation. These may include counselling services, employee assistance programs, or wellness initiatives.
4. Seek Support from Colleagues: Build a supportive network with your colleagues to share experiences, challenges, and coping strategies. Offering each other emotional support can be beneficial for everyone's well-being.
5. Reflect and Learn: Reflect on your experiences and learn from them. Celebrate the positive moments, acknowledge challenges, and use them as opportunities for growth.
6. Know When to Seek Professional Help: If you find yourself struggling with persistent stress, anxiety, or emotional difficulties, don't hesitate to seek professional support from a counsellor or mental health provider.

Remember, taking care of yourself is not a selfish act but a necessary one to ensure you can continue providing the best care for the elderly individuals you support. By implementing self-care strategies and seeking support when needed, you contribute to a healthier and more compassionate aged-care industry.

Here are some resources that aged care workers can use to manage stress and practice self-care

1.  Beyond Blue - Aged Care Workers' Mental Health Toolkit
   Description: Beyond Blue offers a comprehensive toolkit specifically designed to support the mental health and well-being of aged care workers. It provides information, tips, and resources to manage stress, build resilience, and improve mental well-being.
2. Heads Up - Supporting Mental Health in Aged Care
   Description: Heads Up, an initiative by Beyond Blue and supported by the Mentally Healthy Workplace Alliance, offers resources and information tailored to the aged care industry. It includes practical strategies to promote positive mental health in the workplace and provides guidance for workers and employers.
3. Lifeline - Crisis Support and Online Chat
   Description: Lifeline offers a 24/7 crisis support helpline and online chat service. Aged care workers experiencing high levels of stress or emotional challenges can access immediate support and speak with a trained counsellor confidentially.
4. Smiling Mind - Mindfulness Meditation App
   Description: Smiling Mind is a popular mindfulness meditation app that provides guided meditation sessions to reduce stress, improve focus, and promote overall well-being. Aged care workers can use this app during breaks or after work to relax and unwind.
5. Headspace - Meditation and Sleep App
   Description: Headspace is a meditation and sleep app that offers guided meditation sessions and sleep exercises to help manage stress and improve sleep quality. It provides tools to support mental well-being for aged care workers.
6. ReachOut - Stress and Well-being Resources
   Description: ReachOut is an online mental health organisation that offers resources and information on managing stress, building resilience, and improving well-being. It provides articles, tools, and support forums for aged care workers seeking guidance.
7. Employee Assistance Programs (EAP): Many aged care organisations offer Employee Assistance Programs that provide confidential counseling and support services to their employees. Aged care workers can check with their employers to access these resources.

Remember, self-care is essential for maintaining overall well-being and effectively caring for others. Utilising these resources can help aged care workers develop healthy coping mechanisms and manage stress more effectively. If you or someone you know is experiencing severe stress or emotional challenges, consider seeking professional help from a mental health professional or counselor.