​​Sarah-Kaye Page​

Training advisor with ETC Training and a Dementia Specialist

Outdoor activities can be as simple as going for a walk or sitting in the sun, however, they can be as active as gardening, mowing the lawns, or clipping the hedges. The beauty of nature and its positive effects should not be underestimated. As children, we are told to ‘go outside and play’ or ‘go and get some fresh air’ because it keeps us busy, helps to relax our bodies and minds, keeps us active, and helps us to destress. This should not stop just because we are older or in a facility. Being in the sun outdoors increases our immune system, positive mental health, heightened positive emotional state, increased production of vitamin D, increased physical movement, ongoing fine motor skills use, and improved overall quality of life. Research encourages us to spend more time outdoors to improve our physical and mental health and overall well-being.

Nature can offer us connections to our younger years including memories of long summers with family and old friends, relaxing hours spent in the garden, freshly cut grass, wedding flowers, or ones they picked for their first love. It can also encourage people to connect with others or a new hobby that offers increased social connection. We can assist people to remain active by maintaining a client’s fine motor skills, mobility, and problem-solving functions in an outdoor setting.

Engagement with nature can be as simple as a smile, a glance at the sun, or a long-contented sigh. If a person loves flowers, plant more in the garden. If they love birds, plant bird-attracting plants. Eating the food from our garden can be very satisfying and encourage food intake for those struggling with lower nutrition.

Being outdoors and engaging in an activity is beneficial for the body, mind, and soul. For many clients, this is an excellent opportunity to maintain or regain skills by doing tasks they would have done for most of their lives. For others, their creative sides bloom. Ask your clients what they enjoy and tailor your outdoor activities to their enjoyment.

• Going for a walk in the garden
• Gathering fallen leaves/flowers
• Harvesting/gathering food
• Planting/weeding the garden
• Gathering fresh flowers/branches
• Flower arranging 
• Providing flowers for others (in the facility/home or to a charity) 
• Using flowers/leaves/fruit/ nuts/bark in craft activities 
• Cooking with fruit/vegetables produced in the garden
• Bird watching 
• Discussing animals in nature
• Looking at books with flowers

For clients that have mobility issues, getting on the ground to weed the garden may not work. However, this is where pots and tables can be used as alternatives. If fresh flowers are not available, then alternatives can always be found. If it is raining or freezing cold in winter, do inside activities and have these discussions about flowers they got for their loved ones. Some other ideas:

• Raised garden beds 
• Safe and flat pathways
• A variety of colours/smells/textures 
• Cook what is produced
• Flowers that attract birds
• Keep the garden tidy and loved
• For craft activities, adjust the requirements for the level of the individuals. 

Everyone requires sunlight to boost their health and well-being, so working around different physical needs is important so that people can feel the sun on their faces. Remember that being outdoors was part of our childhood and growing up. This is an excellent opportunity to reconnect some clients with the past and an option to re-engage others with chores, tasks, or activities that they have done in the past.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

​​Barbara Barbosa Neves, Alan Petersen, Mor Vered, Adrian Carter, and Maho Omori

​​Monash University​

​​‘The aged care system is well behind other sectors in the use and application of technology’ noted the Royal Commission into Aged Care Quality and Safety in 2021. [1 p77] Yet, the Commission also warned that new technological systems and initiatives must ‘identify older people’s needs and preferences.’ [1 p147] 
 
Since the onset of the COVID-19 pandemic, we have seen a renewed drive to introduce emerging technologies, such as Artificial Intelligence (AI), into residential aged care. [2] This drive is fuelled by the promise that AI can help solve the systemic issues affecting the sector, being the ‘future of elder care’. [3] For example, robots and smart voice assistants can help stave off loneliness and social isolation; smart medical systems can improve clinical diagnoses; smart sensors can predict falls and health decline. And while AI can assist with some of these matters, we must examine its limitations and potential harms.   
 
Our new study, published in the Journal of Applied Gerontology, [4] aimed to understand how AI for aged care is imagined, designed, and implemented. For this, we conducted interviews with a range of stakeholders: AI developers, aged care staff, and aged care advocates in Australia. We explored their views about AI for later life, whether as developers of technologies for the sector or as those who have the power to implement or support their use in aged care settings.  
 
We found that, despite good intentions, developers made many promises about what AI could fix in aged care, from loneliness to staff shortages. But these promises were often made without considering the complexity of such environments and its residents. For instance, developers described stereotypical ideas about older residents. They were seen as a homogenous group and as technologically incompetent or disinterested. These ageist ideas illustrate how easily age-related bias can make its way into how we create AI technologies. But aged care staff and advocates held similar views about the technological incapacity or interest of older people. AI can be ageist by design but also by implementation.  
  
Our study shows that, alongside other prejudices pervading AI technologies like gender and racial biases, age is a serious but overlooked factor in research and policy. Understanding how ageism is embedded in both AI systems and in aged care settings is essential to combat it. This requires more institutional and public efforts to challenge simplistic narratives about older people. These narratives can lead to the development and application of technologies that exacerbate existing stereotypes and inequities, as they neglect the diversity of later life and the various needs and aspirations of older people. Indeed, their autonomy and dignity were rarely discussed across the stakeholders in our research. This was clear even when we were talking about AI for surveilling their everyday movements. Older residents were sometimes reduced to sick bodies to be constantly monitored.  
 
As stressed by the Royal Commission, ‘Ageism is a systemic problem in the Australian community that must be addressed’. [1 p75] We cannot forget to address it at all levels, including in relation to how we develop and use technologies for care. 

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Anna Lions

Communications Coordinator, Southern Cross Care (SA, NT & VIC) Inc

The Government-funded Short Term Restorative Care (STRC) programme helps older Australians to maintain their independence and keep living at home, but what happens when the eight-week program is over? Well, the answer right now, in many cases, is not enough.

A recent research grant funded by the Aged Care Research & Industry Innovation Australia (ARIIA) aims to help STRC participants continue to manage their health after the program ends. The grant is funding the development and trialling of a self-management workbook, My Health in My Hands, which participants will be guided through by Southern Cross Care allied health professionals.

The workbook includes evidence-based activities for setting health goals and learning about healthy activities, with a focus on the ongoing self-management of their health. Once the program has ended, participants can use the workbook for guidance on eating healthily, exercising, and looking after their wellbeing in a way that is both simple and the most beneficial to them.

The development of the workbook has included research into best practice methods, such as positive goal setting, and co-design with older people who have completed the STRC program. One co-design participant who is enthusiastic to see the workbook used is Peter Johnson. He completed the STRC program a few months ago and said he struggled without ongoing support and encouragement.

‘[The STRC program] gave me more confidence and encouragement as well as, and because of, my improved physical abilities,’ Mr Johnson said. ‘The team answered a lot of my questions during the program but I probably didn’t ask all the questions I needed to and at the end of the program I thought, “what happens now?”’ Mr Johnson said the workbook would have helped him to ‘design, plan and prepare’ for the gap between the end of the STRC program and the beginning of his home care services, in order to keep up his progress.

The workbook development is being overseen by healthy ageing expert Dr Tim Henwood, Group Manager Health & Wellness at Southern Cross Care (SA, NT & VIC) Inc. Dr Henwood is excited by the possibilities that this new workbook offers STRC program participants. ‘The workbook will offer all providers of short-term allied health and therapy programs a tool that clients can reference to learn and be more proactive about their own health,’ said Dr Henwood. ‘While we are trialling it in STRC, we hope it can play a key role in the forthcoming Government Support at Home reform by supporting older clients entering restorative pathways, to graduate from them with enhanced knowledge of how to best self-manage their health.’

The research partners are Justin Koegh, Associate Prof, Faculty of Health Sciences and Medicine at Bond University, and Dr Paul Swinton, Associate Prof at Robert Gordon University.

The first of the workbooks have now reached STRC participants. From here, the team will assess the impact of the workbook on participants’ health knowledge, wellbeing and allied health participation during and following their STRC program.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Stephanie Champion

Research Fellow, ARIIA

Evidence is key for effective, innovative, health care practice and informed decision making. More than ever the Australian aged care sector needs evidence-based innovative solutions, to deliver cost-efficient care to meet the growing needs of an ageing population with complex needs and minimise the workloads of aged care workers.

Evidence-based practice (EBP) is defined as ‘an approach to care that integrates the best available research evidence with clinical expertise and patient values.’ [1] The promotion of EBP requires infrastructure and practitioners who support the implementation of evidence-based initiatives. The aged care industry has been comparatively slow to innovate. [2] Complex challenges, such as the shifting needs and expectations of multiple stakeholders, rising costs, and increasing regulatory pressure, among others, have been identified as barriers to innovation.

Moving forward, developing new ways of working now is vital for the long-term sustainability of the industry [3] and to take advantage of new opportunities, such as rapidly evolving technology. [2] The Royal Commission into Aged Care Quality and Safety highlighted the lack of strategy for implementing translational research outputs into practice while recognising that current funding structures fail to support providers who want to innovate. [4]

ARIIA’s Innovator Training Program (ITP) offers a practical pathway towards developing skills in designing implementable projects. Through the ITP, Innovators gain the knowledge and skills to implement innovative, evidence-based change in their setting.

A recent ITP project has achieved positive outcomes through engagement with the ITP. A clinical nurse from Round 1 of the ITP aims to implement an early intervention screening tool for delirium in residential care settings. Through ARIIA, she was connected with a research partner who has been able to help them find a screening tool and plan a pilot. According to this innovator, ‘I obviously came into the [ITP] not knowing how to even do a project or where to start… it's definitely given me like a base knowledge. I'd feel comfortable to start my own little project and know sort of the processes to make and ensure that it's evidence based and that I was on the right track with it.’

Are you working in the aged care sector and have a problem in your workplace? Do you need support to find a solution? The free Innovator Training Program is designed to provide you or your team with tools and skills to use available knowledge and evidence to solve a problem in your workplace.

If you’re interested in becoming an Innovator, please visit our webpage for more information: https://www.ariia.org.au/programs/innovator-training-program. While you’re there, check out our Innovator Essential Series mini-courses and get a sneak peek into our complete Innovator Training Program!

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Penny Neller, End of Life Law Toolkit Developer, End of Life Directions for Aged Care

End of Life Directions for Aged Care (ELDAC)

Voluntary assisted dying (VAD) is an emerging area for aged care in Australia. With VAD operating in all Australian States by the end of November 2023, aged care providers and staff will increasingly receive questions about VAD from those they care for and their families. Some common queries about VAD in aged care are discussed in ELDAC’s new FAQs factsheet and below. 

Is VAD legal everywhere in Australia?  
Every State in Australia has passed VAD laws. VAD is operating in all States except New South Wales, where it will start on 28 November 2023. VAD is currently illegal in the Territories. Each States’ laws are similar but there are key differences. 

Can anyone with a terminal illness receive VAD? 
No. To access VAD a person must meet all eligibility criteria in their State. This includes having:  

• decision-making capacity 
• a disease, illness or medical condition that will cause death within six months, or 12 months if the person has a neurodegenerative disease (such as motor neurone disease) or is in Queensland 
• a condition that is advanced and causing intolerable suffering. 

Can a person with dementia access VAD?  
A person will not be able to access VAD for dementia. This is because a person must have decision-making capacity to request VAD. A person whose dementia is so advanced that they are within 12 months of death will not have decision-making capacity. However, a person who is in the early stages of dementia and has a terminal illness (e.g., cancer) may be eligible for VAD if they have decision-making capacity and meet the other eligibility criteria. 

Who can request VAD? 
Only the person who will receive VAD. It cannot be requested by a family member, friend, substitute decision-maker, or aged care staff. A person cannot ask for VAD in their Advance Care Directive.   

How does a person access VAD?  
The process is different in each State. Generally, a person will need to make three requests for VAD and be assessed as eligible by at least two different medical practitioners who meet particular requirements.   
 
Can a person who asks for VAD also receive palliative care and other treatment?  
Yes. They can continue to receive palliative care and other medical treatment up until their death. 

Do health professionals and care workers have to participate in VAD? 
No. Healthcare professionals have the right to conscientiously object to participating in VAD. However, in some States they may still have legal obligations, such as to provide information to a person requesting VAD. Care workers can also choose not to be involved in VAD. 

Do residential facilities have to provide VAD? 
Residential facilities can decide whether to provide some, all, or no VAD services. However, in South Australia, Queensland and New South Wales residential facilities that choose not to provide VAD services still have legal obligations to enable a resident to access VAD if they wish.

Can health professionals and care workers discuss VAD or give information about VAD? 
Health professionals and care workers can provide information about VAD to a resident or others e.g., family if asked. However, there are restrictions on when healthcare professionals can start a discussion about VAD. Only some health professionals can do this, and in some States, they must provide certain information when they have discussions.  

Want to know more? Visit ELDAC’s End of Life Law Toolkit for everything you need to know about VAD in aged care. You can also download printable VAD factsheets for residential facilities (tailored to the State or Territory you work in) and different health professionals.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.