Understanding the nature and impact of occupational stress on Australian rural aged care workers.

This study explored the nature and impact of occupational stress on direct-care workers employed by aged care providers in rural Australia. The Job demands-Resources (JD-R) model of occupational stress provided the theoretical framework to guide this qualitative investigation. A series of four FGs were conducted with direct-care workers (n = 23), who reported their job demands, job resources and personal resources. Direct-care workers identified six themes related to job demands: time pressure, physical demands, hindrance demands, an inadequate mix of staff, insufficient training to deal with complex conditions and work schedule demands. Four themes related to job resources were identified: collaboration with colleagues, equipment, opportunities for development and work schedule control. Disposition and self-care were identified as necessary personal resources for aged care workers. While the generic JD-R questionnaire captures many relevant workplace characteristics, further investigations with this work group should also consider the inclusion of items related to shift work, disposition and self-care.

Age-friendly care for older adults within rural Australian health systems: An integrative review.

OBJECTIVES: To identify the core elements of interventions and models that facilitate age-friendly care for older adults within rural Australian health systems, and assess the extent to which these align with core elements of the Institute for Health Improvement's (IHI) Age-Friendly Health Systems 4Ms Model. METHODS: Peer-reviewed journal articles examining core elements of Australian rural geriatric care models were collected and analysed using an integrative review methodology. RESULTS: Identified models and interventions addressed all four core elements of the IHI model-what matters, medications, mobility and mentation. There was more evidence relating to mobility and mentation, with lesser evidence relating to medications and what matters. A series of core elements not aligned with the model were also identified. CONCLUSION: The IHI 4Ms Model appears to be applicable in the rural Australian context. More high-quality, systematic evidence is needed to investigate the core elements of age-friendly care across diverse rural contexts.

Preparedness for caregiving: A phenomenological study of the experiences of rural Australian family palliative carers.

The care of people with life-limiting illnesses is increasingly moving away from an acute setting into the community. Thus, the caregiver role is growing in significance and complexity. The importance of preparing and supporting family caregivers is well established; however, less is known about the impact of rurality on preparedness and how preparedness shapes the caregiving continuum including bereavement. The aim of this study, conducted in 2017, was to explore how bereaved rural family palliative carers described their preparedness for caregiving. Interpretative phenomenological analysis was employed following semi-structured interviews with four women and six men (N = 10, aged 55-87 years). Participants were recruited voluntarily through past engagement with a Regional Specialist Palliative Care Consultancy Service in Australia. The experiences of caregivers illustrated a lack of preparedness for the role and were characterised by four major themes: Into the unknown, Into the battle, Into the void and Into the good. The unknown was associated with a lack of knowledge and skills, fear, prognostic communication, exclusion, emotional distress and grief experience. Battles were experienced in a number of ways: intrapsychically (existing within the mind), through role conflict and identity; interpersonally with the patient, clinician and family; and systematically (against health, financial and legal systems). The void was felt during isolation in caregiving, in relinquishing the role, in bereavement and in feeling abandoned by service providers. Positive experiences, such as being valued, included and connected to supports, and the fostering of closer relationships and deeper meaning, occurred less frequently but temporarily buffered against negative aspects. Implications from this study for policy and practice centre on the frequent, purposeful and genuine engagement of caregivers. Services and clinicians are encouraged to enhance communication practices, promote meaningful inclusion, address access issues and enhance support at role relinquishment.

Expectations of care within marriage for older couples.

OBJECTIVES: This study explores the intersection of marriage and caregiving amongst older spousal caregivers in regional Australia. Specifically, we address the research question: 'How do expectations of informal care impact spousal caregivers in later life?' METHODS: These comprise interpretive qualitative in-depth interviews in order to understand the lived experience of caregiving within the context of long-term marriage. RESULTS: Findings highlight the complexity and diversity of marital relationships as the context of informal care. Individual and social obligations were evident in key themes, demonstrating how spouses automatically assume and continue in caregiver roles in later life. CONCLUSION: Caregiving is an expectation of couples in long-term marriages, regardless of the relationship quality and willingness to care. Normative expectations also impact decision-making around future care planning and transitions away from home-based care. These are important considerations for both policy and practice with older adults and their caregivers.

Predicting wellness among rural older Australians: a cross- sectional study.

INTRODUCTION: Prior research on older people's wellbeing and quality of life has lacked clarity and consistency. Research examining older people's health has tended to use these different terms and measurement tools interchangeably, which might explain why the evidence is somewhat mixed. There is a paucity of research that uses the multi-dimensional construct of wellness in rural older people. Addressing both limitations, this study seeks to make a unique contribution to knowledge testing an ecological model of wellness that includes intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. METHODS: Six rural case study sites were chosen across two Australian sites, the states of Queensland and Victoria. A community saturation recruitment strategy was utilised. Telephone surveys were conducted with community-dwelling rural older people (n=266) aged ≥65 years across the sites. The central variable of the study was wellness as measured by the Perceived Wellness Survey. The ecological model developed included the following intrapersonal factors: physical and mental health, loneliness and social demographic characteristics (age, sex, marital status and financial capability). Interpersonal factors included a measure of social and community group participation, social network size and support provided. Institutional factors were measured by series of questions devised around the resource base environment and access to amenities and services. RESULTS: A hierarchical regression analysis was conducted to determine which variables in the model predict wellness. The results showed that a combination of intrapersonal factors (physical health, mental health, loneliness and financial capability) and interpersonal factors (size of social network and community participation) predicted wellness. However, institutional factors, the resource base environment, and access to amenities and services, contributed only marginally to the model. Community factors, including the personal and physical characteristics of community, also only made a marginal contribution. CONCLUSIONS: The study identified the usefulness of using an integrated model of measurement in wellness. This model recognised the interrelated physical, social and economic influences that impact on rural older people throughout their life course. The study found that physical health made the greatest contribution to perceived wellness, followed by mental health. These findings support a body of research that has found that rural older people experience poorer health outcomes than those in urban areas. Lower levels of loneliness were also a strong predictor of perceived wellness, thus supporting research that has examined the impact of loneliness on physical and mental health. The presence of social capital, as measured by social network size, and the degree of community participation, were also predictors of perceived wellness. Overall, the findings of the present study implications for policy as well as subsequent strategies designed to increase the capacity of wellness in rural older people. Such strategies need to consider the contribution of a range of factors.

Challenges to the provision of community aged care services across rural Australia: perceptions of service managers.

INTRODUCTION: The Australian community aged care sector is facing a growing workforce crisis, particularly in rural and regional areas. Its predominantly female workforce is ageing, and recruiting younger, skilled workers is proving difficult. The service sector, too, is proving highly complex and diverse as a result of contemporary aged care service reforms as well as ongoing difficulties in providing services to the growing numbers of older people living in Australia's rural areas. Despite these multiple challenges, there is a gap in research that explores how rural aged care services manage their day-to-day requirements for skilled workers across the diverse service sector. To address this gap, this article reports on the experiences and perceptions of a small sample of service managers whose organisations represent this diversity, and who are accountable for care provision in regional and rural locations. In such areas, recruitment and skill needs are contoured by disproportionate aged populations, distance and reduced service availability. METHODS: Eleven service managers were interviewed as part of a larger project that examined the skill and training needs of community aged care workers within the Riverina, a rural region in New South Wales. Qualitative data drawn from semi-structured interviews were thematically analysed to identify the managers' individual needs for workers and skills in the context of location, service parameters and availability of other health and community services. RESULTS: Thematic analysis of the interview data elicited three themes: services, roles and skill deployment; older workers and gendered roles; and barriers to recruitment. The findings illustrate the complexities that characterise the community aged care sector as a whole and the impact of these on individual services located in regional and rural parts of Australia. The participants reported diverse needs for worker skills in keeping with the particular level of service they provide. Significantly, their varying perceptions and practices reflect their preference for older, female workers; their reluctance to take on younger workers is negatively skewed by a lack of capacity to compete for, recruit and retain such workers and to offer incentives in the form of enhanced roles and career development. CONCLUSIONS: The findings highlight the conceptual ambiguities inherent in definitions of community aged care work as broadly skilled and uniformly sought across the sector. On the one hand, demands for more and better trained workers to meet growing client complexity locate care work as skilled. On the other, managers of narrowly defined service activities may rely on a diminishing workforce whose skills they downplay in gendered and lay terms. This contradiction corresponds with long-held conclusions about the gendered, exploitative reputation of care work, a characterisation discursively constructed by privileging the moral dimensions of the job over the technical skills required for it. Significantly, the findings raise questions about the capacity of services, as they are currently structured and differentiated, to reshape and redefine aged care work as a 'good job', one that holds appeal and tangible rewards for new and younger skilled workers.

Extrinsic and intrinsic factors impacting on the retention of older rural healthcare workers in the north Victorian public sector: a qualitative study.

INTRODUCTION: Workforce shortages in Australia's healthcare system, particularly across rural areas, are well documented. Future projections suggest that as the healthcare workforce ages and retires, there is an urgent need for strategies to retain older skilled employees. Very few qualitative studies, with theoretical underpinning, have focused on the retention of older rural nurses and allied healthcare workers. This study aimed to address these gaps in research knowledge. METHODS: This qualitative study is phase 2 of a large mixed-methods study to determine the factors that impact on the retention of older rural healthcare workers across northern Victoria, Australia. The initial phase, drawing on the effort-reward imbalance model found high levels of imbalance across a large sample of this population. The present study builds on these findings to explore in more depth the organisational (extrinsic) and individual/social (intrinsic) factors associated with retention. A purposeful stratified sample was drawn from participants at the survey phase (phase 1) and invited to take part in a semistructured telephone interview. A diverse group of 17 rural healthcare workers (nurses and allied health) aged 55 years or more, employed in the north Victorian public sector, were interviewed. The data were transcribed and later analysed thematically and inductively. RESULTS: Data were categorised into extrinsic and intrinsic factors that influenced their decisions to remain in their roles or leave employment. The main extrinsic factors included feeling valued by the organisation, workload pressures, feeling valued by clients, collegial support, work flexibility, and a lack of options. The main intrinsic factors included intention to retire, family influences, work enjoyment, financial influences, health, sense of self, and social input. Given the noted imbalance between (high) effort and (low) reward among participants overall, strategies were identified for improving this balance, and in turn, the retention of older rural healthcare workers. CONCLUSIONS: Study outcomes provide important insight into factors that impact on the retention of older rural healthcare workers, and, importantly, the imbalance in effort and reward participants experience in their current workplace. Use of a theoretical approach, and a two-stage methodology, enables a deeper understanding of these factors and the strategies needed to address them. Further research is now needed to test the effectiveness of these strategies in the older rural healthcare workforce.

Till death us do part? A critical analysis of obligation and choice for spousal caregivers.

Research demonstrates a significant number of carers identify obligation or lack of other alternatives as the reasons they undertake informal care. By utilizing critical discourse analysis, this research explores choice for informal caregivers in contemporary Australian social policy. Analysis demonstrates increasing shifts in policy toward choice in consumer-directed care, a feature absent for those who provide care. Familial care is a central pillar of Australian social policy, as it is in many liberal and conservative welfare regimes. Analysis reveals that these core social policies are fundamentally incongruent, with significant implications for individuals and social work practice.

'I'm older and more interested in my community': older people's contributions to social capital.

AIM: To explore and compare older people's contributions to social capital in a large rural community. METHODS: Data were collected from a large representative sample (n= 1431), through a social capital questionnaire. The survey was cross-sectional and measured frequency of participation across different age cohorts in informal social activities, group activities and community and civic activities. RESULTS: Age and life stage pattern proved to be a factor in determining the types of activities people were involved in. While younger people were more involved in social participation that involved public places or group and sporting events, older people, particularly those in the retirement age group of 60-69 were more involved in community and civic activities. CONCLUSION: Older people living in non-metropolitan areas are not only recipients of social capital. Their considerable involvement in volunteer groups, service clubs, church groups and local government demonstrates significant involvement in civic and community life.