Specialised residential care for older people subject to homelessness: experiences of residents and staff of a new aged care home in Australia.

BACKGROUND: The number of older people experiencing homelessness in Australia is rising, yet there is a lack of specialised residential care for older people subject to homelessness with high care and palliative needs. To address this significant gap, a purpose-built care home was recently opened in Sydney, Australia. METHODS: This qualitative study explores the experiences of both residents and staff who were living and working in the home over the first twelve months since its opening. Residents were interviewed at baseline (n = 32) and after six months (n = 22), while staff (n = 13) were interviewed after twelve months. Interviews were analysed using a reflexive thematic analysis approach informed by grounded theory. RESULTS: Three main themes emerged: (1) Challenges in providing care for older people subject to homelessness with high care needs; (2) Defining a residential care service that supports older people subject to homelessness with high care needs, and (3) Perception of the impact of living and working in a purpose-built care home after six months (residents) and twelve months (staff) since its opening. A key finding was that of the complex interplay between resident dependency and behaviours, referral pathways and stakeholder engagement, government funding models and requirements, staff training and wellbeing, and the need to meet operational viability. CONCLUSION: This study provides novel insights into how the lives of older people subject to homelessness with high care needs are affected by living in a specifically designed care home, and on some of the challenges faced and solved by staff working in the care home. A significant gap in the healthcare system remains when it comes to the effective provision of high care for older people subject to homelessness.

An Australian aged care home for people subject to homelessness: health, wellbeing and cost-benefit.

BACKGROUND: Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited. METHODS: This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents' physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived. RESULTS: Thirty-five residents enrolled in the study between March 2020 - April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission. CONCLUSION: While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.

Development of an assessment guide to evaluate meaningful outcomes for people living with dementia who are engaged in reablement programs.

PURPOSE: Clinical practice guidelines for dementia recommend the provision of rehabilitative or reablement interventions that support functioning. This project sought to develop an assessment guide, centring on goal attainment scaling (GAS), for practitioners to measure attainment of meaningful outcomes for people living with dementia participating in reablement programs. MATERIALS AND METHODS: To assist in guide development, two focus groups (people impacted by dementia [n = 10]) explored priority reablement goals. Two further focus groups (allied health practitioners [n = 11]) explored understanding and experience using GAS, opinions on what goals would be realistic, and how an assessment guide could best support practice. RESULTS: The key focus group themes that emerged and which underpinned guide development were: 'what is possible'; 'who sets the goals'; 'practitioner perspectives on using GAS'. Leisure was a key goal priority for people impacted by dementia, and echoed by practitioners. The assessment guide is structured around three steps: choosing goals (using focus group derived Reablement Goal Lists); defining goals (using a new Dementia-specific SMART Framework); scoring goals (using GAS-Light). CONCLUSIONS: Providing a structured approach to evaluation of reablement programs for people living with dementia could lead to more consistent service provision, improved outcomes and opportunities for benchmarking.Implications for RehabilitationDementia is a leading cause of disability in older people.Rehabilitative interventions such as reablement are recommended to support functioning in people living with dementia, but there is currently no consistent method of selecting and evaluating attainment of meaningful outcomes.This study describes the reablement goals identified by people impacted by dementia as being most important, along with allied health practitioner views on goal-setting and the use of Goal Attainment Scaling (GAS).Study findings were used to develop a structured assessment guide employing three steps: choosing reablement goals; defining those goals using a new dementia-specific SMART Framework; and scoring goals using GAS-Light.A consistent approach to goal selection and evaluation of attainment for people impacted by dementia participating in reablement programs may lead to more effective rehabilitative interventions in this group.

Designing residential aged care for people at risk of, or experiencing, homelessness: An exploratory Australian study.

The number of older people experiencing or at risk of homelessness, both long-term and first-time homelessness, is increasing. The proportion of women facing homelessness within that cohort is also increasing. When combined with complex health needs, appropriate long-term care options remain limited. This qualitative study conducted in Sydney, Australia, aimed to explore the care needs of older people with comorbid health issues who are facing homelessness and, from this assessment, derive a preferred model of residential aged care. Interviews and focus groups were conducted with 29 participants from providers in the aged care and homelessness sectors. Data were analysed using a grounded theory approach. Causal and contextual factors, and consequences surrounding the experience of homelessness, informed the wide range of care needs of this group (model of care), and the organisational resources required to deliver them (management issues and staff). A trauma-informed approach to care consistently applied by all staff to all processes throughout the care home was recommended. Such an approach would further strengthen existing models of care and take into account both health needs (such as mental health, substance dependence and acquired brain injury) and significant losses through the life course of this vulnerable population.

Supporting Rural Australian Communities after Disaster: the Warrumbungle Bushfire Support Coordination Service.

AIM: Natural disasters inflict significant trauma upon the individuals and communities in which they occur. In order to gain an understanding of the role of community-based disaster recovery support services in the post-disaster environment, we assessed the acceptability and perceived effectiveness of the Warrumbungle Bushfire Support Coordination Service (BSCS) implemented in response to the January 2013 bushfires in the Warrumbungle Shire, New South Wales, Australia. METHOD: A mixed-methods approach was taken to explore the perspectives of former BSCS users and key stakeholders involved with the service. A survey was distributed to former services users (in both paper and online modalities) and included closed and open-ended questions. Semi-structured interviews were conducted with key stakeholders (face to face or via telephone). RESULTS: A total of 14 former BSCS users and six key stakeholders participated in the research. Almost half of the former service users had accessed the BSCS for more than six months. Regardless of the duration of their use of the service, most reported that the decision to use the service stemmed from the need for 'help'. The majority of former service users were satisfied with the support provided by the BSCS and would recommend the service to others. Although most indicated that the BSCS informed them about where to get support, just over half were confident that they could access appropriate recovery services without the BSCS. Key themes arising from the former service use surveys were connectedness and support, whilst key themes in the interviews with key stakeholders were connectedness and the operation of the service. Both former service users and key stakeholders reported that the BSCS played an important role in facilitating community connectedness in the post-disaster period. Key stakeholders also identified challenges for the BSCS, including finding an appropriate agency and location to oversee the service and made suggestions about sustainability. CONCLUSION: On the whole, the BSCS was perceived by former service users and key stakeholders as acceptable and effective. To develop a better understanding of the role of community-based disaster recovery support services, there is a need for more timely, rigorous and representative evaluation of disaster support services like the BSCS. Recommendations are made for the planning and development of future disaster support services. Key words: bushfires, natural disaster, Australia, disaster recovery support service, rural and remote, communities.

Disaster recovery management in Australia and the contribution of social work.

This article describes Australia's broad disaster recovery planning and management approach, adopting a social and community recovery perspective. The role of social work in Australian disaster recovery management is discussed, and its increasing assertion and maturation of practice. Theoretical underpinnings include trauma, grief, and crisis intervention. Strengths-based, solution-focused approaches to intervention, and a sound understanding of community development principles, are essential to facilitating community recovery. Two examples (flood and bushfire) illustrate the full spectrum of planning, immediate psychosocial response, and longer term community and individual recovery. Issues such as effective multiagency practice, individual case management, and consideration of vulnerable groups are highlighted.

Social work training curriculum in disaster management.

This article describes training approaches in disaster recovery for social workers, allied workers, and volunteers. Recovery workers from diverse disciplines require specific training in the theoretical constructs, interventions, tasks, and policy to undertake their roles. The article links the knowledge and skills base of disaster recovery to core social work professional education. Current debates in disaster recovery practice are discussed. An undergraduate and postgraduate program developed for Singaporean social work students is outlined in detail. Other models of training are described, including interagency programs, ongoing professional development, workshops after impact, specific training for volunteers, and training for the community itself.

Medical social work practice and SARS in Singapore.

This article reports on the findings of a qualitative study exploring the impact of SARS on social work practice in five different hospitals in Singapore. The study sought to examine the range of interventions adopted by 28 medical social workers and the theoretical orientations underpinning them. The findings discussed include the impact of infection control practices on social work intervention, the range of interventions undertaken, respondents' reflections and self-awareness, the role of values and ethics, creativity and training, and their recommendations for future emergencies. While the findings of the study relate specifically to hospital social work practice, the crisis and trauma nature of the work makes it applicable to a broader range of practice in these areas and a range of populations. The findings from this study could also inform the development of training programs for social work and other clinical health workers, and emergency management planning.

Training for disaster recovery: a review of training programs for social workers after the tsunami.

This paper describes a range of training programs for social workers and other recovery workers following the Indian Ocean Tsunami of December 2004. These programs were developed and implemented by the author in Singapore, and with collaboration from Indonesian colleagues, in Indonesia. The content is outlined and the rationale behind the development of the programs is presented. The theoretical bases for the diversity of interventions are argued. A course module for both undergraduate and postgraduate social work education is also described, as inclusion of crisis and disaster recovery management in professional courses is necessary to prepare practitioners for their inevitable involvement in responding to emergencies.