Nurs3008 Community Health:Aged Care Funding Assessment Answers

Discuss the nursing practices when admitting patient in a nursing home incorporating the ACFI standards. In the last part, discuss whether the nurses adhere to the nursing responsibilities with patients under ACFI.

Answer:

Aged Care Funding Instrument (ACFI) refers to the funding system that is applicable to residents in an aged care facility and is operational in the Australian domicile. The Australian Government confers care subsidy for the care recipients subjected to fulfillment of the accreditation requirements by the concerned aged care services authority as proposed in the Aged Care Act of 1997. These aged care facilities are obliged to abide by the accreditation standards that are taken into consideration by the quality agency for assessment regarding their eligibility. The chief four standards that are to be complied with are as follows:

• Standard One encompasses management systems, organizational development alongside staffing
• Standard Two comprises of health and personal care
• Standard Three constitutes lifestyle of the care recipient
• Standard Four refers to physical environment and safe systems (Agedcare.health.gov.au, 2017).

The nurses appointed at the aged care facilities are also entrusted with distinct responsibilities to render optimal care facility to the aged patients in conformity with the accepted conventional practices. Assessment of needs of the residents is carried out by virtue of referring to the questions that belong to three ACFI domains as follows:

• Activities of Daly Living (ADL) that constitute ACFI questions on nutrition, personal hygiene, mobility, continence and toileting
• Cognition and Behavior (BEH) comprise of ACFI questions related to cognitive skills, verbal behavior, wandering, depression and physical behavior
• Complex Health Care (CHC) constituting ACFI questions relevant to medication and complex health care procedures

In order to cater to the diverse needs of the geriatric patients and requirements of their degree of care based on their conditions, a number of assessments are usually undertaken by the concerned nursing professionals. Relevant research findings have suggested the suitable application of adequate staffing as well as skills mix to properly address the needs and demands of the patients in the residential aged care facility and non-conformance to these accepted practices might result in generating negative outcomes (Willis et al., 2016). Another study has explored the issue revolving the usability of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes as part of ACFI assessment. Findings have argued on using CSDD scale for detecting depression and have harped on considering the complexity of scale, time elapsed for procuring pertinent information alongside staff skills and knowledge of evaluating depression to render optimal care to the patients (Jeon et al., 2015).

Nurses being the frontline workforce in the healthcare sector remain in close association with the clients and are directly responsible for carrying out their assigned duties so that positive outcomes for the concerned patients may be achieved. The safety and quality of the care offered by them is of paramount importance in this respect as it is related to the emanation of desirable outcomes. However, a recent study carried out with respect to the contemporary scenario in nursing has focused on the perceptions and experiences of working in aged care as encountered by the registered nurses. The results depict that the nurses face immense challenges in meeting expectations of the consumer, organization, profession and related policy. Workforce instability and resource constraints are also major hindrances in generating satisfactory professional output. Structural barriers and aged care policy environments also threaten sustaining nursing in aged care (Davis et al., 2016). Matter related to residential aged care facility and multipurpose services available was investigated in a study that attended to perceptions of nurses and impact of aged care reform. Funding and resource shortfalls other than skill mix, staffing levels and knowledge deficits were identified as potential barriers to foster optimal care to patients. Limitations to specialist knowledge acquisition related to aged care on the part of the nurses also posed impediments to deliver the optimal care service. Care deficits in complex care such as that involving medication review, pain management and wound care were linked to dependence upon care workers (Henderson et al., 2016). A crucial part of the nursing assessment carried out with respect to provision of quality care for the geriatric patient within the framework of ACFI involves continence care to cater to the ADL in case of the geriatric patients. A study explored the continence care provision in aged care facilities. Outcomes of the study revealed that perceptions and experiences of the staff related to funding model and quality framework lead to the generation of a climate of fear and risk adversity that in turn is associated with unprecedented impacts o the resident’s continence care. Dependence on continence management was incentivized alongside equating the effective continence care and effective pad use. Therefore, propositions were made to reevaluate the quality of continence care within the realm of Australian aged care facility (Ostaszkiewicz, O'connell & Dunning, 2016). Quality of care in aged care in aged care facilities has been found to be largely dependent on the federal government’s regulatory activities thereby necessitating the nurses to act in accordance with the proposed guidelines (Johnson, 2017).

Nursing responsibilities for patients under ACFI caters to the addressing of and carrying out duties that involve assessments relevant to documentation of continence record PAS-cognitive, behavior records encompassing wandering, verbal behavior and physical behavior alongside Cornell scale of depression. Relevant study has focused on the performance of nursing care for people suffering from dementia and avail residential facilities with wander. A social order of practice has been suggested to allow for the generation of maximal outcomes where the interests of the patients are safeguarded and appropriate measures are taken to harbor optimal results (Cope, 2016). Another study has paid attention to focus on the differential needs and demands for dementia care in permanent residential aged care facilities. Increased complexity in terms of assessed care needs concerning nutrition, cognition and continence was noted in case of dementia patients who have been demarcated, as those requiring high care needs when compared against their non-dementia affected counterparts. Accentuated assessed care in permanent residential aged facilities because of increased complexity has been observed in case of dementia patients thereby emphasizing on the need of adopting suitable nursing interventions that are to be diligently followed in their professional practice for achieving desired results (Joenperä, 2017). However, pertinent literatures have supported that it is not always possible for the nurses to adhere to their assigned responsibilities for patients under ACFI. Increased workload linked with the rationing of human and material resources in service delivery has been identified as chief reasons for missed nursing care. Work intensification has been aligned with patient acuity and cost containment while undermining of proposed staffing ratios, altering workloads across shifts, skill mix in addition to insufficient support from colleagues were detected as part of staffing issues. Resource issues are the key barriers in this context that thwart the provision of adequate nursing care (Henderson et al., 2016). Report on the workplace climate and wellbeing of the nurses revealed certain important findings that in turn may be linked with their possible reasons of non-conformance with the usual practices for the aged patients in their stay at the residential aged care facilities. Quote from one of the respondent Registered Nurse has highlighted on the rotting of ACFI as the reason for their lack of enthusiasm in workplace and diminished work output besides other confounding factors like that of poor skill mix and increased reliance on bureaucracy based healthcare rather than knowledge based healthcare. Legislation vagueness and other factors have been held responsible for poor performance of the nurses in performing their duties (Tham & Gill, 2016). Thus, despite the best efforts on the part of the nurses it often turns out to be tedious for them to align by the dictums in caring for geriatric patients under ACFI.  

References

Agedcare.health.gov.au. (2017). Standards | Ageing and Aged Care. Agedcare.health.gov.au. Retrieved 6 September 2017, from https://agedcare.health.gov.au/ensuring-quality/standards

Cope, S. N. (2016). The performance of caring: The construction of nursing care for people with dementia who live in residential facilities and wander(Doctoral dissertation, Queensland University of Technology).

Davis, J., Morgans, A., Birks, M., & Browning, C. (2016). The rhetoric and reality of nursing in aged care: views from the inside. Contemporary nurse, 52(2-3), 191-203.

Henderson, J., Willis, E., Blackman, I., Toffoli, L., & Verrall, C. (2016). Causes of missed nursing care: qualitative responses to a survey of Australian nurses. Labour & Industry: a journal of the social and economic relations of work, 26(4), 281-297.

Henderson, J., Willis, E., Xiao, L., Toffoli, L., & Verrall, C. (2016). Nurses' perceptions of the impact of the aged care reform on services for residents in multi?purpose services and residential aged care facilities in rural Australia. Australasian journal on ageing, 35(4).

Jeon, Y. H., Li, Z., Low, L. F., Chenoweth, L., O'Connor, D., Beattie, E., ... & Brodaty, H. (2015). The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes. The American Journal of Geriatric Psychiatry, 23(8), 784-793.

Joenperä, J. (2017). Tales from the ACFI: Dementia in residential aged care. Australasian Journal on Ageing, 36(1), 10-13.

Johnson, C. (2017). AMA delivers submission to government review into aged care facilities. Australian Medicine, 29(15), 10.

Ostaszkiewicz, J., O'connell, B., & Dunning, T. (2016). Fear and overprotection in Australian residential aged?care facilities: The inadvertent impact of regulation on quality continence care. Australasian journal on ageing, 35(2), 119-126.

Tham, M. T. L., & Gill, F. (2016). What Nurses & Midwives Want: Findings from the National Survey on Workplace Climate and Well-being.

Willis, E., Price, K., Bonner, R., Henderson, J., Gibson, T., Hurley, J., ... & Currie, T. (2016). Meeting residents' care needs: a study of the requirement for nursing and personal care staff.