Download PDF: RAC Communiqué May 2022
In this edition
Editorial
Case: Get me out
Commentary: Advance Care Planning
Commentary: Improving outcomes for residents
Selected Recommendations from the Royal Commission
List of Resources
Welcome to our second print issue of the Residential Aged Care Communiqué for 2022. Our focus as always is on learning from the past to make the future better. A philosophy that has much deeper significance at this time of massive upheaval locally, nationally, and internationally with the overwhelming mood of helplessness and hopelessness affecting people in the aged care sector. Aged care systems around the world are facing massive challenges uncovered by substantive inquiries into failures of the system in the past year. Three key reports are worth noting. The Royal Commission into Aged Care Quality and Safety (2021, Australia); the Public Inquiry into the Safety and Security of Residents in Long-Term Care Homes System (2022, Canada) initiated after residents were murdered at the hands of a healthcare serial killer; and from the National Academies’ report “The National Imperative to Improve Nursing Home Quality” (2022, USA).
It requires effort to maintain a sense of optimism and purpose. This is achieved by valuing each other and the work we do in aged care—doing the seemingly small things in our influence well, each day. We should also be reassured to a degree that there is incontrovertible evidence that drives government to improve the situation for both residents and staff.
This edition of the Residential Aged Care Communiqué focuses on the premature and preventable death of a young male resident from asphyxia. While the actual circumstances leading to the resident’s fall and injury may not have been anticipated, better preparation and incident response would have avoided a fatal outcome.
There are multiple themes emerging from this case relevant to our current and future practice. The most readily overlooked macro or big picture issue is the resident was young, only 63 years of age. We addressed the issue of young people in aged care and the unique risks in our August 2018 edition. The subject was revisited a year later by the Royal Commission into Aged Care Quality and Safety interim report titled Neglect (Oct 2019) which noted there was an urgent need to ‘stop the flow of younger people with disability going into aged care.’
The other themes to emerge are much more familiar. At the meso level (organisation or facility) these are related to staffing levels and training, and at the micro level (individual) these relate to how staff respond in an emergency.
To make the case even more complex, there are ethical questions that also arise around the interpretation of an Advance Care Plan. Specifically, whether a “not for cardiopulmonary resuscitation” order should be adhered to when the incident leading to the emergency was potentially preventable. Our expert commentary is written by Associate Professor Barbara Hayes who is a national leader in the field of Advance Care Planning and end-of-life care.
The second commentary is by Anita Westera who was part of the team that investigated aged care home staffing levels for the Royal Commission.
Remember to make use of our other resources for improving practice, especially our podcast library which has over 10 episodes. Also, have a look at our sister publication, the March 2022 edition of the Clinical Communiqué, which looks at some of the specific challenges clinicians face in assessing older patients. That edition presents two cases of falls that resulted in chest or head injuries where the extent of injury was not fully appreciated until it was too late.
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