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A Focus on Functional Care.

It is most excellent to see the push for a more multidisciplinary team approach in the residential aged care and community care environments, but do we have our focus completely right and are we focused on the right client for best outcomes?

The ageing population is a global phenomenon that has its impacts and complications in delivering services to our elderly citizens. To keep it simple there are THREE cohorts of elderly that can be categorised within the care services.

1.      The Baby Boomers = people aged today between 52 and 72

2.      The Silent Generation = people aged between 72 and 92: and

3.      The Great Generation = people aged between 92 and OMG

There is much new evidence based healthcare information that is being implemented into aged care settings, to support the fact that we can apply restorative and rehabilitation programs and services to the older client, so that they may experience a ‘better activity of daily living’ or so that we can keep the older person mobile and engaged in activity and wellness right up to the point where the end of life begins.

This may be so when we are undertaking assessment and looking at the client holistically and determining what can be ameliorated in their daily care needs. However, is this new age ideology fit for every client? And ‘what about the many clients who do not fit the ‘wellness and re-ablement’ shoe? Do we force them into doing more, being more and getting better so that it will justify having the services because it’s the buzz thing to do? I feel we are losing a focus on functional care for those that are losing multiple functions.

In my opinion, the Live Longer Live Better philosophy being driven by the Government and the COTA is best positioned through the lens of the Baby Boomer cohort, as these clients will have the biggest impact over the next 20 years. Those clients that we may be able to catch early before the chronic disease sets in and they may still have the motivation to improve and meet higher goals. I have no doubt that the government and consumer groups have ideas and fears regarding the large number of people in this cohort. The numbers will have an impact on the big social 5 issues and of course prior planning will prevent overspending (we can hope). I can agree that these older people can benefit from education and promotion to wellness and reablement, if they have the will and the budget in their pocket, there is a way.

But today I ask every leader in aged care to spare a real thought for the other two cohorts of elderly I mentioned above. These are the parents of the baby boomers. The people who have lived through two world wars and the people that have sacrificed much so that we today can have so much more. This cohort of elderly need and deserve true focus on their needs and wishes as they draw closer to the end of life stage more than anyone other. These people are old, more so sitting in the geriatric space of medicine and have significant histories that tell the story of who they are, what they have done and where and why they are going to end up. These people need nursing care.

This cohort (the great generations) needs to be assessed and managed by qualified health professionals that take a holistic focus on functional care needs. Assessment, observation, medical history and personal lifestyle will have impacts on the care needs. I don’t believe that many in this cohort (given the numbers) are ready for or able to be engaged in wellness rehabilitation and/or physical fitness programs, such as exercise physiology. The evidence in the known science of frailty, comorbidity, disability and chronic disease will inform any focused clinician that for many ‘older’ clients, it will be a case of taking a palliative approach to the last stage of life. The reality for individuals and families is that we cannot live forever and the best outcome we can achieve will be a quality end of life, one filled with comfort, care, less burdens and happy memories.

As a nurse, I am concerned that more and more the nursing focus is being removed from the care. More and more the medical model is being eroded from the care needs and more and more the social model and the restorative model is taking over the role in focused care outcomes when it comes to blanketing all older people with the ‘new aged care’ models. I sit with many older people in residential and community care settings, and they are quite direct in letting me know that they don’t want to go to the gym, they don’t want to engage in the community as much anymore and they simply want to be left to live a simple carefree and peaceful life until the end. I sit in many nursing homes and see less and less nursing care.

Perhaps we need to place a focus on the more important needs of the elderly through their life lens, rather than that of the modern researcher and trend setter. I’m not saying that the new science is not going to work as we grow into our new aged of care models, more so that the older science is still good and it works well for those that need it most.

Nursing care is a specialised field in elder care models and given the amount of controversy in the public domain it should be receiving a stronger value. We can do much more in both areas of care if we can find the balance and the fairness when it comes to individualised care planning and applying a multi-mode of services. There is much more that can be evolved by having a better focus on what is functional care and how it is applied when the function is in decline. Don’t just let modern ideology take over and let’s not throw that baby out with the bath water. Nursing care has evolved as much as any other discipline, its focus is one that is still focused in care.

Paulatim… Drew

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