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CHCAC318A.

Work effectively with older people

Author

John Bailey

Copyright

Text copyright © 2009 by John N. Bailey. Illustration, layout and design copyright © 2009 by John N. Bailey.

Under Australia's Copyright Act 1968 (the Act), except for any fair dealing for the purposes of study, research, criticism or review, no part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without prior written permission from John N. Bailey. All inquiries should be directed in the first instance to the publisher at the address below.

Copying for Education Purposes The Act allows a maximum of one chapter or 10% of this book, whichever is the greater, to be copied by an educational institution for its educational purposes provided that that educational institution (or the body that administers it) has given a remuneration notice to JNB Publications,

Disclaimer All reasonable efforts have been made to ensure the quality and accuracy of this publication. JNB Publications assumes no responsibility for any errors or omissions and no warranties are made with regard to this publication. Neither JNB Publications nor any authorised distributors shall be held responsible for any direct, incidental or consequential damages resulting from the use of this publication.

To Order this Publication This publication can be ordered in a wire bound format or as an electronic copy for unlimited copying and editing in an RTO. For distribution details, please visit our website at www.jnbweb.com. or email me at johnb@jnbweb.com .

Published in Australia by:

JNB Publications PO Box 268 Macarthur Square NSW 2560 Australia www.jnbweb.com

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CHCAC318A.

older people CONTENTS

Work effectively with

 

Description:

8

ABOUT THIS UNIT OF STUDY INTRODUCTION

8

THIS LEARNING GUIDE COVERS:

8

LEARNING PROGRAM:

8

 

Additional Learning Support

9

Facilitation

9

Flexible Learning

10

Space

10

Study Resources

10

Time

10

Study Strategies

11

Using This Learning Guide

11

THE

ICON KEY

12

THE

SUPPLEMENTARY ICONS

13

How to Get the Most out of Your Learning Guide:

14

ADDITIONAL RESEARCH, READING AND NOTE TAKING

14

EMPLOYABILITY SKILLS

15

PERFORMANCE CRITERIA

19

SKILLS AND KNOWLEDGE

22

 

Required Knowledge

22

Required Skills

23

RANGE

24

EVIDENCE GUIDE

26

1.

APPLY UNDERSTANDING OF THE STRUCTURE AND PROFILE OF THE RESIDENTIAL AGED CARE

SECTOR

28

 

28

 

Working Definitions

28

1.1

CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE KEY ISSUES FACING OLDER PEOPLE AND THEIR

CARER/S 29

Who are the primary carers?

31

Demands and consequences of caring work

31

Implications for policy and practice

33

Carer health and well-being survey 2007

33

1.2

CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE CURRENT PHILOSOPHIES OF SERVICE DELIVERY IN THE

SECTOR

34

1.3

RECOGNISE THE IMPACT OF AGEING DEMOGRAPHICS ON FUNDING AND SERVICE DELIVERY MODELS

39

Ageing

39

Demography of Ageing

40

Global Ageing

40

Life Expectancy

40

Figure 1a: Life Expectancy for Women*

41

Figure 1b: Life Expectancy for Men*

42

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Biology of Ageing

42

Table 2: Some theories of Ageing

44

1.4

CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF CURRENT LEGISLATION

44

Table 3: Employee and employer responsibilities

45

The Worker’s Common Law Obligations

45

The Employer’s Common Law and Statutory Obligations

45

Statutory framework within which work takes place

46

Residential aged care service standards

48

Home and Community Care National Service Standards

49

Residents' rights

49

Activity 1:

52

Activity 2:

54

Activity 3:

55

Activity 4:

56

2.

APPLY UNDERSTANDING OF THE HOME AND COMMUNITY CARE SECTOR

57

2.1

DEMONSTRATE BROAD KNOWLEDGE OF POLICY AND PROGRAMS SUCH AS HACC, DVA AND GOVERNMENT

COMMUNITY CARE DIRECTIONS

 

57

 

Delivery of Aged Care

59

Figure 3: Australia’s Aged care framework

59

Residential aged care

60

Community based care

60

Key points of an Aged Care Profile of Australia

60

Aged care represents a ‘social product system’

61

A profile of older Australians requiring care

62

Need for care

62

Figure 4: Need for assistance and living arrangements of older persons

63

Figure 5: Need for assistance by age of older persons, 2003

64

Data source: ABS (Survey of Disability, Ageing and Carers: Summary of Findings, Cat. no.

64

Income and wealth

64

Accommodation arrangements

65

Types of care

65

Community care

65

Table 3: Profile of main community care programs

66

Residential care

67

Table 4: Characteristics of permanent residential care clients

68

The role of government in aged care

69

Current policy and legislative framework

69

The main areas of regulatory control

71

Funding services

72

Table 5: Recurrent government expenditure on aged care programs in Australia, 2006-07

73

Setting prices

75

Regulating quality

76

Table 6:

77

Recent trends in aged care

77

Increasing numbers of older Australians requiring care

77

Figure 6: Numbers of older Australians, 1996-2007

78

Figure 7: Government real expenditure on selected social services

79

Greater reliance on user contributions

79

Increasing emphasis on community care

80

Figure 8: Aged care places and packages

80

Increasing support for carers

81

Greater proportion of residents in high level care

81

Decreasing number of small facilities

81

Table 8: Number and size of residential aged care facilities, 1998 and

2007

82

Increasing investment by private for-profit providers

82

Table 9

84

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2.2

COMPLY WITH DUTY OF CARE IMPLEMENTATION IN HOME AND COMMUNITY SETTINGS AND WORKER ROLES

87

 

Duty of Care

87

Standard of Care

87

Duty of Care and Negligence

88

Breach of Duty of Care

89

Duty of Care Dilemmas

89

Access and equity in aged care

89

Anti-discrimination in aged care

90

Complaints mechanisms

90

Figure 9: Sample complaints/suggestions form

91

2.3

DEMONSTRATE BROAD KNOWLEDGE OF AGEING IN PLACE

93

Challenging personal values and attitudes

93

Table 10: Myths about Ageing

94

Stereotypes

94

Media

95

Language of ageing

96

Perceptions of aged people among health professionals

96

Ageing as an individual process-coming to terms with the ageing process

97

The Care Plan

99

The Planning Process

99

Figure 10: Sample Care

100

AIDS

101

 

Other

105

Monitoring

107

Progress Notes

107

3.

DEMONSTRATE COMMITMENT TO THE PHILOSOPHY OF ‘POSITIVE AGEING’

108

INTRODUCTION

108

Table 11: Ten Principles of a Positive Ageing Strategy

109

Table 12: Ten Priority Goals of a Positive Ageing Strategy

110

3.1 TAKE INTO ACCOUNT PERSONAL VALUES AND ATTITUDES WHEN PLANNING AND IMPLEMENTING WORK ACTIVITIES

111

 

Fundamental Principles for Caregiver Assessment

112

Guidelines for Practice

112

Table 13: Recommended Domains and Constructs

114

3.2 RECOGNISE AND MANAGE AGEIST ATTITUDES THROUGH THE SUPPORT OF THE APPROPRIATE PERSON

118

 

Activity ????

118

Our Attitudes

119

Table 13: Cultural Awareness

120

Table 14: Critical Thinking

120

Gerontophobia

121

Table 15 Ageing: Myth Versus Fact

121

Ageism

122

3.3 RECOGNISE THE IMPACT OF CONSUMERISM ON SERVICE DELIVERY

123

 

Table 16: Critical Thinking

124

Advance Directives

124

What does aged care cost?

125

High-level care

125

Low-level care

127

3.4 CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE INDIVIDUALITY OF

128

 

What makes us age?

128

The individuality of ageing

129

Healthier ageing on the horizon

130

3.5 CONDUCT WORK THAT MINIMISES THE EFFECTS OF STEREOTYPICAL ATTITUDES AND MYTHS ON THE OLDER PERSON

131

 

Understanding Ageing and its Biological and Social Processes

132

Activity

135

Activity 11:

137

Activity 12:

138

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4.

APPLY UNDERSTANDING OF

THE PHYSICAL

140

4.1

OUTLINE STRATEGIES THAT THE OLDER PERSON MAY ADOPT TO PROMOTE HEALTHY LIFESTYLE PRACTICES

140

Figure 10 Persons working in long-term care facilities must have excellent communication skills,

141

Effects Of Ageing

141

4.2

TAKE INTO ACCOUNT PHYSICAL CHANGES ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES

142

Physical Changes in Ageing

142

Emotional Adjustments to Ageing

142

Table 17 Physical Changes Of Aging

143

Specific Emotional

145

Figure 10: Residents may exhibit feelings of frustration and

146

Nutritional Needs

147

Figure 11

148

Preventing Infections In Residents

148

Figure 12: Encourage fluid

149

Keeping Residents Safe

151

Other Safety Concerns

152

4.3

RECOGNISE AND ACCOMMODATE THE OLDER PERSONS INTERESTS AND LIFE ACTIVITIES WHEN DELIVERING

SERVICES.153

 
 

Exercise And Recreational Needs

153

Recreation

153

Figure 14: There are many exercises that people in wheelchairs can

154

General Hygiene

154

Partial Baths

154

Total Baths

154

Hand and Foot Care

154

Guidelines For bathing The Elderly

155

Figure 15: Check Shower Seats and Hydraulic Tub Lifts Before Using Them

156

Figure 16: Foot Care Is An Important Part Of Daily Hygiene

156

Hair Care

157

Facial Hair

157

Mouth Care

158

Eyes, Ears, and Nose

158

Mental Changes

158

4.4

ASSIST THE OLDER PERSON TO RECOGNISE THE IMPACT PHYSICAL CHANGES ASSOCIATED WITH AGEING MAY HAVE

ON THEIR ACTIVITIES OF AGEING

 

159

 

Caring is about

159

Growing old presents a variety of threats to independence

160

Activity 6

162

5.

APPLY UNDERSTANDING OF CHANGES ASSOCIATED WITH AGEING

164

5.1

OUTLINE STRATEGIES THAT THE OLDER PERSON MAY ADOPT TO PROMOTE HEALTHY LIFESTYLE PRACTICES

164

5.2

TAKE INTO ACCOUNT PHYSICAL CHANGES ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES

167

Activity 9

168

5.3

UTILISE KNOWLEDGE OF COMMON PROBLEMS ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES

168

Osteoporosis

169

Arthritis

169

Bladder and bowel

171

Breast Cancer

172

Figure 17: Diagram of breast

172

Cholesterol

173

Incontinence

175

Diabetes

176

Heart Disease

179

Irritable bowel syndrome (IBS)

182

Activity 10

184

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5.4

ASSIST THE OLDER PERSON TO RECOGNISE THE IMPACT THAT CHANGES ASSOCIATED WITH AGEING MAY HAVE ON

THEIR ACTIVITIES OF LIVING

184

184

 

Chronic

185

Comorbidity

185

Long-term care

185

Best practices across settings of

185

Client decision

185

Enhancing Client safety

186

5.5

COMMUNICATE SITUATIONS OF RISK OR POTENTIAL RISK ASSOCIATED WITH AGEING TO THE OLDER

186

Ask Yourself

187

Older people and risk

187

Confidentiality

188

6.

SUPPORT THE RIGHTS AND INTERESTS OF OLDER PERSON

189

6.1

ENCOURAGE AND SUPPORT THE OLDER PERSON AND/OR THEIR ADVOCATE/S TO BE AWARE OF THEIR RIGHTS AND

RESPONSIBILITIES

189

Traditional meaning

189

How is advocacy undertaken?

190

6.2 CONDUCT WORK THAT DEMONSTRATES A COMMITMENT TO ACCESS AND EQUITY PRINCIPLES

191

 

An ethical framework for advocacy

191

Social justice

192

Confidentiality

193

6.3 ADOPT STRATEGIES TO EMPOWER THE OLDER PERSON AND/OR THEIR ADVOCATE/S IN REGARD TO THEIR SERVICE

 

REQUIREMENTS

194

The 'professional' consumer/carer

194

Accountability and responsibility

196

Being Prepared

197

6.4

PROVIDE INFORMATION TO THE OLDER PERSON AND/OR THEIR ADVOCATE/S TO FACILITATE CHOICE IN THEIR

DECISION MAKING

197

Being valued

197

Burden of Responsibility

198

Problem solving

199

Types of problems

199

6.5 RECOGNISE AND REPORT TO AN APPROPRIATE PERSON WHEN AN OLDER PERSONS RIGHTS ARE NOT BEING UPHELD

200

6.6 PROVIDE SERVICES REGARDLESS OF DIVERSITY OF RACE OR CULTURAL, SPIRITUAL, OR SEXUAL

201

 

Dealing with organisational culture

201

6.7 PROVIDE INFORMATION TO THE OLDER PERSON AND/OR THEIR ADVOCATE/S REGARDING MECHANISMS FOR

LODGING COMPLAINTS

202

 

NACAP

203

Aged Care Complaints Investigation Scheme

203

Activity 11:

210

Activity 12:

211

Activity 13:

212

Activity 14:

213

Activity 15:

214

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Work effectively with older people -

CHCAC318A.

Description:

This unit describes the skills and knowledge required by the worker to perform work that reflects understanding of the structure and profile of the residential aged care sector, the home and community sector and key issues facing older people in the community

About this Unit of Study Introduction.

As a worker, a trainee, or a future worker you want to enjoy your work and become known as a valuable team member. This unit of competency will help you acquire the knowledge and skills to work effectively as an individual and in groups. It will give you the basis to contribute to the goals of the organisation which employs you. It is essential that you begin your training by becoming familiar with the industry standards to which organisations must conform. This unit of competency introduces you to some of the key issues and responsibilities of workers and organisations in this area. The unit also provides you with opportunities to develop the competencies necessary for employees to operate as team members.

This Learning Guide Covers:

Apply understanding of the structure and profile of the residential aged care sector

Apply understanding of the home and community care sector

Demonstrate commitment to the philosophy of ‘positive ageing’

Apply understanding of the physical and psychosocial aspects of ageing

Apply understanding of changes associated with ageing

Support the rights and interests of older person

Learning Program:

As you progress through this unit of study you will develop skills in locating and understanding an organisations policies and procedures. You will build up a sound knowledge of the industry standards within which organisations must operate. You will become more aware of the effect that your own skills in dealing with people has on your success or otherwise in the workplace. Knowledge of your skills and capabilities will help you make informed choices about your further study and career options.

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Additional Learning Support

To obtain additional support you may:

search for other resources in the Learning Resource Centre (LRC) of your learning institution. You may find books, journals, videos and other materials which provide additional information about topics in this unit.

search for other resources in your local library. Most libraries keep information about government departments and other organisations, services and programs. The librarian should be able to help you locate such resources.

contact information services such as Infolink, Equal Opportunity Commission, Commissioner of Workplace Agreements, Union organisations, and public relations and information services provided by various government departments. Many of these services are listed in the telephone directory.

contact your local shire or council office. Many councils have a community development or welfare officer as well as an information and referral service.

contact the relevant facilitator by telephone, mail or facsimile.

Facilitation

Your training organisation will provide you with a flexible learning facilitator. Your facilitator will play an active role in supporting your learning. Your facilitator will make regular contact with you and, if you have face to-face access, should arrange to see you at least once. Your facilitator will contact you by telephone or letter as soon as possible after you have enrolled to let you know:

how and when to make contact,

what you need to do to complete this unit of study, and

what support will be provided.

Here are some of the things your facilitator can do to make your study easier:

Give you a clear visual timetable of events for the semester or term in which you are enrolled, including any deadlines for assessments.

Check that you know how to access library facilities and services.

Conduct small 'interest groups' for some of the topics

Use 'action sheets' to remind you about tasks you need to complete, and updates on websites.

Set up a 'chat line'. If you have access to telephone conferencing or video conferencing, your facilitator can use these for specific topics or discussion sessions.

Circulate a newsletter to keep you informed of events, topics and resources of interest to you.

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Keep in touch with you by telephone or e-mail during your studies.

Flexible Learning

Studying to become a competent worker is an interesting and exciting thing to do. You will learn about current issues in this area. You will establish relationships with other candidates, fellow workers, and clients. You will learn about your own ideas, attitudes and values. You will also have fun. (Most of the time!) At other times, study can seem overwhelming and impossibly demanding, particularly when you have an assignment to do and you aren't sure how to

tackle it

a movie you want to see is on television

and

and your family and friends want you to spend time with them

Sometimes being a candidate can be hard.

Here are some ideas to help you through the hard times. To study effectively, you need space, resources and time.

Space

Try to set up a place at home or at work where:

you can keep your study materials,

you can be reasonably quiet and free from interruptions, and

you can be reasonably comfortable, with good lighting, seating and

a

flat surface for writing.

If

it is impossible for you to set up a study space, perhaps you could use your

local library. You will not be able to store your study materials there, but you

will have quiet, a desk and chair, and easy access to the other facilities.

Study Resources

The most basic resources you will need are:

desk or table

a chair

a

reading lamp or good light

folder or file to keep your notes and study materials together

materials to record information (pen and paper or notebooks, or a computer and printer)

reference materials, including a dictionary.

Do not forget that other people can be valuable study resources. Your fellow workers, work supervisor, other candidates, your flexible learning facilitator, your local librarian, and workers in this area can also help you.

a

a

Time

It is important to plan your study time. Work out a time that suits you and plan

around it. Most people find that studying in short, concentrated blocks of time (an hour or two) at regular intervals (daily, every second day, once a week) is

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more effective than trying to cram a lot of learning into a whole day. You need time to 'digest' the information in one section before you move on to the next, and everyone needs regular breaks from study to avoid overload. Be realistic

in allocating time for study. Look at what is required for the unit and look at

your other commitments. Make up a study timetable and stick to it. Build in 'deadlines' and set yourself goals for completing study tasks. Allow time for reading and completing activities. Remember that it is the quality of the time you spend studying rather than the quantity that is important.

Study Strategies

Different people have different learning 'styles'. Some people learn best by listening or repeating things out loud. Some learn best by 'doing', some by reading and making notes. Assess your own learning style, and try to identify any barriers to learning which might affect you. Are you easily distracted? Are you afraid you will fail? Are you taking study too seriously? Not seriously enough? Do you have supportive friends and family? Here are some ideas for effective study strategies:

Make notes. This often helps you to remember new or unfamiliar information. Do not worry about spelling or neatness, as long as you can read your own notes. Keep your notes with the rest of your study materials and add to them as you go. Use pictures and diagrams if this helps. Underline key words when you are reading the materials in this learning guide. (Do not underline things in other people's books.) This also helps you

to remember important points.

Talk to other people (fellow workers, fellow candidates, friends, family, your facilitator) about what you are learning. As well as helping you to clarify and understand new ideas, talking also gives you a chance to find out extra information and to get fresh ideas and different points of view.

Using This Learning Guide.

A learning guide is just that, a guide to help you learn. A learning guide is not

a text book. Your learning guide will:

describe the skills you need to demonstrate to achieve competency for this unit;

provide information and knowledge to help you develop your skills;

provide you with structured learning activities to help you absorb knowledge and information and practice your skills;

direct you to other sources of additional knowledge and information about topics for this unit.

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The Icon Key

The Icon Key Key Points Explains the actions taken by a competent person. Example Illustrates the
The Icon Key Key Points Explains the actions taken by a competent person. Example Illustrates the
The Icon Key Key Points Explains the actions taken by a competent person. Example Illustrates the

Key Points

Explains the actions taken by a competent person.

Example

Illustrates the concept or competency by providing examples.

Activity

Provides activities to reinforce understanding of the action.

Chart

Provides images that represent data symbolically. They are used to present complex information and numerical data in a simple, compact format.

Intended Outcomes or Objectives

Statements of intended outcomes or objectives are descriptions of the work that will be done.

Assessment

Strategies with which information will be collected in order to validate each intended outcome or objective.

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The Supplementary Icons

The Supplementary Icons PowerPoint Any PowerPoint associated with a unit will have this icon next to

PowerPoint

Any PowerPoint associated with a unit will have this icon next to them

Forms and Care Plans

If there is a form or care plan associated with a unit there will be an icon like this with the relevant number of the form or care plan in the format FFACF-015

Employability Skills

Where the employability skills are shown to be embedded in the unit and relates to the table in the front of each unit eg: T1, S1, E1.

Readings

Provides backup and reasoning to the underpinning knowledge and skills

Primary Skills Assessments

Where the Primary Skills Assessments are applicable there will be an icon in the format PSA - XX

are applicable there will be an icon in the format PSA - XX World Wide Web

World Wide Web

Where the world wide web is used for an activity in the unit you will find this icon.

Resource Document

Where the Resource documents are applicable there will be an icon in the format RDN - XX

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How to Get the Most out of Your Learning Guide:

1. Read through the information in the learning guide carefully. Make sure you understand the material.

Some sections are quite long and cover complex ideas and information. If you come across anything you do not understand:

talk to your facilitator;

research the area using the books and materials listed under Resources;

discuss the issue with other people (your workplace supervisor, fellow workers, fellow candidates);

try to relate the information presented in this learning guide to your own experience and to what you already know.

Ask yourself questions as you go. For example 'Have I seen this

happening anywhere?' 'Could this apply to me?' 'What if

help you to 'make sense' of new material, and to build on your existing knowledge.

'.

This will

2. Talk to people about your study.

Talking is a great way to reinforce what you are learning.

3. Make notes.

4. Work through the activities.

Even if you are tempted to skip some activities, do them anyway. They are there for a reason, and even if you already have the knowledge or skills relating to a particular activity, doing them will help to reinforce what you already know. If you do not understand an activity, think carefully about the way the questions or instructions are phrased. Read the section again to see if you can make sense of it. If you are still confused, contact your facilitator or discuss the activity with other candidates, fellow workers or with your workplace supervisor.

Additional Research, Reading and Note Taking

If you are using the additional references and resources suggested in the learning guide to take your knowledge a step further, there are a few simple things to keep in mind to make this kind of research easier. Always make a note of the author's name, the title of the book or article, the edition, when it was published, where it was published, and the name of the publisher. If you are taking notes about specific ideas or information, you will need to put the page number as well. This is called the reference information. You will need this for some assessment tasks, and it will help you to find the book again if you need to. Keep your notes short and to the point. Relate your notes to the material in your learning guide. Put things into your own words. This will give you a better understanding of the material. Start off with a question you want answered when you are exploring additional resource materials. This will structure your reading and save you time.

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Employability Skills Certificate III in Aged Care

EMPLOYABILITY

FACETS ADDRESSED: Industry/enterprise requirements for this qualification include the following facets:

Code

SKILLS

 

1.

Listening to and understanding work instructions, directions and feedback

C1

2.

Speaking clearly/directly to relay information

C2

3.

Reading and interpreting workplace related documentation, such as prescribed programs

C3

4.

Writing to address audience needs, such as forms, case notes and reports

C4

5.

Interpreting the needs of internal/ external clients from clear information and feedback

C5

Communication

6.

Applying basic numeracy skills to workplace requirements involving measuring and counting

C6

8.

Sharing information (eg. with other staff, working as part of an allied health team)

C8

9.

Negotiating responsively (eg. re own work role and/or conditions, possibly with clients)

C9

11.

Being appropriately assertive (eg. in relation to safe or ethical work practices and own work role)

C11

12.

Empathising (eg. in relation to others)

C12

 

1.

Working as an individual and a team member

T1

2.

Working with diverse individuals and groups

T2

3.

Applying knowledge of own role as part of a team

T3

Teamwork

4.

Applying teamwork skills to a limited range of situations

T4

5.

Identifying and utilising the strengths of other team members

T5

6.

Giving feedback

T6

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EMPLOYABILITY

FACETS ADDRESSED: Industry/enterprise requirements for this qualification include the following facets:

Code

SKILLS

 

1.

Developing practical solutions to workplace problems (i.e. within scope of own role)

P1

2.

Showing independence and initiative in identifying problems (i.e. within scope of own role)

P2

3.

Solving problems individually or in teams (i.e. within scope of own role)

P3

Problem solving

5.

Using numeracy skills to solve problems (eg. time management, simple calculations, shift handover)

P5

6.

Testing assumptions and taking context into account (i.e. with an awareness of assumptions made and work context)

P6

7.

Listening to and resolving concerns in relation to workplace issues

P7

8.

Resolving client concerns relative to workplace responsibilities (i.e. if role has direct client contact)

P8

Initiative and

1.

Adapting to new situations (i.e. within scope of own role)

 

enterprise

I1

2.

Being creative in response to workplace challenges (i.e. within relevant guidelines and protocols)

I2

3.

Identifying opportunities that might not be obvious to others (i.e. within a team or supervised work context)

I3

5.

Translating ideas into action (i.e. within own work role)

I5

6.

Developing innovative solutions (i.e. within a team or supervised work context and within established guidelines)

I6

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EMPLOYABILITY

FACETS ADDRESSED: Industry/enterprise requirements for this qualification include the following facets:

Code

SKILLS

Planning and

1. Collecting, analysing and organising information (i.e. within scope of own role)

O1

organising

2. Using basic systems for planning and organising (i.e. if applicable to own role)

O2

3. Being appropriately resourceful

O3

4. Taking limited initiative and making decisions within workplace role (i.e. within authorised limits)

O4

5. Participating in continuous improvement and planning processes (i.e. within scope of own role)

O5

6. Working within clear work goals and deliverables

O6

7. Determining or applying required resources (i.e. within scope of own role)

O7

8. Allocating people and other resources to tasks and workplace requirements (only for team leader or leading hand roles)

O8

9. Managing time and priorities (i.e. in relation to tasks required for own role)

O9

10. Adapting resource allocations to cope with contingencies (i.e. if relevant to own role)

O10

Self management

1. Being self-motivated (i.e. in relation to requirements of own work role)

S1

2. Articulating own ideas (i.e. within a team or supervised work context)

S2

3. Balancing own ideas and values with workplace values and requirements

S3

4. Monitoring and evaluating own performance (i.e. within a team or supervised work context)

S4

5. Taking responsibility at the appropriate level

S5

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EMPLOYABILITY

FACETS ADDRESSED: Industry/enterprise requirements for this qualification include the following facets:

Code

SKILLS

Learning

1.

Being open to learning new ideas and techniques)

L1

2.

Learning in a range of settings including informal learning

L2

3.

Participating in ongoing learning

L3

4.

Learning in order to accommodate change

L4

5.

Learning new skills and techniques

L5

6.

Taking responsibility for own learning (i.e. within scope of own work role)

L6

7.

Contributing to the learning of others (eg. by sharing information)

L7

8.

Applying a range of learning approaches (i.e. as provided)

L8

10.

Participating in developing own learning plans (eg. as part of performance management)

L10

Technology

1.

Using technology and related workplace equipment (i.e. if within scope of own role)

E1

2.

Using basic technology skills to organise data

E2

3.

Adapting to new technology skill requirements (i.e. within scope of own role)

E3

4.

Applying OHS knowledge when using technology

E4

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Work effectively with older people CHCAC318A.

Element

Performance Criteria

1.

Apply understanding of the structure and profile of the residential aged care sector

 

1.1

Conduct work that reflects an understanding of the key issues facing older people and their carer/s

1.2

Conduct work that reflects an understanding of the current philosophies of service delivery in the sector

1.3

Recognise the impact of ageing demographics on funding and service delivery models

1.4

Conduct work that reflects an understanding of current legislation

2.

Apply understanding of the home and community care sector

 

2.1

Demonstrate broad knowledge of policy and programs such as HACC, DVA and Government community care directions

2.2

Comply with duty of care implementation in home and community settings and worker roles

2.3

Demonstrate broad knowledge of “ageing in place”

3.

Demonstrate commitment to the philosophy of ‘positive ageing’

 

3.1

Take into account personal values and attitudes when planning and implementing work activities

3.2

Recognise and manage ageist attitudes through the support of the appropriate person

3.3

Recognise the impact of consumerism on service delivery

3.4

Conduct work that reflects an understanding of the individuality of ageing

3.5

Conduct work that minimises the effects of stereotypical attitudes and myths on the older person

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Work effectively with older people CHCAC318A.

Element

Performance Criteria (cont’d)

4.

Apply understanding of the physical and psychosocial aspects of ageing

 

4.1

Outline strategies that the older person may adopt to promote healthy lifestyle practices

4.2

Take into account physical changes associated with ageing when delivering services

4.3

Recognise and accommodate the older person’s interests and life activities when delivering services

4.4

Assist the older person to recognise the impact physical changes associated with ageing may have on their activities of living

5.

Apply understanding of changes associated with ageing

 

5.1

Outline strategies that the older person may adopt to promote healthy lifestyle practices

5.2

Take into account physical changes associated with ageing when delivering services

5.3

Utilise knowledge of common problems associated with ageing when delivering services

5.4

Assist the older person to recognise the impact that changes associated with ageing may have on their activities of living

5.5

Communicate situations of risk or potential risk associated with ageing to the older person

6.

Support the rights and interests of older person

 

6.1

Encourage and support the older person and/or their advocate/s to be aware of their rights and responsibilities

6.2

Conduct work that demonstrates a commitment to access and equity principles

6.3

Adopt strategies to empower the older person and/or their advocate/s in regard to their service requirements

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Work effectively with older people CHCAC318A.

Element

Performance Criteria (cont’d)

6.

Support the rights and interests of older person

 

6.4

Provide information to the older person and/or their advocate/s to facilitate choice in their decision making

6.5

Recognise and report to an appropriate person when an older person’s rights are not being upheld

6.6

Provide services regardless of diversity of race or cultural, spiritual, or sexual preferences

6.7

Provide information to the older person and/or their advocate/s regarding mechanisms for lodging complaints

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Skills and Knowledge

Required Knowledge

The candidate must be able to demonstrate essential knowledge required to effectively perform task skills; task management skills; contingency management skills and job/role environment skills as outlined in elements and performance criteria of this unit These include knowledge of:

Own work role and responsibilities

Principles of access, equity and client rights when working in the aged care sector

Structure and profile of the aged care sector

Relevant policies, protocols of the organisation in relation to Unit Descriptor and work role

Relevant legislation in relation to Unit Descriptor and work role

Contemporary issues facing older people in the community

Current service delivery models

Philosophy of various service delivery models

Factors influencing service delivery models in the sector

Ageing demographics

Understanding attitude, stereotypes and false beliefs associated with ageing

Impact of personal values and attitudes on service delivery

Rights and responsibilities of older people and those working in the aged care sector

Physical and psychosocial aspects of ageing in supporting older people to maintain their quality of life

Impact of “normal” ageing on the older person

Overview of the manifestations and presentation of common problems associated with ageing

Relevant care needs and strategies related to common problems associated with ageing

Principles of access and equity

Role of carers

Principles of empowerment and disempowerment

Principles and practices of confidentiality and privacy

Strategies for supporting an older person and/or their advocate/s to exercise their rights

Strategies for manAgeing complaints

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Required Skills

It is critical that the candidate demonstrate the ability to:

Follow organisation policies and protocols

Liaise and report to appropriately person/s

Adhere to own work role and responsibilities

Apply the principles of access, equity and client rights when working in the aged care sector

Adopt a non-ageist and accepting attitude when working with older people

In addition, the candidate must be able to demonstrate relevant task skills; task management skills; contingency management skills and job/role environment skills These include the ability to:

Apply physical and psychosocial aspects of ageing in supporting older people

Apply reading and writing skills-literacy competence required to fulfil work role in a safe manner and as specified by the organisation/service This requires a level of skill that enables the worker to follow work-related instructions and directions and the ability to seek clarification and comments from supervisors, clients and colleagues Industry work roles will require workers to possess a literacy level that will enable them to interpret international safety signs, read client’s service delivery plans, make notations in client records and complete workplace forms and records

Apply oral communication skills-language competence required to fulfil work role in a safe manner and as specified by the organisation This requires a level of skill that enables the worker to follow work-related instructions and directions and the ability to seek clarification and comments from supervisors, clients and colleagues Industry work roles will require workers to possess oral communication skills that will enable them to ask questions, clarify understanding, recognise and interpret non-verbal cues, provide information and express encouragement

Apply numeracy skills required to fulfil work role in a safe manner and as specified by the organisation Industry work roles will require workers to be able to perform basic mathematical functions, such as addition and subtraction up to three digit numbers and multiplication and division of single and double-digit numbers

Apply basic problem solving skills to resolve problems within organisation protocols

Work effectively with clients, colleagues, supervisors and other services/agencies

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Range Statement.

Older

people

may

Individuals living in residential aged care environments

include:

Individuals living in the community

Prospective individuals to the service or services

Contexts

may

Older person’s own dwelling

include:

Independent living accommodation

Residential aged care facilities

Community centres

Community/government agencies

Issues facing older people may include:

Changes that ageing may bring to:

- Physical processes

 

- Cognitive function (including dementia)

- Social interaction

- Role and family relationships

- Living arrangements

- Level of independence (financial, community access, self-care)

Loss and grief

Family carer issues

Societal attitudes and expectations

Current philosophies

Changing societal expectations (consumerism)

of

service

delivery

may include:

Changing political context (polices and initiatives)

Changing economic context

Impact of ageing demographics

Rights may include:

Privacy

Confidentiality

Dignity

Freedom of association

Informed choice

To lodge a complaint

Right to express ideas and opinions

To an agreed standard of care

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Rights

are

detailed

Legislation

in:

- Residential Care Manual

- Aged Care Act

Industry and organisation service standards

Industry and organisation codes of practice and ethics

Accreditation standards

International and national charters

Organisation policy and procedure

Principles of access and equity may include:

Creation of a client orientated culture

Non-discriminatory approach to all individuals using or accessing the service

 

Respect for individual differences

Appropriate person/s may include:

Supervisor

Member of senior management

 

Colleagues

Carers

Health professionals

External agencies (complaints and advocacy services and professional registering authorities)

Law enforcement officer

Reporting may be:

Verbal

- Telephone

- Face to face

Non-verbal (written)

- Progress reports

- Case notes

- Incident reports

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Evidence Guide

Critical

aspects for

The individual being assessed must provide evidence of specified essential knowledge as well as skills

assessment and evidence required to demonstrate this

competency unit:

 

This unit will be most appropriately assessed in the workplace or in a simulated workplace and under the normal range of workplace conditions

 

It is recommended that assessment or information for assessment will be conducted or gathered over a period of time and cover the normal range of workplace situations and settings

Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Access

and

equity

All workers in community services should be aware of access and equity issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

considerations:

 

In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment:

This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged

Resources required for assessment include:

- Access to appropriate workplace where assessment can take place

- Simulation of realistic workplace setting for assessment

- Relevant organisation policy, protocols and procedures

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Method of assessment

Observation in the work place

Written assignments/projects

Case study and scenario analysis

Questioning

Role play simulation

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1.

Apply

understanding

of

the

structure

and

profile

of

the

residential aged care sector

and profile of the residential aged care sector Introduction. 1.1 Conduct work that reflects an

Introduction.

1.1 Conduct work that reflects an understanding of the key issues facing older people and their carer/s

1.2 Conduct work that reflects an understanding of the current philosophies of service delivery in the sector

1.3 Recognise the impact of ageing demographics on funding and service delivery models

that reflects an understanding of current

1.4 work

Conduct

legislation

Working Definitions

1 . 4 work Conduct legislation Working Definitions Family Caregiver is broadly defined and refers to

Family Caregiver is broadly defined and refers to any relative, partner, friend, or neighbour who has a significant personal relationship with, and provides a broad range of assistance for, an older person or an adult with a chronic or disabling condition. These individuals may be primary or secondary caregivers and live with, or separately from, the person receiving care.

Care Recipient refers to an adult with a chronic illness or disabling condition or an older person who needs ongoing assistance with everyday tasks to function on a daily basis. These tasks may include manAgeing medications, transportation, bathing, dressing, and using the toilet. The person needing assistance may also require primary and acute medical care or rehabilitation services (occupational, speech, and physical therapies).

Caregiver Assessment refers to a systematic process of gathering information that describes a caregiving situation and identifies the particular problems, needs, resources, and strengths of the family caregiver. It approaches issues from the caregiver's perspective and culture, focuses on what assistance the caregiver may need and the outcomes the family member wants for support, and seeks to maintain the caregiver's own health and well-being.

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A caregiver is a person who provides for the needs of a relative or friend

who is ill or disabled. The person being cared for may need help due to physical illness or injury, mental illness, memory problems, or some combination of these. The caregiver is often an adult daughter or daughter-

in-law and may be an older adult herself. Many caregivers are also caring for young children or grandchildren as well.

A caregiver's job can be very rewarding but may also be frustrating and

stressful. Most caregivers are not specifically prepared or trained for the role. It is a role some people assume reluctantly because there appears to be no other choice.

1.1 Conduct work that reflects an understanding of the key issues facing older people and their carer/s

of the key issues facing older people and their carer/s  You must be realistic about

You must be realistic about what to expect. The following suggestions may

help:

Get information about the person's medical problems. Information can help you better understand his or her limitations, know what symptoms to expect, and have an idea of the likely course of the condition.

Often the person being cared for cannot control what he or she says or does. This is especially true for people who have dementia, head injury, or

a stroke. Reminding yourself that the behaviour is a symptom of the

disease and not in the person's control may help decrease your anger,

frustration, and hurt feelings.

Allow the person to do as much as he or she is able to do. Include them in decision making whenever possible. Give the person limited choices when you can. For example, "Do you want your red shirt or the blue one?" The person may take longer to do things without help but could also find great satisfaction in taking part in his or her own care. For example, you could seat the person in front of the sink, set out the toothbrush and toothpaste, and help only if help is needed. Provide cues and directions in simple steps. He or she might need assistance performing tasks in the proper order. For example, you might say "Pick up your coat, put your arms in, button it up," rather than, "Put on your coat."

Tell the person what to do instead of what he or she should not do.

person what to do instead of what he or she should not do. It’s this expectation

It’s this expectation of what a carer’s role is that leads to many discussions both informally and formally. It is also a lack of understanding that leads to

a devaluation of a carer’s role. However, relatively little research has

attempted to generate more meaningful constructions of carers by drawing these considerations together.

"Carers face physical and mental challenges every day and should be more visibly supported and appreciated for the generous and loving hard work that they do." 1

1 http://www.telegraph.co.uk/health/healthnews/5469023/Carers-reaching-breaking-point.html- 08 Jun 2009

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The Survey of Disability, Ageing and Carers (SDAC) was conducted by the Australian Bureau of Statistics (ABS, 2004) throughout Australia, from June to November 2003 to collect information about three population groups:

people with a disability

older people (i.e. those aged 60 years and over)

people who provide assistance to older people and people with disabilities.

“In 2003, there were 2.6 million carers who provided some assistance to those who needed help because of disability or age. About one fifth of these (19%) were primary carers, that is, people who provided the majority of the informal help needed by a person with a disability. Just over half (54%) of all carers were women. Women were also more likely (71%) to be primary carers. Of those providing care, 1.0 million (39%) were in the 35- 54 year age range. This age group's caring responsibilities involved children, partners and/or ageing parents.

Those who provided care to people with a disability were more likely to be older and/or have a disability than those who did not provide care. Twenty- four per cent of primary carers were aged 65 years and over, compared to 13% of the total population. Of those living in households, the disability rates were 40% for primary carers, 35% for all carers and 20% for non- carers.” 2

About one in five carers were identified as primary carers who provided the majority of informal help to a person with a disability. Most primary carers (78%) cared for a person living in the same household. The 45-54 years age group contained the largest number of both male and female primary carers (32,200 and 83,400 respectively).

In 2003, the percentage of people living in households that were identified as carers increased gradually with age from 9% of 18-24 year olds to 22% of 55-64 year olds, and then declined to 18% of those aged 75 years and over, although this was 5 percentage points higher than the overall rate of

13%.

The proportion of people who were primary carers also increased gradually with age, from 1% of 18-24 year olds to 5% of 55-64 year olds. Unlike the overall carer rate though, it did not decrease for the older age groups, staying at 5%.

Australian Bureau of Statistics (2003) presented results from the Survey of Disability, Ageing and Carers (SDAC) conducted from June to November 2003 3 The final sample comprised 36,241 people for the household component and 5,145 people for the cared-accommodation component. The primary objective of the survey was to collect information about three population groups: people with a disability; older people (i.e. those aged 60 years and over); people who provide assistance to older people and people with disabilities.

The SDAC survey was a major achievement for the community care sector as much of these data have underpinned subsequent analyses of

2 ABS, 2004

3 Disability, Ageing and Carers, Australia: Summary of Findings, Catalogue No. 4430.0.

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population need and provided the basis for negotiating agreements between jurisdictions on program allocations.

In their 2004 report, the Australian Institute of Health and Welfare (AIHW) present a picture of informal care in contemporary Australia (AIHW 2004) based on the SDAC data. The report sought answers to the following questions: who are the primary carers, who do they assist and what does caring involve? The report also explored the impact of caring work and patterns of formal service use with informal care.

By revisiting the 1998 ABS data and other key studies, the AIHW report was able to explore some issues in more detail and report a more complex profile of carers in Australia. It has built on “a growing body of research that has identified the characteristics of carers and the extent of burden of their carer role.” (p. 2) 4

The main findings from the AIHW 2004 report (pp xii-xvi) were described under a series of headings covering the characteristics of carers, the demands on them, the changing context, wider social trends and the relationship to formal services. These findings are outlined below followed by observations of their significance for community practice in carer support, or for a continuing research agenda.

Who are the primary carers?

a continuing research agenda. Who are the primary carers? Caring for a person with a severe

Caring for a person with a severe or profound core activity restriction in a community setting is predominantly a female occupation. Men and women are more equally represented among carers of people with any level of disability than among primary carers of people with a severe or profound core activity restriction.

Over half of primary carers cited family responsibility as the reason for taking on the caring role; other common reasons given by primary carers were 'could provide better care' and 'emotional obligation'. A similar proportion of partner and parent carers said that they could offer the best possible care for their family member.

Overall, 79% of primary carers in 1998 lived with their care recipient; the rate of co-residency among primary carers of people aged 65 years or over is somewhat lower (62%).

Demands and consequences of caring work

Primary carers had a lower labour force participation rate (39%) than people who were not carers (68%). 37% of primary carers spent on average 40 hours or more per week providing care and 18% spent 20 to 39 hours per week. Over one-half of primary carers spend 20 or more hours per week in the caring role and over one-third spend 40 or more hours per week on unpaid caring work.

Three-quarters of primary carers in 1998 had spent at least 5 years in the caring role and 40% had been caring for at least 10 years. Detailed data collected by the ABS on co-resident primary carers in 1998 revealed that 60% of care recipients always needed assistance with between one and

4 AIHW 2004 report

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four activities of daily living and a further 24% always needed assistance with between five and nine activities of daily living.

The intensity of a caring role is reflected in substantially lower labour force participation among working-age carers compared to non-carers of the same age, with an inverse relationship between primary carer labour force participation and weekly hours of caring work.

Negative consequences of a primary caring role reported by primary carers in 1998 include reduced hours of paid employment and resignation from positions of employment, lower overall life satisfaction and a reduced feeling of wellbeing, and increased feelings of fatigue and depression.

wellbeing, and increased feelings of fatigue and depression. Document Name: CHCAC318A Work effectively with older

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Implications for policy and practice

Implications for policy and practice Caring as a mainly female occupation has two implications, one being

Caring as a mainly female occupation has two implications, one being the need to strengthen older women’s networks and improve the capacity of those networks to offer mutual support and practical assistance, and the second implication is the necessity to promote more gender equity in the caring sphere, with attention to promoting men’s roles and abilities as carers.

Growing numbers of frail aged care recipients over the coming decades highlight the importance of training in manual handling procedures for carers and access to mobility and bathroom aids. This short list of practical tools can be extended to include the management of medicines, the growing number of home health monitoring tools, medical devices, and tele-health aids, as well as more permanent home modifications.

Beyond strengthening the capacities of carers to cope in the home environment there is also the need to develop social strategies for greater workplace assistance for employed carers and easier access to income support in reinforcing the value of the carer role.

Carer health and well-being survey 2007

of the carer role. Carer health and well-being survey 2007 Carers Australia contracted with Deakin University’s

Carers Australia contracted with Deakin University’s Australian Unity Well- being Index Project to survey approximately 4000 carers, contacted through the data bases of the state/territory Carers Associations The survey was used to assess factors concerning their personal well-being, depression and stress using standardised scales (in particular the Personal Well-being Index) and additional questions related to their carer situation. 5

The report on the survey focussed on the subjective wellbeing of family carers in Australia. The Personal Wellbeing Index score is the average level of satisfaction across seven aspects of personal life (health, personal relationships, safety, standard of living, achieving in life, community connectedness, and future security), and two additional psychological outcome measures were used and these were the depression and stress sub-scales from the Depression, Anxiety and Stress Scale.

In summary, carers have the lowest collective wellbeing score of any group Deakin University has sampled, and have an average rating on the depression scale that is classified as moderate depression. Female carers have lower wellbeing than male carers, and the most disadvantaged carer household group is sole parents.

The report reinforced the known characteristics of the group of self- identified carers who are connected to Carer Associations. It presented the results under five headings.

Demographics and employment

The survey reinforces the usefulness of recent initiatives for those carers who are employed, as over one third of those surveyed has a degree of worry about losing their job that depresses their wellbeing even further.

5 (Cummins, Hughes and Tomyn et al. 2007). http://www.deakin.edu.au/research/acqol/index_wellbeing/index.htm

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Carer challenges

The wellbeing of carers is more vulnerable to physical pain than is normal, are more likely to be experiencing chronic pain, to be carrying an injury and/or a significant medical or psychological condition is associated with lower wellbeing. Carers are likely to be not receiving treatment for themselves for a significant medical or psychological condition as they have no time or cannot afford the treatment.

Carer resources

The wellbeing of carers is less than that of the general population sample and their satisfaction with their ability to afford the things they would like to have, and to save money are all severely comprised for carers compared with a general population sample.

Intensity of the carer role

Wellbeing decreases linearly as the number of hours spent caring increases and primary carer responsibility for any time each day is extremely damaging to wellbeing. Female primary carers have lower wellbeing than male primary carers and caring for adults imposes fewer burdens than caring for disabled children. The wellbeing of the 3,049 people (83% of the sample) who live with the person requiring care is 58.4 points, the lowest value recorded for large samples.

Satisfaction with caring and leisure

High satisfaction with leisure is more strongly associated with higher carer wellbeing than satisfaction with caring hours.

1.2 Conduct work that reflects an understanding of the current philosophies of service delivery in the sector

the current philosophies of service delivery in the sector The policy changes that led to the

The policy changes that led to the growth of home and community based services have reflected a mixture of social, health and economic goals. The rationale of most recent policy is to delay or prevent functional impairment and subsequent nursing home admissions, and behind the ‘prevention’ agenda was an important idea promoted through work on what is known in the literature as the ‘compression of morbidity’ hypothesis. 6 This theory promoted the value of preventive interventions for older people and raised the possibility of reducing cumulative lifetime morbidity. Since chronic illness and disability usually occur in late life, the theory suggested that cumulative lifetime disability could be reduced if primary prevention measures postponed the onset of chronic illness, while decreases in health risks may also increase the average age at death.

“The hypothesis predicts that the age at the time of initial disability will increase more than the gain in longevity, resulting in fewer years of disability and a lower level of cumulative lifetime disability. There is some controversy in this hypothesis with some contending that healthier lifestyles may actually increase morbidity (and health expenditures) late in

6 (Fries 1980)

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life by increasing the numbers of years with chronic illness and disability.”

7

This change in the morbidity profile has clear implications for there being a growing need for carers looking after very old people with a range of degenerative conditions, and is confirmed in the recent publication of the AIHW on the burden of disease and injury in Australia in 2003, which stated: “The rate of disability will actually decline in most age groups, except for those 80 years and over, where it is expected to increase and thereby offset some of the gains for younger age groups. The growing rate of disability in the oldest age group mostly comes from expected increases in diabetes and neurological conditions.” 8

The most relevant example of the increased burdens of disease from increased longevity is associated with dementia, as described by AIHW (2006). “Because Australia’s population is ageing, there has been growing recognition that dementia represents a significant challenge to health, aged care and social policy. This report estimates that the number of people with dementia will grow from over 175,000 in 2003 to almost 465,000 in 2031, assuming the continuation of current dementia age- specific prevalence rates.” 9

In terms of the social impact these changes are likely to make, Access Economics (2003) for Alzheimer’s Australia estimated that growth of 6% per annum in the HACC program would be required to keep up with increasing demand (even after a 20% top up for current unmet need), plus additional respite services will be needed to better support informal caregivers. 10

So the increase in lifespan has not been matched by an extension of health, and the extra years are spent with disability, disease and dementia, creating a challenge for social policy in making the end of life worth living for both carers and their care recipients.

The success of medicine in keeping people alive and the prevalence of degenerative disease with age have led to an expansion of morbidity, not a compression. Acute forms of death have been converted to chronic death or disabilities as heart attacks become heart failure, stroke leads to vascular dementia and cancers become chronic disabilities 11

The AIHW burden of disease study drew out the obvious implications for services: “Ageing of Australia’s population will result in increasing numbers of people with disability from diseases more common in older ages such as dementia, Parkinson’s disease, hearing and vision loss, and osteoarthritis. This will increase demand for services in the home, community care, residential aged care and palliative care sectors.” 12

There are also expected to be changes to the profile of available carers in the future. The AIHW published a study on the future supply of informal care from 2003-2013 13 where they estimated that the informal carer sector provides the equivalent of one million full time positions, and informal carers provide 77% of all the care that enables people with disabilities to

7 (Binns 2007)

8 (Begg et al. 2007, p. 8)

9 AIHW (2006).p xii

10 Access Economics (2003) p6
11

(Brown 2007).

12 (Begg et al. 2007, p. 8)
13

(Jenkins et al. 2003)

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stay at home. The study points out that structural and numerical ageing of the population signals higher demand for primary carers and heightens concern about the circumstances of a growing number of older carers. Becoming unable to care can cause significant anxiety and practical difficulties for older carers in particular.

In the AIHW study on The future supply of informal care 2003-201314

it was estimated that the informal carer sector provides the equivalent of one million full time positions, and informal carers provide 77% of all the care that enables people with disabilities to stay at home. This contribution of the household sector has an imputed value of approximately $28.8 billion, and $19.3 billion of this is the estimated value of the work of unpaid carers.

The study points out that structural and numerical ageing of the population signals higher demand for primary carers and heightens concern about the

circumstances of a growing number of older carers. Becoming unable to care can cause significant anxiety and practical difficulties for older carers

in particular.

Over 50% of partner and parent carers said that they could offer the best available care for their family member, confirming the widespread preference for care in the community. Overall, 79% of primary carers in 1998 lived with their care recipient. The rate of co-residency among primary carers of people aged 65 years or over is somewhat lower (62%). Future provision of informal care to people aged 45 to 64 years, in particular, could prove vulnerable to higher rates of relationship breakdown than has been evident in previous generations.

The number of people aged 10 years or over in need of ongoing assistance is projected to increase by approximately 257,100 persons (22%) between 2003 and 2013. Assuming all other factors are held constant, in 2013 the ratio of primary carers to the population in need of assistance from a primary carer will have declined from the ratio observed

in 1998 from 43 primary carers per 100 persons with a severe or profound

restriction to around 40.

This projection is driven by high growth in the age groups from which large numbers of primary carers are traditionally sourced, counteracting the effect of a moderate reduction in the proportion of working-age women who are willing to reduce paid work to care compared to 1998.

Flexible working hours, access to a range of affordable formal support services and being able to share the load with other family members will prove to be the key to women continuing in their caring roles and offer potential for more working men to accept a higher profile in family caring activity.

A 64% increase in lone person households over the past 12 years, and

predictions that this trend is set to continue, will lead to a shortfall in the

number of primary carers in 2013, relative to 1998. The scenario in the AIHW (2004) report suggests it may be around 32 primary carers per 100 persons. Access Economics (2005) clearly summarised the findings on the changing context of informal care in its report on The Economic Value of Informal Care for Carers Australia (described below), with commentary on the methods used: