A reflection on current practice by Stephanie Chong
By the time an older person has arrived at an aged care service, they have spent on average 3-4 hours completing assessments and retelling their story to multiple workers and professionals in the community. Retelling their story to multiple people can add to the additional stress an older person is feeling about receiving care.
The My Aged Care service has been introduced to streamline information about the older person with the aim to reduce the stress for the older person as well as the workload for aged care assessors.
However, this process has many teething issues. Workers in aged care assessment services have expressed their frustration to me in providing timely care and resources to older people who need assistance. Comparative to the previous year, some of the people I spoke to have estimated that productivity has been cut by over 40% in some places since the introduction of My Aged Care. This means the waiting list is growing for older people who are not perceived as high and immediate need.
While workers are getting better at navigating these new administrative issues, it is also a time to consider how we can address the older person’s spirituality at all stages of their care. For the older person, this doesn’t just start when they move to a new location or receive care in their homes, it starts when they accept that they need assistance as they reach a new stage in their lives.
For spiritual need to be recognised in aged care, this needs to start at the very beginning, the assessment stage. Unfortunately, the importance of spiritual care is gate-kept by workers who in many cases have not had any acknowledgement of spirituality in their professional education or training.
Following is a reflective piece that aims to provide some information on current processes, how this affects the assessment workers and older people, and some suggestions for the future to ensure spirituality is considered in the assessment process.
The Aged Care Assessment Team (ACAT) or Aged Care Assessment Service (ACAS) if you live in Victoria, is a multi disciplinary team that consist of social workers, physiotherapists, occupational therapists and geriatricians who conduct a ‘comprehensive’ assessment of older people to determine a low or high need for homecare packages, residential, respite care and transitional care programs.
For an older person to access Commonwealth funded services, they will have to be assessed by ACAT. After an assessment from My Aged Care or from a referral from a hospital, one of the ACAT team members will visit the person in their home or in the hospital and ask questions from the National Screening and Assessment Form (NSAF) by using an app on a tablet called MyAssessor. This helps to identify what the older person is physically capable of, what they need assistance with, the supports they have and what medical interventions they are receiving.
This is then taken to a case conference where the ACAT workers come together to present their ‘cases’ so that each can contribute their professional knowledge and ensure the older person is observed holistically. The Geriatrician will usually have the final say on what can be provided for the older person and will be notified by mail of the outcome. The older person has the right to appeal against the decision.
Assessment workers may create a barrier to identifying the spiritual needs of an older person, but these workers also face many systemic issues of their own. The adoption of My Aged Care has stretched the waiting time for outcomes to up to 12 weeks in some places, and workers are struggling to keep up with demand. This often means that not all ‘cases’ are brought to the case conference meetings. It also means that not all questions are asked in the NSAF as this can take up to 3 hours to complete, leaving the older person and the worker exhausted.
A major concern of ACAT workers that I have been made aware of is the level of expertise of assessors at the initial My Aged Care stage. This is where an older person is required to complete an over the phone assessment before they can have a referral to their local council or an ACAT. This initial phone assessment can take up to an hour to complete and is often conducted by people who may not have sufficient training in aged care. In these situations, the subsequent notes that are passed on to an ACAT are insufficient to make an assessment on the actual level of need. Instead of the streamline service that was promised, the introduction of My Aged Care seems to rely on double handling to function, leaving ACAT assessors to bear the burden.
The initial assessment process could indicate to the aged care service if the older persons has spiritual needs required to be addressed immediately. Assessing an older person’s spiritual needs earlier on can also minimise the number of times their story needs to be repeated. This is important to consider as the current assessment process is already quite time consuming and can add to the older person’s stress in accessing care.
Transitioning to care can also be a stressful time for older people. Identifying a spiritual need as early as possible can prepare an organisation to ensure a smooth transition with the appropriate support. For the older person, transitioning to care can bring up strong feelings about their identity and their place in the world. Many older people often think about being closer to death and may need additional support for these confronting thoughts. Spiritual assessments can help to identify what strengths and resources the older person already has within to overcome adversity.
There is a potential for spiritual needs to be addressed in the initial assessment stage. While spirituality is not currently explicitly addressed, there are a few questions that could potentially indicate spiritual need. Spiritual needs are also closly connected to emotional needs and this needs to be acknowledged among staff who conduct assessments.
In 2014, Val’s Café, a not for profit organisation that advocates for older LGBTI communities, collaborated with ACAS in Victoria and produced the Aged Care Assessment Service Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) inclusive guide sheets to highlight to assessors specific needs of older LGBTI people and how to incorporate this into their practice. This has been successful at addressing the needs of the community while incorporating more inclusive language in the NSAF.
The assessment of older people accessing Commonwealth funded services are constantly changing to address the specific needs of older people. While there are some teething issues with My Aged Care now, room must be made for spiritual care to be a priority in initial assessments. ACAT workers need to be involved in the process for this to be successful. This means understanding how they operate and their current challenges. Here are my suggestions moving forward for spiritualty to be incorporated into initial aged care assessments:
– provide spiritual training to ACAT assessment staff
– work with ACAT and create a resource and training tool for workers to acknowledge the importance of spirituality in aged care
– advocate for a Spiritual Assessment Tool as an additional or supplementary assessment to the NSAF*
– advocate for a person’s religion and/or what supports they have in the community to be identified explicitly in the assessment.
You can find more information here: http://www.myagedcare.gov.au/eligibility-and-assessment/acat-assessments
*Meaningful Ageing Australia raised this issue with the Department in 2015
Contact Stephanie: firstname.lastname@example.org