Skill gap sparks need for in-reach services

Increased acuity and care needs of residents, limited access to timely and appropriate medical care and a lack of skilled nurses on shift are behind Victorian aged care homes frequent use of in-reach services, according to research presented at a national conference.

Residential-in-reach services were introduced in Victoria in 2008 to reduce the inappropriate transfer of deteriorating residents to hospitals.

La Trobe University was commissioned by the Victorian Department of Health and Human Services to understand why some aged care homes use residential-in-reach services more frequently than others.

The study, which evaluated a geriatrician-led and nurse-led in-reach model, involved interviews with 143 participants including residential aged care staff, general practitioners and residential-in-reach staff in Victoria.

From 2013 to 2018, the use of residential-in-reach services increased by 131 per cent in non-government residential aged care services and 70 per cent in their public counterparts, lead researcher Dr Jo-Anne Rayner said.

The study identified three key contributors to the frequent use of the in-reach services.

“The first theme, which is not surprising, was the increased acuity and care needs of residents. Older high care residents need more frequent medical care,” Dr Rayner told the Australian Association of Gerontology conference on Wednesday.

The second reason is limited access to timely and appropriate medical care, she said.

“GPs were just too busy to attend during office hours with their primary care practices and after hours were very problematic for residential aged care staff.

“Many GPs do not work at nights or over the weekend, which were particularly difficult for aged care staff. Both of these issues increased the use of the residential-in-reach services,” said Dr Rayner, a senior research fellow at the Australian Centre for Evidence Based Aged Care at La Trobe University.

The third reason was a lack of skilled nurses available on site.

“There were just too few or no registered nurses on the shift. This increased the use of the residential-in-reach services,” she said.

The study also identified that some aged care homes had policies in place that limited registered nurses’ scope of practice, leading to a loss of their skills, Dr Rayner said.

“This limited their decision-making and their ability to manage residents who are deteriorating in their home service,” she said. “The use of residential-in-reach services substituted one form of nursing care with another and deskilled aged care nurses,” Dr Rayner said.

“The complex care needs of residents coincide with limited access to medical care and this is very difficult for residential aged care staff,” she said.

The number of skilled registered nurses able to work within their scope of practice needs to rise to provide residents with quality care, Dr Rayner said.

The 2021 AAG Conference takes place on 9 – 12 November.

Australian Ageing Agenda is a media partner of the AAG.

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