Current challenges and the future of allied health services in Australian residential aged care

<p dir="ltr">Allied health services (e.g., physiotherapy, occupational therapy, and speech pathology) are instrumental in the maintenance of quality of life and independence. However, little is known about how allied health services are delivered in Australian residential aged care (RAC) (i.e., nursing homes) day-to-day as the data are limited and siloed by professional disciplines. This thesis aimed to synthesise and generate new knowledge on allied health services in RAC, including service use, impact on resident outcomes, and service delivery trends in the context of recent global and national events, the COVID-19 pandemic and aged care system reforms. The new information generated is used to propose consumer-centred policy and research directions for the future. Global evidence on the quantity of allied health services delivered in RAC and its impact on resident outcomes was synthesised in a systematic review. The review demonstrated, that internationally, there is limited information about how much allied health care is delivered in any health system. However, there is some evidence that higher rates of allied health staffing and accessibility is associated with improved resident health and experience outcomes (Publication 1). The impact of the COVID-19 pandemic and Australian RAC reforms was explored using surveys, interviews, and routinely collected data. A thematic analysis of 15 allied health professional interviews found that these professionals frequently have poor experiences working in RAC as they feel undervalued and under resourced. In interviews, allied health professionals highlighted that the quantity and quality of allied health care in RAC worsened during the pandemic (Publication 2). In a survey of 104 allied health professionals, 52% reported that they stopped delivering care in RAC during the pandemic. Part-time and contractually employed allied health professionals were more likely to experience a pause in care delivery (Publication 3). A perspective article describes RAC allied health data challenges and its implications on Australian research and policy (Publication 4). An analysis of 2,996 RAC residents’ incident data using generalised estimating equations demonstrated that resident falls increased by 32% during COVID-19 lockdowns–when allied health activity reportedly reduced–compared with pre-pandemic rates (Publication 5). Consumer-centred policy solutions were scoped through a Consumer Forum and presented in a Policy Brief. Sixteen RAC consumer participants expressed, using card sort techniques at a Consumer Forum, that a wide array of allied health services is important for high-quality care in RAC. Many consumers also expected allied health services to be offered in greater quantities than is currently available (Publication 6). Proposed policy solutions, developed in consultation with Australian policy advocates, focus on addressing minimum allied health service provision standards in RAC, funding quantity and scope limitations, low multidisciplinary activity in RAC, and data reporting on allied health services (Publication 7). This thesis presents an industry first synthesis of the state of allied health services in RAC and how services were impacted by the 2020–2023 Australian and global context. The thesis highlights the need for improved allied health data collection and reporting and multidisciplinary research to deliver better resident outcomes in Australian RAC.</p>