Nursing Focus on Aged Care

This essay examines the complexities of nursing in aged care facilities in Australia, specifically focusing on the Aged Care Funding Instrument (ACFI). It explores the four key ACFI standards (management, health and personal care, lifestyle, and physical environment) and the three assessment domains (Activities of Daily Living, Cognition and Behavior, and Complex Health Care). The essay reviews several studies highlighting challenges faced by nurses, including meeting consumer expectations, workforce instability, resource constraints, and policy limitations. These challenges impact the quality of care provided, particularly in areas like continence care, medication management, and pain management. Studies on the impact of ACFI on nursing practices, the challenges of caring for dementia patients, and the effects of workload and resource limitations on adherence to ACFI guidelines are discussed. The essay concludes by emphasizing the need for addressing these challenges to ensure optimal care for aged patients within the ACFI framework.

Running head: NURSING- FOCUS ON AGED CARE
Nursing- Focus on Aged Care
Name of the Student:
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Aged Care Funding Instrument (ACFI) refers to the funding system that is applicable to
residents in an aged care facility and is operational in the Australian domicile. The Australian
Government confers care subsidy for the care recipients subjected to fulfillment of the
accreditation requirements by the concerned aged care services authority as proposed in the
Aged Care Act of 1997. These aged care facilities are obliged to abide by the accreditation
standards that are taken into consideration by the quality agency for assessment regarding their
eligibility. The chief four standards that are to be complied with are as follows:
 Standard One encompasses management systems, organizational development alongside
staffing
 Standard Two comprises of health and personal care
 Standard Three constitutes lifestyle of the care recipient
 Standard Four refers to physical environment and safe systems (Agedcare.health.gov.au,
2017).
The nurses appointed at the aged care facilities are also entrusted with distinct
responsibilities to render optimal care facility to the aged patients in conformity with the
accepted conventional practices. Assessment of needs of the residents is carried out by virtue of
referring to the questions that belong to three ACFI domains as follows:
 Activities of Daly Living (ADL) that constitute ACFI questions on nutrition, personal
hygiene, mobility, continence and toileting
 Cognition and Behavior (BEH) comprise of ACFI questions related to cognitive skills, verbal
behavior, wandering, depression and physical behavior

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 Complex Health Care (CHC) constituting ACFI questions relevant to medication and
complex health care procedures
In order to cater to the diverse needs of the geriatric patients and requirements of their degree
of care based on their conditions, a number of assessments are usually undertaken by the
concerned nursing professionals. Relevant research findings have suggested the suitable
application of adequate staffing as well as skills mix to properly address the needs and demands
of the patients in the residential aged care facility and non-conformance to these accepted
practices might result in generating negative outcomes (Willis et al., 2016). Another study has
explored the issue revolving the usability of the Cornell Scale for Depression in Dementia
(CSDD) in nursing homes as part of ACFI assessment. Findings have argued on using CSDD
scale for detecting depression and have harped on considering the complexity of scale, time
elapsed for procuring pertinent information alongside staff skills and knowledge of evaluating
depression to render optimal care to the patients (Jeon et al., 2015).
Nurses being the frontline workforce in the healthcare sector remain in close association with
the clients and are directly responsible for carrying out their assigned duties so that positive
outcomes for the concerned patients may be achieved. The safety and quality of the care offered
by them is of paramount importance in this respect as it is related to the emanation of desirable
outcomes. However, a recent study carried out with respect to the contemporary scenario in
nursing has focused on the perceptions and experiences of working in aged care as encountered
by the registered nurses. The results depict that the nurses face immense challenges in meeting
expectations of the consumer, organization, profession and related policy. Workforce instability
and resource constraints are also major hindrances in generating satisfactory professional output.
Structural barriers and aged care policy environments also threaten sustaining nursing in aged

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care (Davis et al., 2016). Matter related to residential aged care facility and multipurpose
services available was investigated in a study that attended to perceptions of nurses and impact
of aged care reform. Funding and resource shortfalls other than skill mix, staffing levels and
knowledge deficits were identified as potential barriers to foster optimal care to patients.
Limitations to specialist knowledge acquisition related to aged care on the part of the nurses also
posed impediments to deliver the optimal care service. Care deficits in complex care such as that
involving medication review, pain management and wound care were linked to dependence upon
care workers (Henderson et al., 2016). A crucial part of the nursing assessment carried out with
respect to provision of quality care for the geriatric patient within the framework of ACFI
involves continence care to cater to the ADL in case of the geriatric patients. A study explored
the continence care provision in aged care facilities. Outcomes of the study revealed that
perceptions and experiences of the staff related to funding model and quality framework lead to
the generation of a climate of fear and risk adversity that in turn is associated with unprecedented
impacts o the resident’s continence care. Dependence on continence management was
incentivized alongside equating the effective continence care and effective pad use. Therefore,
propositions were made to reevaluate the quality of continence care within the realm of
Australian aged care facility (Ostaszkiewicz, O'connell & Dunning, 2016). Quality of care in
aged care in aged care facilities has been found to be largely dependent on the federal
government’s regulatory activities thereby necessitating the nurses to act in accordance with the
proposed guidelines (Johnson, 2017).
Nursing responsibilities for patients under ACFI caters to the addressing of and carrying out
duties that involve assessments relevant to documentation of continence record PAS-cognitive,
behavior records encompassing wandering, verbal behavior and physical behavior alongside

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Cornell scale of depression. Relevant study has focused on the performance of nursing care for
people suffering from dementia and avail residential facilities with wander. A social order of
practice has been suggested to allow for the generation of maximal outcomes where the interests
of the patients are safeguarded and appropriate measures are taken to harbor optimal results
(Cope, 2016). Another study has paid attention to focus on the differential needs and demands
for dementia care in permanent residential aged care facilities. Increased complexity in terms of
assessed care needs concerning nutrition, cognition and continence was noted in case of
dementia patients who have been demarcated, as those requiring high care needs when compared
against their non-dementia affected counterparts. Accentuated assessed care in permanent
residential aged facilities because of increased complexity has been observed in case of dementia
patients thereby emphasizing on the need of adopting suitable nursing interventions that are to be
diligently followed in their professional practice for achieving desired results (Joenperä, 2017).
However, pertinent literatures have supported that it is not always possible for the nurses to
adhere to their assigned responsibilities for patients under ACFI. Increased workload linked with
the rationing of human and material resources in service delivery has been identified as chief
reasons for missed nursing care. Work intensification has been aligned with patient acuity and
cost containment while undermining of proposed staffing ratios, altering workloads across shifts,
skill mix in addition to insufficient support from colleagues were detected as part of staffing
issues. Resource issues are the key barriers in this context that thwart the provision of adequate
nursing care (Henderson et al., 2016). Report on the workplace climate and wellbeing of the
nurses revealed certain important findings that in turn may be linked with their possible reasons
of non-conformance with the usual practices for the aged patients in their stay at the residential
aged care facilities. Quote from one of the respondent Registered Nurse has highlighted on the

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rotting of ACFI as the reason for their lack of enthusiasm in workplace and diminished work
output besides other confounding factors like that of poor skill mix and increased reliance on
bureaucracy based healthcare rather than knowledge based healthcare. Legislation vagueness and
other factors have been held responsible for poor performance of the nurses in performing their
duties (Tham & Gill, 2016). Thus, despite the best efforts on the part of the nurses it often turns
out to be tedious for them to align by the dictums in caring for geriatric patients under ACFI.

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References
Agedcare.health.gov.au. (2017). Standards | Ageing and Aged Care. Agedcare.health.gov.au.
Retrieved 6 September 2017, from
https://agedcare.health.gov.au/ensuring-quality/standards
Cope, S. N. (2016). The performance of caring: The construction of nursing care for people with
dementia who live in residential facilities and wander(Doctoral dissertation, Queensland
University of Technology).
Davis, J., Morgans, A., Birks, M., & Browning, C. (2016). The rhetoric and reality of nursing in
aged care: views from the inside. Contemporary nurse, 52(2-3), 191-203.
Henderson, J., Willis, E., Blackman, I., Toffoli, L., & Verrall, C. (2016). Causes of missed
nursing care: qualitative responses to a survey of Australian nurses. Labour & Industry: a
journal of the social and economic relations of work, 26(4), 281-297.
Henderson, J., Willis, E., Xiao, L., Toffoli, L., & Verrall, C. (2016). Nurses' perceptions of the
impact of the aged care reform on services for residents in multi‐purpose services and
residential aged care facilities in rural Australia. Australasian journal on ageing, 35(4).
Jeon, Y. H., Li, Z., Low, L. F., Chenoweth, L., O'Connor, D., Beattie, E., ... & Brodaty, H.
(2015). The clinical utility of the Cornell Scale for Depression in Dementia as a routine
assessment in nursing homes. The American Journal of Geriatric Psychiatry, 23(8), 784-
793.

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Joenperä, J. (2017). Tales from the ACFI: Dementia in residential aged care. Australasian
Journal on Ageing, 36(1), 10-13.
Johnson, C. (2017). AMA delivers submission to government review into aged care
facilities. Australian Medicine, 29(15), 10.
Ostaszkiewicz, J., O'connell, B., & Dunning, T. (2016). Fear and overprotection in Australian
residential aged‐care facilities: The inadvertent impact of regulation on quality
continence care. Australasian journal on ageing, 35(2), 119-126.
Tham, M. T. L., & Gill, F. (2016). What Nurses & Midwives Want: Findings from the National
Survey on Workplace Climate and Well-being.
Willis, E., Price, K., Bonner, R., Henderson, J., Gibson, T., Hurley, J., ... & Currie, T. (2016).
Meeting residents' care needs: a study of the requirement for nursing and personal care
staff.