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Aged care
58
JCPSLP
Volume 17, Number 2 2015
Journal of Clinical Practice in Speech-Language Pathology
KEYWORDS
AGED CARE
COMMUNICATION
QUALITY OF LIFE
SERVICE
PROVISION
SPEECH
PATHOLOGY
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Michelle K.
Bennett (top),
Elizabeth C.
Ward
Challenges to communication
management in residential
aged care
Michelle K. Bennett, Elizabeth C. Ward, Nerina A. Scarinci, and Monique C. Waite
characteristics that are to be considered sacred and held
in deep respect by others (Kitwood, 1997). Personhood
provides the foundation for person-centred care, the
model of care on which current national and international
aged-care service provision recommendations are based
(Productivity Commission, 2011; Department of Health,
2012; World Health Organization (WHO), 2002). Inherent
within these service provision recommendations is an
emphasis on equal and shared contribution to health care
by the health professional and the service user (i.e., the
older person and their significant others), and a focus on
psychosocial models of service provision in addition to
biomedical models. In broadening service provision beyond
traditional biomedical care, person-centred care explicitly
supports health services to facilitate subjective well-being
and meaningful life participation (National Ageing Research
Institute, 2006).
For older people residing in residential aged care,
subjective well-being and meaningful life participation have
been found to be largely dependent on the availability of
opportunities and support to make life choices, express
one’s identity and sense of self, and continue to form and
maintain interpersonal relationships (Ball et al., 2000). With
social engagement, self-expression, decision-making, and
the initiation and maintenance of relationships dependent
on effective communication (Nilsson, Ekman, Ericsson,
& Winblad, 1996), the provision of support for residents
with communication difficulty is, therefore, essential. Past
research indicates that as many as 98% of older people
living in residential aged care experience communication
difficulty (Worrall, Hickson, & Dodd, 1993). Further, for all
residents, communication interaction has been found to be
limited in both scope and frequency, to be care focused,
and largely directed by care staff (Carpiac-Claver & Levy-
Storms, 2007; Savundranayagam, 2014).
As specialists in the assessment and management
of communication difficulties speech pathologists have
the potential to take a lead role in the delivery of person-
centred care, and the facilitation of resident participation
and subjective well-being. At present, little is known
about communication management provided by speech
pathologists in residential aged-care settings. Therefore,
this study aimed to explore the perceptions of speech
pathologists about the importance of, nature of, and factors
influencing communication management in the setting.
The findings of this study may be used to inform both the
current and future direction of speech pathology services in
residential aged-care settings.
Communication enables the expression of a
person’s fundamental attributes, defined as
one’s personhood. Communication
impairment threatens personhood, reducing
autonomy and independence, limiting self-
expression, and restricting interpersonal
relationships. The majority of older
Australians living in residential aged care
experience communication impairment, yet
speech pathology services provided in this
setting are limited. With an ageing population
and global focus on person-centred aged
care, there is a need to better understand
issues impacting communication
management in residential aged-care
settings. To facilitate this understanding,
individual, in-depth, semi-structured
interviews were conducted with 10 speech
pathologists working in residential aged care.
Qualitative content analysis revealed
disparate opinions among participants about
the importance and nature of communication
management in the setting. Numerous factors
challenging clinicians’ ability to provide
services for communication in the setting
were discussed. Despite these challenges,
the majority of participants expressed a
desire to expand communication
management in residential aged care.
T
here is a growing body of research illustrating the
negative impact of communication impairment on
quality of life (Cruice, Worrall, Hickson, & Murison,
2003; Hilari & Byng, 2009; Morgan, Hickson, & Worrall,
2002; Park et al., 2013; Yorkston, Bourgeois, & Baylor,
2010). The impact of communication impairment increases
with ageing (Yorkston et al., 2010), presenting a significant
barrier to an older person’s ability to adapt to the ageing
process (Lubinksi & Welland, 1997), and to preserve and
express one’s personhood in his or her later years (Kitwood,
1997; Lubinksi & Welland, 1997; Yorkston et al., 2010).
Personhood is defined as a person’s individual and unique