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JCPSLP
Volume 17, Number 2 2015
Journal of Clinical Practice in Speech-Language Pathology
communication management in residential aged-care
settings. All participants indicated that they were unsure
about, how and whether speech pathology services
should adhere to broader aged-care legislation and
recommendations. When asked about current aged-
care funding assessments and aged-care standards,
participants made comments such as “I am not very
clear on this” (Participant 1), “Again it doesn’t roll off my
tongue with easy familiarity” (Participant 6), “I’m not sure
specifically” (Participant 7), “Not too sure, I assume it is a
set of standards that health professionals must comply with
in order to work with the aged population” (Participant 3).
Two participants who regularly conducted
communication management in the residential aged-care
settings they serviced both commented that the service
they provided was highly dependent on the involvement
of family members and friends of the resident. Family
members and friends were noted as the primary source of
referral for services to facilitate resident communication,
often fund the service, and take a lead role in carrying out
therapy tasks. Participant 8 discussed the role of speech
pathologists in advocating for communication management
in residential aged care:
If relatives around see me working with someone else
they might come and have a chat with me and ask
what I am doing, and say that looks great, can I ask
you about my relative … so I will have a chat with
them. I think speech pathologists can raise awareness
of what we can offer for communication and make this
appealing to residential aged-care facilities.
Theme 3: Speech pathologists have
a desire to advance communication
management in residential aged care
Of the 10 participants, eight commented that in “an ideal
world” they would like to increase services for
communication management in residential aged care. Most
participants emphasised the importance of facilitating social
communication among residents. Most participants also
commented on the importance of ensuring that the
individual communication needs of residents were assessed
and that interventions provided were tailored to meet these
needs. In doing so, participants acknowledged that all
residents are not the same, “They might all have dementia
but are still all very, very different” (Participant 3). All
participants discussed several different roles that speech
pathologists may take in facilitating resident
communication. These roles included as consultants and
doing “trouble shooting” (Participant 6) with both staff and
residents when communication breakdown occurred, as
educationalists providing training for residential aged-care
staff and family members in maximising communication
opportunity and success, and as clinicians providing both
individual and group assessment and intervention services.
Discussion
With national and international aged-care legislation and
reform recommendations emphasising the importance of
person-centred care and therefore the maintenance of
personhood (Productivity Commission, 2011; Department
of Health, 2012; WHO, 2002), services to facilitate effective
communication with clients are essential. In a setting such
as residential aged care, where the majority of clients
experience communication difficulty, there is marked
potential for speech pathology services to facilitate
Theme 2: Communication management
in residential aged care is limited and
impacted by numerous factors
All participants stated that referral for speech pathology
services and the nature of speech pathology services in
residential aged care is dominated by “swallowing”. Only
two of the 10 participants stated that they regularly
provided communication management in aged-care
settings. Participants also commented that communication
management is often not a priority of aged-care
management or care staff. One participant did, however,
state, “I think the nursing staff prioritise communication the
best way they know how” (Participant 3). Overall, most
participants indicated that prioritisation of communication
management in residential aged care by speech
pathologists would not necessarily translate to increased
aged-care sector prioritisation and support for
communication management.
All participants discussed the impact of lack of funding
in residential aged care for communication management.
Most participants discussed a lack of support from
speech pathology management to provide communication
management in residential aged care, and a lack of
specialist training for speech pathologists working in the
setting. All participants indicated that they felt strongly
that limited funding for communication management was
associated with many factors including: low prioritisation
of communication management by facility staff; lack of
acknowledgement of communication needs in aged-
care funding allocation tools; and limited awareness
by residential aged-care staff about, options for and
the benefits of, speech pathology services to facilitate
communication. Most participants also commented that
they themselves had limited knowledge regarding funding
options that were available for communication management
in residential aged care.
Further commenting on the support they received
from their own professional management, all participants
emphasised the negative impact of time and resource
limitations. As a result, all participants prioritised what they
were referred for – “swallowing”. One participant stated “I’m
aware of everything, aware of communication, but I know
I’ve got to hurry up and get out of there you know, I’m not
allowed” (Participant 1).
Many participants also indicated uncertainty about which
resources and communication intervention approaches
were best suited to meet residents’ needs. When asked
about the nature of services they would provide to facilitate
resident communication if given the opportunity, many
participants expressed uncertainty about the intervention
approach they would use, the areas of communication
they would target, and the outcomes they would hope to
achieve. This uncertainty largely related to the complex
nature of communication impairment among residents
of aged-care facilities, including the high prevalence
of cognitive impairment, degenerative disease, and
comorbidity.
All participants commented that they would welcome
further pre- and post-qualification training specific to
facilitating communication in residential aged care,
particularly for residents with cognitive-communication
impairment. Many participants also expressed a desire for
further training about expectations for client outcomes,
reporting uncertainty about the applicability of, and
means of implementing, a person-centred approach to