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JCPSLP Volume 17, Number 2 2015 61
then be communicated to aged-care facility management
and care staff, with speech pathologists taking the role
of educationalist to raise awareness of opportunities to
facilitate communication with residents with cognitive
communication impairment. To achieve and sustain
long-term change, current and future models of speech
pathology service provision in residential aged care must be
reviewed to better align with person-centred care. In doing
so, the importance of effective communication in enabling
meaningful life participation and facilitating subjective well-
being must be highlighted.
Conclusion
As the population ages, the demand for speech pathology
services in residential aged-care facilities will increase. As
the majority of older people in residential aged-care facilities
experience communication difficulty, greater attention is
needed to determine how the speech pathology profession
can optimise services to facilitate communication. Current
speech pathology services targeting communication are
limited and impacted by numerous barriers within and
outside of the profession. The current data indicates that
speech pathologists in this setting have a desire to increase
the profile of communication management in residential
aged care. Current aged-care legislation and reform is based
on the principles of person-centred care and, thereby,
provides a legislative platform on which to advocate for
communication management in aged-care settings. As
such, there is an opportunity for the profession to align itself
with current aged-care legislation and reform, raise the
profile of communication, and position the profession as a
key player in the delivery of care to older people.
References
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Hopper, T., Cleary, S., Oddson, B., Donnelly, M. J., &
Elgar, S. (2007). Service delivery for older Canadians with
dementia: A survey of speech-language pathologists.
communication. In doing so, speech pathologists may
further highlight the link between communication and
participation, and between communication, subjective
well-being, and person-centred care. In addition, the profile
of this client group both within the speech pathology
profession and in the wider health service and political
arena may be raised.
Achieving service change for communication in
residential aged care will, however, first require profession
specific change. This Australian-based study supports
prior international research (Hopper, Clearly, Oddson,
Donnelly, & Elgar, 2007) indicating a degree of uncertainty
and inconsistency among speech pathologists working
in residential aged care. Key challenges include (a)
inconsistency in perceptions about the importance and
prioritisation of communication management in the setting
and (b) uncertainty about the validity of assessment and
intervention approaches with the client population, given the
high prevalence of cognitive impairment and degenerative
disease (Hopper et al., 2007). The current study also
confirms the findings of previous studies indicating that the
management of “swallowing” is the primary focus of speech
pathology professional services in residential aged care
(Bennett, Ward, Scarinci, & Waite, 2014; Casper, 2013;
Hopper et al., 2007).
Further factors discussed that may inhibit speech
pathology services for communication in residential aged
care included resource constraints, lack of awareness of
aged-care facility staff about communication management
and the role of speech pathologists in providing this care,
and limited education for speech pathologists specific
to providing communication management in aged-care
settings. These barriers are consistent with barriers
identified as also inhibiting speech pathology management
of mealtime difficulties in Australian residential aged care
(Bennett et al., 2014). The impact of these barriers on
both communication and mealtime management suggests
the need for wider consideration of speech pathology
service provision in residential aged care, including further
exploration of the perceptions of a larger cohort of speech
pathologists working in the setting. Such exploration may
better guide training for speech pathologists working with
older people and in residential aged-care settings, and
may further assist in clarifying the current position of the
profession in providing aged-care services.
Despite the challenges faced in working in residential
aged-care settings, speech pathologists in the current
study expressed a strong desire to expand communication
management in the setting. To assist the majority of the
resident population who experience communication
difficulty as well as staff caring for these residents, and
speech pathologists working in the setting, the profession
must unite in advocating for the need for speech pathology
services for communication in residential aged care. With
current aged-care legislation and reform founded on the
principles of person-centred care, there is current legislative
support for communication management in the setting.
To assist speech pathologists entering the profession
and clinicians already working in the setting, pre- and
post-qualification training relevant to residential aged care
must ensure clinicians are aware of challenges inherent
in working in aged-care settings, and strategies to
address these (Bennett et al., 2014; Hopper et al., 2007).
Training in the management of cognitive-communication
impairment and appropriate expectations for treatment
outcomes must also be prioritised. This knowledge must