JCPSLP Vol 17 No 2 2015_web

Aged care

Challenges to communication management in residential aged care Michelle K. Bennett, Elizabeth C. Ward, Nerina A. Scarinci, and Monique C. Waite

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

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.

KEYWORDS AGED CARE

COMMUNICATION QUALITY OF LIFE SERVICE PROVISION SPEECH PATHOLOGY THIS ARTICLE HAS BEEN PEER- REVIEWED

Michelle K. Bennett (top), Elizabeth C. Ward

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JCPSLP Volume 17, Number 2 2015

Journal of Clinical Practice in Speech-Language Pathology