My Aged Care: Social Workers' Experiences and Ethical Challenges

Bernadette Dimla

doi:10.25907/00947

The Australian aged care system underwent reforms in 2012, which were designed to meet the needs of a growing ageing population within a constrained fiscal environment. The reforms introduced a consumer-driven service delivery model, a national system for equitable and prioritised distribution of Commonwealth-funded home-based care packages, and the My Aged Care system, which is a web-based portal, as an access point for aged care services. The availability of aged care services had not sufficiently met the increasing demand of older Australians, creating some challenges in metropolitan, regional, rural, and remote communities. The hospital system was also affected by the lack of access to aged care services, impacting the safe and smooth transition of older Australians back to their own homes. This research explores the experiences of social workers during these changes as they undertook discharge planning tasks for older patients who may have limited or no access to aged care services. A qualitative study was conducted with 17 social workers practising in metropolitan, regional, rural, and remote hospitals across Queensland from 2018 to 2023. Queensland is one of Australia's most sparsely populated states and has the most disadvantaged regional, rural, and remote communities. Regional, rural, and remote communities face difficulty accessing healthcare and resources due to geographical location, lack of infrastructure and scarcity of resources. Older people from metropolitan communities experience challenges with access to care due to complex social issues. The study involved semi-structured interviews conducted face-to-face, via video, or teleconferences to accommodate environmental and geographical challenges during the project, including the COVID-19 pandemic. Thematic analysis identified two key themes, choice and control, interpreted through four lifeworld existential dimensions: corporeality or lived body, temporality or lived time, spatiality or lived space and relationality or lived relationships. The participants described their experiences and ethical challenges supporting patients and families whilst working within the constraints of their organisational role in the context of the current aged care system. The availability, accessibility, and funding of aged care services that were meant to meet care needs, inform patient outcomes, and influence discharge planning practices were either adequate or inadequate. The identified challenges considerably impacted older patients residing in regional, rural, and remote communities, including outer metropolitan suburbs, many of whom are from low socio-economic groups. Discharge planning is one of these challenges and involves the assessment of the patient’s needs, coordinating support, and consultation with families, the multidisciplinary team, and external stakeholders. Limited access to aged care services during discharge planning impacts older patient outcomes, causing ethical dilemmas for social workers. The interactions between the aged care and hospital systems can impede effective discharge planning, affect patient outcomes, and cause moral conflict among social workers. This phenomenon was experienced within the lifeworld realms of corporeality, relationality, temporality, and spatiality. Social workers reported implementing compensatory actions to alleviate moral conflict, sustain ethical practice, and preserve professional self-hood within the contemporary aged care system. The findings of this study also brought to light how social workers navigate the limitations of the National Disability Insurance Scheme and how involvement with systemic advocacy and research could neutralise feelings of professional inadequacy. The significance of this study is its demonstration of social workers' resilience and performative actions that could inform and influence patient outcomes despite resource-constrained welfare systems and government policies. The results of this study suggest the importance of preparing social work students for the challenges in contemporary practice and of maintaining professional resilience through reflective practice, lifelong learning, systemic advocacy, and research.

My Aged Care: Social Workers' Experiences and Ethical Challenges

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