Younger People In Nursing Homes - Fact Sheet
The provision of long-term care options for
younger people with severe Acquired Brain Injury and high-level
care needs has been limited.
Often, younger people with Acquired Brain Injury are placed into
aged care facilities where the appropriateness of care is
questionable. In the past two decades, there have been extensive
public health strategies for injury prevention. Advances in medical
technology and trauma care services have resulted in an increasing
number of people surviving the acute phase of serious brain injury.
These advances have created a new population of individuals with
high level care needs who require lifelong health, welfare and
While life saving procedures following traumatic injury should
continue to be given the current high level of priority in our
society, there is also a responsibility for society to provide
life-long support for the people who survive such trauma.
In Australia, the provision of services for rehabilitation and
long-term care of people below the age of 65 years with severe
Acquired Brain Injury appears to be limited, with few accommodation
options for younger people with high levels of care needs. Those
who are left with severe and lasting disabilities are often
discharged to the care of families or into aged care facilities.
Some, though physically fit, are psychologically and socially
disabled with unique and individual care needs that are not met by
generic or aged care services.
Many people with Acquired Brain Injury will remain highly
dependent on either their families and/or community services for
ongoing care, regular supervision and support. However, families
are rarely equipped to meet the challenges of caring for a relative
with Acquired Brain Injury.
The Kendall report in 1991 estimated that 11,000 people in
Queensland would be admitted to hospital each year suffering from
some form of brain injury, and only 10% of those people affected by
brain injury would receive any type of assistance in the community.
The report provided a review of service provision and explored the
needs of people with Acquired Brain Injury. From the results,
Kendall concluded that in Queensland, people with Acquired Brain
Injury had many unmet needs .
Existing Facilites in Queensland
There are only two Qld Health funded long-term accommodation
facilities for young people with Acquired Brain Injury in
Queensland: Casuarina Lodge at Wynnum and The Jacana Centre, Bald
Hills Hospital. There are few permanent accommodation options for
people below the age of 65 years who have high level care needs,
and no government funded residential services for people in the 45
to 65 age group. Often, younger people with Acquired Brain Injury
who are left with severe and lasting impairments are discharged
into aged care facilities for long-term care. In Australia in 1998,
there were 5,924 people with a disability under the age of 65 years
accommodated in residential aged care facilities.
According to Australian Institute of Health and Welfare (AIHW)
'Residential aged care in Australia 2006-07: A statistical
overview,' nationally there were 6,613 residents aged less than 65
years accommodated in aged care services . This number comprised
4% of all residents, with a pattern similar across all states and
territories. However, with exception to the Northern Territory,
where the number of residents aged less than 65 years was higher,
at 13%. The report indicated that residents of services in remote
areas had a higher age profile with 46% of residents aged 85 years
Why Aged Care is Inappropriate
There are many reasons why aged
care is not suitable for many younger people with an acquired brain
There is a lack of peer interaction for younger residents who
are in the minority and have nothing in common with other
residents. Residents with Acquired Brain Injury frequently seek
staff contact in preference to other residents as they are closer
in age, interests and can offer more meaningful interaction than
some residents who are frail or have dementia. In general, aged
care facilities primarily attempt to maintain a serene, quiet
atmosphere for aged residents to live their remaining years. Social
activities, entertainment, music, exercise and even diet
understandably cater for the elderly.
Aged care building design for younger
In some facilities there is a lack of privacy and single rooms.
Young residents with Acquired Brain Injury may share rooms with
people who are elderly and sometimes have dementia. Such living
restrictions often create feelings of depression, loneliness,
frustration and boredom, thus compounding any existing problems of
mood swings, behaviour and impulse control often resulting from a
brain injury. As many people with Acquired Brain Injury do not have
a shortened life span their stay in supported care could be lengthy
depending on the age of entry. Younger residents may experience
significant loss, through death of many roommates when they reside
in aged care facilities for a number of years.
Rehabilitation of younger residents in an
aged care setting
Younger residents are usually more physically fit and stronger,
requiring a very different level of stimulation and rehabilitation
to frail aged residents. On average, younger residents with
Acquired Brain Injury require higher numbers of staff hours to meet
their nursing and exercise needs than aged residents. Aged care
staff are usually not trained in aspects of Acquired Brain Injury.
They frequently report problems in communication, managing
challenging behaviours and managing the emotional needs or moods of
younger people with Acquired Brain Injury. Research has indicated
that aged care staff believe that the social, Cognitive and
rehabilitation aspects of care were of greatest difficulty, and the
areas in which the needs of this client group were being least
Meeting care needs
Aged care staff report the majority of needs as being met.
However, there is a markedly different picture with regards to the
rehabilitation, emotional, cognitive and social aspects of care.
Staff often identify difficulties with providing supervision,
communicating with, and managing the emotions and moods of
residents with Acquired Brain Injury, and dealing with their
challenging behaviours such as disinhibition, verbal or physical
Adjustment issues for younger
For the resident, feelings of loss of independence and control,
and post-placement depression are common in adjustment to the new
environment and high levels of ongoing support and counselling are
often needed. It is often the staff who work in aged care
facilities who are faced with providing this complex and ongoing
support, with a lack of resources, inadequate levels of training,
and skills in the area of Acquired Brain Injury, and limited access
to specialised rehabilitation and community services.
Often families wish to participate and be involved in all aspects
of their relatives' care. Research has indicated, however, that
there is limited family participation in the physical aspects of
resident care, in contrast with the more frequent leisure and
social interaction. There are a number of possible reasons for this
finding. Families may have chosen to hand the burden of care to
professional staff but maintain social and leisure contact. Daily
tasks of care are mostly completed in the morning and evening, at
the times of day when visitors are not available or not permitted
to visit. Some families were reported to have limited contact as a
result of their own emotional distress. Sometimes young children
and teenagers can be distressed by the aged care environment. It is
also possible that aged care facilities do not encourage family
participation in the physical aspects of client care, viewing this
as predominantly the professional caregiver's role.
Preferred Alternatives of Care
A better alternative to aged care
facilities are group homes or small residential facilities designed
for groups of up to five young people with high-level nursing
needs. Such facilities provide care for people with significant
cognitive impairment and associated physical disabilities. An
individualised package is an option that can enable people to
remain living at home or in their own places in the community,
based on providing funding tailored to the needs of individuals.
Finally, specialist facilities can be designed for people with
Acquired Brain Injury who have specific behavioural difficulties to
provide specialist support programs, such as what we provide
Disability Services QLD (DSQ) ran the Younger People in Aged
Care Initiative, which was a Council of Australian Governments'
(COAG) initiative. The aim of the initiative was to divert those at
risk of entering aged care facilities following discharge from
hospital or support those who chose to remain in aged facilities.
Under the initiative Disability Services Queensland developed a
continuum of support models which provide a range of supported
accommodation options to younger people with a disability. We are
currently embarking a change in the systems, looking towards a
National Disability Insurance Scheme (NDIS). The information is
always changing and developing on this, so try to keep up to date
by visiting the NDIS website, and the
Disability Services website.
The current use of aged-care facilities for housing younger
people with high level care needs resulting from Acquired Brain
Injury is inappropriate and inadequate to meet the specific and
complex needs of this group. There is a need for redress in
government policy and service planning provision for people below
the age of 65 years with Acquired Brain Injury requiring long-term
high level care.
References and further information