Advance wellbeing and dignity with care leaver-informed care

Older care leavers are individuals who have spent parts of their lives in out-of-home care, including children’s homes, foster care or orphanages. With more than 500,000 older care leavers transitioning into the aged care support system, a National Centre for Healthy Ageing-led review has explored key issues they face. Published in the Journal of Gerontological Social Work, the narrative review was authored by Professor Philip Mendes, Associate Professor Susan Baidawi, Lena Turnbull and Sarah Morris, and involved an examination of Australian and international literature on older care leavers’ experiences with and perceptions of aged care services.

The support-at-home preference

The literature included older care leavers’ specific fears and anxieties about institutional aged care and revealed that most older care leavers would prefer to remain in and receive support at home — suggesting that maintaining the familiar comforts of their own homes and reducing their levels of distress regarding the prospect of re-entering institutionalised care environments was important for older care leavers.

“Older care leavers who spent their childhoods in institutional and other forms of out-of-home care are a vulnerable group,” Mendes said. “Our narrative review of existing local and international literature identified that most of this cohort prefer to remain at home, assisted by services that respect their autonomy and personal history,” Mendes said.

Aged care facilities can evoke distress

“Aged care services need to adopt trauma-informed approaches to meet their needs and advance their wellbeing and dignity in aged care settings,” Mendes said, with the review suggesting that aged care facility environments can evoke distress in older care leavers due to similarities with childhood institutions. Issues such as the nature of communal living, lack of privacy and certain physical triggers like corridors and architectural features being reminiscent of past institutions were identified, as were specific odours and some institutions sharing the name of childhood orphanages.

Trauma-informed care within aged care facilities is made difficult due to workforce challenges, the review found. Such challenges include disparities in staff skill levels, high rates of staff turnover, and cultural and linguistic divergences between staff members and residents — this was particularly the case with those from non-western backgrounds. Constrained resources were also identified as further complicating the delivery of effective and sensitive care services.

Care leaver-informed aged care

“For older Australians who grew up in childhood institutions, their past experiences of trauma in these settings can deeply influence how they perceive and interact with other institutions — in this case, aged care services,” review co-author Turnbull said, noting that the literature recommends that all aged care services should be trauma-informed, care leaver-informed and person-centred.

“For older Australians who grew up in childhood institutions, their past experiences of trauma in these settings can deeply influence how they perceive and interact with other institutions — in this case, aged care services,” Turnbull said. “Trauma-informed care recognises and responds to these traumatic experiences, ensuring that care environments are safe, supportive and respectful.

“It shapes how services look and feel and how staff behave, in an attempt to build trust, reduce re-traumatisation and provide the tailored support needed to meet the unique emotional and psychological needs of this vulnerable group,” Turnbull said, calling for additional, flexible funding to facilitate older care leavers’ ability to continue living at home. “This alongside the need for sustained access to counselling and specialised services and the support of an advocate or guide to aid in their navigation of aged care support systems is important.”

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