Breaking traditions of practice: workforce challenges in implementing disability service standards within purpose-built accommodation for younger adults

Abstract

Inadequate community housing and support for adults under 65 years with complex health needs often leads to residential aged care placement. In 2006, Australian government authorities funded a range of supported housing alternatives for younger adults requiring access to 24-hour support including the Integrated Living Model (ILM). The ILM provided purpose-built accommodation for 10–20 people and represented a change in practice from traditional 24/7 nursing care toward a more holistic, individualised approach. Aim: Examine workforce challenges in implementing disability service standards (DSS) within an ILM. Method: Thematic Analysis of workforce practices was conducted by coding staff interviews (n = 20) against the prevailing DSS. Results: Emerging challenges identified against each standard were: expectation management; coordination; client expertise; blurred boundaries; role confusion; valued status beyond client; unclear practice boundaries; multilayered communication; reflective practices; and mixed service model responses. Conclusion: This ILM setting requires workforce development in rights-based practice, personalisation and effective communication. Key paradigm shifts are also recommended.