Heat-Ready: Adapting Aged Care Facilities to prevent premature death in elderly Australians
Adaptation Research Grants Program
Executive summary from final report
Australia has a hot, dry climate and a projected rise in average daily temperatures by 4°C by the year 2100. As a result periods of extreme heat are increasing in frequency, duration and intensity. Extreme heat is associated with an increase in illness and death, particularly in vulnerable groups such as the frail aged. As Australia’s population ages, more frail aged Australians will be exposed to periods of extreme heat. Many of these will reside in Aged Care Facilities (ACFs) who provide continuity of care to the aged.
The Heat-Ready study was designed to capture information on the current knowledge, policy status, preparedness and adaptive capacity to heatwaves in staff who work in ACFs in three Australian states. The three states (New South Wales (NSW), Queensland (QLD) and South Australia (SA)) were chosen because of their differing climates, experience of extreme heat events and variation in level of heatwave preparedness. This report presents the results of the Heat-Ready Study conducted in NSW, Queensland and South Australia and discusses the similarities and differences between states. Clinical and administrative ACF staff were invited to participate in the study, which involved a semi structured computer assisted telephone interview (CATI) of 20 minutes duration. In total 1,561 ACFs were invited to participate in the study. Although 568 facilities or organisations agreed to participate in the study, at study close only 287 facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.
Heatwave policies were not routine in all ACFs in any state. Many ACFs had a heatwave plan or guideline as part of their ACF Plan or Emergency / Disaster Plan, particularly in South Australia where heatwave planning is a major focus of SA Health and SAFECOM (Safety Commission) however these were not consistent either across or between the states investigated. The majority of ACF staff were of the opinion that air-conditioning prevents heatwave illness in ACF residents, but many had not considered the strategies which would be required if power outages occurred during periods of extreme heat. In South Australia, ACFs were more likely, than in either NSW or Queensland, to have a back-up generator. Staff knowledge of the health effects of extreme heat, and the best ways to care for the elderly during very hot weather was variable and inconsistent in all states.
The ACF staff who participated in this study raised many issues critical for the ongoing care of Australian elderly. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather. Systemic issues, which are important to support and underpin the clinical strategies used by staff are just as critical and include; adequate policy development and planning, education, training and communication, and infrastructure. To do nothing is not an option. Continuous improvement strategies in both clinical and systemic processes are essential in order to adapt to the increasing demands of an elderly population in an increasingly hot climate.
In order for Australian ACFs to adapt to future extreme heat, to minimise risk and to provide a safe environment for residents and staff, the adaptive strategies highlighted should be considered and supported by high level ACF management. The adaptive strategies include the development of facility specific heatwave plans (as part of the ACF Emergency/Disaster Plan), in-service and educational training in heatwave preparedness, clinical protocols and assessment of adaptive capacity. These should be a routine part of ACF core business and continuous improvement strategies as these actions will ultimately have a positive impact on resident and workplace safety.