“This is the last stop in our journeys… You are safe. There are nurses on site 24/7. But it can become so boring here. You want to do a lot of things but you can’t do too much. In my own home, I had the garden, and I could go shopping, and I had more than just a room. Takes time to adjust to these changes. To live with others and accept their differences.” [Resident]

The Royal Commission into Aged Care Quality and Safety (2021) exposed widespread failings in mental health care for older Australians in aged care, particularly regarding access to psychologists. It found that despite high rates of mental illness, especially depression and anxiety, these conditions were often overlooked or inadequately treated. Barriers included a shortage of qualified mental health professionals, insufficient funding, poor integration between aged care and mental health systems, and an over-reliance on medication to manage behaviours, rather than using psychological interventions.

The Commission recommended reforms such as

• establishing multidisciplinary mental health outreach teams
• mandating that aged care providers arrange access to allied mental health professionals
• integrating mental health training into the aged care workforce and
• reducing the inappropriate use of restrictive practices.

Recently, we evaluated two PHN-commissioned programs providing mental health and wellbeing services to older people living in residential aged care. These have provided valuable insights outlined below. 

The journey into aged care and responding to mental wellness needs

Mental health and wellbeing services in aged care should be tailored to reflect the emotional impact of transitioning into aged care, along with older generations’ attitudes toward mental health and perceptions about to whom mental health services are appropriate.

Moving into aged care is an emotionally difficult transition for many residents and families – and for some, even traumatic. Feedback highlights the critical need for emotional support during this time for both residents and their loved ones. This also aligns with the Royal Commission’s recommendation to enhance psychosocial supports in aged care.

“Our resident was emotionally withdrawn and his family were at a loss. He didn’t want to live at the facility. Since seeing [mental health clinician], the resident always has meals at the dining room, he’s made friends and he’s joined the men’s club. He’s now a different person.” [Facility Manager]

A lack of understanding about mental health, coupled with the stigma of seeking help, is common. Many residents haven’t used formal mental health services before and may believe such support is only for acute conditions, often preferring to manage their struggles privately. Cultural backgrounds also play a role, with some expecting mental health issues to be handled exclusively within the family.

Past trauma can also resurface during aging, requiring sensitive service responses.

“This age group has been through a lot. Many of the people in our facility have been through all sorts of traumas in their childhood. Sexual assault, beatings, rape, families turning out to not be their families… Dementia also brings out a lot of the previous traumas, people go back in history, in time. There is lots of emotional stuff here.” [Lifestyle Coordinator]

For these reasons, residents may respond better to less formal mental health care approaches, for example, low-intensity therapies that can be tailored to address potential treatment reluctance. It is also crucial to talk to residents about whether they would like their families to be informed or involved. When they do, telehealth can be useful.

By providing targeted support during this life adjustment, mental wellbeing can be supported, residents can feel valued, and they can be assisted to define what a meaningful and enjoyable life in a new home may look like on their own terms.

Loneliness and social connectivity 

Loneliness is a recurring theme in aged care. A social void may be experienced by many new residents due to feeling disrupted connections with family and friends, a lack of appropriate social programs (such as reduced community volunteerism following COVID-19), and  needing to adjust living alongside those with various cognitive impairments. While approximately half of residents live with dementia (AIHW, 2024), residents without cognitive decline described a lack of opportunities for meaningful social interaction.

“There are about 90 residents here and about 75 have dementia. One day they treat you well, the next day they’re aggressive. They have the strength of a lion… These residents always take priority over residents who are well… I spend a lot of time in my room.” [Resident]

Findings highlight the importance of social engagement for improved resident emotional wellbeing, which again aligned with Royal Commission findings. We have seen how thoughtful interventions such as facilitating peer connections and enabling remote communication with loved ones can have a significant impact.

Engaging residents with complex care needs in evaluation

We encountered assumptions that residents with complex care needs, especially dementia, cannot meaningfully contribute to evaluations. However, with proper professional support, they can share valuable insights.

Simple communication strategies such as rewording questions, repeating prompts, and gently redirecting the person to the topic at hand have assisted in supporting those with cognitive decline to participate in evaluations.

This directly aligns with the Royal Commission’s focus on ensuring all aged care residents, regardless of cognitive ability, have their voices heard and dignity respected. It is particularly relevant to facilities that care for residents with more complex care needs, including public sector residential aged care facilities, with whom we are also currently working.

Supporting the aged care workforce

Staff burnout and turnover remain challenges in residential aged care.

The Royal Commission emphasised improving workforce conditions, and service providers delivering psychological supports to residents sometimes reported that they would also be useful for facility staff.

“It’s a stressful job. Residents can be physically and verbally abusive. There is the EAP but staff avoid using this service out of fear that it may impact their employment. Psychological support is needed…” [Registered Nurse]

To improve retention and job satisfaction, we would like to see aged care providers offering peer support; providing fully confidential access to trusted mental health professionals; and implementing training to address real-life workplace challenges.

In summary…

Drawing on our experiences and the insights gathered through these projects, we’ve learnt:

• Making social and emotional wellbeing supports accessible to residents is highly valued by residents, their families, and facility staff, including soon after transition into residential care
• Service providers need to be mindful of generational stigma and include tailored interventions for residents with dementia and other cognitive challenges
• Loneliness and unsupported adjustment are key determinants of unwellness – fostering meaningful social connections among residents is important
• Staff continue to struggle with workload and increasing demands, and require their own supports including access to confidential therapy / counselling when required.

At Larter, we’re dedicated to driving positive change in aged care. Ready to explore how our insights can benefit your work? Contact us today – we’d love to connect.

References:

Australian Institute of Health and Welfare (2024). Dementia in Australia. https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/aged-care-and-support-services-used-by-people-with/residential-aged-care

Royal Commission into Aged Care Quality and Safety. (2021). Final Report: Care, Dignity and Respect. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/publications/final-report