No model of care specified to determine the delivery of care
’ desire
SAID
The NZ Government service specifications outline Organizations were acutely aware of the NZ Government service specifications and what they were paid to provide. They also knew that the configuration and delivery of services were not dictated by the Government. A senior management participant quoted the service specification almost word for word, “there’s a responsibility to ensure that older people remain active and have access to doing active things…there’s not a specific model of care, if you like. And so the variation in the sector, not just for [organization name] but for everyone, is significant” (SM#1). Management participants knew that physical therapy was not in the service specifications. Most facilities had access to physical therapy however, this was variable within and across organizations, “physio is a bit of a challenge in the aged care sector and for us particularly it’s quite variable. So it is something that I think has more, has value, but there isn’t a really clear program of how physios would actually interface with aged care” (SM#1).Usual therapy for residents was planned and supervised by physical therapists but often delivered by unregistered health professional staff: “[We] do a thorough physio assessment on them and then at facilities where we have assistants, we hand on to them mostly, for the ongoing care” (FAC#3). A management participant echoed “[physical therapist name] is more of like overseeing what’s happening in the care home. So that’s why she has a physio assistant. So the physio assistant can continue the plan. She’s like the brain and the physio assistant is the skills” (Mgmt#3). Several participants expressed the personal conflict experienced by knowing what residents needed wasn’t necessarily provided, “it comes back to my core values and belief that we don’t have a reablement pathway in aged residential care at the moment. And it’s not even everybody that needs it, is it? But for those that do, I think it’s unfair that they don’t really get that” (SM#3). Similarly, another said: “they [residents] often come in very deconditioned and we build them up. So being able to actually do some really good physio intervention as part of that gets them into a much better health state. So it should be part of what we do, frankly” (SM#2).Senior and management participants’ desire to care for people revealed the ethos of their clinical background. They understood how the service specifications impacted on service delivery through what was and wasn’t specifically funded and how this effected outcomes for residents in their care.