Leadership And Management In The Aged Care Sector: Challenges And Strategies

Background

Aged care is a sensitive context when it comes to the health care sector and the importance of quality health care to the elderly patients has been neglected alarmingly until recently. The mortality rates in the palliative and end of life units have been increasing at a rapid rate all across the globe. The disparity in the effectiveness of the treatments in the geriatric care unit have only recently caught the attention of the global health care authorities, hence more and more policies and protocols are being introduced into the aged care sector (Baker, Webster, Lynn, Rogers, & Belcher, 2017). Considering the Australian context, the aged care has been subsidised by the national governments a few decades ago and ever since, numerous new legislatives have been incorporated into the existing regulations and protocols. However, the complicated regulations and guidelines only created disorganization and chaos in the sector and the care standards are decreasing every single day (Kallio, et al., 2016).

According to different authors, clinical leadership can serve as the only solution to the inadequate compliance with aged care policies and the importance of the quality care can be restored by enforcing adequate clinical leadership. It has to be understood that the challenges for successful compliance to aged care policies are involved with lack of guidance, motivation and training. Clinical leaders, like medical officers or registered nurses with adequate experience aid in guiding the professionals in techniques that are apt for aged care. Also the financial instability associated with a career in aged care, the physical and psychological burnout can be easily dealt with the interpersonal communication and counselling by the clinical leaders (Cooke & Bartram, 2015). This research study will aim to discover the aspects of challenges associated with the aged care compliance and quality, and explore how these challenges can be overcome by establishing compassionate and supportive clinical leadership.

Health care is a basic necessity, and every single individual of this society has a right to attain optimal treatment and care for any ailment they suffer with. However, there have been many health care disparities in the society and the health care authorities have long neglected the differential needs of the different age groups (Stodart, 2016). One conspicuous example of this situation can be the lack of a sound and detailed aged health care policies and protocols until recently. However, the efficient advancements in the healthcare sector has facilitated the health care priorities to be changed as well, and current emphasis on providing quality and safe health care services to the elderly patients dealing with various complicated health care needs is a prime example of it.

There are various aged care policies in place for the elderly population nowadays that caters to the specific needs of aging patients. Enforcing these policies and protocols can change the face of aged care, and the care standards and delivery provided to the aging patient population can improve drastically. However, the main issue with this context is the lack of compassionate effort and compliance in the health care workforce to enforce those aged care policies in intricate detail (Webber, Aitken, & Jones, 2017). Many authors have suggested that the implementation of efficient leadership management in the healthcare workforce can change the scenario positively and help the health care professionals understand the severity and importance of their role as a health care provider and how change in their processes and approach can ensure optimal care delivery for the aged members of the society.

Research Questions

Considering the Australian context, the percentage of the patients over the age of 70 has increased 10 times in the last decade, and the number will continue to rise in the years to come (Myagedcare.gov.au., 2017). Hence, the need for residential aged care will expand effectively as well and in order to meet the escalating demands, the health care workforce needs to enhance skills and expertise to ensure that optimal care is being delivered without compromising on either the quality or the regulations. According to the most of literature published previously, the biggest challenge discovered to the optimal delivery of quality aged care services is the lack of proper training and skills in the health care staff and compliance with the excessive and complicating regulations enforced regularly (Gao, Newcombe, Tilse, Wilson, & Tuckett, 2016). Proper guidance and leadership can help them effectively overcome the challenges and help them provide a care of extremely high standards. This research study will attempt to determine and interpret the leadership needs in the sector associated aged care industry and also determines how leadership management strategies can help the professionals improve their skills and professional approach towards providing the most scientific and compassionate care for the elderly (Tarzia, Bauer, Fetherstonhaugh, & Nay, 2013).

The systematic review for the this research study will be based on a set of questions considering the need for appropriate leadership management in enforcing active compliance to the residential aged care protocols in the nursing care and the positive impact it can facilitate in this approach.  The questions are:

• What are the major challenges to successful implementation of all the recent and improvised aged care protocols in the Australian health care sectors, compared to other countries?
• How are these challenges associated with need for leadership management and how leadership strategies can overcome those challenges?
• What are the leadership management needs in the quality of aged care and optimal delivery scenario in Australia, compared to USA, UK and Canada?
• What can be the positive impacts that leadership management can bring to enforcing compliance to aged care policies in the residential sector?

The alarming rate, at which the aging population is increasing in Australia, is frightening; however, the scenario all over the globe is very similar. In this context, it has to be mentioned that the health care sector had never invested much attention to the aged care and its specific needs and requirements until now. However, health care authorities, both national and international, have invested attention to the health care needs of the aged members of our society and as a result many aged care policies and protocols are now being introduced to ensure optimal health care delivery to the elderly patients (Ostaszkiewicz, O’Connell, & Dunning, 2016). However, the implementation of the aged care policies across the globe is not very promising and the room for improvement is vast. Especially in case of the residential aged care, the lack of understanding and compliance in the health care staff regarding the improvised aged care policies are substantial. Many authors have suggested at the need for adequate leadership in the health care staff in order to enforce better understanding and compassionate compliance to the aged care protocols across the globe.

This research study attempts to explore the limitations to the compliance and effective implementation of aged care plans in the residential sector and how it can be overcome by enforcing a leadership management within the nursing workforce. This systematic review study will compare and contrast the data from the Australian context with that of USA, UK, and Canada to determine the need for leadership management in residential aged care, and the positive impact that the leadership strategies can bring to the improvements to residential aged health care scenario. This research study is backed by a systematic literature review including peer reviewed journals that will bridge the gaps left behind in the context of health care needs of the elderly population and how that can be met with leadership management in the mix. Furthermore, this research study can be fertile ground for researchers to establish the need for leadership management in establishing improved policies in both aged care contexts and other related public health priorities as well.

Research Scope

In order to complete a particular research study, having a clear conception of the research aims and objectives is extremely important (Jeon, Simpson, Chenoweth, Cunich, & Kendig, 2013). The primary aims of this research study will revolve around the need for a sound leadership management in successful completion of the implementation procedure of the improved aged care policies in different health care units. For this research study we have incorporated SMART research objectives to ensure that our research paper is as relevant, relatable and transferable as possible, incorporating the most recent data and literatures. The set of SMART objectives for this research study is as follows,

• The specific aim of the research will focus on determining the impact of a succinct leadership and management in place to implement and monitor the aged care policies in the health care facilities.
• The measurable aim for the research study is to determine the improvements in the compliance to the aged care policies in different health care environments with sound leadership and management plans in place.
• The research will attempt to compare the data of Australia with that of USA, UK and Canada to achieve the goal set for determining the impact leadership management can bring on improving the aged care scenario.
• In order to ensure the relevance of the research study to the recent public health priorities, our study will aim at gathering all the statistics regarding aged care challenges in place without proper leadership and management across the different nations selected and compare the data to arrive at a concise conclusion.
• This research study will utilize all the tools and techniques required to ensure that the research can be completed within the proposed timeframe positively.

Aged care is a substantial part of the health care sector, although it also been one of the most overlooked parts of the health care industry (Brownie & Nancarrow, 2013). Neither the health care industry nor the society has taken interest in improving the living standards of the aging members of the society till now and it is disheartening how the society has neglected the health and safety of the elderly (Stockhausen & Mowbray, 2015). It must not be overlooked that the aged patients have different sets of needs or requirements in a health care facility or in a health care environment, due to the restrictions put forth by age and the health related complications it comes coupled with and there has always been extreme need for special attention to the caring techniques and needs especially for the elderly patients; that is the reason why there had been improved care plan and programs, specific to cater the needs of the aged patients (Stockhausen & Mowbray, 2015). Although these plans and techniques can not be implemented effectively without a strong leadership management in place to oversee the implementation procedure of the aged care plans, and motivate the health care staff to invest time and effort in compliance with the protocols for aged care delivery (Jeon, Simpson, Chenoweth, Cunich, & Kendig, 2013).

As mentioned above, the need for effective implementation and compliance to the adequate aged care plans and policies are paramount, and in order to establish the compliance, effective leadership management in the health care workforce is absolutely necessary. This research study will attempt to investigate the benefits of proper leadership and management in place for the employees to better understand the aged care plans in detail and how to implement them and also to explore what leadership and management techniques can be the most effective in achieving the said goals by the means of comparing different policies across the chosen countries (Mackey & Gass, 2015). This research study will be based upon a systematic review which will summarize the existing literature on the same topic in order to come to a conclusion regarding the positive impact of leadership and management practices to facilitate effective implementation of aged care plans.

A systematic review can be defined as the research methodology that attempts to draw conclusion to the research questions by the means of summarizing and extracting the core elements of the previously published authentic literature. This review technique is considered as the research methodology that can delimit the probability of the research content that being biased by incorporating research techniques like systematic gathering, critical appraisal and synthesis of all appropriate and relevant studies on a specific topic (Vangrieken, Dochy, Raes, & Kyndt, 2015). It is a method of incorporating the ideas of previous research studies in order to answer the search questions and investigate areas of further research based on the chosen topic of research study. The difference between the traditional review techniques and systematic review is based on the fact that systematic research adheres to meticulous scientific protocols for the review purposes and integrates all necessary elements into the research to make it utmost valid and authentic.

Research Aims and Objectives

Systematic reviews are extremely applicable in the clinical settings by the virtue of being a highly time saving and extensively intricate researching technique, which gives the researcher the liberty to include extreme volumes of research into the study without prolonging the tenure of the research extensively. It is a technique designed to construct an accurate and exhaustive summary of the recent literature that bears relevant connection to the research questions decided for the study and provides authentic data to ensure the absolute accuracy of the study design. The information extracted from the systematic reviews are considered to be the most dependable or transferable source of information as this review not only helps in segregating the relevant information from insignificant data but also to find answers to clinical questions more accurately, hence it is by far the best research design for the evidence based medical research practices (Mackey & Gass, 2015). It also eliminates the possibility of the study having any kind of research bias due to the extensive analysis of the existing literatures and the transparent strategies used to extract the information and articulate them in the research findings. Systematic review makes the research unequivocal and completely dependent on qualitative data analysis techniques omitting the quantitative data to avoid any chances of inaccuracy or prejudice. Hence, this research study has opted for the systematic review technique for the research study in order to arrive at the most plausible conclusion regarding the need for leadership and management in implementation of aged care in residential setting and health care facilities (Jeon, Simpson, Chenoweth, Cunich, & Kendig, 2013).

The very next step for a research study after the selection of the topic is articulating a set of clear and succinct research questions. Clear research questions serve the purpose of guiding the research study in an orderly manner along with that a research question also eliminate the chances of any research bias from the systematic review completely. Studies suggest that the research questions must comply with a certain criteria in order for it to be accurate and within the point (Trahair, Horowitz, & Jones, 2014). The research questions cannot be very broad for the research to arrive at a definite and although, if the research questions are too narrow, the chances for the research study to be transferable is decreased. Hence the research questions need to be to the point but yet they need to be broad enough for there to be scope for the research to be relatable and transferable. For this particular research study the research questions were formulated before the research study to eliminate the chances of bias and escalate the chances for adequate literature search for the study to have genuine and most recent data.

As the systematic review study is acutely based upon the data and literature found in the journals and books published previously, it is important to have a sound search strategy that aligned properly with the research questions that are selected for the study. In this case, the literature search involved all relevant articles and books published from 2010 and onwards to ensure that the data collected for the research is authentic (Vangrieken, Dochy, Raes, & Kyndt, 2015).  The systematic reviews mainly utilize online databases PubMed, WebMD, CINAHL and Google scholar.

For the search items, a series of adequately broad terms were selected to ensure that the research could include as many relevant articles as possible. The search terms included Boolean operators to ensure best results, the search phrases include: ‘aged care’, ‘aged care policies’, ‘aged care in health care facilities’, ‘residential aged care’, ‘aged care health care staff’, ‘leadership in aged care’, ‘leadership management in the nursing workforce’, ‘need for leadership management in aged care’, ‘implementation of aged care policies’, etc. The entire researching process also included the medical subject headings or MeSH terms to ensure that the search conducted eliminates the probability of bias completely.

Out of all the search results, every article cannot be included in the systematic review, and hence there is a need for a particular selection criterion for the articles that were to be involved in the research study. In this research the articles with abstracts and full pdf access were selected at large. Moreover, the articles with unclear data or conclusion were rejected along with the research articles that were in any other language than English (Mackey & Gass, 2015). The research articles that involved implementation of aged care policies and the challenges associated with it along with impact of leadership management on eliminating those challenges were selected for the study. The research article that did not relate to the research question directly was excluded to ensure accuracy of the research further.

Inclusion criteria: journal articles for this research study were included if:

• They were written in English and were published in journals that are peer reviewed.
• Full text papers were available along with abstracts.
• The studies discussed the challenges to successful implementation of aged care policies.
• The studies discussed the need for leadership management in the similar context and its positive impact.
• As this research study aimed to compare the data from different countries, research studies belonging to USA, UK, Canada, and Australia has been included.

Exclusion criteria: journal articles for this research study were excluded if:

• They were published before the year of 2010.
• They were written in any language other than English.
• They were irrelevant to the key research questions.
• They were not available with full text and abstract.
• They contained incomplete, unreliable and inaccurate data.  

Serial number	Title of the article	Authors	Year of publication	Reason for selection
1.	Leadership and management skills of first?line managers of elderly care and their work environment.	Abdelrazek et al.	2010	It is a peer reviewed journal article and it clearly depicts the positive impact of leadership on the quality of care and adherence to the policies.
2.	Effective nursing leadership of older persons in the community – a systematic review.	Holm, A. L., & Severinsson, E.	2014	It is a peer reviewed article explaining in detail effective nursing leadership on person centred care for the senior patients utilizing a carefully curated systematic review.
3.	Towards person?centredness in aged care – exploring the impact of leadership.	Backman et al.	2016	It is a peer reviewed article explaining in detail effective nursing leadership on person centred care for the senior patients
4.	Nursing care of older patients in hospital: Implications for clinical leadership.	Milton-Wildey, K., & O’Brien, L.	2010	A peer reviewed journal with focus on implications of clinical leadership on particularly nursing care for the elderly.
5.	Influence of leadership on quality nursing care	Mendes, L., & de Jesus José Gil Fradique, Maria.	2014	A peer reviewed journal that provides a clear and succinct idea overall on the impact of leadership in nursing care.
6.	Policy options to improve leadership of middle managers in the Australian residential aged care setting: A narrative synthesis.	Jeon, Y., Glasgow, N. J., Merlyn, T., & Sansoni, E.	2010	Policy improvements to facilitate sound leadership for the nursing scenario, a peer reviewed
7.	Experiences of registered nurses as managers and leaders in residential aged care facilities	Dwyer, D.	2011	Peer reviewed journal that explains in details about how experienced registered nurses can play the role of clinical leaders
8.	Innovation in aged care leadership: Overcoming workforce and care quality issues?	Jeon, Y.	2014	Peer reviewed journal that explores the innovation and challenges in present day aged care
9.	The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: Design of a cluster randomised controlled trial.	Jeon, Y., Simpson, J. M., Chenoweth, L., Cunich, M., & Kendig, H.	2013	A peer reviewed randomized control trial article describing the benefits of leadership in aged care.
10.	Beyond ‘doing’: Supporting clinical leadership and nursing practice in aged care through innovative models of care.	Venturato, L., & Drew, L.	2010	Peer reviewed article explaining the challenges and solutions to aged care.
11.	Validation of a clinical leadership qualities framework for managers in aged care: A delphi study	Jeon, Y., Conway, J., Chenoweth, L., Weise, J., Thomas, T. H., & Williams, A.	2015	A peer reviewed article explaining the challenges and solutions to aged care by validating leadership management
12.	We just do the dirty work’: Dealing with incontinence, courtesy stigma and the low occupational status of carework in long?term aged care facilities	Ostaszkiewicz, J., O’Connell, B., & Dunning, T.	2016	Explaining in details the struggles and challenges to aged care sector through a peer reviewed article.

A research study will be absolutely incomplete without the inclusion of valid or authentic data, and any research procedure can involve primary data, secondary data or both. Primary data can be defined as the data that is collected in person, by questionnaires, surveys or personal interviews (Mackey & Gass, 2015). On the other hand the secondary data refers to the data that has been collected or selected carefully from the literature that has been published previously. As this is a strictly systematic review the data collected for this research study will be secondary.

Data analysis is mainly of two kinds, qualitative data analysis and quantitative data analysis. The quantitative analysis determines the result of the research by judging the data numerically, and the qualitative analysis focuses on data that is not numerical and arrives at a conclusion based on the verdict from non-numerical data. As this research involves secondary qualitative data, the data analysis process opted is qualitative analysis procedure.

Every research study that involves the human subjects will have a series of research limitations to overcome. One of the major issues with this particular systematic study includes the privacy and confidentiality of the data collected and utilized in the study (Brownie & Nancarrow, 2013). Other than that, time and the budget constraints also served to be one of the major research limitation that strongly rivalled by the availability of data on the biomedical databases.

Hodgkin and his co-authors have discussed in their research article that in the last decade the elderly population belonging to Australia have increased 10 times, and in the coming decade the expansion rate will jump to 20% (Hodgkin, Warburton, Savy, & Moore, 2017) However the authors have not taken into account the factors contributing to this rise.

Aging population of Australia (Myagedcare.gov.au., 2017)

https://www.myagedcare.gov.au

It is inevitable that in the coming decade the need for quality aged care in the Australian context will only expand; hence, the heath care sector will need to improve their skills, attitude, approach and techniques to cater to their changing needs and requirements. This review of literature will explore all the aspects of residential aged care and how leadership management can help in improving the aged care delivery and adhering to the recent guidelines and regulations (Grealish, Henderson, Quero, Phillips, & Surawski, 2015).

Aged care or in simple terms the eldercare can be defined as the task of catering to all the minute and special needs of a senior patient with complex health care needs and supporting them to carry out daily activities. The concept of aged care is not new however; there has not been enough emphasis in differentiating between the health care needs of an adult patient and a senior patient until the past few years. The term aged care can be considered as the umbrella term and it includes services like assisted living, long term care, adult day care, hospice care, and most importantly the residential care. Residential aged care is provided to the elderly patient in the health care facility by a multidisciplinary team to address the complex and complicated health needs of the particular elderly patient (Tilse & Wilson, 2013).

As mentioned by the Baldwin and his co-authors 2015, residential aged care can be of two categories, permanent residential aged care and residential respite care (Baldwin, Chenoweth, & dela Rama, 2015). Permanent residential aged acre is associated with frail senior patients with much more complicated diseases requiring permanent or long term residence in the heath care facility. On the other hand residential respite care can be defined as the short term care where a senior or elderly patient suffering with a particular ailment requires short-term health care services. There are different aged care policies that safeguard the best interest of the elderly community and ensure that the health care needs of the senior patient are being met efficiently. Taking the Australian context for example, there are different aged care packages like Community Aged Care Package (CACP), Extended Aged Care At Home (EACH) and extended Aged Care at Home for Dementia (EACHD), to cater to whatever requirements that the elderly patients are having (Myagedcare.gov.au., 2017). These packages involve a variety of different services like domestic assistance, feeding assistance, personal care, counselling, mobility assistance, and social support. According to author, the different packages are definitely meant to assist the elderly patient in receiving the specialized care that they are in need of, however, there are various internal and external challenges that hinder the policies to be rightfully implemented (Jeon, et al., 2015). The challenges however have not been discussed in acute details in the article, and the contributing factors behind these challenges have not been mentioned as well.

The context of aged care is bound by many a regulatory policies and protocols to ensure the standardization of the quality of care received by the elderly and the cost they need to bear for the same. For instance, the Australian aged care aims to minimize the costs of aged care services so that the residents only pay for only what they can afford. Furthermore, the Australian health care authorities have incorporated many regulations that ensure that the quality of the care provided to the senior patients is not compromised in any manner in order to reduce the costs for the treatment (Venturato & Drew, 2010). For the same, there are 6 legislations on which the aged care policies are developed on and these legislations guide the protocol standardization and policy making in case of the aged care services. There are 17 aged care principles that regulate the quality of care delivery and approaches taken by the health care professionals to deliver the care and most of the regulations are based on the Aged Care Act, 1997 (Myagedcare.gov.au., 2017).

Similarly the aged care policies in other nations like USA, UK and Canada are centred on improving the caring qualities for the senior patients and reducing the costs that the patients need to bear. There are a dominating number of legislations and regulations that govern the aged care standards and policies in the nations like UK, USA and Canada as well (GOV.UK, 2017). However despite the various regulations and standards the aged care statistics have not improved much and the mortality rates in the aged care facilities continue to increase.

Fatality rates in aged care sectors across nations (Stodart, 2016) https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6137a6.htm

According to Ostaszkiewicz and his coauthors 2014, any reform involving Health Care will have challenges, and the aged care sector is no exception to this phenomenon as well (Ostaszkiewicz, O’Connell, & Dunning, 2014). There are various challenges associated with a quality aged care complying with all the necessary regulations posed by the National and international authorities. One of the major challenges is the lack of training and skills in the healthcare workforce to meet the exquisite and specialized needs of elderly patients. It has to be understood that age comes coupled with a myriad of different health complications, and the senior patients are often irritated and exhausted due to the complex treatment procedures and never ending list of health related restrictions. Hence the healthcare workforce employed in the aged or end of life care sector needs to be compassionate perseverance and exquisitely skilled. This article explains the challenges and the reason behind those perfectly; however specific data about the Australian context validating the information outlined is lacking in the article. However the healthcare workforce across the Australia lack the specialized skills that will help the nursing professionals understand the different needs of an elderly patient and attempts to address them in a clinically reasonable and compassionate manner (Jeon Y. , Simpson, Chenoweth, Cunich, & Kendig, 2013).

Government expenditure in the aged care sectors in USA, Australia and UK respectively (Baldwin, Chenoweth, & dela Rama, 2015)

https://203.2.121.30/aged-care/residential-and-community-2011-12/aged-care-in-australia/

It has to be understood in this context that the majority of elderly patients requiring residential aged care are in need of palliative attention; however the aged care staff rarely has adequate knowledge and skills that are compatible with a palliative unit. Hence the patient satisfaction only continues to decrease and the mortality rates continue to increase. The research study by the Jeon, 2014 suggest that almost 60% of the nursing staff across the aged care sectors of Australia lack the proper training and skills to understand the complex and Critical palliative needs of frail elderly patients (Jeon, 2014). Moreover the majority of the workforce feel that proper training and guidance can help them radically well in performing their professional responsibility with much more competency and efficiency. Hence the need for guidance in the aged care professional workforce has become paramount. Along with Australia, aged care workforce of USA lack expertise and specialized knowledge about how to support and care for elderly patients and what protocols to follow (Dwyer, 2011). Although, the article by Dwyer does not contrast the data of Australia with the data of other relevant countries suffering with similar issues in aged care.

Another important hindering factors to successful and efficient aged care delivery across the healthcare industry is the dynamic policy changes in the elderly care division. Taking Australia for example the aged care policies are frequency modified and modified provisions are frequently added to the existing policies to improve the aged care sector drastically. However it only creates complications and confusion in the Healthcare workforce regarding the correct protocol in different clinical situations, the dynamic changes leave the healthcare workforce puzzles and exhausted; in the end they are absolutely clueless regarding the standards to follow when caring for the elderly patients in an aged care facility (Jeon, Glasgow, Merlyn, & Sansoni, 2010). The recent pre-entry leave cut policy is one such dynamics changed in the aged care sector that has created a lot of confusion and chaos the nursing workforce interfering with the optimal care delivery for the patients. There are counters similar policy changes happening all across the globe and the lack of guidance is creating highly chaotic situation and diminishing the quality and safety of the health care provided to the senior patients.

Policy changes in Australia (Myagedcare.gov.au., 2017)policy changes in UK (GOV.UK, 2017)

https://www.aihw.gov.au/reports/australias-welfare/australia-s-welfare-2015-in-brief/contents/older-australians

A crucial factor that can be considered as a hurdle in case of aged care delivery is the professional Burnout and lack of financial stability. It has to be understood that nursing or healthcare in general is an exhaustive profession, which demands both physical and emotional investment from the professional. According to Mendes and his coauthors, due to the recent inadequate staffing in the healthcare sector the workload and burnout is one of the major concerns of the healthcare authorities (Mendes & de Jesus José Gil Fradique, 2014).The percentage of increase in burnout in the staff post staffing shortage explains the direct relationship between the workload and burnout excellently in the article, although any data supporting the direct impact of burnout on lack of quality and compliance is not present. As a result of excessive pressure and burnout the healthcare professionals are unable to invest optimal efforts to their professional responsibilities and the lack of attention and effort only imparts a detrimental effect to the health and well-being of the patients. Especially in case of aged care the professional exhaustion and responsibilities are increased multiple folds catering to the complicated Health Care needs of senior patients, who face many health related restrictions such as irritation, mobility strain speech constraint, feeding assistance and chronic illnesses. In such situations the need for patience and compassion becomes pivotal in delivering optimal care. Only leadership and proper guidance can motivate and train the existing force to improve prove the professional competence and help them gain job satisfaction and inspiration for the optimal professional growth (Milton-Wildey & O’Brien, 2010).

A leader can be defined as the guide, trainer, motivator and role model, an individual who can guide the professionals in the right direction and help them achieve their goals with problem solving, inspiring and assertive skills (Dwyer, 2011). Clinical leadership can be explained by the clinical expertise in an individual in the specialty practice area who utilizes interpersonal communication skills to enable the Healthcare professionals to deliver optimal care to the patients. The clinical leaders in most cases are registered nurses efficiency and experience of significant period of years. A leader in the team of aged care Health Care professionals will provide training and support to the other team members in both educational experience and interpersonal skills. According to the Beckman and his coauthors the supported management provided by the clinical leader will enforce equality fairness justice focus reliability and transferability in the caring approach to improve the quality of care and enforce compliance to the regulatory guidelines (Backman, et al., 2016). Holm & Severinsson, 2014 have opened that the workplace culture and environment plays a pivotal role in designing quality care, having a sound clinical leadership in the team will help the professionals curate open collegial, flexible professional experience (Holm & Severinsson, 2014). Along with that a sound clinical leadership will also ensure that the disparities in the work environment that brings burnout and dissatisfaction can be overcome such as workload, pressure, inadequacy, lack of training, knowledge and confidence and lack of personal investment. Therefore, it can be said that clinical leadership in the context of aged care can bring forth expert guidance, interpersonal training and communication to help the professional find job satisfaction and motivation in providing quality aged care along with complying to regulatory guidelines in all demographics, Australian or others (Abdelrazek, et al., 2010). Although it has to be mentioned that there is a conspicuous lack of analytical cohort studies on the impact that efficient leadership management can bring to the present scenario of aged care, hence there is need for research emphasis on this particular sector of health care so that aged care can be improved drastically supporting thousands of unfortunate aging patients dealing with a multitude medical complexities. 

Abdelrazek, F., Skytt, B., Aly, M., El?Sabour, M. A., Ibrahim, N., Engström, M., & Gävle., .. .. (2010). Leadership and management of the first line managers of elderly care and their work environment. Journal of Nursing Management.

Backman, A., Sjögren, K., Lindkvist, M., Lövheim, H., Edvardsson, D., & Statistik, .. .. (2016). Towards person cemtredness in aged care-impact of leadership .  Journal of Nursing Management.

Baker, J. R., Webster, L., Lynn, N., Rogers, J., & Belcher, J. (2017). Intergenerational programs may be especially engaging for aged care residents with cognitive impairment: Findings from the avondale intergenerational design challenge. American Journal of Alzheimer’s Disease & Other Dementias,, 213-221.

Baldwin, R., Chenoweth, L., & dela Rama, M. (2015). Residential aged care policy in australia – are we learning from evidence?: Residential aged care policy in australia. Australian Journal of Public Administration.

Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8.

Cooke, F. L., & Bartram, T. (2015). Guest editors’ introduction: Human resource management in health care and elderly care: Current challenges and toward a research agenda. Human Resource Management, 711-735.

Dwyer, D. (2011). Experiences of registered nurses as managers and leaders in residential aged care facilities: A systematic review. International Journal of evidence based health care.

Edberg, A. K. (2015). Job strain and stress of conscience among nurse assistants working in residential care. Journal of nursing management, 368-379.

Gao, F., Newcombe, P., Tilse, C., Wilson, J., & Tuckett, A. (2016). Challenge-related stress and felt challenge: Predictors of turnover and psychological health in aged care nurses. Collegian.

GOV.UK, O. p. (2017, August 26). Older people – GOV.UK. Retrieved from Gov.uk. : https://www.gov.uk/government/policies/older-people

Grealish, L., Henderson, A., Quero, F., Phillips, R., & Surawski, M. (2015). The significance of ‘facilitator as a change agent’ – organisational learning culture in aged care home settings. Journal of Clinical Nursing, 961.

Haines, H. M., Bannon-Murphy, H., Amos, T., & Krones, R. (2016). Prevalence and management of diabetes in residential aged care facilities in north-east victoria, australia. Australian Family Physician.

Hodgkin, S., Warburton, J., Savy, P., & Moore, M. (2017). Workforce crisis in residential aged care: Insights from rural, older workers. Australian Journal of Public Administration.

Holm, A. L., & Severinsson, E. (2014). Effective nursing leadership of older persons in the community – a systematic review.  Journal of Nursing Management.

Jeon, Y. (2014). Innovation in aged care leadership: Overcoming workforce and care quality issues? . Australian Nursing and Midwifery Journal.

Jeon, Y., Conway, J., Chenoweth, L., Weise, J., Thomas, T. H., & Williams, A. (2015). Validation of a clinical leadership qualities framework for managers in aged care: A delphi study. Journal of Clinical Nursing, 999-1010.

Jeon, Y., Glasgow, N. J., Merlyn, T., & Sansoni, E. (2010). Policy options to improve leadership of middle managers in the australian residential aged care setting: A narrative synthesis. BMC Health Services Research, 190.

Jeon, Y., Simpson, J. M., Chenoweth, L., Cunich, M., & Kendig, H. (2013). The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: Design of a cluster randomised controlled trial. Implementation Science.

Kallio, S., Kumpusalo-Vauhkonen, A., Järvensivu, T., Mäntylä, A., Pohjanoksa-Mäntylä, M., & Airaksinen, M. (2016). Towards interprofessional networking in medication management of the aged: Current challenges and potential solutions in finland. Scandinavian Journal of Primary Health Care, 368-376.

Mackey, A., & Gass, S. M. (2015).  Second language research: Methodology and design. . Routledge.

Mendes, L., & de Jesus José Gil Fradique, M. (2014). Influence of leadership on quality nursing care. International Journal of Health Care Quality Assurance, 439-450.

Milton-Wildey, K., & O’Brien, L. (2010). Nursing care of older patients in hospital: Implications for clinical leadership. Australian Journal of Advanced Nursing.

Myagedcare.gov.au. (2017, August 26). Myagedcare.gov.au. . Retrieved from meta.og.title.: https://www.myagedcare.gov.au

Ostaszkiewicz, J., O’Connell, B., & Dunning, T. (2014). Ethical challenges associated with providing continence care in residential aged care facilities: Findings from a grounded theory study. Australian and New Zealand Continence Journal, 179-186.

Rokstad, A. M., Vatne, S., Engedal, K., & Selbæk, G. (2015). The role of leadership in the implementation of person?centred care using Dementia Care Mapping: a study in three nursing homes. Journal of nursing management.

Stanley, D., Latimer, K., & Atkinson, J. (2014). Perceptions of clinical leadership in an aged care residential facility in Perth, Western Australia. Health Care: Current Reviews.

Stockhausen, L., & Mowbray, C. (2015). Evaluation Of A Leadership In Aged Care Clinical Placement In An Undergraduate Bachelor Of Nursing. HNE Handover: For Nurses and Midwives, 8.

Stodart, K. (2016). Rewards arise out of ARC’s challenges: Due to the autonomous nature of the work, an RN in aged residential care can develop and use her skills to a high degree, a dedicated aged-care nurse believes.(profile)(gene ruiz on aged residential care challenges). Kai Tiaki: Nursing New Zealand, 24.

Tarzia, L., Bauer, M., Fetherstonhaugh, D., & Nay, R. (2013). nterviewing older people in residential aged care about sexuality: Difficulties and challenges.  Sexuality and Disability.

Tilse, C., & Wilson, J. (2013). Recognising and responding to financial abuse in residential aged care.  The Journal of Adult Protection, 141-152.

Trahair, L. G., Horowitz, M., & Jones, K. L. (2014). Postprandial hypotension: a systematic review. Journal of the American Medical Directors Association, 394-409.

Van Bogaert, P., Dilles, T., Wouters, K., & Van Rompaey, B. (2014). Practice environment, work characteristics and levels of burnout as predictors of nurse reported job outcomes, quality of care and patient adverse events: A study across residential aged care services. Open Journal of Nursing, 343.

Vangrieken, K., Dochy, F., Raes, E., & Kyndt, E. (2015). Teacher collaboration: A systematic review. Educational Research Review, 17-40.

Venturato, L., & Drew, L. (2010). Beyond ‘doing’: Supporting clinical leadership and nursing practice in aged care through innovative models of care. Contemporary Nurse.

Webber, L., Aitken, J., & Jones, L. (2017). Challenges to collaborative practice in the aged care setting. The Journal for Nurse Practitioners, 343.

Images retrieved from:

https://www.myagedcare.gov.au

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6137a6.htm

https://www.aihw.gov.au/reports/australias-welfare/australia-s-welfare-2015-in-brief/contents/older-australians

https://www.aihw.gov.au/reports/australias-welfare/australia-s-welfare-2015-in-brief/contents/older-australians