Knowledge and skills for standing in Osteopathy Australia’s Aged Care Clinical Practice Group (CPG)

Improving outcomes for older adults

People aged 65 years or above are Australia's fastest-growing demographic; by 2030, older adults will make up more than 20% of the population. The number of people aged over 85 and older will more than triple between 2022 and 2023¹. Those aged 85 years and over are the key consumers of aged care services². These older adults are prone to frailty and co-morbidities that impact their independence and wellbeing, and activities of daily living can become increasingly difficult to perform without assistance or supervision for safety. Aged care expenditure makes up one of the top five long-term spending categories for the Federal government¹ Most Australians will require aged care services when they reach old age, which is being driven by a growing and older population.

As primary health care practitioners, osteopaths can help older adults requiring assistance with mobility, pain, and cognition to either continue to live independently in their own homes or comfortably in supported accommodation.

The osteopathic profession

Osteopaths in Australia complete a double Bachelor or a Bachelor and Master qualification at an accredited university and are registered with the Australian Health Practitioner Regulation Agency (AHPRA).

Osteopathy Australia is the peak professional body, representing approximately 90% of registered osteopaths in Australia. The osteopathic profession is becoming increasingly diversified, with many members of Osteopathy Australia completing further tertiary qualifications in specific areas of clinical practice to expand their clinical skills. Others, through dedicated experience, have developed core competencies and skills relating to specific clinical issues and patient groups.

Promoting clinical excellence in osteopathic practice

Current evidence suggests an interdisciplinary approach promotes the best clinical outcomes. To facilitate excellence in interdisciplinary care between osteopaths and other health professions, the development of quality clinical practice is vital.

Designing Continuing Professional Development (CPD) pathways that promote key clinical skills in specific areas of practice and processes that recognise members withstanding in areas of practice is a priority for Osteopathy Australia. This strategic focus will build on and complement Osteopathy Australia’s Statement of Scope of Practice in Osteopathy.

Purpose of this framework

This framework acknowledges that the knowledge, skills, and scope of practice of osteopaths with a focus on aged care vary depending on education, workplace requirements, clinical team requirements, and relevant industry policies. It is not intended to define all knowledge sets and skills possessed by these osteopaths, nor all interventions these practitioners offer.

The framework relates to Osteopathy Australia’s Aged Care Clinical Practice Group (CPG). It outlines knowledge and skills that the organisation expects osteopaths seeking standing and recognition within this group to possess as a minimum requirement. This framework is not mandatory and pertains only to members of the CPG.

During the COVID-19 pandemic in 2020, the number of osteopaths working in aged care settings increased substantially and rapidly. To ensure that osteopaths continue to practice in a fashion that is safe and effective in this unique setting, this document seeks to outline broad competencies for formal extended and advanced practice certifications under the Osteopathy Australia (OA) clinical skills recognition pathways.

While there is a need for additional assessment of competency in caring for older adults, the standard training packages offered for osteopathy in Australia do allow for the effective integration of osteopaths into allied healthcare teams. Graduate osteopaths can safely and effectively provide examination and diagnosis of primary musculoskeletal pain, manual therapy, as well as ergonomic and lifestyle advice of non-complex patients, under broader supervision within a care team, within the generally accepted scope of osteopathic practice.

Definitions

Older adults: A person aged over 65 (or 50, for Aboriginal and/or Torres Strait Islander Peoples).

Residential aged care facility (RACF): An aged care facility, where larger numbers of older adults live full-time and are cared for by medical, nursing, and allied health staff.

Independent and Assisted Living (IAL): A hybrid model of care in a single home, provided by the aged care service, where an older person lives, and is visited by healthcare professionals as needed.

Home care is a service delivery in which the older person receives required aged care support in their home.

Extended practice recognition: An osteopath who has demonstrated adequate skill and knowledge to be able to practice in an aged care context safely, and effectively.

Advanced practice recognition: An osteopath who has demonstrated significant skill and knowledge, who can provide high-level care, management, and leadership in an aged care context.

 

Extended Practice Recognition

Osteopaths who achieve extended practice recognition should be able to provide:

1. Appropriate risk screening for relevant psychological, cognitive, and physical pathology
2. Safe and effective, evidence-based musculoskeletal care for older adults in RACF or IAL
3. Tailored exercise programs to older adults, appropriate to an individual’s physical and cognitive condition
4. Understanding of the medical and legal frameworks as relevant to aged care provision
5. Safe, respectful, and effective management and handling of older adults in care

An osteopath who achieves extended practice recognition would be expected to show exposure to aged care environments, including additional training or professional development in the space. They would typically be providing clinical services in an aged care delivery service of some kind, as part of a broader care team for older adults. The osteopath would be required to show evidence of experience or formal training in these areas.
 

1. Appropriate risk screening for relevant psychological, cognitive, and physical pathology

To offer safe and appropriate care, an extended practice certified osteopath should:

• Show understanding of the clinical manifestations and risk factors associated with:
  • Early cognitive impairment and dementia
  • Osteoporosis and sarcopenia
  • Frailty
  • Falls
  • Malnutrition and dehydration

• Understand the use of relevant risk stratification and screening tools commonly used in an aged care setting, such as the psychogeriatric assessment scales (PAS) and Falls risk assessment tool (FRAT), as well as appropriate pain outcome measures and cognition measures for consent
• Be able to identify indicators associated with important geriatric disease and other issues including:
  • Mental health conditions
  • Elder abuse
  • Malignancy
  • Cardiovascular disease
  • Respiratory disease

2. Safe and effective musculoskeletal care for older adults in care

To demonstrate that an extended practice osteopath can provide safe musculoskeletal care and advice, they should:

• Show understanding of current best practices in the management of musculoskeletal conditions relevant to older adults, including:
  • Chronic musculoskeletal pain
  • Osteoarthritis
  • Osteoporosis and sarcopenia
  • Frailty

• Demonstrate experience providing manual therapies to older adults in care facilities
• Demonstrate evidence-based application of treatment and advice in the context of osteopathic practice
• Understand the role of an osteopath in the inter-professional collaborative care team in aged care
• Understand and interpret mobility assessments and requirements, gait aids, and fall management plans.

3. Tailored exercise programs to older adults, appropriate to an individual’s physical and cognitive condition

Given the critical role of physical activity in the health of older adults, an extended-practice osteopath should:

• Show understanding of the evidence and recommendations for physical activity and exercise in older adults
• Demonstrate ability to design and deliver safe therapeutic exercise in older adult populations
• Demonstrate experience leading older adults in supervised exercise.

4. Understanding of the medical and legal frameworks as relevant to aged care organisations

To safely and effectively work within a broader aged care context, an extended practice osteopath should:

• Demonstrate effective knowledge of the legislative and medicolegal requirements of working in aged care institutions, e.g. AN-ACC, Professional Negligence and conduct, MyAgedCare
• Demonstrate understanding of important implications of cognitive impairment, authorised medical treatment decision-maker representation
• Understand the role, responsibility, and scope of an osteopath and an allied health professional in the aged care sector, within a larger collaborative team

5. Safe, respectful, and effective management, and handling of older adults in care

To be able to work safely in an aged care setting, an extended-practice osteopath should demonstrate:

• Experience operating critical equipment such as personnel lifts in a way that is safe for the user and operator
• Ability to apply effective manual handling when moving older adults
• Understand the rules and regulations about restraint in older adults.

 

Advanced practice recognition and titling

Advanced practice titling recognises significant skill and expertise in the management of older adults in care. An individual receiving advanced titling would be expected to have significant experience working in aged care facilities and organisations. They would typically be able to work autonomously, without direct supervision and oversight, and manage more medically complex patients and procedures. An advanced practice titled osteopath would commonly lead other allied health team members in developing management and care plans. They would lead advanced diagnosis and management in complex cases and oversee patient care.

In addition to clinical duties, an advanced practice osteopath is likely to be involved in more complex planning of aged care service acquisition with patients and their carers, complex case management, and coordination of health teams. Additionally, an advanced practice osteopath would be a leader, both locally and at a professional level, providing guidance, education, and advice on the clinical care of older adults. They would also contribute to the evidence base surrounding the care of older adults, whether through the production of research, its clinical dissemination, or the professional development of others.

Broadly, an advanced practice osteopath would be able to demonstrate excellence in these domains:

1. Clinical excellence in the care of older adults with complex health needs
2. Inter-professional and healthcare leadership in aged care
3. Evidence-based practice and training development in osteopathic aged care
4. Care planning for older adults with complex health needs.

 

1. Clinical excellence in the care of older adults with complex health needs

An advanced practice osteopath would be able to demonstrate evidence supporting the following, in addition to the requirements of extended practice:

• Development and execution of effective management plans for patients with complex multi-morbidity
• Coordination of referrals to additional care providers as necessary, including both medical and allied health services
• Application of treatment and management strategies in complex settings, such as palliative care, oncology, respiratory disease, cardiovascular disease and cognitive impairment
• Awareness of medication issues in aged care and the role of Residential Medication Management Review Services in supporting the safe and quality use of medicines in aged care.

2. Inter-professional and healthcare leadership in aged care

An advanced practice osteopath will be able to demonstrate evidence of health leadership in an aged care setting, not only contributing to the care of older people but leading and overseeing their management as part of a broader allied health team. This would include evidence of:

• Ability to manage patient care as they interface with a range of other allied healthcare professionals as they perform discipline-specific roles
• Understanding of the different allied health services required, and the frameworks that underpin them (i.e. funding, referral structures, etc.)
• Leadership in patient care, with capacity for safe and effective planning and delivery of high-level services, such as falls risk management plans
• Engage with the planning and delivery of multi-disciplinary care plans, including with medical, allied health, and nursing personnel.

3. Evidence-based practice and training development in osteopathic aged care

An advanced practice osteopath will be able to demonstrate a commitment to the development and furthering of the evidence base surrounding osteopathic care in older adults. This may include evidence of:

• Production of high-level, peer-reviewed evidence in aged care (e.g. case studies, reviews, or other research)

• Research mentoring and training of others, whether in the community more broadly or in aged care specifically
• A commitment to the integration of evidence into practice at all levels, understanding the medical, nursing, and allied health literature base as it pertains to aged care.

4. Care planning for older adults with complex health needs

An advanced practice osteopath will show clinical excellence in the management of complex cases, including dealing with patients in specialist medical settings. This will include evidence of:

• Understanding the medicolegal and care frameworks in palliative care, including the role of osteopaths and allied health in this - including an understanding of transitions to palliative care
• Safely and effectively manage patients in important specialist settings, such as oncology, pulmonology, neurology, and cardiology, showing an understanding of the role and requirements of osteopaths and allied health providers in these contexts. This includes an understanding of best practice in the provision of neurological care particularly for neuro-rehabilitation cases (such as stroke recovery, dementia, Parkinson's Disease, Multiple Sclerosis, neuropathies, etc), and the appropriate role of osteopaths in this context.

Prepared by: Dr. Jack Feehan, Ph.D. – Senior Research Fellow, Interventions in Healthy Ageing and Chronic Disease Program, The Institute for Health and Sport, Victoria University