title: Breaking traditions of practice: workforce challenges in implementing disability service standards within purpose-built accommodation for younger adults.
abstract: Inadequate community housing and support for adults under 65 years with complex health needs often leads to residential aged care placement. In 2006, Australian government authorities funded a range of supported housing alternatives for younger adults requiring access to 24-hour support including the Integrated Living Model (ILM). The ILM provided purpose-built accommodation for 10-20 people and represented a change in practice from traditional 24/7 nursing care toward a more holistic, individualised approach.
  
  
  OBJECTIVE
  Examine workforce challenges in implementing disability service standards (DSS) within an ILM.
  
  
  METHODS
  Thematic Analysis of workforce practices was conducted by coding staff interviews (n = 20) against the prevailing DSS.
  
  
  RESULTS
  Emerging challenges identified against each standard were: expectation management; coordination; client expertise; blurred boundaries; role confusion; valued status beyond client; unclear practice boundaries; multilayered communication; reflective practices; and mixed service model responses.
  
  
  CONCLUSIONS
  This ILM setting requires workforce development in rights-based practice, personalisation and effective communication. Key paradigm shifts are also recommended.
authors.affiliation: a School of Human Services and Social Work , Griffith University (Logan campus) , University Drive, Meadowbrook QLD 4131 , Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Crozier
authors.affiliation: b Centre for National Research on Disability and Rehabilitation Medicine (CONROD) , Griffith University (Logan Campus) , Meadowbrook QLD 4131.|c Menzies Health Institute Queensland , Griffith University (Logan Campus) , Meaowbrook QLD 4131.
authors.forename: Heidi
authors.initials: H
authors.lastname: Muenchberger
authors.affiliation: b Centre for National Research on Disability and Rehabilitation Medicine (CONROD) , Griffith University (Logan Campus) , Meadowbrook QLD 4131.|c Menzies Health Institute Queensland , Griffith University (Logan Campus) , Meaowbrook QLD 4131.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040561:Assisted Living Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D001315:Australia; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019145:Rehabilitation Nursing / Q000592:standards*; D055815:Young Adult
keywords: disabilities; holistic needs; nursing practice; residential; service standards; workforce; younger adults