A Survey of Intergenerational Programs in Australian Residential Aged Care Homes During the COVID-19 Pandemic

ABSTRACT

People living in residential aged care homes in Australia often have limited opportunities for meaningful social engagement. The present study aimed to characterize the state of intergenerational programs in residential aged care within a nationwide Australian sample. A total of 572 valid survey responses were received. A large number of aged care homes had existing programs, but only 18.2% had active programs; 44.4% reported their programs as temporarily suspended, predominantly due to COVID-19. The most common activities included singing (67.8%), games (56.8%), reading (51.1%) and craft (41.5%). Mental health and wellbeing, opportunity to socialize, and connection with the community were considered as the main benefits. There is consensus on the benefits of well-placed programming and engagement. Several barriers and challenges to engagement exist, including the COVID-19 pandemic. Aged care homes need adequate information and support to increase their ability to offer intergenerational programs between residents and community members.

Contribution to the field

• The survey provides insight into intergenerational programs in Australian aged care homes during the COVID-19 pandemic

• Staff completing the survey reported positive views of the benefits of the programs to both old and young participants

• The findings highlight the diversity of participants’ ages, places, mode of delivery and types of activities – frequently singing, games, reading and craft, but also dancing and reminiscence, and even robotics. While COVID-19 posed significant challenges, there were creative solutions including written letters and shared journals, virtual interaction and simple strategies such as access to areas where residents could observe children at play or in passing.

KEYWORDS:

• aged care
• survey
• nursing home
• intergenerational relations
• children

Background

In Australia in 2022, approximately 190,000 people were living in residential aged care homes (also referred to as nursing homes or long-term care or permanent care) (Aged Care Quality and Safety Commission, 2022). Social isolation is of particular concern for older people living in aged care. The Royal Commission into Aged Care Quality and Safety in Australia highlighted the importance of mental health and social wellbeing for people living in aged care homes (Royal Commission into Aged Care Quality and Safety, 2021). Interventions that include opportunities for social connection in a group-based format have been identified as effective at reducing social isolation (Dickens et al., 2011). The provision of opportunities for meaningful engagement is both a requirement for aged care providers and has been identified as an indicator of quality within the aged care setting (Australian Government, 2021). However, the COVID-19 pandemic has restricted visitors and social programs within residential aged care, possibly compounding the impact of social isolation on older people’s health and wellbeing (Brydon et al., 2022; Low et al., 2021).

Intergenerational programs can enable connection with community, social relationships and offer the opportunity for meaningful engagement for all involved. These programs have been variably defined in the literature, with a common central theme of providing the opportunity for two generations, typically children or adolescents and older people, to interact in a positive and mutually beneficial way (Giraudeau & Bailly, 2019). This opportunity for social connection is of critical importance for older people who are more likely to experience loneliness and social isolation (DiPerna et al., 2023; Kenning et al., 2021). Challenges associated with loneliness and social isolation are even more problematic in the residential aged care setting as relationships can often be more superficial and there can be difficulty connecting with people of differing mental capacity (Gardiner et al., 2020).

Numerous benefits of intergenerational programs for young and older people have been described, and there is increasing interest in implementing these programs within the residential aged care context (Laging et al., 2022). Benefits ranging from increased quality of life, decreased depressive symptoms and subjective health among older people have been identified (Ronzi et al., 2018). Benefits for children and young people have also received attention, with some evidence of impacts on attitudes toward older people and aging, improved communication skills and prosocial behavior (Kessler & Staudinger, 2007). While positive benefits of intergenerational programs are often described, findings from a recent systematic review identified substantial heterogeneity and lack of reliable outcome measures that would improve the ability to examine outcomes (Peters et al., 2021).

While the evidence for program benefits remains unclear, there is broad interest and enthusiasm for these programs from the community at large, with findings from a study of over 250 participants in Australia revealing support and interest from older people, parents of young children, carers, and aged care workers (Kenning et al., 2021). This sentiment is reflected in the popularity of the Australian Broadcasting Corporation documentary series “Old People’s Home for Four Year Old’s” which ranked as the second most viewed non-children’s program of 2021 on this national network (Australian Broadcasting Corporation, 2021). However, while there is growing interest in the use of intergenerational programs within residential aged care, the availability and characteristics of these programs in Australian aged care is unclear. Further, the perspective of residential aged care workers on the benefits and challenges associated with intergenerational programs is not well understood.

The current study aimed to characterize intergenerational programs available within the Australian residential aged care setting. With this in mind, we aimed to understand the number of aged care homes with an existing intergenerational program, the programs offered, and identify the perceived benefits along with barriers and challenges associated with offering intergenerational programs within this setting.

Methods

We conducted a cross-sectional online survey of Australian residential aged care staff. Ethical approval was granted by the University of Canberra Human Research Ethics Committee (20229332). A nested mixed methods approach was taken (Shorten & Smith, 2017). The main design of the study is a quantitative questionnaire, as there is scarce data describing intergenerational programs in residential aged care in Australia. Questions were embedded into the questionnaire to elicit further insight into intergenerational programs and are presented descriptively and in a qualitative narrative descriptive analysis.

Sample

A database of Australian residential aged care services was compiled from the Australian Government GEN Aged Care Data (Australian Institute of Health and Welfare, 2021). A total of 2,704 services offering residential aged care places were identified in Australia as of June 2021. This study did not include services exclusively providing respite or day care services.

Three researchers worked to contact all organizations by e-mail and alternatively by telephone if required to invite them to participate. A single staff member with knowledge of the activities offered to residents in their workplace was invited to complete the survey. The survey was available online, and a link was sent directly to services based on publicly available contact information. For several large providers with multiple sites, key informants within the organization identified the relevant individual staff member at each site and assisted in distributing survey links to that staff member. Participants were initially directed to a participant information form and informed consent page before proceeding to the questionnaire. Surveys were completed online and took approximately 10 minutes to complete. Where no response was received after 2 weeks, a follow-up e-mail was sent. Data collection was conducted between December 2021 and November 2022. During this time, most residential aged care homes in Australia continued to implement COVID-19 visiting restrictions according to government guidelines, which included temperature screening, use of personal protective equipment such as masks, rapid antigen self-tests for staff and visitors and restriction of the number of people (including children) allowed to enter the aged care home (Australian Government 2021).

Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Canberra. REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies.

Measures

A survey consisting of 25 items was developed by the authors based on study aims for the purposes of this study and piloted. The survey included three sections. First, brief questions were asked about the nature of the respondent’s role and characteristics of the aged care home. The second section focussed on the characteristics of intergenerational programs where programs were offered (including type of program, duration and frequency), the characteristics of program participants, the perceived benefits, and the perceived barriers or challenges related to these programs. Finally, respondents were given the option of providing their demographic characteristics. Questions included fixed choice responses and the opportunity to include free text responses where further information could be provided or fixed choice responses were not applicable. Free text responses enabled participants to provide additional descriptions to compliment or support their responses to survey questions where “Other” was provided as an option or where further detail was requested to elicit additional information on future plans for an intergenerational program. At the end of the survey, an open-ended question asked participants if they had any other comments about intergenerational programs in residential aged care. The survey is available from the authors upon request.

Analysis

Descriptive statistics were calculated using SPSS (Version 28.0). Normally distributed data are displayed using mean and standard deviation. Non-normally distributed data are displayed using median and interquartile range. As several questions included an “Other” option, this data is reported descriptively. For questions on whether the aged care home is planning an intergenerational program in the future and the final question on general thoughts on intergenerational programs, a qualitative narrative descriptive analysis of text-based responses was conducted as a form of naturalistic inquiry (Colorafi & Evans, 2016) to compliment the quantitative survey data. Two authors reviewed and summarized the responses (S.M & D.G), and a third author checked and confirmed the analysis (N.M.D).

Results

Characteristics of participants and their responses are presented in Table 1. A total of 572 responses were received from designated staff members at the aged care homes. Of these responses, 58% were in the lifestyle and activities coordinator or manager role, while 22% were aged care home managers. A smaller proportion of respondents identified their primary role as “other” (4.9%), while others specified their roles as lifestyle and activities assistants (4.5%), diversional therapists (3%), clinical care managers (3%), occupational therapist (2.1%), registered nurse (1.6%) and administration (.9%).

Table 1. Characteristics of respondents.

		n	%
State	NSW	239	41.8%
	VIC	141	24.7%
	ACT	11	1.9%
	QLD	71	12.4%
	SA	40	7.0%
	TAS	14	2.4%
	WA	51	8.9%
	NT	5	0.9%
Geographical area	Major city or metropolitan	226	39.9%
	Regional city or town	197	34.7%
	Rural area	132	23.3%
	Remote area	12	2.1%
Ownership model	Non profit or charity	312	55.5%
	Private	157	27.9%
	Government	59	10.5%
	Religious	16	2.8%
	Community based	15	2.7%
	Other	3	0.5%
Primary role or title	Residence manager	126	22.0%
	Clinical care manager	17	3.0%
	Registered nurse	9	1.6%
	Lifestyle and activities coordinator or manager	332	58.0%
	Lifestyle and activities assistant	26	4.5%
	Diversional therapist	17	3.0%
	Occupational therapist	12	2.1%
	Administration	5	0.9%
	Other role	28	4.9%
Age	18–24	11	1.9%
	25–34	67	11.8%
	35–44	96	16.9%
	45–54	228	40.2%
	55–64	81	14.3%
	65–74	39	6.9%
	75 years or above	25	4.4%
	Unknown	25	4.4%
Gender	Female	500	88.0%
	Male	58	10.2%
	Other	2	0.4%
	Unknown	12	2.1%

Responses were received from all states and territories, with the majority of responses from New South Wales (41.8%) and Victoria (24.7%). Most respondents were from either a major city or metropolitan area (39.5%) or a regional city or town (34.4%). Responses were also received from rural (23.1%) and remote (2.1%) areas. Our sample included a lower proportion of those from major cities relative to the data for all aged care in Australia (aged care data 63% major cities) and a higher proportion of those from regional (inner regional 24%) and rural areas (outer regional 11.76%) and similar for remote areas (1.55%).

More than half of responding aged care homes were from a nonprofit or charity ownership model, while 27.9% were from a private organization, 10.5% from a government organization, 2.8% from a religious organization, 2.7% from a community-based model, and 0.5% identified as “other” ownership model (not known).

Availability of intergenerational programs

Of the 572 aged care homes, 18.2% currently offered an intergenerational program, while 44.4% offered an intergenerational program that was temporarily suspended. Among those who reported a suspended intergenerational program, most indicated that the program was last offered in 2019 (n = 76, 38%), 2020 (n = 86, 43%) and 2021 (n = 30, 15%). Programs were offered in the past but not at the current time by 23.4% of aged care homes and 14% of aged care homes had reportedly never offered an intergenerational program (Table 2).

Table 2. Intergenerational programs in residential aged care.

	N	%
Intergenerational program is suspended temporarily (e.g. due to the COVID-19 pandemic)	254	44.4
Do not currently offer an intergenerational program but have in the past	134	23.4
Currently offer an intergenerational program	104	18.2
Never offered an intergenerational program	80	14.0

Of those who did not currently offer a program (38%), 27.6% (n = 59) were aware of plans to introduce a program in their aged care home in the future. When asked to describe the plans if they were known to the respondent, 54 respondents described various stages of initiation and planning for programs, such as having made initial contact with local schools. Several described COVID-19 as an expected barrier to the implementation of programs. Thirty-seven percent of respondents (n = 79) said there are no current plans to introduce a program, and 24.3% (n = 52) did not know if there were plans to start an intergenerational program. A small proportion (11.2%, n = 24) of respondents selected “Other” and provided a detailed response about future plans to introduce a program. More than half of these responses (n = 13) referenced COVID-19 as the key influence as to whether they will introduce an intergenerational program in the future. A higher percentage (32.1%, n = 43) of respondents from aged care homes that previously offered programs reported plans for a future program compared to those who had never offered a program (20%, n = 16).

Intergenerational program location

Most intergenerational programs (including those that were temporarily suspended) were conducted on-site at the aged care home and involved younger people visiting residents at the aged care home (n = 287, 80.6%). Of these, a small proportion involved visiting young people at a co-located aged care home on the same or directly adjacent grounds (n = 26, 7.3%). Few respondents described programs that required residents to go off-site and visit a childcare, preschool or school site (n = 15, 4.2%) or other community-based location (n = 4, 1.1%). Other delivery modes included virtual programs, both on- and off-site visits, and pen pal or letter-writing programs.

Intergenerational program participants

Including responses from participants who reported a temporarily suspended program, the young people participating in the programs were predominantly drawn from a childcare center, preschool or school (n = 313, 87.4%), with the remainder coming from a community organization, charity, or group (n = 50, 14%) or the wider community (n = 45, 12.6%). The age of the young people was most commonly children and pre-schoolers aged 3–5 years (58.9%, n = 211), but ranged from babies to young adults (7%, n = 25), as presented in Figure 1.

Figure 1. Age of young participants taking part in intergenerational programs.

Note. Percentages do not add to 100 as respondents could select more than one age group.

Most respondents (n = 314, 88.2%) indicated that all residents were eligible to participate in the intergenerational program. Among those who stated not all residents were eligible to participate (n = 42, 11.7%), eligibility was determined based on a range of factors, including resident interests, needs and abilities. Of these, eight respondents described capacity to engage in the program, while seven respondents described resident choice or interest as factors which determine inclusion in the program. Other respondents described reasons for exclusion, including the presence of aggressive behavior (n = 7), cognitive ability (n = 3), criminal history (n = 1), ability to travel by car (n = 1), and physical appearance (n = 1). Two respondents specifically cited dementia as a reason for program exclusion.

The median number of residents taking part in the groups was 15 (IQR 10) and the median number of young people and their parents or carers was 10 (IQR 10).

Program characteristics

Respondents indicated that the programs were conducted at intervals ranging from once per month (n = 103, 29.2%), once per week (n = 82, 23.2%) or once per fortnight (n = 76, 21.5%) or on special occasions, holidays, or events (n = 52, 14.5%). The duration of the program ranged from less than one hour (n = 122, 34.3%), between one and two hours (n = 219, 61.5%), more than two hours (n = 5, 1.4%) or other duration (n = 10, 3.7%). One respondent described an all-day program.

The focus of the programs varied, and most respondents identified more than one main activity conducted in the program. The most common activities included singing (67.8%), games (56.8%), reading (51.1%) and craft (41.5%). A full list is displayed in Figure 2. Other activities described by respondents included reminiscence, life stories and conversation (n = 20), dancing (n = 5), celebrating special events and occasions (n = 7), knowledge sharing (n = 5), general play (n = 12), sharing food together (n = 4), and a robotics activity (n = 1).

Figure 2. Main focus of intergenerational programs.

Note. Percentages do not add to 100 as respondents could select more than one activity.

Perceived benefits of intergenerational programs

An overview of program benefits is presented in Table 3. Ninety-three percent of respondents with existing programs identified mental health and wellbeing as a benefit, and 92.6% of respondents identified connection with the community as a benefit. Most respondents (88%) identified the opportunity to socialize as a program benefit, and 82.6% identified engagement in meaningful activities as a benefit. Over 75% identified generativity or passing on of knowledge and wisdom as a perceived benefit. A sizable proportion of respondents identified improved physical health (35.9%) or learning new skills (31.6%) as benefits.

Table 3. Program benefits.

	Responses		Percent of Cases
	N	Percent
Mental health and wellbeing	327	18.5%	93.2%
Connection with the community	325	18.4%	92.6%
Opportunity to socialise	309	17.5%	88.0%
Engaging in meaningful activities	290	16.4%	82.6%
Generativity, or passing on of knowledge and wisdom	268	15.1%	76.4%
Physical health	126	7.1%	35.9%
Learning new skills	111	6.3%	31.6%
Other	14	0.8%	4.0%

Other benefits described by respondents included “connection with culture and spirituality,” reciprocal benefits related to social contact between young and old, building friendships, fostering respect, and reminiscence. Several respondents described the sense of enjoyment both younger and older people gain from the interactions which extend beyond the older and younger people who are the program participants. Staff members who were involved in the programs or had observed the impact of the programs on residents described individual benefits, such as positive emotions and role satisfaction.

The benefits of having children visiting the home are immense. Watching how the residents interact with the children is heart-warming. Residents who may not participate or engage in daily activities love seeing the children.

The families of both residents and children as well as the teachers are enjoying it so much. I look forward to delivering the journals each fortnight and seeing the smiles on the residents faces when they read their stories. It is wonderful.

“Maintaining consistency and regularity is important for establishing meaningful relationships.”

The children are amazed at what knowledge the older folk have, and it also breaks the barrier of children’s perception of what a nursing home looks like.

We have found it extremely beneficial for our residents, their entire demeanour, even for a short period of time, changes completely.

I think it is very important for not just our residents but also you get people to have that interaction. For our residents, it’s the visits and something to look forward too [sic], for the younger generations, there is a wealth of knowledge that, if interested, they can learn.

More than half of respondents (n = 317) provided a general comment when asked if they had any other comments about intergenerational programs in the residential aged care setting. These responses generally included positive sentiments about intergenerational programming and the impact on both older residents and younger people involved.

Intergenerational programs are great things. A lot of people in aged care crave to be around kids as they offer the unexpected but also comfort. Kids will remind them of their own but will also shock them with new and wacky things which makes their entire day.

I feel intergenerational program[s] offer a sense of belonging for both seniors and children. It allows seniors to tell their stories and for children to learn first-hand history. Children tend to remember a basis of history, when it has been told by someone they have created a bond with.

Barriers and challenges to engaging in intergenerational programs

The barriers and challenges to program delivery identified among respondents with existing programs (active or suspended) included practical concerns (21.2%), staffing (19.6%), safety concerns (13.3%) and lack of community interest (11.1%). A large proportion of respondents (n = 105) provided a text-based response describing other challenges. The most common response regarding existing programs was the impact of COVID-19 and associated restrictions (n = 89), including the infection risk to residents, visitor restrictions, entry requirements, testing and vaccination requirements, and the impact of lockdowns. One respondent described staffing/resource-related issues, including a sense of a lack of collaboration between the childcare staff and aged care staff and an expectation that aged care staff would “totally run the program”. Similarly, another respondent highlighted a need for planning and program organization for the program to be successful. The cost of equipment and setup time needed for the program was also a potential barrier. Others described specific concerns related to transport, including the small number of residents that could be transported off-site or challenges associated with transporting children to the aged care home. One respondent described a potential barrier of teenagers’ “lack of sensitivity” and one expressed concern about young people’s behavior and the noise associated with having young people in the care home.

Among those who did not offer an intergenerational program (n = 214), the perceived barriers or challenges to intergenerational programs included staffing (21.7%), practical concerns (13.1%), safety concerns (12.9%) and lack of knowledge or expertise in delivery of intergenerational programs (12.4%). A substantial proportion of respondents (n = 65) also reported other perceived barriers or challenges associated with introducing an intergenerational program. The overwhelming majority of these responses (n = 60) described COVID-19-related concerns related to visitors, such as infection control and entry restrictions related to vaccination and testing. One respondent referenced challenges associated with policies and procedures, and one referred to the constantly changing requirements for on-site visits, which may also reflect the additional procedural requirements associated with COVID-19. Another respondent identified challenges related to setting up the program, two identified a potential lack of interest from the community, and two described their aged care home as newly established and not in a position to implement a program at the time of responding.

Challenges and barriers were described in the open-ended responses. This included those they faced in the past and anticipated in the future.

I originally struggled to find a local Childcare Centre or school that was interested and able to visit. One Childcare Centre wanted each resident to have a Working with Children Check! One school was very keen, but transport was an issue.

Transport was a huge barrier for us. We still have young school-aged children attend the facility a couple of time a year and they perform a concert for the residents. We plan on recommencing our preschool program as soon as it is safe to do so.

Staffing concerns related to those within the aged care homes and the availability of suitable childcare- and school-based staff were also reported.

Childcare staff expect aged care staff to totally run the program- we are not child care experts. Needs to be collaborative - all staff working together.

Another respondent reflected on what they saw as the value of intergenerational programming and shared concerns about the impact of the COVID-19 pandemic on the ability to resume programming in their workplace:

We may never see a full return of the elderly residents welcoming children back into their communities as they have been conditioned over the last 2 years to see them as vectors of infection rather than as part of quality of life, preserving heritage, sharing history and stories and meaningful engagement. My residents are now too frightened to resume the intergenerational program and it makes me very sad as to what has been lost.

Similarly, others reflected on what they experienced due to the loss of these activities owing to COVID-19 and its impact on residents and visitor restrictions.

Our residents had previously benefited greatly with weekly visits from daycare [sic], primary and high school-aged children. This has been a massive loss.

Seeing the mental wellbeing benefits on the participating residents of having school children visit the home, I would very much want to continue this, but because COVID-19 has not well and truly been eradicated, I’d rather keep the residents and children safe by not facilitating in-person intergenerational activities. We also have tried pen pals with older age primary school students.

… Now with COVID-19, I think some of our residents would be to [sic] scared to interact with children like they have in the past as they are scared of catching COVID, which is extremely sad.

Some respondents expressed concerns about the amount of interest in an intergenerational program from their residents, the broader community, and their workplace.

It is a great idea, but difficult to manage - there are no schools/preschools in walking distance and transport needs to be arranged …

I think they are extremely beneficial; I wish more residents would take up the opportunity to meet and interact with the students. Some seem very wary, but those that have attended have a great time and find the experience valuable, rewarding or simply fun.

In the general comments, there were disparate views on the value of pre-planning the program activities.

I feel that intergenerational programs can only really be of value if they are structured, ongoing, and there is the opportunity for residents to really connect and form relationships with the younger people. Having regular group “visits” is great, but it is only when 1:1 connections are created that real value is achieved.

I love these programs structured activities or not watching the interaction is always rewarding.

Other responses included the challenge associated with video conferencing for programs, a mode of delivery that some used due to COVID-19 and described by some respondents as less engaging for the residents.

The intergenerational program which was offered at our facility in 2022 was virtually connecting with a local primary school. Unfortunately, due to poor internet connection and the volume not being great, only a few residents were able to attend each week as they found it hard to hear the children.

They are very difficult to maintain without children coming on site. Although our residents love seeing the kinder children, most find it difficult to hear and interact through the TV screen.

Discussion

The aim of this study was to provide an overview of the current state of intergenerational programs within residential aged care homes in Australia from the perspective of staff currently working within aged care. More than half of the respondents indicated that their care home offered an intergenerational program. A smaller percentage indicated that they had an active program. Our findings also highlight the impact of COVID-19 on intergenerational programs within residential aged care. Where programs were suspended, a range of COVID-19 related reasons were frequently described as impacting programs. To our knowledge, this is the first study to provide an overview of intergenerational programs offered within residential aged care in Australia and describes the characteristics of these programs and the perspectives of staff regarding benefits and barriers or challenges to intergenerational programming in this setting.

Major benefits

Our findings reveal that respondents were generally positive about intergenerational programs in residential aged care and demonstrated a high level of interest in these programs. There was a diverse range of programs offered, ranging in age of participants, location, mode of delivery and types of activities, with some offering different formats and including young people of different age groups. Respondents’ attitudes toward programs were generally positive and enthusiastic, with numerous perceived benefits described for the older and younger participants. The programs were generally perceived as offering benefits to both older people and children, with mental health benefits and social connectivity considered the most common perceived benefits of the programs. This aligns with previous Australian findings by Kenning et al. (2021), who found the wealth of experience of older people can facilitate teaching and learning through generativity, and potentially reduce social isolation and loneliness. This is supported by Laging et al. (2022), who found improved wellbeing, perceptions of social isolation, and reduced ageism in a systematic review of 10 intergenerational program studies in the nursing home setting and their impact on adolescents and older people. In another systematic review, Giraudeau and Bailly (2019) found positive changes in attitudes, behaviors, confidence and competence in children, and quality of life, and mental and physical benefits in older people.

This study highlights several benefits of intergenerational programs within residential aged care for both residents and perceived benefits for younger people. The most commonly identified were the benefits for mental health and wellbeing, connection with the community and the opportunity to socialize. There is also emerging research on the benefits of university students living in residential aged care where they assist staff and engage in meaningful activities (Angelou et al., 2022). However, a recent meta-analysis describing benefits of intergenerational programs for residents living with cognitive impairment found improvements in enjoyment and behavior, but not on measures of quality of life, depressive symptoms or engagement (Lu et al., 2022).

Opportunities for meaningful engagement and maintaining social connections with the broader community are crucial for emotional, psychosocial and physical wellbeing of older people living in aged care (D’Cunha et al., 2020). Intergenerational programs can allow older people to meet each of these needs, for connection to community, social connection and participation in activities that are meaningful to the individual. However, despite the increase in popularity of these programs and important policy implications (Radford et al., 2018), findings from reviews reveal an absence of rigorous empirical evidence related to their use (Peters et al., 2021; Ronzi et al., 2018).

In a study that sought to examine factors that enhance intergenerational engagement and contribute to successful intergenerational programming, findings revealed group structure, activity type and duration contribute to improved success within programs (Kirsnan et al., 2022). Others have found that conversation is the preferred activity by older people (Aguilera-Hermida et al., 2019). Yet, others have demonstrated that informal contact between older people and younger generations is also beneficial (Cortellesi & Kernan, 2016), suggesting the type of program and structure may not be critical to achieving intended outcomes.

In the present study, respondents often considered intergenerational programs as an opportunity to foster connection between older people and younger generations and connections with the community at large. Some benefits of intergenerational programs may be more challenging to define and measure over a short period of program delivery and follow-up, which has been a feature of previous studies of intergenerational programs to date (Radford et al., 2018). Studies have examined changes in young people’s attitudes toward aging (Holmes, 2009) and increasing dementia awareness (DiBona et al., 2019), yet few statistically significant and consistent findings have been reported.

As reflected in the general comments made by respondents in the present study, program benefits may extend to aged care staff through improved personal and role satisfaction. This increase in intrinsic rewards and personal satisfaction may have implications for improving overall workplace satisfaction and job retention, which have been ongoing challenges within the Australian aged care sector (Hodgkin et al., 2017). However, more research is needed to explore staffing challenges in delivering intergenerational programs (Radford et al., 2018). Importantly, intergenerational interactions may play a role in the recruitment of age-friendly health professionals. A recent study highlighted that “intergenerational normative solidarity” – that is, where people find social norms can reinforce the value of children, parents and grandparents as supportive mutual attachments – was inversely associated with ageism (Ozaydin et al., 2022). Normalising intergenerational engagement may be a crucial part of longer-term planning to address staffing issues in aged care.

Challenges and barriers

Our findings also reveal the presence of barriers and challenges associated with intergenerational programs. The most commonly reported barriers and challenges were related to the COVID-19 pandemic and associated restrictions regarding vaccination and visitor entry requirements when entering aged care. The reported impact of COVID-19 on intergenerational groups is expected, given the restrictions to social visits and group activities during the early phases of the pandemic (Jarrott et al., 2022). However, the continued impact of COVID-19 is notable given the easing of strict controls and restrictions that were commonplace early in the pandemic, and current guidelines which support visitors to residential aged care in recognition of the critical importance of maintaining psychosocial wellbeing (Australian Government, 2021). There was a high level of interest in resuming programs as care providers adapt to COVID-19 or instigating programs where there were no existing programs. Given the established association between a loss of social connection on resident mental health and wellbeing (Brydon et al., 2022; Low et al., 2021), identifying ways to reinstate programs appears vital (Jarrott et al., 2022).

Staffing concerns were also identified among the most prominent barriers to offering intergenerational programming in this setting. Such concerns have been ongoing in the aged care sector and workforce sector shortages remain a threat to the provision of effective care (Gibson, 2022). Other common barriers identified include logistical challenges such as transport or concerns about safety and mobility, which are exacerbated by staffing limitations. Yet, several of these barriers can be overcome. One promising model is that of a collocated or shared site model whereby services for older people and those for children or young people located in the same geographic site connect with one another, thereby reducing some of the limitations related to access, staffing and safety (Cartmel et al., 2018; Radford et al., 2018). The shared site model is overwhelmingly supported by aged care staff (Jarrott & Bruno, 2016; Weeks et al., 2016). However, co-locating aged and child care would require careful planning and collaboration, and consideration of infection control, presence of ageism, and whether the older people actually want to spend a lot of time around children (Radford et al., 2022).

Limitations

This study is not without limitations. We received responses from just over 20% of aged care homes in Australia. To our knowledge, the only other published survey of Australian aged care homes during the pandemic had a response rate of approximately 10.7% using the same database (Brydon et al., 2022). Respondents interested in intergenerational programs may have been more likely to respond to our survey request. Some providers had strict ethics review requirements which limited responses from all organizations as intended. Survey links were sent via e-mail, and it is possible that e-mails with external links were blocked, or staff trained to refrain from clicking on links from outside sources. This study did not focus on all aspects of intergenerational programming in residential aged care, including specific elements of programs. In addition, several respondents described characteristics of programs that reflected more than one discrete program in their aged care home.

Future research

Further work should address the barriers to intergenerational programming and opportunities that may enable programs to continue operating in light of the challenges present in this setting, including COVID-19. The focus or content of the intergenerational program did not appear to be important; it was more about social connection, wellbeing and the enjoyment of bringing together people from different generations. More research is required to support anecdotal benefits and testimonials into evidence to encourage greater engagement and investment into intergenerational programs at the policy level. Recent recommendations have been made on how to appropriately design evaluations to further establish an evidence base for investment into cost effective and sustainable intergenerational programs (Vecchio et al., 2020). At present, it appears as though most intergenerational contact is unstructured which may contribute to some of the challenges identified by other researchers examining the evidence on specific benefits associated with participation. Another logical step to further the understanding of intergenerational programs in Australia is to survey childcare centers and schools to further unravel the potential benefits, and barriers and challenges from their perspectives.

Conclusion

This study provided an overview of the current state of intergenerational programs available in Australian residential aged care homes. To our knowledge, this is the first study to provide an overview of the number of programs conducted in the residential aged care setting and their characteristics. The findings from this study have implications for the availability of intergenerational programming in Australia. Importantly, this study highlights the barriers and perceived challenges associated with conducting intergenerational programs including practical and safety concerns, staffing, and the COVID-19 pandemic. There are also creative examples of solutions and responses to those challenges. Taken together, these findings may contribute to improving access to intergenerational programming if these perceived barriers can be overcome.

Acknowledgments

The authors would like to thank the participants for the time taken to complete our survey. We would also like to thank Bre Cave, Alysson Flynn, Craig Greber and Fanke Peng for their contributions to the research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was funded by Northern Sydney Local Health District.