A new study will trial a program aimed at guiding residential aged care providers through the approach and organisational change required to effectively deliver consumer directed care, with hopes results will serve as a model to government.
A team headed by Professor Marita McCabe, director of the Institute of Health and Ageing (IHA) at Australian Catholic University, was recently awarded a $193,524 grant to conduct the study by the Dementia Collaborative Research Centres.
While government has indicated it will eventually implement consumer directed care (CDC) in residential care, it has yet to outline what that would look like.
Professor McCabe told Australian Ageing Agenda that successfully implementing CDC in the residential setting would likely be more complex than in community aged care.
In order for residential providers to have the capacity to deliver CDC, there would need to be large scale organisational change, in terms of workplace arrangements, staff roles and business processes, and it would also require transformational leadership, she said.
For example, Professor McCabe said that due to the need to form strong working alliances with residents, it was much more likely care staff would need to work with a smaller group of residents. Job roles would also involve a greater diversity of tasks and need more flexibility and autonomy.
Where a resident did not have the capacity to articulate their preferences due to dementia or cognitive impairment, staff would also have to work closely with family and other staff, she said.
“It’s not going to be a quick fix. It’s going to require quite significant changes to the way in which care is currently delivered within residential care,” said Professor McCabe.
Trial and evaluation
Six residential aged care facilities from Queensland and Victoria will participate in the research, which will be conducted across three different conditions.
In the first condition, staff will participate in a training program focused on what CDC is, how to best determine the needs and preferences of residents, and the organisational implications of these preferences. A majority of the program will significantly focus on the change and leadership required to deliver on residents’ choices effectively, and examine barriers and enablers.
In the second condition, staff will receive the same training, but will also be provided additional ongoing support by an expert in order to assist them in embedding the program into everyday practice.
‘It might be enough to have the program, or it might be the organisation needs that extra support to embed it in practice to make sure it’s sustainable into the longer term,” said Professor McCabe.
The third condition will be a control, or ‘care as usual’ condition.
How well consumer-directed care plans are developed and implemented will be assessed. Resident and staff wellbeing will also be evaluated prior to and three months after the study, and an economic evaluation of the costs of each condition conducted.
The focus on organisational change builds on previous research by the IHA that found a training program for staff on the management of behavioural and psychological symptoms of dementia and depression was most effective when accompanied by support as to how the program could be embedded into daily organisational practice.
A model for government
Professor McCabe said that while the overarching principles of CDC would be the same across the board, how it worked in practice in residential environments would vary according to the individual provider’s nature.
The research team would work closely with organisations to make sure that the outcomes of the program were tenable, she said.
“You can’t just come in and have a one-size-fits-all,” she said. “We’re going to have to accommodate that complexity and still adhere to the basic protocol.”
Professor McCabe said that the implications of this research for the sector were large.
“It will serve as a model to government as to how this needs to be done, and demonstrate the complexity of the process,” she said.
Further, she said the economic evaluation would also indicate to government potential costs of CDC in residential care and therefore what an appropriate funding model could look like.
After the pilot was completed, Professor McCabe said she hoped to be able to secure further funding to do a larger trial of the program.
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