A household model of person-centred care is proving to give Uniting NSW ACT residents more control over their day-to-day lives.

The model, which the provider has been progressively rolling to its 72 residential aged care homes since 2015, focuses on giving residents greater freedom to make their own choices, such as meal times, throughout the day in smaller households of 18 to 20 people.

Uniting NSW ACT engaged University of Technology Sydney to evaluate the household model at 12 metropolitan and regional facilities, which transitioned to the approach between 2015 and 2019.

Uniting NSW ACT executive manager practice excellence Lana Richards, who will discuss the model and evaluation at next week’s ACSA National Online Summit, said the organisation has successfully translated person-centred care into practice and at scale.

“The interviews conducted for qualitative study demonstrated the model enhanced residents’ wellbeing and autonomy, recognising their individuality and embracing family members. Staff reported increased job satisfaction, greater teamwork and shared responsibilities,” Ms Richards told Australian Ageing Agenda.

Lana Richards

“Over time, residents shared that they felt a greater sense of control and experienced warmer, deeper relationships with staff that created safety, but also led to greater meaning and purpose in their day through shared interests.”

The study found that Uniting transitioned over half of the facilities without substantial negative impact on clinical, financial and human resource performance indicators, she said.

“There’s something quite significant about the timeline that was done over the five years to not have a negative impact or negative trends with that,” Ms Richards said.

It also identified that the organisation needs to collect more subjective indicators on resident health and wellbeing, she said.

Ms Richards said this model and its focus on providing a home has changed how Uniting delivers residential care.

“The household model at its core is about our residents living their day their way, being able to have control over when they get up and when they eat, and doing the things that are important to them with the people that matter to them,” Ms Richards said.

“It turns traditional ways of providing residential care on its head so it focuses more in on the relationships amongst people in smaller more intimate settings.”

She said evaluation also found the majority of staff interviewed were committed to the model and of the opinion that it created an atmosphere of home.

“Although this is not without its challenges like balancing resident choices about daily routines with clinical needs,” Ms Richards said. “The research found that overtime the longer people worked in the model, the better they understood it and in turn committed to it.”

Overcoming challenges

The constant changing of residents’ needs, staff turnover, and getting staff to move away from a task-based approach to care were the main challenges while implementing the model, Ms Richards said.

“A number of the challenges are around needing to unlearn and relearn the ways of working particularly for staff in giving them permission to adjust their routines and workflows to meet the residents’ needs, rather than the needs of the organisation. That takes a while to build that trust and build the confidence in the team to take that on and do that,” she said.

To overcome the barriers Ms Richards said they found it important to acknowledge the existence of the challenges and ensure consistency of the leadership to support the team to be able to make decisions.

“If they get things wrong [they know] that’s okay and it’s about learning,” she said. “But also acknowledging that slipping back into those institutional ways is easy to happen and to almost expect it, but not to see it as failure.”

Tips for providers

For other providers thinking of implementing a similar model Ms Richards recommends they avoid  overthinking it while starting small.

“Go sit down with your residents, families and staff and talk to them about what home means to them and what they could be doing differently to support that,” she said.

“Whilst we were ambitious wanting to transition all our homes, we started slowly and chipped away a little bit before we were then able to replicate that to other homes. It’s a learning process. You’re going to get stuff wrong and that’s the good thing.” 

To date Uniting NSW ACT has transitioned 70 per cent of its homes to the household model and expects to reach the rest by May 2022, Ms Richards said.  

The ACSA National Online Summit takes place 17 – 21 May.

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