More interpersonal care needed, research finds

Aged care residents and their families wish for a more relationship-based and holistic model of care with a focus on wellbeing, according to University of Sydney research.

The qualitative study was led by Cathy Monro – a PhD candidate at the university’s Faculty of Medicine and Health. Speaking to Australian Ageing Agenda, Ms Monroe explained the purpose of the study.

“Older people often enter residential aged care at a stage of increased frailty and diminished capacity and rely on their families for support. This study aimed at exploring consumer perspectives of residential care in the context of Australia’s ongoing aged care reforms.”

Ms Monro and her research team – whose findings were published in the Australasian Journal on Ageing – concluded that “adequately addressing the relational and interpersonal elements of care delivery is critical in fulfilling the reforms’ consumer-orientated objectives.”

Increased funding and support are needed, said the researchers, so that providers and staff have the required knowledge and skills to better meet the relationship-based components of care delivery.

While the small cohort studied – four residents and six family members across two not-for-profit providers – generally expressed satisfaction with their experiences in residential aged care, the findings illustrate a desire for a more personalised approach from staff.

“They need to upgrade their staff a little bit in training,” said study participant Mary, a family member of a resident with dementia. “They have got to have an awareness of what they are dealing with in aged care, and the people they are dealing with.”

Mary – not her real name, all participants were assigned pseudonyms – described her family member’s previous facility as a “revolving door” with staff coming and going on a regular basis. “You’d get someone that was any good and they’d be gone because they just could not cope.”

Family members placed a particular value on residents being treated like “part of the family” with staff “going above and beyond” in meeting individual needs, said the researchers.

To achieve a more personalised level of care, a consistent workforce roster is required so that staff can have a better understanding of those individual needs, said study participant and family member Karen.

Staff at one facility “that you get used to” were dispatched to a different building and new ones brought in, said Karen. This changed staff-resident relational dynamics. “Not that the level of care would not be there, but the level of understanding … there’s comfort in being familiar.”

“They become forgotten people.”

Another participant, Nancy – a family member – complained that interpersonal interactions would cease once a resident declined in health. “If you first come in and you are mobile, more proactive, more mentally alert, you are still a person,” said Nancy. “But once you start to deteriorate, they become forgotten people.”

Family members wanted their loved ones to be considered a “whole person”, regardless of any changes in their health, said the researchers.

According to Margaret – a family member who also works as an assistant-in-nursing at one of the facility’s studied – mental health support was also often lacking.

“Mental health assistance for the aged is just about non-existent,” said Margaret. “A lot of older people in particular do not want to talk about it. We need people to understand what it’s like, and can communicate with them, and be able to talk them through some of these issues.”

Key finding

A key finding for the researchers was that clients and their family members had different expectations and experiences of the care delivery provided, said Ms Monro. “More specifically, the discrepancy between the experiences of care delivered and expectations of initial and changing care needs being met was a major concern.”

From both the client and family perspective, the researchers found that – as individual care needs and expectations change – “it is critical for staff to have a corresponding level of understanding and related skills to appropriately meet the changing needs.”

There needs to be a “staff-resident-family relationship component in care delivery,” suggest the researchers, and communication strategies informing families of residents’ progress and wellbeing.

Addressing the 200 minutes of care per resident per day that all facilities will be expected to deliver from October 2023, the researchers said implicit in that reform is a “perpetuation of a task-oriented, performance-driven approach.”

Rather than focus on the amount of time spent on a resident, there needs to be consideration of the various facets of quality care delivery “that require levels of skills and knowledge encompassing nursing, pastoral care, and interpersonal elements.”

In closing, the researchers admit that their study is limited by the small sample size and the experiences recorded may not be representative of other aged care facilities.

However, “the study presents a snapshot of the expectations and experiences of both the client and family cohorts in residential care and provides insights into an end-user perspective during the reform implementation process,” Ms Monro told AAA.

“For clients and families, high-quality care requires some sense of consumer choice and control in meeting all assessed care needs including adequately addressing the relational and interpersonal elements of care delivery,” she added.

As Australia continues to undertake aged care reforms, further research will be needed, said Ms Monro, to gain a greater understanding “of the different dimensions of care provision in the context of responses to the royal commission and to inform strategies to ensure the reform objectives are met and to minimise the risks of unintended consequences for consumers.”

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