There’s been much debate in recent times about quality, or at times the lack of it, in Australia’s aged care system.
I want to state upfront that the egregious examples of elder abuse and neglect highlighted recently in the media are outrageous and indefensible. I’ve spent much of my professional life working on the issue of elder abuse and neglect; looking at what it is, trying to improve the awareness of professionals and the community about its existence, and acting to respond and ideally prevent it.[i]
My focus in this blog is to explore the flip side – what marks out good quality care and how we can encourage it.
Is it about value for money?
As government policy has gradually shifted into a consumer-driven marketplace for aged care, value for money has become a more prominent feature. For example, the Federal Government has explicitly built into its My Aged Care website a capacity to compare residential and home care services based on cost.
Understandably, as older people are asked to pay more, their expectations about the quality of the service they receive are rising.
But value for money isn’t what older people talk about on a daily basis.
What do older people want?
One thing we’ve known for decades is that older people prefer to receive care at home. I remember when I first started working in this field about thirty years ago, reading the following summary:
Many studies in Australia and overseas have emphasised the desire of older people to maintain themselves in their own homes for as long as possible.[ii]
It sometimes amuses me to hear people talk as though the baby boomer generation’s desire to live at home is some sort of radical departure from the wishes of previous generations, who were assumed to delight in congregate accommodation models like residential care. In reality, residential care is now, and will be in the future, for most people a ‘distress purchase’, undertaken only when staying at home is no longer viable.
Further, we now have a growing evidence base about what it is that older people are interested in when it comes to aged care – whether delivered in their own home or in a residential setting. The most recent work comes from La Trobe University in their work for the Aged Care Quality Agency’s Consumer Experience Survey.[iii] La Trobe found the following aspects were most relevant to determining residents’ experience of aged care:
- Respect from staff
- Feeling safe
- Having my needs met
- Follow up to my concerns
- Having things explained to me
- Food I like
- People I can talk to if I’m feeling sad or worried
- Encouragement to do things for myself
- Staff who know what they’re doing
- A well run service.
Is it quality of care, or quality of life?
It’s interesting to note that very few of the items identified by aged care residents relate to quality of clinical care. I’ve recently participated on a Technical Advisory Group for the Department of Health assisting in developing new Aged Care Standards. There was regular debate on that group about what the right balance is between a focus on quality of clinical care and on quality of life.
Of course, at one level it’s a false dichotomy. Older people in modern residential care services (and higher level home care too) are nearly all frail, with multiple chronic health conditions and a majority have some level of cognitive impairment. Inevitably the quality of clinical care for a cohort of people in this situation is vital.
But when you ask people what matters to them, you get a list like the 10 items above. Only two of these items (numbers 3 and 9) could possibly be categorised as referring to clinical care, and even they probably refer to aspects beyond merely clinical interventions.
Aged care is about relationships
It really is impossible to reduce people’s experience of quality of life to one or two areas. But I want to have a go at pointing out what is possibly the most important characteristic of quality of life.
Ultimately the human relationship between staff members or volunteers and the older person is fundamental to quality in aged care. When I interviewed my mother Ruth Sadler (a Home Care Package recipient) for a presentation on quality in aged care in 2016, the conversation went like this:
Q: How would you sum up quality in aged care for you?
A: If I’m getting help in, it is the relationship angle that is really important to me. If the people that are helping me seem to be happy and seem to want a relationship too, that’s great.
Further, older people often express satisfaction with aged care services if they help them maintain key relationships in their lives, such as with their primary carer, family members and friends. Similarly, for many people connections into their community, such as churches, community groups or volunteering opportunities are vital. And for others, maintaining contact with trusted doctors or health professionals is important.
In the second installment of this blog I will show how Presbyterian Aged Care is achieving quality in aged care by fostering good relationships – and it’s not by just creating more policies mandating carers do so….
Paul Sadler, CEO, Presbyterian Aged Care NSW & ACT
Disclaimer: Paul Sadler is a member of the Minister for Aged Care’s Aged Care Quality Advisory Council. The views expressed here do not represent an expression of the views of the Aged Care Quality Advisory Council.
[ii] Rowland, D.T. (1991) Ageing in Australia, Longman Cheshire, Melbourne, p.113.