Aged care staff and organisations are faced with a number of challenges to providing consumer choice and control.
While delivering our Resident at the Centre of Care (RCC) Program, which trains staff to implement Consumer Directed Care (CDC), we learned much about the barriers to delivering CDC in residential aged care.
Residents may fear being perceived as ‘difficult’
For staff it can be incredibly difficult to gather detail from residents about their preferences. Residents are often reluctant to voice their needs for fear of being perceived ‘difficult’.
Residents don’t want to impose on staff
They also know staff are very busy and don’t want to impose, and therefore often state they are happy with existing approaches. Overall, residents are unlikely to spontaneously request changes to their routine – it is up to staff to initiate (and sustain) conversations about care and lifestyle preferences with residents.
Concern may not be able to meet residents’ needs
Another hurdle for staff is the fear of asking residents what they would like to change about their day. Staff worry about the time it takes to have these conversations and that they won’t be able to meet the residents’ needs. Also, this type of conversation will be new for many staff, as will the responsibility that goes with responding to, and implementing, resident requests.
Historic focus on tasks rather than relationships
For the broader residential aged care industry, there are many aspects of the sector that work to discourage a consumer-led approach. Many of these challenges relate to residential care’s historical ties to the hospital-style medical model, which prioritises completion of tasks over relationships with care recipients. Also, the current funding model for residential aged care “rewards” reduced independence and functional capacity of residents.
How do residents know what is best for them?
Although staff cite many concerns and challenges to implementing CDC, they also instinctively recognise the benefits of such a model of care.
Initially, many staff believe that CDC is not a viable approach for the following reasons:
- Concern that residents may be disappointed if all requests cannot be met (either due to “unrealistic” requests or insufficient staffing/resources).
- Concern that residents may not choose what is best for them (seems to refer most to care needs, particularly hygiene and refusal of care).
- The potential increased workload (attending to individual resident requests).
- Concerns about meeting regulations and how to work within policies and procedures.
- Concern about the cost – both in terms of changes resulting from CDC and potential impact on current funding (ACFI).
“It can be stressful since you just want to make them satisfied with their life but if you can’t…then it is heart-breaking”.
“Time spent with residents would increase as well as extra documentation required.”
“Some [residents] really have no insight into care needs.”
“No support from management or family members.”
Staff become more optimistic when practicing CDC
As training progresses, these perceived barriers change, with staff less concerned about resources and staffing. They become noticeably more optimistic about their ability to provide CDC. They see that if they make the changes outlined above in communication, work environment and staff roles, and they have support from management to make these changes, they can develop a CDC Implementation Plan that works for their facility.
“It seemed overly daunting at first and we could not imagine how it would be at all possible to make this happen, but as the training continued, it became clear that we could actually do this.”
“[CDC is] more enjoyable, not so time-restricted”.
Removing the barriers
So how do staff move from a ‘this cannot be done’ view of CDC to actually developing a CDC model of care that improves resident quality of life, as well as their working environment? Integral aspects of our RCC training program are that staff are guided to:
- Explore and address the barriers to providing CDC,
- Identify current and future opportunities to increase choice and control for residents across care and lifestyle tasks, and
- Experience the process of working with residents to determine (and respond to) their needs and preferences.