Captive in controlled environments? Choice central to aged care quality

HammondCare’s views on quality in aged care featured in the Australian Aged Care Quality Agency’s (AACQA) ‘Let’s Talk About Quality’ report released this week.

The report - which covered issues such as consumer choice and citizenship, innovation and specialisation, culture and purpose and the benefits of rating - drew on more than 160 written and online submissions as well as 16 hours of forums that explored “the best possible ways to define, encourage, measure and monitor quality in aged care services”.

Same rights as those living at home

“At home we have the right to smoke, have pets, get fat and have sex if we want; but in aged care facilities we become captive in a controlled environment where we are ‘protectively disciplined,’” says HammondCare Chief Executive, Dr Stephen Judd, on page 14 of the AACQA report, in a section addressing “what is quality?”

He continues: “Shouldn’t we be able to have the small aspects of our life considered? Whose schedule is it? Whose choice? I might like to sleep until eight or nine and have soft poached eggs on toast for breakfast. I’d like to think I could get out on the golf course. I don’t want to conform to a set schedule and set activities decided for me without my wishes and choices being considered and I wouldn’t put up with it.”

Specialisation plays a role

While this comment and other contributions emphasised choice and citizenship as key aspects of quality, the role of specialisation was also emphasised by HammondCare:

“Some consumers look for specialisation in a certain area or a service that is particularly responsive to the needs of an identified target market. That could mean a service that has a particular focus on providing excellent restorative care or supporting people with dementia.” (page 19).

Safety is part of the quality mix

Safety was acknowledged as “essential but not enough” in considering quality. HammondCare said that psychological – alongside physical - safety, was vital in the care setting. For this to occur HammondCare argued providers needed a culture of safety:

“To enable a safe culture, it is essential that services and organisations have a consistent approach, an empowered workforce and a strong feedback loop that considers the views of service users as well as data that is recorded to monitor and improve safety.” (page 26)

More than minimum standards

HammondCare and other submissions argued strongly for a move away from a compliance approach and the meeting of minimum standards. As part of this there was acknowledgment of the need for “providers to clearly articulate their philosophy of care”.

A quote from HammondCare encapsulated this point (page 26): “As the aged care sector moves towards a market approach, it is important for providers to clearly articulate their vision and philosophy, outlining where they have come from and the purpose they are seeking to achieve. This broader narrative will enable prospective residents and clients to understand the service and place it within its proper context.”

Rating services problematic but beneficial

The AACQA “Let’s Talk About Quality” report discusses the issue of rating services. HammondCare argued that while not all consumers were looking for the same thing, and that aged care services themselves may be striving for different objectives, a rating system that was mindful of this would still be beneficial.

Quoting HammondCare, the report said: “While it may be problematic to label one provider better than another, there is great benefit in rating services according to their performance in key areas. These ratings could become the focus of accreditation audits and could be incorporated into accreditation reports.

“Ratings could be based on direct observations from qualified external observers as well as feedback from service users and staff and other information, such as data from quality indicators and examples of innovation.

“Using these factors to rate services will provide a strong incentive for services to provide the highest quality possible. At the same time, it will give consumers more meaningful information on which to base their choices between services, along with other considerations such as organisational philosophy and price.” (page 29)

Board to beside commitment to excellence

In addressing the issue of excellence, HammondCare had argued that for care staff to display the attributes that would deliver quality care – such as a desire to nurture the whole person, willingness to learn, valuing teamwork - they would need to be part of an organisation that maintains and promotes these values. The AACQA report took up this point, quoting HammondCare:

“It is unreasonable to expect care staff to listen to service users if their supervisors do not listen to them; it is not possible for staff members to take the time to get to know the people they are caring for if they are expected to complete tasks as quickly as possible; and a willingness to learn accounts for little if there are no opportunities for taking part in continuing education.” (page 33)

Innovation encouraged, not penalised

The report found that “service providers cannot afford to stand still” if they are “to meet changing requirements and expectations and [engage] effectively with stakeholders and staff”.

HammondCare agreed with other contributors when it said that innovation was linked to quality and that while this could not be mandated, government could provide the right environment for it to occur:

“Innovation cannot be mandated or directed by Government, but Government does shape the environment in which innovation occurs. The best way for Government to promote innovation is to create an environment where innovation is supported rather than penalised. Government should celebrate innovative ideas that work.

“…innovation should also be acknowledged in accreditation reports (and) unsuccessful innovations should not be penalised.” (page 57)

It is understood the “Let’s Talk About Quality” report will be submitted to the Minister for Aged Care, Sussan Ley and may influence key strategic and policy directions in the quality framework for aged care in Australia.

Click here for the full “Let’s Talk About Quality” report from the Australian Aged Care Quality Agency.