'You become their advocate': The experiences of family carers as advocates for older people with dementia living in residential aged care.

AIMS: The aim of this study was to identify features of well-performing residential aged care services (RACS) as experienced by family carers. BACKGROUND: Family carers can have an integral role in residential aged care providing social support and are well-placed to engage with staff and monitor care. DESIGN: A qualitative descriptive design was used. Semi-structured face-to-face and telephone interviews were conducted with family carers of current or past residents of Australian RACS between November 2018 and January 2019. Interview transcripts were analysed thematically. RESULTS: Rather than reporting features of well-performing RACS, participants shared stories of sub-standard care, dysfunctional management and poor resident-staff-family interactions. An overarching theme emerged of 'having to be an advocate' for residents' needs, which covered four major categories: organisational accountability (including transparency and individualised care), good communication, connection and trust. Combined, these constitute what carers perceive are the necessary conditions for determining the features of a well-performing RACS. CONCLUSION: Family carers need to feel confident and trust RACS staff when they hand over the role of carer for their relative with dementia. RELEVANCE TO CLINICAL PRACTICE: This study provides insight into the needs and challenges of family carers when they relinquish the care of an older relative with dementia. Strategies to build confidence and trust between RACS and family carers are essential. Aged care nurses can play a pivotal role to support this through the development of open communication and relational connections with residents and their families.

Evaluation of the impact of The Little Things training on personal care assistants' confidence to communicate with residents in aged care.

OBJECTIVES: To evaluate The Little Things training program, designed to assist personal care assistants (PCAs) from culturally and linguistically diverse (CALD) backgrounds to communicate more effectively with aged care residents. METHODS: This project included PCAs from residential aged care facilities (RACFs) and Certificate III students from registered training organisations (RTOs) in Melbourne, Australia. A control group (n = 18) was also included. Measures included the following: pre- and posttraining confidence to communicate and rankings of task importance; posttraining perceived change in confidence; and posttraining impacts on practice. RESULTS: Altogether, 75 PCAs and 30 RTO students participated in Intake I of the training and 31 PCAs and 34 RTO students in Intake 2. Confidence increased in The Little Things participants relative to those in the control group (ß = 0.11, T = 1.99, p = 0.05). Change did not vary by Intake or whether someone was in the RACF or RTO group, F (2, 147) = 0.58, p = 0.5; nor by sociodemographic characteristics. Most training participants (84%) thought their ability to communicate with older people would 'improve a lot' as a result of the training. Training participants also ranked the importance of duties such as 'Speaking in a friendly and informal way to older people' more highly after than before the training (p = 0.01), while little change was observed in the control group. CONCLUSIONS: The Little Things program increased training participants' confidence to communicate and shifted perceived priorities towards interacting with residents in a way that enhanced resident well-being.

Volunteering for a better future: A pilot Sustainability Ambassadors Training Program.

OBJECTIVE: Older adults are an untapped resource for leading sustainability change. This study assessed a pilot study of a Sustainability Ambassadors Training Program for older adults. METHODS: The pilot training program was conducted with a sample of 14 older adults over a single day, with some follow-up activities for participants at home. Activities included completing a sustainable action card-sorting activity measuring an individual's ability to make sustainable changes within their lives. A brief researcher-devised empowerment scale was administered pre- and postworkshop. RESULTS: Quantitative data revealed that sustainability empowerment increased from pre- to post-training sessions and was related to the number of sustainability actions participants thought were achievable. CONCLUSIONS: The data suggest that such a brief training workshop can both yield personal change and potentially provide opportunities for a peer network to facilitate change within communities.

What predicts consumer experience in residential aged care? An analysis of consumer experience report data.

Objectives This study explored whether consumer experience report (CER) data from residential aged care services (RACSs) could be combined into a general factor and determined whether poor experience in RACSs could be predicted by known resident or home characteristics or sampling procedures. Methods CER data collected by structured interviews in 2018 and early 2019 were analysed using structural equation modelling and linear regression analysis. Results Data were available from 17194 interviews undertaken at 1159 RACSs. The 10 CER items loaded onto two independent factors. Bifactorial modelling indicated that items could be combined into a general factor. Controlling for state or territory, consumer experience was best predicted by home size: those in large facilities reported poorer experience than those in smaller facilities. Other significant negative predictors with small effect sizes included not being independently mobile, being male and not being randomly selected. Dementia did not predict total CER score. Conclusions The results of this study support the inclusion of people with dementia and exclusion of volunteer participants from published CERs. Further research is needed to explore why a relatively poor consumer experience is reported by people in larger homes, men and those with mobility issues. What is known about the topic? Poor experience in aged care is a persistent concern for government, individuals and aged care services. The recent Royal Commission into Aged Care Quality and Safety has identified systemic failure. Although many organisational features and processes have previously been identified as important in determining the quality of care, few studies have explored the characteristics that predict the consumer experience of residents in aged care. What does this paper add? This paper provides empirical evidence that several variables influence consumer experience in aged care, including facility size and resident sex and mobility. There is evidence that smaller facilities provide care that is perceived better by residents, and that men and people with mobility issues have worse experiences in aged care. There is a lack of clarity as to what other influences, such as facility ethos, facility location and staffing levels, may contribute to resident experience. Such clarity is important, because Australian aged care is currently facing comprehensive scrutiny, and governments are looking to ensure the safety and quality of aged care services. What are the implications for practitioners? Identifying and addressing inequities in aged care services and mitigating risks must be a priority in Australia to ensure aged care services provide safe and high-quality care. The results of this study challenge current funding structures that encourage the development of larger aged care homes, and instead suggest that better funding for smaller-sized facilities may be able to improve the experience of residents in aged care. The results also suggest that facilities and governments should attend to the experiences of specific groups, such as men and people with mobility issues.

Quality and Safety in Aged Care Virtual Issue: What Australian research published in the Australasian Journal on Ageing tells us.

OBJECTIVE: To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions. METHODS: Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality. RESULTS: Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care. CONCLUSIONS: It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.

Development of a consumer experience reporting questionnaire for residential aged care homes in Australia.

OBJECTIVE: To develop and pilot a short interview tool to be implemented by the Australian Aged Care Quality Agency (AACQA) in residential aged care, to inform prospective consumers about the quality of care and services received-the consumer experience report (CER). METHODS: Twenty-four questions addressing the four Aged Care Quality Standards were piloted with 140 residents and 48 representatives (including 27 resident-representative pairs). A method for approximating random selection was also trialled. Fifty-two residents were interviewed twice, one week apart, and each question's usability was rated by 11 surveyors and two interpreters. Selection criteria for questions included consumer preference, test-retest reliability, resident-representative agreement, usability and low missing data. RESULTS: Nineteen questions performed well on missing data, 16 on test-retest, 17 on resident-representative agreement and 12 on usability. Ten quantitative and two open-ended questions were selected. CONCLUSIONS: The CER questions proved suitable to collect data systematically on consumer experience in residential aged care. AACQA (now the Aged Care Quality and Safety Commission) uses the CER interview to support their audit process, and aggregated results are published online.