Consumer Directed Care in residential aged care: Evaluation of the Resident at the Centre of Care training program

The 2012 Living Longer Living Better aged care reforms impacted significantly on aged care service delivery for Australians. These reforms encouraged a sector-wide shift to a more person-centred approach emphasising consumer choice and wellbeing. The introduction of Consumer Directed Care (CDC) in aged care homes requires providers to more comprehensively meet the often-complex individual care needs of each care recipient, substantial regulatory burden, and mounting consumer expectations, including residents’ demands for more care choice, and to be treated with greater dignity, autonomy and independence. National and international examples of CDC in aged care homes are limited, with the majority of studies exploring CDC delivery in community aged care (Benjamin, 2001; Eustis, 2000). While some person-centred approaches have been evaluated in the Australian aged care context (Chenoweth et al., 2015; Stein-Parbury et al., 2012), with some positive outcomes, staff training programs where staff are trained to ensure that decision making about care is directed by the resident (i.e. CDC), have not been evaluated in aged care homes. Our project was designed to rectify this gap in knowledge by providing an innovative approach for CDC implementation in Australian aged care homes. Our research (e.g. McCabe et al., 2017) and that of others has identified a range of critical factors for sustainable evidence-based change in aged care practices. Difficulties associated with implementing a resident-directed approach include the lack of staff empowerment to handle the shift towards CDC philosophy, job restructuring, resistance to change, and the need for strong leadership. There is a pressing need for workforce training to implement CDC approaches that include appropriate attention to change management, leadership strategies and the working relationship between carers and carerecipients. Our Resident at the Centre of Care (RCC) training program was developed to address these critical factors in order to drive real and sustainable change towards implementing and embedding CDC in residential aged care

An evaluation of a consumer directed care training program for nursing home staff

Objectives: This study evaluated a training program to support the delivery of consumer directed care (CDC). It was hypothesized that both interventions, compared to the control condition, would demonstrate increased levels of CDC in nursing homes, increased staff practice of CDC, and improved resident QoL. The training plus support group was expected to show greater gains, compared to the training only group. Materials and methods: In a cluster RCT design, 33 nursing homes were randomly allocated to one of three conditions: training plus support, training only, and care as usual. Outcome measures included level of CDC within each home, staff practice of CDC, and resident QoL. Results and discussion: Hypotheses for this study were partially supported. Nursing homes became more CDC-oriented but with minimal changes in staff practice of CDC. Resident QoL also demonstrated limited change. The findings are discussed in terms of organizational barriers to change within nursing homes

A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

Background: Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care. Methods: The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling. Discussion: The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care. Trial registration: ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/)