Constructive StaffFamily Relationships in Residential Aged Care Presenter Dr Michael Bauer Professor

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Constructive Staff/Family Relationships in
Residential Aged Care (Presenter) Dr Michael
BauerProfessor Rhonda Nay (Presenter) Dr Tenzin
BathgateDr Deirdre FetherstonhaughDr Margaret
WinboltMs Linda McAuliffePresentation to
Centre for Cultural Diversity in Ageing, Migrant
Families in Aged Care An Intergenerational
Perspective Seminar, Melbourne, 28 August 2009
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Family involvement in care

• A family carer is anyone who has been involved
  and wants to remain involved with the person who
  is living, or will be living, in residential aged
  care. This can include friends.
• Health care workers need a good understanding of
  the issues that impact on family involvement in
  care
• Family carers need enough information, confidence
  and support to positively liaise with staff in
  care arrangements for their family member.

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CALD aged care needs

• Very little systematic, published evidence based
  research has been conducted on the needs of the
  CALD community in aged care (Radermacher et al
  2008AB, Rao et al 2006, Adams 2009, LF Low et al
  2008, Haesler et al 2006, Bartlett et al 2006)
• What we do know from current evidence-based
  research in relation to CALD communities is
  that

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CALD Family Carers

• Older people from CALD communities face many of
  the same support needs as other older Australians
  (Radermacher et al 2008A, Atwell et al 2007
  2005)
• The key barriers to service provision for older
  people from CALD backgrounds in aged care are
  language barriers and lack of accessible
  information. (Radermacher et al 2008B, Rao et al
  2006 Runci et al 2005 Cangiano et al 2009).

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Research aim Staff-Families Project

• Identify and address the barriers to constructive
  staff-family carer relationships in residential
  care on the basis of a systematic review of the
  literature on staff-family relationships

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Research aims

• Based on the systematic review
• Develop clinical guideline for staff
• Develop audit tool for staff (based on the
  clinical guideline)
• Develop consumer booklet for family carers
• Incorporate themes of systematic review in a
  survey of staff and family carers in order to
  identify the quality of staff-family relations
• Collaborate
• With three residential aged care facilities in
  Melbourne, Australia to pilot implementation of
  clinical guideline, audit tool and conduct survey
  with staff and family carers

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CALD Australians in the 3 facilities

• Two out of the three facilities had significant
  CALD populations
• Facility 1 Public Sector 60 CALD, 11 language
  groups. Majority Italian and Greek
• Facility 2 Private Sector 40 CALD, 14 language
  groups. Majority Italian followed by Greek and
  Maltese
• Facility 3 Private Sector 4 CALD, 3 language
  groups

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Discussion today

• 1 Findings of the systematic review
• 2 Discussion of the clinical guideline and
  consumer booklet
• 3 Discussion of survey results
• 4 Where to from here?

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1 Findings of the systematic review
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Evidence based systematic review

• Aimed to present the best available evidence on
• the strategies, practices and organisational
  characteristics that promote constructive
  staff-family relationships in the care of older
  people in an institutional setting
• The review was completed in 2006
• An expert reference group guided the review
  process

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Key finding

• Family members perceptions of their
  relationships with staff showed that a strong
  focus was placed on opportunities for the family
  to be involved in the residents care. Staff
  members also expressed a theoretical support for
  the collaborative process, however, this belief
  often did not translate to the staff members
  clinical practice.
• Emily Haesler, Michael Bauer, Rhonda Nay Factors
  associated with constructive staff-family
  relationships in the care of older adults in the
  institutional setting International journal of
  Evidence-Based Healthcare, 4(4), 2006, p.289

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Four key factors

• essential to interventions designed to support a
  collaborative partnership between family members
  and healthcare staff
• Communication
• Information
• Education
• Administrative support

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Communication and Information 1

• Staff characteristics most important to the
  development of constructive staff-family
  relationships
• Communicate openly and honestly
• Work in partnerships
• Provide information
• Promote the uniqueness of the resident

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Communication and Information 2

• Interventions designed to promote constructive
  family-staff relationships should address
• Communication
• Provision of information
• Education
• Administrative support

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Education

• Incorporation of staff and family education into
  interventions designed to promote constructive
  staff-family relationships is highly recommended
• Education should include relationship
  development, power and control issues,
  communication skills and negotiating techniques

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Administrative support for staff

• Support from administration and management staff
  is more likely to result in sustained positive
  effectives from interventions designed to promote
  constructive interactions
• Support should include addressing workloads and
  staffing issues, practical support or education
  and introduction of care models focused on
  collaboration with families

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2 Discussion of the clinical guideline/tools
and consumer booklet
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Clinical guideline and audit tool

• A clinical guideline for health professionals
• Creating constructive staff-family relationships
  in the care of older adults in the residential
  aged care setting.
• Synthesises and condenses systematic review in
  order for it to be of practical use by staff.
• Incorporates an audit tool so that facilities can
  benchmark and meet indicators based on the
  recommendations of the systematic review

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Implementation process

• Workshopped clinical guideline and audit tool
  with key staff including
• Facility manager and nominated staff to ensure 14
  audit indicators could be realistically met by
  the facility in the long term
• Primary care staff at handover to discuss
  strategies for addressing issues that might arise
  with family carers

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Workshop example, key staff

• Clinical Guideline recommendation Establish
  formal communication channels for both staff and
  families
• Audit Indicator 8
• 100 of regular care staff can provide detailed
  information (within their scope of practice) as
  requested by family

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Workshop example, key staff

• Barriers identified by staff
• Existing communication problems, time constraints
  and different hours of work
• Solutions identified by staff
• Explore what information families might want to
  know
• Develop a list of base-line information each
  level of staff should know.
• Examine how existing documents support this
  indicator

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Consumer booklet

• Supporting families and friends of older people
  living in residential aged care
• A 12 page booklet designed for family carers and
  based on systematic review
• Is being distributed to family carers via
  nominated residential aged care facilities

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Consumer booklet

• Key points
• My family member is an individual
• Family members have needs as well
• Maintaining communication
• Controlling what happens in care
• Management issues
• Collaborative care
• Care interventions
• Useful contacts

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Consumer booklet

• One of our main recommendations to the funding
  body was that this booklet be translated into the
  identifiable languages spoken by residents and
  their family carers in Victorian RACFs
• A PDF copy of the booklet is available on
  www.latrobe.edu./au/acebac

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3 Discussion of survey results
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Survey described

• A survey of staff and family carer experiences
  developed and administered over a 3 year period
  with 3 sites
• 267 surveys completed over two survey periods

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Some demographic points

• The majority of respondents were female
• Most staff interviewed were PCAs or ENs
• Most family carers fulfilled the role of primary
  carer of the resident they visited with most
  family carers identifying as children of
  residents
• The most frequently selected visiting period for
  family carers was 2-3 days per week

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Results

• The majority of respondents (both staff and
  family carers) viewed staff-family relationships
  and quality of care positively
• For example, overall there was a greater
  agree/strongly agree response to statements in
  the survey
• For example, there was an overall positive
  response to the following question

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Positive response

• First survey Relationships between staff and
  families are generally good

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Positive response

• Second survey Relationships between staff and
  families are generally good

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However, there is room for improvement

• Staff tended to view relationships more
  positively than family carers
• Differences in staff and family carer responses
  to particular statements in relation to
  information and communication skills of staff.
• For example family carers asked for more
  information from staff about their relative
  including better induction meetings, more updates
  on how their family members were going and in
  some cases improvements in communication skills
  of staff
• Two examples of differences in perception between
  staff and families are shown below-

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Survey 1 Staff take time to teach family carers
the skills they need to care for their relative
in the facility
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Staff always listen to the residents views about
their care and treatment survey 2
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4 Where to from here?
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Report to DOHA

• Recommendations
• Facilities examine their practices in relation to
  family care and adopt the audit tool against
  which to benchmark those practices
• Facilities distribute the consumer booklet to all
  family carers of residents
• To facilitate cross-cultural communication, the
  translation of the consumer booklet into the
  identifiable languages spoken by residents and
  their family carers in Victorian residential aged
  care facilities should be pursued

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Report to DOHA

• Recommendations continued
• The survey tool is further contextualised and
  tested for use in the Australian residential aged
  care context
• A key staff member at each aged care facility be
  designated as the point of contact for other
  staff and families and be responsible for driving
  the adoption and implementation of the clinical
  guideline and audit tool
• That the research be replicated in a wider range
  of facilities

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ACEBAC will also

• Update the systematic review Factors associated
  with constructive staff-family relationships in
  the care of older adults in the institutional
  setting(2006)

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References

• Adams, V (2009) Residential aged care nurses
  caring for dementia residents from culturally and
  linguistically diverse backgrounds, Hawke
  research Institute, University of South Australia
• Atwell, R, Correa-Velez I and Gifford S (2007)
  Ageing out of Place Health and well-being needs
  and access to home and aged care services for
  recently arrived older refugees in Melbourne,
  Australia International Journal of Migration,
  Health and Social, 3 (1) 4-14.
• Atwell, R, Correa-Velez I and Gifford S (2005) A
  profile of Victorian seniors from Refugee
  Backgrounds. Health and wellbeing needs and
  access to aged care health and support services,
  A study conducted by the Refugee Health Research
  Centre, La Trobe University for the Department of
  Human services, Victoria.
• Bartlett, H, Rao, D and Warburton, J (2006)
  Ageing and Cultural Diversity in Queensland.
  Working together to make a difference. Report of
  Scoping Project, Australasian Centre on Ageing,
  University of Queensland and Queensland
  Government
• Bauer, M, Nay, R,.Bathgate, T, Fetherstonhaugh,
  Winbolt, M, McAuliffe, Linda (2009). Constructive
  Staff/Family Relationships in Residential Aged
  Care, Report to Department of Health and Ageing
  (Publication Pending)
• Cangiano, A, Shutes, I, Spencer, S and Leeson,
  G(2009) Migrant Care Workers in Ageing Societies
  Research Findings in the United Kingdom. Report,
  Centre on Migration, Policy and Society (COMPAS),
  University of Oxford, viewed 18th August 2009,
  http//www.compas.ox.ac.uk/fileadmin/files/pdfs/Mi
  grant_Care_Workers/MCW20report20-20final20-20
  website20version.pdf
• Haesler, E., Bauer, M., Nay, R. (2007).
  Staff-Family Relationships in the Care of Older
  People A Report on a Systematic Review. Research
  in Nursing Health, 30, 385-398.
• L-F Low, Gomes, L and Brodaty H (2008) Australian
  Dementia Research current status, future
  directions? A report for Alzheimers Australia,
  paper 16, DCRC, University of New South Wales
• Radermacher, H, Feldman, S and Browning, C
  (2008A) Mainstream versus ethno-specific
  community aged care services Its not an either
  or Australasian Journal on Ageing, 28 (2),58-63.
• Radermacher, H, Feldman, S and Browning, C
  (2008B) Review of literature concerning the
  delivery of community aged care services to
  ethnic groups, Healthy Ageing Research Unit,
  Faculty of medicine, Nursing and Health
  Scieinces, Monash University, Prepared for the
  Ethnic Communities Council of Victoria and
  partners.
• Roa, DV, Warburton J and Bartlett, H (2006)
  Health and social needs of older Australians from
  culturally and linguistically diverse
  backgrounds issues and implications,
  Australasian Journal on Ageing, 25(4), 174-179.
• Runci, SJ, OConnor, DW and Redman, JR (2005)
  Language needs and service provision for older
  persons from culturally and linguistically
  diverse backgrounds in south-east Melbourne
  residential care facilities, Australasian Journal
  on Ageing, 24(3), 157-161.

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THANK YOU

• Thats all folks!