Constructive Staff/Family Relationships in Residential Aged Care (Presenter) Dr Michael Bauer Professor Rhonda Nay (Presenter) Dr Tenzin Bathgate Dr Deirdre Fetherstonhaugh Dr Margaret Winbolt Ms Linda McAuliffe Presentation to Centre for Cultural Diversity in Ageing, Migrant Families in Aged Care: An Intergenerational Perspective Seminar, Melbourne, 28 August 2009

Title of presentation goes here | 1 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.

Title of presentation goes here | 1 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 2008A&B, 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…

Title of presentation goes here | 1 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).

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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?

Title of presentation goes here | 1 1 Findings of the systematic review

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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 resident’s 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

Title of presentation goes here | 1 Four key factors… …essential to interventions designed to support a collaborative partnership between family members and healthcare staffCommunicationInformationEducation Administrative support

Title of presentation goes here | 1 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

Title of presentation goes here | 1 Communication and Information 2 Interventions designed to promote constructive family-staff relationships should address… –Communication –Provision of information –Education –Administrative support

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 2 Discussion of the clinical guideline/tools and consumer booklet

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 ‘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 Consumer booklet

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 3 Discussion of survey results

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 Positive response First survey: Relationships between staff and families are generally good

Title of presentation goes here | 1 Positive response Second survey: Relationships between staff and families are generally good

Title of presentation goes here | 1 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:-

Title of presentation goes here | 1 Survey 1: Staff take time to teach family carers the skills they need to care for their relative in the facility

Title of presentation goes here | 1 Staff always listen to the resident’s views about their care and treatment – survey 2

Title of presentation goes here | 1 4 Where to from here?

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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

Title of presentation goes here | 1 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)

Title of presentation goes here | 1 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) 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 18 th August 2009, 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, L-F Low, Gomes, L and Brodaty H (2008) Australian Dementia Research: current status, future directions? A report for Alzheimer’s 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: It’s not an ‘either or Australasian Journal on Ageing, 28 (2), 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), Runci, SJ, O’Connor, 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),

Title of presentation goes here | 1 THANK YOU That’s all folks!