1. Measuring the quality of staff-family relationships in residential aged care Dr Michael Bauer Dr Deirdre Fetherstonhaugh Dr Virginia Lewis

2. Project purpose  To improve the quality of staff-family relationships in Australian residential aged care facilities  Aims:  Develop a tool that enables Australian residential aged care facilities to assess the quality of current staff-family relationships.  Develop a tool to measure the underlying attitudinal beliefs staff hold about the relationship between staff and residents’ families in Australian residential aged care facilities. 2

3. Title of presen tation goes here | 1

4. Residential Aged Care in Australia ► 2,772 aged care facilities providing 182,850 residential aged care places (AIHW, 2011) ► High care ► Low care ► Mixed ► Respite 4

5. Residential Aged Care Ownership in Australia 5 Organisation types Australia % Not for profit Charitable 16.4 Community-based 16.3 Religious 27.3 60.0 Government Local government 2.1 State government 8.8 10.9 Private 29.1 100.0 Australian Institute of Health & Welfare (AIHW), 2011

6. Older people living in aged care ► 70% of residents are women ► >50% aged 85 years and over ► 71% of residents are assessed as needing high care ► People with dementia: ► 63% high care ► 23% low care 6

7. Background  Most family maintain contact with their relative and expect some involvement in their relative’s care (Marziali, Shulman, & Damianakis, 2006; Port, et al., 2001) Duncan & Morgan, 1994; Nolan & Dellasega, 1999; Russell & Foreman, 2002)  Residents will experience better care outcomes when staff and family have a constructive relationship (Gaugler, 2006, Haesler, Bauer & Nay, 2010) 7

8. Why the family matters  Support and provide some care of the older person living in residential aged care.  Hold unique knowledge and expertise that can inform care  Family and staff share a common goal of preserving the health and identity of residents through the provision of individualised quality care.  The nature of relationships between staff, residents and family are a determinant of whether the care experience is a negative or a positive one (for each stakeholder) and this influences how families perceive the quality of the care provided. 8

9. Family and the residential aged care accreditation standards Standard 1 Within the philosophy and level of care offered in the residential care service, management systems are responsive to the needs of residents, their representatives, staff and stakeholders, and the changing environment in which the service operates. Standard 2 Residents’ physical and mental health will be promoted and achieved at the optimum level, in partnership between each resident (or his or her representative) and the health care team. 9

10. Staff-family relationships can be ambiguous Developing and maintaining positive relationships between staff and families is often difficult  Many barriers to the development of constructive staff-family relationships and the participation of family carers  Eg. Communication skills of staff, power and control issues, staff workloads, no family involvement in decision making, family perceptions of personalised care, issues of trust/respect, family dynamics, staff-family conflict 10

11. Existing staff-family relationship measurement tools  Not adequately validated.  No measure that draws together the existing evidence about factors that affect the development and maintenance of staff- family relationships.  Attitudinal measures about families in non-aged care contexts (eg. paediatric, intensive and emergency departments).  Generic measures about nurses’ attitudes about the importance of families in nursing care. 11

12. Tools developed  Family and Staff Relationship Attitude Tool (FASRAT)  To identify and measure underlying attitudinal beliefs of care staff with respect to the factors that are known to promote constructive staff-family relationships  Family and Staff Relationship Implementation Tool (FASRIT)  To appraise current practice against what is known to be best practice in the promotion of constructive staff-family relationships.  Tool items as 'probes’ to allow facilities to explore staffs’ views and practices. 12

13. Tool development in 3 phases  Phase 1  Development of item pools based on a systematic review of the research literature  Interviews with residential aged care staff and families  Review of the initial item pools by an expert panel  Phase 2  Initial testing of the psychometric properties of the tools with residential aged care staff and managers  Phase 3  Final testing of the psychometric properties of the tools with residential aged care staff and managers 13

14. Underlying construct  Items development based on systematic reviews of the research literature (Haesler, Bauer & Nay, 2006; 2010)  Eight content domains within the overall construct of factors that support or impede staff-family relationships.  recognition of the uniqueness of the resident  information sharing between staff and families  familiarity, trust, respect and empathy  family characteristics and dynamics  collaboration in care  staff/family communication  organisational barriers to positive relationships  promoting positive relationships. 14

15. Brief overview of tool development phases  Confirmed content validity through:  Focus groups and face to face interviews with facility staff (n=26) and family members of residents (n=14) from four residential aged care facilities  Review by national and international experts (n=28) in ageing, residential aged care and staff-family relationships.  Tested first draft of tools with n=200  High internal reliability (0.94/0.91)  Single factor structure  Selected smaller set of items; some minor modifications to wording; retained 8 domains for content validity 15

16. Brief overview of tool development phases  Final scales tested (n=90)  FASRAT – 26 items  Internal consistency of 26 item scale satisfactorily high, without indicating excessive redundancy (alpha coefficient = 0.88).  Single factor structure for this sample.  Distribution skewed, but only small ceiling effect  FASRIT – 25 items  Internal consistency of 25 item scale satisfactorily high, without indicating excessive redundancy (alpha coefficient = 0.94).  Single factor structure for this sample.  Distribution skewed, but only small ceiling effect 16

17. Example of FASRAT items Staff need to see residents as individuals in order to establish good relationships with families. SA/MA/D/A/MA/ SA /Don’t know Tensions will occur if staff and families have different expectations about care. Families should have the opportunity to be involved in decision- making about their relative’s care. I think families’ knowledge of day to day care needs should be acknowledged by staff. Open communication between staff and families is necessary for the formation of good relationships. Families should give feedback about the contribution staff make to their relative’s care. Cultural differences between staff and families can hinder their relationship.

18. Example of FASRAT items Staff should be provided with training to work with families. SA/MA/D/A/ MA/SA /Don’t know Good relationships between staff and families are more likely when they agree about residents’ individual needs. Good relationships develop when staff and families share the same goal. Good leadership in the facility should encourage staff and families to work together to provide care. Families need emotional support from staff. Families should always be offered updates about changes to their relative’s care. Staff should have an understanding of the potential effects of cultural differences on their relationship with families. I think care staff should make all decisions about residents’ care. Staff can do their job without the involvement of families. 18

19. Example of FASRIT items Staff know a lot about each resident. Never/Sometimes /Often/Always /Don’t know Staff have good relationships with families. Staff ask families for information about their relatives. Staff know what the residents need. Information about the facility is given to families before the decision is made for their relatives to move into the facility. Information about the aged care facility’s mission, vision and values is given to families.

20. Example of FASRIT items Families are offered updates about their relatives’ care. Never/Sometimes/ Often/Always /Don’t know Families are involved in reviewing the facility’s mission, vision and values. Families are encouraged to ask for information whenever they need it. Families and staff share the same goal about the residents’ care. Staff and families work well together. Staff provide opportunities for families to be involved in decision-making about their relatives’ care if they wish. Staff ask residents if they would like their families to be involved in decision making about their care. Staff and families are clear about their roles in the care of residents. Staff and families agree about residents’ individual needs. 20

21. Conclusions  Tested with relatively small although professionally diverse samples to date  Both scales demonstrate good basic psychometric properties  Further exploration of the structure of the scales in future  Extending use to families or special care settings  Tools will support quality in residential aged care through:  identifying gaps which impact on the quality of staff-family relationships  identifying areas where further education is required  providing a validated instrument for evaluation of interventions and monitoring quality over time 21

22. Thank you 22 m.bauer@latrobe.edu.au d.fetherstonhaugh@latrobe.edu.au v.lewis@latrobe.edu.au