In late January 2020 the Aged Care Quality and Safety Commission (ACQSC) issued a Consumer Engagement in Aged Care Literature Review, which made this surprising finding:

“While consumer-centred care has been associated with high quality care in Australia and abroad over the past two decades, there are still many residential care services that claim to provide it, but ‘their actions do not always match the rhetoric. Task orientated rather than person orientated approaches continue to prevail.”

In other words, everyone agrees that consumer-centred care is a great idea but there are still many aged care providers who aren’t delivering it or aren’t delivering it very well. Why? In this article we take a closer look at some of the barriers to achieving good consumer-centred care and how you can overcome them.

What is Consumer-Centred Care and Why Does it Matter?

Consumer-Centred Care

In its literature review, the ACQSC broadly defined consumer-centred care as “care and services that are designed around the consumer and delivered in a way that meets the individual’s goals, needs and preferences.”

Benefits of Consumer-Centred Care

As the ACQSC’s literature review shows, there is strong evidence that consumer-centred care provides a range of benefits to consumers and providers, including:

• improved health outcomes for consumers
• improved services, including improved capacity to identify gaps in services and training
• enhanced credibility of service providers
• improved staff satisfaction and retention
• improved organisational efficiency and reduced long-term costs.

Consumer-centred care is particularly beneficial – perhaps vital – when providers are faced with dynamic problems such as the rapidly changing COVID-19 pandemic. Consumer-centred care facilitates trust, making providers and consumers more willing and able to share information with each other, which in turn facilitates the kinds of fast, radical actions that may be needed to contain the spread of the virus.

What is the Difference Between “Consumer-Centred Care” and “Consumer Engagement”?

In its literature review, the ACQSC said that consumer engagement “is about involving consumers (and their families and carers) in all aspects of care.”

What is the difference between consumer-centred care and consumer engagement? In the simplest terms, “consumer-centred care” is a broader concept while “consumer engagement” is a narrower concept that describes a specific action. In other words, “consumer engagement” is one of many things you can do as part of a broad program of “consumer-centred care.”

This difference is more important than you might think. This is because the evidence of the benefits of consumer-centred care is strong but the evidence of the effectiveness of consumer engagement is weak. According to the ACQSC’s literature review, “There is debate about the degree to which consumers seek involvement, the best way to involve them and the impact or evidence of the benefit of consumer involvement.”

That is, we know that consumer-centred care is beneficial, but we don’t know if consumer engagement is an effective way to achieve it. As we discuss below, this can be one of the main barriers to delivering good consumer-centred care.

Consumer-Engagement and the Aged Care Quality Standards

The jury may still be out on the effectiveness of consumer engagement, but that hasn’t stopped the ACQSC from regulating it. Consumer engagement is mandatory under the Aged Care Quality Standards. The main source of this obligation is Standard 1, which requires providers to give consumers choice in all aspects of their care. Other relevant Standards are Standard 2, which requires providers to partner with consumers in planning and assessment processes, and Standard 8, which requires providers to engage consumers in the delivery and evaluation of care (Standard 8).

Barriers to Delivering Consumer-Centred Care 

If consumer-centred care is so beneficial, why are some providers not delivering it as well as they could be? The ACQSC in its literature review and Resource for Working with Aged Care Consumers suggests that this may be because:

• consumer-centred care is hard to measure and the best means of achieving it are unclear
• providers are wary of the cost and perceive it as a burden that takes resources away from the actual provision of care
• although improved consumer-centred care might increase efficiency in the long run, staff don’t have the time, skills or mental bandwidth to lay the necessary groundwork right now
• providers assume they are already delivering good consumer-centred care
• governing bodies and staff see consumer-centred care as a threat to their identity or power
• consumers resist efforts to improve consumer-centred care. This may be for various reasons, including sensory and cognitive difficulties, frailty and fatigue, lack of confidence, and unwillingness to criticise the provider.

The key themes running beneath all these points are difficulty and uncertainty. Change is difficult, so if you’re going to put in the hard work and take the risks, you want to be certain about what to do and confident that it will be worthwhile. But, as the evidence in the ACQSC’s literature review shows, when it comes to the best ways to effect consumer-centred care, nobody is certain or confident.

How to Overcome Barriers and Achieve Better Consumer-Centred Care

The ACQSC acknowledges that the task of improving consumer-centred care is fraught with uncertainty. In its Resource for Working with Aged Care Consumers, the ACQSC advises governing bodies to find the best way to engage with their consumers by “Try[ing] different things, accepting that some may not work.”

Many aged care providers may be tempted to respond to that advice with words to the effect of “Are you kidding?” In an aged care home, most resources are used up just achieving what you must do, with a few left over for achieving what you know will make the home better. The idea that aged care homes have unused resources lying around that they can devote to experimentation seems absurd.

But, absurd or not, it’s something that providers somehow have to do. Why? Because the ACQSC Assessors will test you on it, and it will improve your services and outcomes. So, here are three small, simple things you can do right now to improve your consumer-centred care:

• On your own or at a governance or management meeting, open the Resource for Working with Aged Care Consumers and do a word search for “Consider…” This will help you cut through the overwhelming 66 pages of advice to the practical suggestions. You can also use a similar process to draw out some handy information from the ACQSC’s Guidance and Resources for Providers to Support the Aged Care Quality Standards. Just search for “Reflective questions.”
• Introduce staff to the terminology. Chances are, your staff are already performing a hundred acts of “consumer-centred care” and “consumer engagement” every day but they may call these acts something else or not even reflect on them at all. A common language will help them identify and share their achievements. This will also make it easier for you to…
• Record, record and record. Staff are almost certainly engaging with residents and their families about all sorts of aspects of care – plans for the garden, ideas for outings, perils of Coronavirus. Is anyone jotting this information down? Is anyone compiling it? Is management reading and reflecting on it? Can you incorporate this kind of record keeping into your self-assessment processes?

Conclusion 

When it comes to consumer-centred care, do you have the resources to “Try different things, accepting that some may not work”? The good news is, you’ve probably already made a good start. Don’t let it go to waste. Find out what you’re already achieving and record, record, record.