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.
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.”
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:
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.
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.
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).
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:
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.
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:
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.