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Trials of CDC in residential aim to bolster staff-resident relationships

Communication between residents and care staff is vital to the success of consumer directed care in residential aged care, write Michelle Campbell, Marita McCabe and Elizabeth Beattie.

Australia is striving towards a vision for residential aged care that is both centred on and directed by the consumer.

Consumer directed care (CDC) is designed to support older people to make decisions about their care and everyday routines and have a care plan that is, where possible, directed by them (or where necessary, by a family member).

The likely introduction of CDC in residential aged care facilities will change how service providers deliver care.

Within this context, there is a need to consider the role of communication between residents and care staff, and the impact of communication difficulty on the implementation of CDC.

Older people living in residential care are a vulnerable and complex group with a high rate of cognitive and communication impairment.

Resident capacity to participate in CDC – to reflect on their care needs, understand the options available, make informed decisions and self-direct funds – will be limited for many residents.

Care staff will need to play a key role in facilitating successful communication with residents to support them in the transition to CDC and to facilitate their ongoing engagement and participation.

Further, the relationship between residents and staff will be central to the success of CDC. Communication is important to enable this relationship to develop.

In implementation trials of CDC, both staff and residents must be educated about CDC and the change in expectations and roles of provider and consumer that a shift to CDC brings.

Care staff must be provided with the skills to facilitate communication with residents, including those with communication difficulties.

Addressing the communication skills, deficits and needs of older Australians has always been a challenge given funding and resource limitations in the sector.

However, many older Australians with communication impairment are capable of participating in CDC and taking a more active role in decision making if appropriate supports are available.

Such supports would ultimately be determined on an individual basis and could include service options from rehabilitative therapy for residents through to the provision of communication partner training for care staff and family members.

At the outset of the implementation of CDC in residential care, attention should be given to acknowledging the impact of communication impairment on resident capacity to participate in CDC, and the ability of care staff to foster and sustain an equal and supportive working relationship with residents.

Current trials of CDC in residential

Addressing the vital contribution of the working relationship between residents and care staff, and the challenge of communication and cognitive impairment on resident capacity to participate in CDC, our research team has embedded communication awareness and facilitation education within current trials of CDC in residential care.

Other partner organisations are Deakin University, Queensland University of Technology, Cairnmillar Institute and University of Wollongong.

Building on the principles of transformational leadership, and with an emphasis on the need for support all stakeholders throughout change, the research team is considering the process of change and the implication that a change in healthcare roles and expectations has on the consumer.

Results from a trial of CDC in six residential aged care facilities in Victoria and Queensland will guide further development of training for care staff, in facilitating communication with residents, building an equal working relationship, and fostering resident engagement and participation in CDC.

Lessons learnt will assist in the development of successful and sustainable models of CDC for adults with communication impairment applicable across the wider ageing and disability sector.

Dr Michelle Campbell is executive dean of health sciences at the Australian Catholic University. Professor Marita McCabe is director of the Institute for Health and Ageing at Australian Catholic University. Professor Elizabeth Beattie is director of the Dementia Collaborative Research Centre (DCRC) – Carers and Consumers at Queensland University of Technology.

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