What is Quality Care in aged care?

A quality standards framework would be expected to meet the tenets of the speciality it supports. In aged care, whether residential or community and home care focused, that would mean respecting the tenets of gerontology – which is a multi-dimensional subject including self determination and goal setting in all life areas; social, clinical and medical. 

‘Person centred care’ is a phrase used far too loosely at times, with a task oriented focus used to promote this concept, tasks that people need support with rather than goals people need to achieve to feel self worth. No matter what age we are, we need to feel useful, have a level of continued control about our life and have certain goals each day to feel a sense of self respect.

This requires those around us to ask us or observe us, and determine what makes us feel valuable. This requires those around us to ensure they assess our personal needs not from a task focused approach of ‘providing shower support’ for example, or ‘assisting us to eat or drink’ but documenting, care planning and ensuring we are supported to do what we can for ourselves – that helps to maintain our dignity. 

Quality care documentation and care provision is about providing all day every day experiences for older persons (or those we support), this includes their spiritual, cultural, religious and sexual identity as well as their clinical and medical needs. That means knowing what makes the person feel good about themselves. 

A shower is not just a shower, it is a time for a person to receive, usually in the first experience of the day, some comfort. A warm experience where dignity is shown by knowing exactly what support is needed and wanted – knowing exactly what the person wants to do for themselves, and what we need to do. It is not a task to be ticked off – as done. The attitude towards the task must be: ‘yes we provided shower support today’.

It is an activity that starts the day off in the right or wrong tone, assisting the person to make choices. Choices regarding the soap to use, the area to wash first, the area to dry first, what part of the body to dress first so the person doesn’t feel too cold, what creams, lotions and jewellery, perfume or aftershave to apply. What clothes the person usually likes to wear or if they will select their own clothes that day. Are there hip protectors, hearing aids or stockings to apply, wounds to ensure are dressed, continence aids to use or toileting regimens to follow, or a favourite watch or necklace to offer?

It is the care experience, the outcomes of care and the focus of staff on providing a supported, caring environment where a person is listened to, even in their world where dementia is experienced. The skills of staff and their understanding of concepts such as infantilisation, where staff talk over, don’t listen and speak to the older person as a small child regardless of their confused state or not, makes all the difference.

Knowing what to assess, covering every quality care consideration including fall prevention without onerous restrictive practices, manual handling support that prevents pressure injuries, confusion and medication management that minimises psychotropic use, results in quality care.

Knowing what types of social relationships and contact with the community a person wants and needs is what person centred care is about. Knowing that the person likes to look at family photos, or wish to participate in some hobby, or watch or listen or read that particular topic contributes to provision of quality care. That is the person centred experience those we support need to receive – but to do so means staff need to assess and document and communicate these intricate wishes with each other.

That is what a person centred care plan is about. It is about ensuring the older person can make informed choices, where their health and well-being is managed by skilled care ‘assessors’ who pick up body twitches, movements, odours and looks that are managed and supported in a comfortable service environment and is documented so all others supporting that person know as much as possible about the person they will support during their shift. Support that prevents the older person having to repeatedly explain what they need and want to each person that approaches them. Staff require support to understand how to assess, document and plan care and then be supported to apply those practices every day.

For further reading, there are over 75 quality research papers or articles, some free to download available from the PUBMED National Library of Medicine site, focused on the experiences of older people, carers and managers experience and what defines quality care for older persons.

Dr Caroline Lee leads the Leecare team behind Platinum6, aged care’s leading software and electronic health record platform focused on providing quality technology to support gerontology and primary care teams. You will find more information on how to strengthen your care delivery, compliance and medication management on Leecare’s website.