Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

7.2Sustaining benefits for consumers and stakeholders

Sustaining community care project benefits

Five of the six community care projects aimed to influence client behaviours or client outcomes directly and therefore might be expected to have some sustained benefits for individual consumers. For example, clients enabled to have greater involvement in decision-making about their care in CC4 are likely to continue to be able to use their newly acquired skills and processes in an ongoing manner. Clients who received support from CC1 would expect to have their leg ulcer healing and skin health improved and those who received priority dental therapy within CC5 would have their treatments completed; however, should these issues or needs recur outside of the project delivery, it is unclear whether these improvements would be sustained. Despite CC1 and CC5 demonstrating positive impacts of the education, such as increased knowledge, changes in relevant self-care behaviours, and increased self-efficacy, confidence and quality of life, it is unclear whether these will continue in the event the initial problem recurred after the project has finished. CC2 involved home care workers helping clients to set recreational and social goals and incorporate potentially beneficial activities (e.g., music, reminiscence, play, physical activity) into usual care. In CC3, one specific recreational activity (music listening) was targeted. Both these projects demonstrated improvements for clients, such as increased engagement, reduced agitation and apathy, and better mood and there is no reason to expect these outcomes to change if the activities continue. However, one interviewee noted that keeping clients interested over time was a challenge and that the education may be less suitable for those with dementia or limited mobility, or those without an informal carer (CC1_3).

The training provided to staff to deliver the education/goal setting/music and the quality of resources provided are key factors impacting on sustainability. For CC1, most of the changes to knowledge and behaviour were retained by staff at 12 weeks following the intervention. For CC5, the provision of accessible materials to clients (bathroom prompts, booklets and, to a lesser extent, online resources) was expected to assist in retaining knowledge and maintaining self-care, however this not supported by evidence in the final report.

For CC2 and CC3, sustainability of benefits relies on continuation of project activities (which is discussed further below). It also relies on appropriate targeting of those activities, as some clients may prefer a more task-focused service. Stakeholders interviewed by the evaluation team for CC2 suggested that LEAP was less suitable for perhaps 20% of clients who already had busy social lives or placed less priority on lifestyle goals (CC2_3, CC2_4). As noted in the CC3 final report, it may be necessary to vary project activities somewhat (e.g., occasionally updating the playlist of music provided to clients, or reviewing their goals) in order to maintain clients’ interest and engagement. There are promising signs that clients, family carers and home care providers are taking the initiative to continue project activities by using their own devices to search the internet for additional music to supplement the tailored CDs produced by CC3 project staff.

All five community care projects aimed to change the knowledge and behaviour of aged care providers including nurses, case managers, home care workers and personal carers. Participants in CC1, CC2, CC4 and CC5 received training and support to enable them to deliver education to clients and/or incorporate new practices (e.g., leg ulcer compression bandaging, skin health monitoring, recreational goal setting, and oral health assessment) in usual care. Two projects (CC1, CC5) were able to demonstrate positive impacts on providers’ skills, understanding or attitudes, and two others (CC2, CC3) showed increases in job satisfaction. Staff turnover is, of course, a risk for all projects that involve training; however, building capacity among staff members has been shown to contribute positively to the sustainability of project activities.^{51 52}

Sustaining national roll-out project benefits

While both RC1 and RC2 were conducted similarly, the change management and sustainability was more explicitly built into the latter. RC2 was successful in targeting its workshops at more qualified and influential staff within the facilities (more than two-thirds of participants were registered nurses, nurse managers, educators or consultants) and the findings from pre- and post-surveys indicated increased confidence both in their wound management skills and their ability to facilitate change in their organisations. The inclusion of the change management components and the ‘train-the-trainer’ approach were deliberate strategies to enhance the uptake and sustainability of new wound management and skin care practices, guided by the resources. Although there were no implementation strategies directly targeted at residents, feedback from participating sites suggested there were some positive impacts such as reduced incidence of skin tears and greater comfort. For RC1, there was no specific action required on the part of workshop participants when they returned to their organisations and so change management efforts were dependent on the skills and motivation of the individuals involved. There was some adaptation of the resources to meet local needs. Consumer outcomes were not measured.

For both these national rollout projects, staff turnover is a risk to sustainability of benefits for providers, but this is ameliorated somewhat by the availability of high quality resources distributed to all residential aged care facilities across Australia (and, for RC1, on the CareSearch website). Sustainability of the benefits for consumers (RC2 only) will depend on how successful project ‘champions’ are in establishing the new practices as part of usual care in their organisations. In theory, the workshop training in change management has equipped them with the skills and knowledge they will need.