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

7.3Continuing the activities

Continuing the activities of community care projects

Several community care projects have indicated in their final reports that staff who were trained will continue to use their new skills in their daily encounters with clients. Health workers who undertook the SAP training (CC1) will continue checking clients’ skin and reporting problems to nursing staff; recreational and social activities such as reminiscing and music listening can be carried out while the care worker is doing housework or driving the client to an appointment (CC2). Delivery of preferred music listening will be taught to new home care workers as part of their induction procedures (CC3_3). More than half the care packages delivered by the host organisation for CC4 are now based on the CDC model and there will be ‘no turning back’ (CC4_2).

In the medium to long term, staff members will need to take on responsibility for engaging new clients and carers in these programs. Empowering staff to take responsibility for implementing and sustaining change is another identified factor in sustainability (Maher et al., 2003). One goal of CC5 was to empower home care workers to broaden their focus beyond completing tasks (such as housework or shopping) to a more holistic view of caring for their elderly clients. The project aimed to give them greater awareness of oral health issues, the knowledge to make oral hygiene a part of routine care, and confidence to advocate for clients to have their problems addressed. Workers are also more likely to remember and prioritise new activities if they have high face validity (i.e., they are self-evidently useful) and they can see the benefits immediately (Maher et al., 2003). For example, CC2 reported that participating organisations had witnessed positive impacts on both clients and care workers. The project had:

Changed a lot of minds in the organisation; LEAP provided a different mindset as to how to work with clients into the future. (CC2_2)

The challenge of changing minds should not be underestimated; CC4 stakeholders acknowledged some resistance from both staff and clients unused to the new ways of working. For example:

Staff thinking that this was a project and that from 1 January they can revert back to the old way of doing things – there has been some resistance from case managers. The service manager comes from an accountancy background and not a care background. Looks at dollars and cents and not about the service itself. Took a long time to change his mindset. It is not so much about training it is a shift in philosophy. (CC4_6)

Changes to work patterns that make work easier and more efficient provide benefits to staff members, who are then invested in sustaining those changes (Maher et al., 2003). In the case of the community care projects, none actively sought to simplify or streamline work processes. However, in many cases the new tasks were not time consuming and did not require expensive resources, making it more likely they would be incorporated into ongoing practice. LEAP (CC2) was one such project where implementation was relatively easy and inexpensive; according to one interviewee, resources could be as simple as printing out a crossword (CC2_5). This was not always the case, and continuing project activities in the absence of dedicated project time will depend on the motivation of individual workers:

In the program, RDNS gave staff extra time to carry out the 10 week project with clients. This is not possible outside of the project, after program there is simply no time to work closely with clients on this issue alone. But it has built good working habits. (CC1_1)

Without the project, there is nothing to incentivise staff to continue. (CC1_7)

We ask such a lot of our care workers…everyone is so busy. (CC5_2)

Lack of specialised resources may be a barrier to sustainability for some of the community care projects. For example, the LUPP component of CC1 will continue in its original form at the Victorian regional sites only as long as the kits are available (100 kits were put aside for their use). The LUPP kits cost $113 each, not including the DVD, health worker and participant booklets, and it is unclear whether further money will be available to replenish the supply. The kits have been made available via an external supplier, Independence Australia, used by clients of RDNS. The booklets, DVD and self-directed learning package will require updating from time to time. The CC3 final report acknowledges that producing tailored music collections and songbooks for individual clients is a time-consuming process that may not be feasible without EBPAC program funding. The cost of providing the CDC model, with access to a choice of services, varies according to whether the client lives in a suburb or a rural location (CC4_1, CC4_9). Funding will be required to update the CC4 training resources regularly and meet the costs of web hosting.

Project activities may be sustained in some form if they can be adapted in response to evaluation findings, stakeholder feedback or organisational needs.⁵³ For instance, the most effective aspect of the SAP project (CC1) was the education of health workers. Nevertheless, client education was seen as important, and therefore other options for communicating the importance of skin health maintenance to older people (e.g., stand-alone delivery; peer education) have been explored and are being considered for the future. The evaluation also provided useful information to guide improvements to some of the LUPP (CC1) activities and sessions to enhance effectiveness. If it proves impractical to create a tailored music collection for each client, the CC3 project can draw on its existing library to develop more generic CDs that meet clients’ preferences for artists or genres.

Continuing the activities of national roll-out project

The main activities of RC1 and RC2 were workshops for large numbers of participants and distribution of the resource kits nationally. While these are now complete, it is reasonable to expect that some form of ongoing training will be facilitated at the local level through the skills and resources provided to participants as part of the workshops. The Palliative Approach toolkit will continue to be accessible on the CareSearch website, the main repository of palliative care resources nationally; however, the extent to which aged care staff access the site is unclear. Updating resources will require additional funding; RC2 will need to seek funds to conduct evidence reviews every two to three years and to continue disseminating the CSI toolkit.