Isn’t aged care quality meant to delight us? – Opinion

How would you rate the quality of an aged care service if you were the client?

It would have to meet your needs so that your life improves.

Which doesn't sound too hard – most of us do this every day with the services we use.

So, why don't we do this with aged care?

Because we don't decide what quality is, the government does. It's based on what it's prepared to pay for – primarily physical care.

Now, aged care clients value this physical care enormously. But tell us that without also having a life to live, their overall view of quality will always be very low.

They told us that they live their lives through their roles. And that the roles they cherish are things like doing the domestics, cooking, gardening, pottering, grandparenting, caring for a pet, being neighbourly, belonging to groups, having a coffee, answering the doorbell, shopping, holidays, getting out, learning something, using technology, keeping fit, playing games, being useful, making things, volunteering, getting active on social issues, being in nature.

Sure, varying in amount, style and support as capacity diminishes. But it is never going away.

We found that this "role quality" wasn't hard to measure.

What roles have you got? How many hours per day are you in them? Do they connect you with others? Are you equipped and supported to do them? Are you learning on the job? Are you enjoying the benefits? Do you feel like you've got some purpose? And is care provided in ways that support this?

But staff told us that it takes a lot of work to deliver.

So, we looked at the services the rest of us use to see what they could teach us about delivery.

Think shops, cleaners, cafes, schools, hotels, doctors, airports, mechanics, informers, entertainers.

All of the services that support the roles come from where we live, learn, work and play. Or those services that simply make it easier for us to be in these places. So we can put more time and energy into our roles.

All these services use service models comprising a range of component parts – staff, skills, buildings, equipment, processes, language, client groupings, communication, and brand. How well they are matched to one another, and then in total to the service needs of the clients, determines success.

We get good matches. And if we don't, we walk away.

Aged care seldom does. At least not in the hundreds we've looked at so far.

Seems aged care services either try to do too many different things and end up with component parts that don't match (jack of all-trades service models). Or the parts fit well but not with the client's needs (institutional service models).

The Training Institute (University of Syracuse) has empirically demonstrated that these "incoherent service models" rarely deliver high-quality human services.

And that testing for the presence of "coherent service models" accurately indicates the existence of high quality.

They say (Valor Press, 2022) that learning about and building coherent service models around clients' specific needs is the surest way of getting high-quality services.

Let's be clear here – this evidence indicates that we should be in no doubt that the current service models will rarely deliver the modest quality older people want. And will lock out a whole generation of providers from experiencing it.

Good on you, SAGE Global Study Tours (Anchor Excellence), for showing us examples of using coherent service models.

Here, we saw various service models where frail people sustain their home-making roles, which was impressive enough.

But we also saw people sustaining and growing their networks, fitness, interests, skills, contributions, time use, and care.

In ways that we don't typically see in aged care. And are "taught" to think that is not possible.

We saw that different needs require different service models. That staff can gracefully deliver when they work in coherent service models. Using a range of service models is no more confusing for older people or providers than for the rest of us.

And that coherent service models do become a significant attractor of clients.

But it still needs to be a market force for sector quality improvement.

The Australian Government was hoping that's what star ratings would do.

But being driven away from the worst aged care services is more of a fear-force.

Market forces require the construction of quality that clients are drawn towards. And in aged care, older people tell us that this must combine care quality and role quality.

So, star ratings help the funder see if it's getting what it's paying for. But only tell older people a little bit about the life they're signing up for.

Or move providers to be anything more than "not the worst", which is unsurprising. If we don't also have ways to learn about role quality. And the use of coherent service models to deliver quality. And the evidence base for this.

And the opportunity to experience using this to design services that clients are delighted with. Even happy to pay for it.

And when we've done all this, then let's have some star ratings for role quality.

So, in aged care, there are plenty of opportunities to make quality work for clients. Opportunities for government, consumer groups, providers, start-ups, Quality Commission, training bodies and now the Inspector General.

But not much love for it.

Mike Rungie specialises in the intersection between good lives and aged care. He is a member of a number of boards and committees, including ACFA, Every Age Counts, and GAP Productive Ageing Committee.

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