Consumer Directed Care in residential aged care: Transforming care staff practices through the Resident at the Centre of Care (RCC) training program

The Resident at the Centre of Care (RCC) program is designed to increase staff awareness and understanding of Consumer Directed Care (CDC), educate staff on the use of a Resident Care Form to obtain resident choices on care, empower leaders to address the organisational barriers to implementing CDC and support staff in this implementation of the RCC program. The training program will be delivered by a member of the research team with experience in facilitation in the aged care sector. The five sessions are spread over 9-weeks (1 week between sessions except 4 weeks between sessions 3 and 4), with each training session will run for approximately 2-hours during work time at the Residential Aged Care Facility (RACF). Session 1 - Transformational Leadership: This session is for senior staff only. It will provide an overview of RCC program and CDC in residential aged care. It will also examine the role of senior staff during the RCC program and throughout the transition to a CDC model of care. Senior staff will also be provided with an overview of the key skills associated with a Transformational Leadership style and its importance in promoting successful change. Session 2 – Barriers and Enablers to CDC: This and all subsequent sessions will be attended by all staff participants. Detail about the RCC program and CDC will be provided for the benefit of general staff. Staff will also be encourage to consider the barriers and enablers to implementing CDC specific to their facility. This discussion will be supplemented by an overview of the organisational factors associated with successful and sustainable change. Session 3 - Communication and Autonomy: Addresses the integral role of staff and resident collaboration and communication to CDC. Example approaches to eliciting resident choice and promoting control will be examined and practised. The session also provides staff with an opportunity to practise minimising the earlier identified barriers and fostering the enablers of successful CDC implementation. Session 4 – CDC Plan outline: Following a 4-week break, staff will review their experience of working with residents to determine their care and leisure preferences. Staff will use this experience to guide the development of clear processes for collecting, recording and implementing resident preferences. The session ends with staff developing an outline of the essential elements of the CDC Implementation Plan for their facility. Session 5 – CDC Implementation Plan: This session asks staff to refine the CDC Plan outline created in Session 4. By the end of the session, staff will have created a detailed CDC Implementation Plan to guide them through the transition to a CDC model of care. This plan will include milestones with specific achievements at various time points (e.g. in the next month, in 3 months, and so on). Staff will also consider approaches to ensuring they stay on track with their plan and how to address newly identified barriers in the future. Procedure The RCC program is a face-to-face group training intervention that will be implemented and evaluated in a three-arm cluster RCT research design. A total of 39 residential aged care facilities (RACFs) will be randomly allocated into one of the three conditions (13 sites in each) – “training + support”, “training only” or “care as usual”. Training + support: Implementation of the 5-session RCC program among managers, Registered Nurses, Personal Care Attendants, lifestyle, kitchen and other support staff. Additional organisational support will be provided for one day per week for four weeks between Session 3 and 4, and a further one day per week for 12 weeks following Session 5. The research personnel providing support will work with staff to assist them to create the climate in which CDC can prosper and to ensure the embedding and sustainability of the leadership and organisational changes from the RCC program. Training only: Implementation of the RCC Program among managers, RNs and PCAs as well as lifestyle and kitchen staff; no additional organisational support. Adherence to the intervention will be monitored by the Project Coordinator via regular supervision with the training facilitator (for session preparation and debrief). The effectiveness of the RCC Program in improving resident QoL and staff job satisfaction and reducing staff stress and turnover will be determined through a timeline of evaluations planned for pre/post-intervention and at 3, 6 and 12 months follow up. We will assess whether RCC training results in effective CDC implementation (comparison of “training + support” and “training only” with the “care as usual” condition) and if provision of additional organisational support results in better sustainability of CDC implementation (comparisons of “training + support” and “training only”). Even if some aspects of CDC are currently being adopted in some facilities, we would expect our comprehensive RCC program (“training + support” and “training only” conditions) to effect greater changes in resident and staff measures compared to “care as usual” (control condition) as well as testing the value of additional organisational support. Participants The participants will be aged care residents and staff recruited from RACFs managed by our partner organisations. Informed consent will be obtained from facility managers, staff, and the residents themselves, or if they are unable to provide consent because of communication or cognitive difficulties, from their family or guardian. All data will be de-identified when they are coded and questionnaires will be kept confidential to the researchers. Every resident at each participating site who meets the following inclusion criteria will be invited to take part: Residents older than 65 years and living in the RACF for more than three months. Exclusion criteria will be: acute medical illness likely to compromise participation in the program; inability to effectively communicate due to no English language or severe dementia (PAS score = 16 or higher). Based on our previous work with RACFs, we expect an average of 20 residents per facility to be eligible and willing to take part in the study. Across the 39 sites, we expect to recruit a total of 833 staff (an average of 21-22 staff per facility; sample size calculation is detailed below). This will include approximately equal numbers of senior staff (e.g., facility managers, RNs) and support staff (personal care attendants, lifestyle and kitchen staff). To facilitate knowledge translation, staff in each of the 26 sites randomised to the intervention groups (Conditions 1 and 2) will be trained to work with the remaining staff to promote the philosophy of CDC and in organisational procedures for adopting the CDC approach. Session 1 of the RCC program will be for senior staff only, while Session 2-4 are for all staff.