Optimising Transition to Residential Aged Care

The aim of this research is to obtain feasibility and acceptability outcomes for a new care pathway designed to better support the transition of new residents into residential aged care facilities (RACFs). The intervention has three arms: PEARL- program to support residents, aSTART- program to support families/carers, and Staff Training to support RACF staff. 1. PEARL- program to support residents. The PEARL program is an evidence-based manualised program (Davison et al, 2020) based on self-determination theory and shown to assist aged care residents to adjust to their new residence and circumstances. In PEARL, residents will take part in five 1-hour talk-therapy sessions over 11 weeks. These sessions are delivered to newly arrived residents at the RACF by supervised psychology and occupational therapy students, who will undergo an additional 8 hours of online and face-to-face training in general counseling skills and the PEARL program. PEARL training is delivered by a member of the research team who is a clinical psychologist with experience both working with the aged population and in delivering the PEARL program. The first three PEARL sessions occur in consecutive weeks with session 4 occurring in Week 6 and the final session (5) occurring in Week 11. In the PEARL program, residents work with therapists on tasks built developed based on self-determination theory and designed to improve adjustment to their new environment. The first three sessions cover content designed to improve autonomy, relatedness, and competence, while the final two sessions review previous learning and connect insights obtained in the first sessions with approaches available within the facility. The 11-week program also involves two staff-focused sessions in which the PEARL therapist connects with relevant staff to drive connection between the new resident and the facility and two "booster" sessions designed as collaborations between the resident, the PEARL leader, and facility staff. In all, PEARL is designed to give residents a chance to discuss their own preferences for life within the residential care facility and provide a space to talk about their emotional and social adjustment to their new environment. PEARL is a manualised program with specific tasks to be completed at each session. Progress on the intervention is tracked by session checklists to be completed by the PEARL therapist and logged with the residential facility and research team. PEARL reference: Davison, T.E., McCabe, M.P., Busija, L. et al. A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents. BMC Geriatr 20, 98 (2020). https://doi.org/10.1186/s12877-020-1492-5 2. aSTART- program to support families/carers The aSTART program is an adapted version of the evidence-based, manualised START program (Livingston, et al 2014) that is shown to support family carers of those living with dementia. The adapted aSTART focuses on supporting family carers of individuals who have made the transition to residential aged care. These adjustments have been made in collaboration with the research team who designed the original program to ensure the key focus and approach remain the same. aSTART consists of up to 8 sessions focusing on psychoeducation of grief, depression, stress, and dementia, alongside practical strategies that family carer's can implement to better their own experiences of stress, as well as improving communication and interaction with their relative. The specific sessions to be completed within the aSTART program are determined collaboratively between the clinician and the participant in the first introductory session. aSTART will be offered via Telehealth or face-to-face the University of Newcastle’s Psychology Clinic or at RACFs. aSTART will be delivered by psychologists who will undergo an additional 8 hours of online and face-to-face training in the aSTART program. aSTART involves 5-8 talk therapy sessions (depending on client needs), each of which is designed to support family carers through changes in their role as their family member moves into RACF living. Training in the program is provided by clinical psychologists with experience in delivering the aSTART program and working with the specific population (i.e. relatives of older adults who are experiencing cognitive decline or have moved into residential aged care). aSTART is manualised and flexible, allowing family carers to work with the therapist to tailor the program to their specific needs. For example, participants can decide to focus on behaviour management if this is a primary concern and/or if their relative has a dementia diagnosis, option dementia modules can be included. Each session has a programmed set of tasks and checklists are used to monitor progress. aSTART will be offered to family carers of new residential care residents regardless of whether or not their relative has decided (or has the capacity) to participate in PEARL. Dyads are not required or assessed for this trial. Family carer's are offered participation in aSTART during their relative's orientation to the facility and may begin immediately after this date, but this is not essential. Researchers will re-offer the program twice in the first 6 weeks of their family members move into the facility. START reference: Livingston, G., Barber, J., Rapaport, P., Knap, M., Griffin, M., Romeo, R., et al. (2014) START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol Assess, 18(61), https://doi.org/10.3310/hta18610times, 3. Staff training- supports for RACF staff RACF staff will be supported with additional training in mental health, dignity of choice, and in understanding the PEARL program being delivered within their facility. This training is delivered by a Psychologist with both clinical and Ph.D. training and vast experience in the aged care field. The training is in face-to-face format on-site at their place of work and is 3 hours in duration. The training involves a combination of instructor-led learning of theory, interactive activities, group discussion, and case-study analysis. Participants are provided with a copy of workshop content as well as practical guides they may use to implement in their daily practice at the facility. Session participation is monitored by attendance check-lists and survey responses before and after the session.