Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

9.3 - Gaps in the current program

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The clinical areas chosen as priorities for the EBPRAC program were based on an internal DoHA review of issues identified from aged care complaints and accreditation processes which are generally consistent with the clinical areas identified by the high level stakeholders who were interviewed during the evaluation.

One of the gaps in the program was the missed opportunity to develop a degree of coherence within the program, and between the individual projects. This was particularly evident in Round 1, where it was recognised early on by project leads that there were linkages between each of the clinical areas e.g. improved oral health can reduce pain and improve nutrition, improved nutrition can reduce the risk of falls. There is little evidence that these connections were actively pursued, and the email list-servers to promote communication between projects were underutilised. The clinical areas addressed in Round 2 provided more coherence, with three palliative care projects and three projects targeting behaviours of concern, which provided the opportunity to identify common tools and lessons. However, no links were established between projects focused on different areas of practice. Perhaps understandably, the overall focus has been for each project to meet the requirements in their contract, with coordination between projects a secondary consideration.

A key advantage of the choice of project leads was that many of those involved in EBPRAC were also involved in other aged care and industry related projects. There is evidence that this has resulted in some cross-fertilisation between EBPRAC and the project leads’ other activities.

Another gap, not so much in the program itself but the sector more broadly, has been the lack of coordination and coherence at a policy level, with major industry-wide initiatives underway simultaneously with the potential to impact on the delivery of the EBPRAC projects. Some projects reported a sense of ‘change fatigue’ amongst staff arising from a sector that is in a constant state of change. Some industry stakeholders who were participants on key industry committees convened by DoHA also had limited awareness of the program, or of its potential to impact on their deliberations. Similarly, initiatives were underway by State and Territory governments which also aligned, or had the potential to confound, the EBPRAC projects.

This theme of coherence and coordination at the policy and project levels is also reflected at the individual client level. There is increasing recognition of the importance of a holistic approach to care, rather than an issue-specific approach, and yet the EBPRAC program tended to focus on very specific aspects of care in isolation. The concept of ‘person-centred care’ was at the core of the behaviour management projects but increasingly this approach is being adopted more generally across health and aged care. While there is good evidence about the benefits of this approach for people with dementia, the uptake of person-centred care within the sector appears to be driven primarily because of a fundamental philosophy rather than the evidence base regarding its efficacy. The Aged Care Standards and the Code of Ethics for Residential Aged Care endorsed by key leaders in the sector espouse similar sentiments. Therefore a gap, which has been partly addressed by EBPRAC, is the evidence about how person-centred care can be well-implemented across the sector. This has implications for the way aged care is provided into the future, particularly the clinical outcomes of older people in care, and the staff and system which support them.
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