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

10.2 - Cost implications for providers

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For the purposes of identifying the cost implications of the EBPRAC projects for participating facilities data was collected on four main types of cost:

1. Costs of staff training.
2. Costs incurred as a result of the time spent by staff assisting in project implementation, other than the cost of staff training.
3. Any other costs associated with participating in the project i.e. any costs not included in cost categories (1) and (2).
4. Cost savings arising from the project.

All except five facilities received payments from the lead organisations for their participation, with the rationale for the payments being that costs (1), (2) and (3) had been incurred by facilities. The level and purpose of those payments are summarised in Table 28. The main reason for the payments was the cost of staff time to participate in various project activities – attend education, work as local facilitators, collect data and attend national workshops.

In the absence of common outcome measures across the 13 projects it is difficult to judge the extent to which the amount of money paid to facilities was associated with improved outcomes. Two of the projects with least evidence of any impact paid small amounts of money to facilities but so did one of the projects with good evidence of a positive impact. For projects that paid larger sums of money to participating facilities the evidence of impact was very mixed.

Table 28 Payments to facilities and purpose of payments

Project No.	Average payment per facility ($)	Purpose of payments
1	35,718	Provision of champions. Backfill costs for staff attending education and training up to a maximum of 16 hours per staff member. Attendance at the EBPRAC national workshops.
2	12,100	Assistance with audits and surveys. Backfill staff involvement in practice development, offset costs of minor equipment purchases and other resources to enable facilities to implement the changes required.
3	34,067	Purchase of equipment. Backfill cost for resource nurses and staff to attend meetings. Environmental modifications.
4	18,990	Project liaison officers one day per week.
5	7,500	Link staff time involved in planning and implementation of the project.
6	460	Backfill staff when attending EBPRAC national workshops or workshop at lead organisation. Staff time for data collection.
7	2,679	Attendance of staff at education and training events. Data collection and other involvement in project activities.
8	952	Backfill for staff to attend training.
9	3,308	Participation in project meetings, data collection, backfilling to allow attendance at EBPRAC national workshops.
10	14,813	Backfill for staff to attend training.
11	7,378	Backfill for nurse champions.
12	15,000	Backfill associated with the training.
13	62,857	Funding for champions. Backfill for staff to attend training and management to attend workshops. Support participation in the consortium and implementation of best practice. Support staff in-house e learning. Environmental modifications.

The amount of time reported by projects as being spent by facility staff on project activities, in addition to the time involved in staff training, varied considerably between projects, as can be seen from the data in Table 29. There was no association between the amount of money paid to facilities and the reported amount of time spent on project activities by facility staff.

The data in Table 29 are not consistent, and tend to underestimate the time spent by facility staff on implementation, in part because of different interpretations of what is meant by the term ‘implementation’. Comparison of the data in Table 29 with information elsewhere in this report (e.g. the changes in resident care summarised in Appendix 16) indicates that time spent on implementing the changes in practice have not generally been reported. As indicated in Section 3.4 the practice changes tended to be small scale and incremental in nature. It is not only difficult to estimate the extent of such changes, it is also difficult to estimate the time spent implementing those changes e.g. the additional time to use a new assessment tool, the time spent giving regular rather than PRN pain relief.

Table 29 Time spent by facility staff assisting with project implementation, in addition to participation in workshops and training

Project No.	Average hours per facility	Description of activity
1	25	Staff had a role in timetabling of education and in sourcing backfill for these activities. In most facilities a team was formed which met on a regular basis (usually monthly) for about one hour. In two facilities the project team met on a monthly basis for about one hour with three facility staff to ensure strong communication. Some staff involved in completion of two assessment tools for participating residents. Staff assisted with the process of obtaining informed consent from residents.
2	300	Development and implementation of action plans.
3	Not known	Some additional time outside meetings and other training and workshops spent implementing interventions. The amount of time was not recorded and would have been difficult to separate out from time spent on other activities.
4	Not known	Coordination of evaluation activities. Care activities for residents.
5	No answer	Question not answered.
6	20	Extra time spent at the beginning of the project setting up network contacts and generally taking time to understand the purpose and requirements of the project.
7	360	Each facility manager or delegate spent time on data collection and entry and additional hours with other facility staff in discussing, developing and submitting Plan-Do-Study-Act cycles.
8	54	Facility staff spent time assisting with file audits, implementing care planning tools, piloting care pathways and reviewing application of proposed minimal data set.
9	36	Pilot facilities completed chart audits, trialled evaluation tools and provided feedback to the project team. Facility staff completed evaluation tools, attended EBPRAC workshops and spent time scheduling staff for training and education. Most facilities established committees. Senior facility worked to ensure pathways were used and introduced other staff to clinical resources folder. At some facilities staff spoke at meetings of residents and relatives about the project.
10	10	Attendance at case conferences.
11	Nil	No additional time that project staff are aware of.
12	43	External facilitation – approximately one hour per fortnight per person involved. Assessment for evaluation purposes.
13	170	E-learning not supported with backfill funds from the project. One facility provided study leave for some staff to complete it. One ran small group sessions in work time. For the most part facility staff completed in their own time.

Projects were asked if facilities incurred any other costs. One project estimated additional costs at just over $2,500 per facility for items such as equipment, manuals, travel costs and miscellaneous office costs. All other projects did not estimate additional costs but gave examples of what would have contributed to increased costs:

• Infrastructure costs associated with use of office space by project staff.
• Various office costs including phone calls, computer use and photocopying.
• Time spent collecting data, either for project evaluations or additional resident assessments arising from project implementation.
• Equipment purchases e.g. syringe drivers, food preparation equipment, pressure reducing mattresses.
• Environmental modifications.
• Consumables such as wound care products and oral hygiene products.

Projects were asked if there was any evidence that project implementation had resulted in facilities being able to save any staffing costs in other areas. This question was generally not well answered and there were no estimates of any savings in staff time.

The only project which attempted to compare the cost of what was being implemented with potential savings was the oral health project which estimated the cost of providing oral health products for residents with natural teeth as approximately $55 per year. For residents enrolled in the project who required dental treatment the average cost of that treatment was $386 (based on Department of Veterans Affairs fee scale).
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