Most people in residential aged care feel safe and respected: Report

Most people in residential aged care feel safe, respected and that their healthcare needs are met.
 
Such were the findings of a new report by the Australian Institute of Health and Welfare (AIHW) which assessed consumer experience of residential aged care facilities (RACFs) via a 10-question survey.
 
Nearly 31,500 residents were interviewed, 65% of which were women.
 
Professor Dimity Pond, a GP with a special interest in dementia and aged care, told newsGP she is pleased with the findings.
 
‘It is lovely that they could find so many positive responses, that’s really good,’ she said.
 
‘If you just take the report on face value, they surveyed by interviewing around 10% of residents across over 2000 facilities, which is great.’
 
Professor Pond said that interviewing is a ‘good way’ of collating such data in this population, considering people in RACFs often have impaired vision.
 
However, she has ‘reservations’ over how the data was gathered, and reflected on how that may have played a part in residents’ responses.
 
Professor Pond said that if the interviewer was a member of, or perceived to be associated with, the RACF, respondents may have skewed their responses due to feelings of disempowerment.
 
‘If someone with a clipboard comes along and asks you questions and you’re [a resident] in the facility, potentially not dressed in your nicest clothes and in some sort of recliner chair or something, you’re not at your best,’ she said.
 
‘So there’s a power differential and that might translate into you tending to say everything was all right just to be nice.’
 
Professor Pond was particularly concerned about how responses were elicited from residents with dementia because, of such residents who answered the questionnaire, approximately a third of those responses came from proxies.
 
‘So that means perhaps that the relatives didn’t really have a personal experience of living in the place and probably they might not know if the person with dementia had someone to talk to, if they felt down or depressed; that would be a hard thing to answer as a proxy,’ Professor Pond said.
 
‘So I think there probably needs to be a more careful examination of how people with dementia are treated in RACFs and I feel less sure about the responses of those people to this survey because they were proxy respondents.’
 
Professor Pond said a proxy could have based their answers to the questions on the opinion of employed carers, who may have painted a more optimistic picture than the reality.
 
‘An employed carer might say, “Yeah, they’re all right. They’re fine, they’re happy, there’s always someone to talk to”,’ she said.
 
Professor Pond also noted the discrepancy in the percentage of residents with dementia included in the survey (29%), versus the percentage of such patients in RACFs, which she says is over 50%.
 
‘In that way, it’s probably not representative [of all RACF residents],’ she said.
 
However, Professor Pond acknowledges it makes sense not to have included such a high percentage of residents with dementia, as they may not have been able to answer the questionnaire.
 
‘It could be that people with dementia have a particularly hard time in residential aged care, and that certainly seemed to be coming out in some of the responses to the [aged care] royal commission,’ she said.
 
In terms of other findings, Professor Pond was not surprised the report found that residents from smaller RACFs gave more positive responses than those at larger places.
 
‘It makes sense to me that big facilities might tend to sacrifice a bit of personal care for economies of scale, and that might not be the nicest environment for residents,’ she said.
 
‘But, having said that, even so there was quite a nice response even across the bigger facilities.’
 
While the report revealed many positive responses, it also found that people with restricted mobility and those with higher care needs were less positive about their autonomy.
 
Meanwhile, the statements with the lowest proportions of positive responses related to food, and having staff with whom to talk.
 
‘There’s been lots of reports of food in residential aged care being less than wonderful, and that came across in that survey,’ Professor Pond said.
 
The issue of RACF staff supporting residents’ autonomy is a complicated one, Professor Pond said.
 
‘Having autonomy supported actually takes time and effort from staff, and we know from the royal commission that staff are very much under the pump in these facilities and don’t have training for how to support autonomy in older people,’ she said.
 
Professor Pond hopes further studies into consumers’ experiences of residential aged care take into consideration issues such as who is administering the survey, and the accuracy of proxy responses.  

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