Using complaints to improve aged care

As a sector, aged care has a breadth of responsibility that sets it apart.

Supporting not only older people’s daily activities, living arrangements, and social needs but also attending to many of their health-related care needs.

For aged care clients and residents with life-limiting illnesses such as dementia and advanced heart disease, integration of palliative care is appropriate.

With its focus on quality of life and physical, social, spiritual, and emotional needs, palliative care mirrors the breadth of aged care and has much to contribute.

In 2021, more than 59 per cent of people in residential aged care and 30 per cent of people accessing home support were aged 85 years and older.

Death is inevitable and providing care at the end of life is an expected part of aged care.

Given this broad remit, availability of standards outlining the expectations of aged care are useful in focusing attention.

As well as giving voice to older people and their families, having procedures in place for complaints can also provide constructive guidance.

Knowing where expectations are not being met or complaints made tells us what matters to people receiving care and where improvements are needed.

The challenge is to view this as an opportunity to improve care and build workforce capability.

As noted in the latest sector performance report, ‘low or high complaint numbers are not, by themselves, a measure of good or poor service delivery.

A service with a positive complaints culture encourages feedback and uses it as an opportunity to improve service delivery’.

In 2021, non-compliance among Australian aged care services was found most often against Standard 3 – Personal and clinical care.

Overall for complaints about aged care services, 7 per cent related to end-of-life care, 20 per cent to recognition and response to deterioration, and 44 per cent to safe and effective personal and clinical care.

Specifically, the top three complaints were about medication administration and management, personal and oral hygiene, and personnel number/sufficiency.

For in-home care, the highest number of complaints related to lack of consultation or communication, costs, and consistency of client care and coordination.

Ongoing workforce development can help the aged care sector in responding to these issues.

A cost-effective approach would be to draw on freely available resources from the Australian-government-funded palliative care initiatives and programs.

Examples of how this might be achieved are illustrated here with resources from two of these projects.

In selecting resources to develop workforce capability, it's important to appreciate that despite a shared passion to support and care for older people, individual responsibilities, training, health literacy, and experience will vary.

Additionally, given the prime focus on providing direct care selection of training and education needs to be cognisant of time constraints and the need for flexibility to tailor responses and integrate training into workflows.

A mix of approaches may be needed.

Beginning with evidence takes the guesswork out of approaches to quality care. 

PalliAGED, the national care evidence and practice resource project managed by CareSearch at Flinders University, helps to identify, appraise, and synthesise research evidence to support palliative care practice and training.

PalliAGED is specific to care of older people while CareSearch has a broader perspective across the life course.

For staff new to palliative care and/or aged care consider beginning with the rapid learning palliAGED introduction modules.

Highlighting core topics in palliative care and each taking approximately 12 minutes to complete, the ten modules are well suited to induction of new staff.

Once orientated to the basics, the palliAGED Practice Tip Sheets might then be used as part of in-house training and to support discussions either generally or in relation to specific clients/residents and their needs.

Covering 42 topics relevant to quality care of older people, the parallel series aligned with nursing and care worker scopes of practice highlight what can be done and prompt reflection on current practice.

Thinking back to the 2021 complaints outcomes, useful Practice Tip Sheets might include oral care, constipation, recognising deterioration, nutrition and hydration, and supporting families.

For nurses with more experience in aged and/or palliative care, the palliAGED Practice Centre and the CareSearch Nurses Hub can be used for practical support when tailoring care to local contexts and individual needs.

Again, thinking back to the 2021 complaints report, the newly expanded CareSearch Nurses Hub sections on common clinical issues and symptom management in palliative care can help.

Similarly, the practical tips on communication and care coordination as provided in both websites speak to areas of need in workforce development.

The breadth of these evidence-based palliative care resources clearly reflects the broad remit of aged care.

With staff turnover and increasing demand for services, developing workforce capability will require sustained effort.

Combining compliance reports and complaints with local knowledge to guide selection of training resources from the national palliative care program offers an affordable pathway.

Dr Katrina Erny-Albrecht is a Senior Research Fellow at CareSearch in the College of Nursing and Health Sciences at Flinders University.

Susan Gravier is a Research Officer at CareSearch in the College of Nursing and Health Sciences at Flinders University.

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