Robert Johnson is 89 years old.  His wife died three years ago.  He has five children of which Felicity is the youngest.  He has moved to Sunset Hills about 18 months ago.  He mobilises well with a wheelie walker and only needs assistance with showering.  He still makes his own bed each day.

Robert made the decision, with his family, to move into Sunset Hills as cleaning and maintenance on the family home was becoming too much and he stated it was just too big.

Robert has some minor osteoarthritis and mild hypertension that is well controlled with an antihypertensive.  He is generally fit and well.

Staff have noted Robert is not as happy and outspoken as when he first arrived.

You are working as a Registered Nurse at the Sunset Hills Aged Care Facility.  This is a supported living hostel arrangement.  Residents each have their own room with shared dining and recreational facilities.

You are a part of the Clinical Governance Committee and one of the committee functions is to review and respond to complaints.

In today’s meeting, the following letter is tabled.

Dear Management of Sunset Hills.

My name is Felicity Brookes, and I am the daughter of Robert Johnson in Room 261.

At my last visit with Dad, he was quite flat and upset.  When I asked him what was wrong, he stated he was ‘just tired’ as he is woken almost every morning at 6am to shower.  My father has never been an early riser and when he first came to Sunset Hills, we were assured that Dad could shower when he wanted and assistance would be available.

When I pressed Dad for further details, he stated a carer by the name of Ruth is the main staff member that is causing my father distress. Apologies, I do not know her last name.

When Ruth wakes Dad for his shower at 6am, she is rude and abrupt.  She has made Dad feel very uncomfortable in what should feel like his home.  On top of this, when Dad asked another staff member about the shower time and being woken so early, Ruth commented to him that he shouldn’t talk about staff members behind their backs.  This was not his intention.

My siblings and I are quite concerned for Dad’s wellbeing and are looking for your response and reassurance that this matter will be dealt with.

Yours sincerely

Felicity Brookes

You have been charged with finding out more details for the complaint.  The following are details you have uncovered by interviewing Robert and staff.

1. Another carer tells you they have been assisting Ruth and that she is quite abrupt and has refused to use Robert’s own moisturiser.  She has insisted the facility provided moisturiser is better but then told the carer that Robert should be happy to have the facility moisturiser as it is free for him.
2. The kitchen staff have told you that Robert is usually seen in the TV/sitting room prior to meals, chatting with other residents and usually appears quite happy.  When Ruth is working, he is noticeably absent.
3. When new in services and training schedules are posted, you have overheard Ruth, as have other staff, that she will not be doing any of the training until she is paid to attend and that she is only here for the money.
4. Robert is reluctant to discuss the matter and states, “Maybe Ruth has something going on at home, and that is what makes her this way’.

It is noted that Ruth has a Performance Review meeting next week and this matter will also be discussed with her.  This is not the first complaint of Ruth’s behaviour.

• Discuss the role of the Aged Care Quality Standards (ACQS) with regards to a person’s health and wellbeing.

• Identify two (2) areas in the case study where ACQS are not upheld.

• Drawing on the Clinical Governance Framework students will be required to identify and describe two (2) evidence-based strategies to improve the quality of care and person-centred outcomes, for Robert in line with RN Standards for Practice.

ANSWER

The Role of Aged Care Quality Standards (ACQS) in Health and Wellbeing

The Aged Care Quality Standards (ACQS) are regulatory standards in Australia that guide and assess the quality of care and services provided in aged care facilities, with a focus on promoting the health and wellbeing of residents. These standards provide a framework to ensure that older adults receive safe, effective, and person-centered care that respects their dignity, autonomy, and individual needs.

Areas in the Case Study Where ACQS are Not Upheld

1. Standard 1: Consumer Dignity and Choice – The ACQS require that residents are treated with dignity and respect, and their preferences and choices are acknowledged. In the case study, Ruth’s behavior towards Robert and her refusal to use his preferred moisturizer violate his dignity and choice. Ruth’s assertion that the facility-provided moisturizer is better and her insistence on using it disregards Robert’s preferences, which goes against the principles of consumer choice.

2. Standard 7: Human Resources – This standard mandates that staff providing care have the necessary skills, qualifications, and attitude to deliver safe and effective care. Ruth’s abrupt and rude behavior, as reported by both Robert and other staff members, indicates a lack of appropriate attitude and communication skills. Her comment about training and her primary motivation being money demonstrates a negative attitude that hinders person-centered care delivery.

Evidence-Based Strategies to Improve Quality of Care and Person-Centered Outcomes for Robert

1. Implementation of Communication Training: One evidence-based strategy is to provide communication training for staff members, including Ruth. This training should focus on enhancing communication skills, empathy, and respect when interacting with residents. By fostering effective communication, staff can create a positive and supportive environment that upholds dignity and choice, thus improving resident satisfaction and emotional wellbeing.

2. Person-Centered Care Planning: Developing individualized care plans that reflect residents’ preferences and needs is crucial. In Robert’s case, a care plan should outline his preferred shower time and use of his own moisturizer. Engaging Robert and his family in care planning empowers them to make decisions that align with his values and lifestyle, contributing to his overall wellbeing and quality of life.

By addressing the communication skills of staff and ensuring person-centered care planning, Robert’s experience at the facility can be improved in accordance with the RN Standards for Practice. These strategies align with the principles of clinical governance and quality improvement, aiming to provide respectful and personalized care that meets the ACQS requirements and enhances the health and wellbeing of residents like Robert.