Faculty of Health

Bold insights into quality home care in Australia.

Ms Jenny Mee Lecturer in Nursing, RN, BN, Master of Applied Science (Research), PhD Candidate

Acknowledgements:

Principal Supervisor: Dr Linda Jones

Associate Supervisors: Dr Daniel Terry and Associate Professor Penny

Cash.

Federation University Australian Post Graduate Research Scholarship

National Education Excellence Leadership Incentive Women in Leadership

Scholarship (ASAM)

To my participants- thank you

Faculty of HealthBackground to the researchAIHW (Australian Government, 2014) in 2010-

2011 report that 1,192,800 people accessed care

from Disability Services or Home and Community

Care (HACC) services across Australia.

Aging population- by 2026 5 million or 20% of

population will be over 65 (Commonwealth of

Australia, 2015).

Impacts on social & political planners for health,

social & human services. Major political reforms

occurring in aging & disability sectors (Anderson-

wurf 2017).

Defining Home Care:

Home care encompasses an array of

medical, nursing and social care, which are

essential to assisting people to maintain their

independence at home or in their space

within their communities.

Australian Government, Department of Social Services, 2014; Toofany, 2007; Blackman, 2009; Byrd, 2012;

Goodridge et al., 2012; Hendig, Mealing, Carr, Lugic, Byles and Jorm 2012; Brennan et al., 2012; AIHW,

2012)

Social & Historical Home

Care Contexts

Past History

Public health during industrialization

Traditions of district nursing in UK

Not-for-profit traditions, church and charity

Poor public funding

RN lead care “Queens Nurses”

Volunteers & family as care givers

Modern Day

1985 HACC funding- fragmentation of care

Governing of the private spaces

Common Community Care standards

Aged Care Reforms- Consumer Directed

Funding/ new CHSP

Disability Reforms NDIS

Privately funded/ private businesses

emerging

Limited research published in home care

governance

Integrated Review of LiteratureLiterature Review Approach (Commenced 2013)

Search terms:

community care in home, home care, home care service, in-home care, home care service

Databases included:

Cinahl, Cochrane, Medline, PsychINFO, SocINDEX, Health Business Elite

Excluded:

home care for children and foster care

Further consideration and exclusions applied:

palliative care, end stage renal failure treatment, technology monitoring, institutional respite

care, and informal care

Initial yield = 86 articles

Secondary and tertiary sources then examined to develop a genealogy of home care in

Australia

Trends in the literature

• Mostly interventionist & evaluation of health outcomes of programs and care plan delivery

• Experiences of consumers & program evaluation

• Home care governance costs, policy & quality– local & international

• Recent paper on Consumer Directed Care early perceptions & experiences of staff, clients

and carers (Gill et al., 2017)- conducted in NSW and SA. Highlighted difficulties of the culture

of industry, industry controls and client expectations, staff and client/carer role change. To

note was the recommendation for effective education, information and redistribution of power

relationship through change management and resourcing systems and education.

• Gaps in research – limited research on home care business managers/owners and especially

inclusive of the for-profit sector

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The PhD Research Question:

What are the challenges for business managers of home care

services in meeting regulatory quality requirements of state and

national standards in Australia?

The PhD Research Purpose

1. To gather information about home care business in Australia

and how business owners/managers meet quality processes.

2. To provide new insights and additional information about

home care quality & governing for policy makers, researchers

and practitioners.

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PhD Title: Australian Home Care Quality:

a Political Tango

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Power of the political tango: Quality in the home care

arena

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Qualitative Research Approaches & Methods

Post structural critical discourse analysis and creation of a genealogy (informed by theorists eg. Foucault, 1978; Dean, 2010; Powers, 2001 & Cheek, 2000)

Qualitative researcher informed by critical social research with post modern/ post structural sympathies.

Face to face semi-structured interviewing & self reflectivity through journaling (Denzin and Lincoln, 2018 & 2011; Fook, 2011; Cheek, 2000; King & Horrocks, 2010).

Governmentality in the Home Care Arena

Dean, 2010; Burchell, Gordon & Miller, 1991; Foucault 1978

Surveillance

Discipline

Economics

Reasons of

state

Knowledge

Power

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Ethical considerationsPower/knowledge

• Power over data- consent

• Collecting data

• Company secrets

• Storing data

• Analysing data

• Rigor- concept of confirmability

1. Federation University Ethics approval granted October 2015

2. Adaptive snowballing recruitment of 10 business owners and managers of home care services (Qld & Vic)

3. Face to face semi-structured interviews X 3 for each participant from April 2016 to February 2017- gift certificates given for participation

4. Journaling

5. Dissemination

Profile of the Participants

• 10 participants from Qld and Victoria

• All had tertiary qualifications: nursing, medicine, psychology, occupational therapy, social work, gerontology, disability and management (some with multiple degrees)

• Some professionally registered, some were not

• Represented metropolitan, city, urban, regional/ rural and remote areas of Australia.

• Business models ranged from LHAs, LGAs, NGOs (not for profit), private (for profits) and brokered including franchised business models

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Cheering in the arenaBusiness growth- both private & public

Staff adjusting to changes

Models of business changing

Navigating My Aged Care-

Finding the rules & score cards & the

requirements of the arena

Bigger players doing

better & some

competitive moves over

smaller business

Meeting & adhering formal

quality standards

Meeting goals

of

finance/account

keeping &

changing

systems over

Watching for Risk – ‘Moves in the Field’Communication in the arena

Dirty plays in the field

Brokerage rules and tensions

Power over clients

Control over communication with

clients & quality control issues

Moves with difficult clients

Accessing & deciphering information

Misinformation in the sector

Connectivity issues- networking with

people and with IT

Concerns of unethical marketing to

consumers

Advocacy- hearing silenced

voices

Marginalised clients-poor mental health,

hoarders, dementia & other mental health

concerns- knowing how to care

Field staff knowledge & qualification low

Competition in the market place & smaller

competitors

Potential for risky situations

Geographically location- regional &

remote areas

Poor assessment of needs and

communication of same

Tensions and Challenges in the Arena:

Cross cultural communication

Managing cultural expectation of clients and staff:

Sharon: I’ve had two occasions I think where I’ve gone back and said to the

brokerage, I won’t provide staff for this client, because you know, they’re not just

there to be treated like that, you know. It was more around that, you know, I want

someone of a specific race because you know, they’ll work harder than anyone else,

or something like that. And I won’t - I won’t do that. Yeah. It’s not nice. It’s not, you

know. I have to - you know, my staff need to be treated with respect you know, as

well as we, you know, treat the clients with respect.

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Challenges in client care: Communication & sharing

of information

Sharon:

Well, you cannot provide a quality service if you don’t know what the service is you’re

providing. I’m sending staff into homes that you know, I haven’t got a clue. I - we end up

googling half the time. Doing the view of the home to make sure the external environment -

you know, sometimes you can make an assessment on the external environment and go,

there’s a house that’s falling down so we know that the inside’s going to be probably pretty

much looking like the outside, you know. So there’s a risk, you know.

We always get for new clients - our staff to do a home safety assessment on their first visit.

But you know, I’ve got staff going out, so there’s a risk if I don’t know what the environment

is ….. you know, if you haven’t got a comprehensive picture of the client, you know. Are

there behavioural issues? Are they at risk? Is their family hanging around? Is there - you

know, you don’t know, you know. So there’s risks to the clients and there’s risks to the staff

going in, you know….Risks of injury. Risks of harm.

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Challenges with complex behaviours

Jasmine

It's a - it's a challenge because if someone's living at home and they've got cognitive impairment and they don't have family, that can be real challenging getting someone on the program so that we can start helping them… But even them understanding, understanding their illness, yeah. Like I went out with one of my care managers last week and the um, we spoke to the husband and the son for quite a long time. And the wife who will come onto the package, she had a stroke about five months ago in February, and… she had some cognitive impairment before the stroke but had some more after the stroke.

And she (is).. legally blind, and you know, the son and husband were talking about different things that she was doing, you know, some of it's because of the blindness and some of it's because she - she wants control over whatever, you know, the little she's got left… behaviour associated with their illness, you know.

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Challenges in the ArenaMarketing Performance

Local is Best:

David: Regardless of what's happening in the marketplace, …I think the culture has certainly been

local is best, and establishing that loyalty and that brand awareness and relationship-building at a local

level. This office doesn't try and deliver a service all over the state. It's really just focused on one portion

of the metropolitan area. So my interest isn't across the other side of town at all. It is just here, and I think

that that sort of goes well in building up that local reputation.

New small business versus traditional large service provision:

Daphne: And you have to start thinking okay well if, if potentially because of these huge monoliths that are

already out there and established over 50 years, that little pie, has to sustain us, so how is that going to

sustain us? You know are we just going to accept that we’re a boutique business and that we focus on

some special aspect of the aged cared sector. ... So those are, those are part of the challenges you know

over this 12 months…. And so we’ll have our own little niche that we do very well [um] and not even try

and compete with them.

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Disrupting, Innovating and Thriving

for the Future of Quality Home Care

Policy SupportMore research and inclusion of people from

the margins (especially regional, remote

and socially isolated)

More seeking and hearing the voice of all

industry performers and competitors

More instruction on the rules in the arena

(for-profits and regional areas)

Codes of practice for equal and fairer

competition and to protect clients

Infrastructure SupportResearch & Development funding for regional collaborative networks

Research funding for online/ virtual training for workers caring for complex clients

Online home care simulation research & development (Partnering with academic experts)

Development needed of webinars & online networking forums to collaborate with others & improve accessibility to information

Money, time & support for IT, software transition, NBN needed for reliable & faster connectivity (regional & remote)

Faculty of HealthRegional Innovation Potential

Multi Campus University:

Victoria: Ballarat, Gippsland & Berwick

Queensland: Brisbane

Fed Uni School of Nursing, Midwifery and Healthcare is

uniquely and strategically positioned to:

• Develop online & face to face educational programs

and forums which are inclusive of regional and

remote areas

• To provide expertise in online education, forums and

simulation and high fidelity learning.

• Home care simulation curriculum content and utilise

SHELLs (Simulated Home Environment Learning Laboratory)

• Draw on existing networks & collaborations in the

regional areas with LHAs, LGAs, NGO services and

private providers.

Innovations in Simulated Home Care

Learning Photos by J.Mee 2015

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Home care simulation in action

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Conclusions for bold insights for quality in home care:

Inclusive practice & developing new knowledge for home

care quality through research and education

An inclusive analysis of the disruptive events to inform policy & consumer directed change is vital for ensuring quality provision of home care services for the consumers.

Based on some of the new knowledge emerging from this study, new alternative and innovative ways of communicating in the business of home care Is needed so as to be inclusive of all groups and communities of practice.

This can be realised in Australia through research development and educational strategies to address the changing needs of home care communication across the sector.

Faculty of Health

Any Comments or Questions?

Images: Retrieved 29/1/2015 from google images unitedwayballarat.org.au and theposh.com

Contact Jenny Mee

Email: j.mee@federation.edu.au

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