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Thursday, June 30, 2022

New quality of life measurer for those in home and community-based aged care gets thumbs up

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A new type of ‘Quality of Life’ (QOL) assessment tool developed by Flinders University to provide contemporary and comprehensive measurement of elders’ wellbeing, has been put to the test and passed with flying colours.

The tool, which assesses six key quality of life dimensions relevant to both residential and home care, was found by consultancy firm PricewaterhouseCoopers (PWC), via a six-week trial, to be a robust and valid measure of quality of life for older people accessing home and community-based aged care services.

Professor Julie Ratcliffe, a Flinders University professor in health economics, says it’s clear that society expects older Australians to be properly cared for, treated with dignity, and supported to enjoy a good quality of life; thus an effective tool for measuring that is vital.

Our newly developed tools not only measure what the current experience of life is for older people but are also a catalyst for driving improved health and wellbeing outcomes, including through modern technologies such as digital and virtual supports.

Flinders University‘s, Professor Julie Ratcliffe

“Many of the long-established QOL tools are no longer addressing all contemporary needs.

“It’s therefore pleasing that we’re beginning to see more progressive approaches to valuing contemporary tools that are helping to foster improvements in care, too.”

“Our newly developed tools not only measure what the current experience of life is for older people but are also a catalyst for driving improved health and wellbeing outcomes, including through modern technologies such as digital and virtual supports.”

Professor Julie Ratcliffe, who’s specialist area is health economics at Flinders University, says that latest research data proves that additional, quality-of-life-based assessments will be a vital asset to the reform of aged care service quality.

Current quality indicators, as mandated by the Federal Government’s introduction of The National Aged Care Mandatory Quality Indicator Program (QI Program), focus mainly on clinical outcomes, measuring incidences of pressure injuries, physical restraint, weight loss, falls and medication management.

To complement these metrics, the Flinders University team analysed domestic and international literature, as well as engaging in a co-design process with older Australians, to identify the six key metrics of quality of life that rang truest to them, which are:

  • Independence
  • Mobility
  • Social connections
  • Emotional wellbeing
  • Pain management
  • Engagement with Activities

Aged care workers will find that the tool is simple to administer in practice, requiring residents to self-report on the six wellbeing dimensions by grading themselves on a quantified, five-point scale.

For example, residents are asked to reflect on statements such as ‘I am able to get around as much as I want to’, ‘When I experience pain, it is well managed’, ‘I am generally happy’.

They are then able to respond: ‘all of the time,’ ‘most of the time’ ‘some of the time’, ‘a little of the time’ or ‘none of the time’.

With these additional metrics providing a more holistic insight into older persons’ wellbeing, Ratcliffe tells Aged Care News that the tool is likely to be added to the QI Program.

“Our new quality of life and quality of aged care experience tools are now fully developed… we are looking towards a national roll out with aged care partners throughout Australia to promote best practice and with the Department of Health which seems likely through the new quality indicators program.”

So far, QOL-ACC has been implemented with more than 1000 older Australians to date in home and residential care settings, to deliver an improved set of standards and provide transparency in aged care quality.

Ratcliffe says the publishing of the PWC trial data in the journal Quality of Life Research, is a welcome proof-of-concept for the tool.

‘We’re pleased that the transparency, versatility and effectiveness of these tools are being increasingly recognised through analysis such as the PWC pilot.”

Flinders University began working on the QOL-ACC tool in 2018, with funding from the Australian Research Council, however its necessity was validated by the Royal Commission into Aged Care Quality and Safety.

In the royal commission’s final report, released March 2021, recommendation 22.2c calls for the routine collection of quality of life data as part of quality assessments in aged care.

Flinders University researchers worked closely with commissioners as the royal commission enquiries were being carried out, also developing a second tool called the Quality of Care Experience – Aged Care Consumers (QCE-ACC) instrument in 2020.

Another person-centred tool, this instrument measures another six metrics, including:

  • Being treated with dignity and respect
  • Being supported to make their own decisions about care and services they receive
  • Being cared for by trained aged care staff
  • Being provided with daily services that actually improve health and wellbeing
  • Being supported to maintain relationship and community connections
  • Being confident in lodging complaints with their provider

In the following video, Dr Claire Hutchinson, a research fellow at the Flinders University Caring Futures Institute explains more about the additional tool, which is also being rolled out to aged care facilities across the country.

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  1. Please explain how reliable and accurate data can be collected with this tool/s when the resident has dementia? Their cognition varies over time and place; if they cannot understand the question how can they respond in any meaningful way to such surveys? I would suggest the % of NH residents with (and at varying stages) of dementia must impact on the usefulness of such tools.

    • I had a similar thought. I’d suggest a partnership with an org like Dementia Australia combined with ethnographic research could produce an observational tool. Assistive technology might also be able to use pictograms to facilitate understanding. Definitely more thinking in this area is required!

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