Measuring wellbeing and quality of life in aged care

A provider’s new care model integrates an international care outcome measurement tool in an exciting and unique way.

Measuring wellbeing outcomes and the impact of aged care services on quality of life, consistently and systematically, is a challenge for most aged care providers.

In 2015, Whiddon launched its new ‘MyLife’ model of care which is focused on a person’s wellbeing. Prior to launch, our review of care planning practices had identified a gap around consistent evaluation, goal setting and structures in residents’ wellbeing. More importantly, some registered nurses (RNs) said they were not confident initiating and conducting conversations around emotional and social needs with residents.

Across the residential care industry, care planning is typically focused on clinical needs. There is some goal setting around lifestyle and leisure preferences and activities not always linked to wellbeing outcomes. This has resulted in a lack of focus on evaluating the impact of services on wellbeing. Whiddon was committed to changing this, and as part of establishing an evaluation framework for our new model of care, we spent most of 2015 investigating the best approach and tools, one of which was the Adult Social Care Outcomes Toolkit (ASCOT).

ASCOT is an internationally recognised, robust tool that measures social care-related quality of life and, importantly, it links closely to the seven outcomes in Whiddon’s MyLife model of care by measuring quality of life against eight wellbeing domains. The eight domains of wellbeing cover four lower order needs (accommodation, food, safety and personal care) and four higher order needs (social interaction, occupation, control over daily life, and dignity).

The four lower order domains are traditionally much easier to support, whereas the four higher are more challenging for service providers to support well.

The integration of ASCOT in care planning in residential care, and the ‘circle of care’ interview methodology that allowed for participation of people with dementia, represented an innovative practice in care planning. RNs led conversations with residents, engaged family members and residents’ dedicated Whiddon carers.

Questions were across each of the eight domains of wellbeing and then rated as to whether they comprised an ideal state, no need, some need or high need. This new use of ASCOT could greatly enhance holistic care for older people both in Australia and internationally.

Trialling and embedding the ASCOT tool

Whiddon partnered for the trial with ASCOT founders, the University of Kent in the United Kingdom. The ASCOT team was keen to assist with this new use of the tool, integrating it into care planning and in residential aged care.

The 15-month trial took place across 2016 and 2017. The main goals were to test the value to care planning of using the ASCOT tool, as well as the sustainability and effectiveness of the methodology that we had designed. This included:

• Value to residents and improved quality of their care (including its alignment with our MyLife model and relationship-based care approach)
• User friendliness and effectiveness of the tool and ‘circle of care’ methodology for residents, families and RNs
• Sustainability of conducting ASCOT conversations as part of care planning in terms of additional RN time and burden to residents and families
• The value to quality improvement of services at individual, service and system level.

We found that conducting the ASCOT conversations—in a systematic way that was integrated with care planning for individual residents—had great benefits for our residents, their families and our care approach. Residents and family members reported feeling empowered by the conversations, and that the formal structure of the conversations enabled them to talk about their emotional and social needs.

Whiddon resident Doris Grainger participated in the ASCOT trial. Image courtesy of the Whiddon Group.
The current generation in aged care is not used to talking about these needs and will often not vocalise them for fear of being seen to ‘whinge’. The conversations were a valuable support to Whiddon’s relationship-based care approach. Residents and families felt that staff really cared about
them, particularly when they saw tailored initiatives that had been identified in the conversations being implemented and followed up.

Some important areas for improvement were highlighted through the trial around food and the dining experience. Despite Whiddon’s award-winning food programs, food is a complex area and touches many emotional and social needs. The additional feedback from the ASCOT conversations was invaluable to service improvements.

The trial gave us important pointers on improving support in the higher order wellbeing domains and in the meaningful occupation area, particularly for men. This was consistent with other findings that Whiddon had gathered from consumer experience research amongst clients, including the University of Sydney’s LIFETime longitudinal study 2016–18.

The increased empowerment of Whiddon’s residents and families and the underpinning of Whiddon’s relationship-based care approach were two of the strongest factors in Whiddon’s decision to pursue full integration of ASCOT in our care planning processes and systems.

The ASCOT tool is now being implemented across Whiddon’s 19 aged care homes and eight community care services in alignment with the rollout of the MyLife model of care.

Karn Nelson is the Executive General Manager, Strategy & Innovation, the Whiddon Group.