Care providers need a clear, detailed framework setting out what ‘good’ care looks like, report argues
Governments need to focus more on people's quality of life and how they are supported to maintain good relationships when they assess the quality of residential care, a study has concluded.
The research found that politicians and policymakers should consider three markers of quality – organisation-focused, consumer-directed and relationship-centred – but should prioritise the latter, which is characterised by a concern for residents' individual wellbeing.
"To help people make good decisions it is important to think about quality in these three ways," said Dr Lisa Trigg, who led the study at CPEC.
"There has been lots of government focus on making services safe and standardised," Dr Trigg added. "But we know what really matters for residents is a good quality of life, having meaningful relationships with the other people in the home and staff, family and friends, and feeling like human beings. It’s about community, but also recognising residents as individuals with their own needs and personalities."
The study report also argued that governments should communicate to care providers what high-quality services look like, to help them know what to aim for.
Different approaches
The study, which examined residential care both in England and Australia, set out to investigate what governments can do to raise care standards, in a context of ageing populations, scarce resources and uneven performance by providers.
It was based on two groups of interviews – with experts, including politicians, regulators, academics and service user group representatives; and with staff from care homes in both countries.
While the two countries had comparable proportions of care home residents – 4.1% of England's over-65 population, vs 4.8% of Australia's – the research found considerable differences in how they deliver and inspect services.
England's starting point of 'welfarist' local authority responsibility for care contrasts – despite England’s reliance on private care providers – with a more 'consumerist' approach in Australia, where independent agencies have always taken the lead.
In terms of gauging quality, meanwhile, England's system foregrounds the ability of individuals to live good lives, with providers scored between 'outstanding' and 'inadequate', while Australia's is more process-driven and based around a simple 'pass' or 'fail'.
Measures of quality
Despite distinct local pictures, however, governments who rely on private care providers, whether profit-making or not-for-profit, face common challenges in terms of benchmarking those firms' quality and encouraging them to improve it.
With quality meaning different things to different people, the research found it was important to consider how it could be categorised – which it grouped into three types:
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Organisation-focused quality, in which providers are focused on ensuring residents' safety and consistency of access to clinical care.
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Consumer-directed quality, in which residents and their families are treated like customers, with the emphasis on things like the presentation of care homes and the organised activities available to those who live in them.
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Relationship-centred quality, in which every resident is treated as an individual with her or his own personality, regardless of how unwell she or he is.
The study found inspection regimes and the promotion of consumer choice tended, respectively, to drive some advances in the first two types of quality. The third – most crucial – measure was more likely to be influenced by the ethos of individual providers than by the actions of government.
That said, the four-grade English rating system, which also reports on what life is like in homes, was found to offer useful templates, as well as motivation, for providers seeking to improve. The regime includes a so-called 'mum test' – whether an inspector would be happy for a relative to live in a particular home – and one provider commented that even the possibility of relatives examining ratings meant they were important.
By contrast, the Australian model made it hard for both peer organisations and the public to understand which providers were excellent and which merely average, given that 98% achieved a pass.
Encouraging relationship-centred quality
In order to drive residential care quality in future, governments need to focus on communicating to providers what 'good' looks like, the study concluded. Involving different groups of people in the evaluation process, for instance local safeguarding teams and advocacy groups, could help build a more detailed picture and prevent poor quality slipping through the net.
Providers in both England and Australia noted that for governments to help improve care quality across the board, problems relating to resources, both in terms of money and the supply of skilled workers to the social care sector, need attention.
But interviewees also mentioned other factors that can be beneficial, including better guidance around delivering different models of care, and access to peer networks where insights around quality can be shared.
"Having outstanding ‘role model’ providers that people can learn from is a really powerful mechanism," said Dr Trigg. "You may not be able to have people trooping in and out of care homes to see what real relationship-centred quality looks like, but there are certainly ways to get people talking about it."
Findings summary
Trigg L (2019) Improving the Quality of Residential Care for Older People: A Study of Government Approaches in England and Australia, Personal Social Services Research Unit, London.
Contact
Dr Lisa Trigg
l.j.trigg@lse.ac.uk