The Royal Commission into Aged Care Quality and Safety espoused the small household model as the ideal for delivering quality of life and care to aged care residents – but does the evidence back this model up?
The Victorian-based Not For Profit Benetas is sharing the results of an internal evaluation that found its apartment-style model was no better for quality of life than other models of care – and was not as cost-effective as other care models of care.
CEO Sandra Hills says that the organisation is now sharing the results of the 2019 review of its ‘Best Life Model of Care’ in the interests of having an open conversation with the industry.
The evaluation – which was carried out while the Royal Commission was underway – looked at seven Benetas facilities: three apartment-style facilities, two hybrid model, which had a higher number of beds, and two traditional aged care homes.
Each apartment had eight beds with a common room and a primary carer working morning and night shifts.
Each site was evaluated over a three-month period from both a model of care and a financial perspective with residents, staff and families interviewed.
The results?
$600K increase in staffing costs
The review found that “site type is not a key determinant of resident quality of life, resident health and functioning, quality of care, or financial performance.”
In short, the smaller household model made little difference to the outcomes for residents.
The cost of the model was also widely underestimated. While the building costs were the same – around $275,000 per bed – the operating costs, namely staffing, were significantly more expensive.
“The carer costs around $7,900 extra per client per year, which is about $600,000 more expensive in increased costs compared to our other facilities,” said Sandra.
This staffing model also creates a challenging environment for the new requirements that are coming in for 24/7 Registered Nurses in July and 40 minutes of care from a RN from October.
Staff also gave feedback that they needed more support and felt like they were missing opportunities for mentoring and connecting with their team.
There was also a challenge with resident compatibility in terms of care needs and personality.
Some of the residents and families also said the environment was too hotel-like.
On the positive side, many of the residents enjoyed the privacy and opportunities for recreation and time with family and friends.
The model also promoted greater independence among residents with assistance from their carer and the lifestyle teams.
“You would see residents setting the table and helping others to serve meals,” said Sandra. “I visited one facility where a resident was helping herself to breakfast and reading the newspaper at 9:30am – it was a far less regimented lifestyle.”
16 to 22 bed apartments the preferred option
Benetas is now applying the learnings to its portfolio, including the design of its facilities, support for workforce and model of care.
“We have plans to build and upgrade another facility, but we would look at 16 or 22 beds,” said Sandra. “We wouldn’t be likely to repeat the eight-bed apartments again.”
“We also need to make sure that our communal spaces strike the right balance between being large enough to cater for the whole facility events and small enough to provide a home-like welcoming space.”
While the findings are being used for continuous improvement, they are a direct contradiction to the Royal Commission’s claim that the small household model delivers better care and quality of life.
“We understand that there is a view that everyone wants to live in small houses,” said Sandra.
“We want residents to have flexibility but our trial has shown that this style of living doesn’t suit everybody and it’s not cost effective.”
Given the Government forecast that we will need another 150,000 aged care beds by 2040, is it time for more guidance – backed by evidence-based research – to be provided to aged care providers on the best way forward?
