Raise the bar: A pilot evaluation of the effect of a residential aged care workforce development model on staff and residents

Background: A range of staff with different skills undertake care for older people in residential care. When older people in care become unwell, a transfer to hospital may be avoided if their illness is recognised early by staff, and assessed, monitored and treated. Objectives: To improve residential aged care workforce capacity and professionalism, by implementing a new pilot workforce model, and to evaluate the model’s impact on staff and residents, including provision of complex palliative care, confidence and hospital transfer rates. Design: Mixed methods, including staff semi-structured interviews, staff quality improvement surveys, and assessment of monitoring, interventions and resident transfers. Settings: Three aged care residences in Victoria, Australia. Participants: Staff (n=278) in all three aged care residences. Intervention: Implementation of a comprehensive care model, developed to decrease unnecessary transfers of older people to acute care from residential care, and to improve skills in staff. Measurements: Number of ‘Stop and Watch’ reports made, percentage of ‘Stop and Watch’ reports resulting in an intervention, average monthly hospital transfers of residents to acute care (baseline, implementation and post -implementation), percentage of End of life Care Pathways completed based on number of deaths, and staff confidence. Results: Staff reported more confidence in identifying and caring for unwell residents, their capability to provide palliative care was perceived to increase, teamwork with external services improved, and new interventions and a decrease in hospital transfers occurred. Conclusions: This project showed improvement in early detection of deterioration in residents’ health condition, reduction in hospital transfers and improvements in staff satisfaction and confidence. Limitations of the study were the lack of control group and the small sample.