Why person-centred care is at the core of clinical governance
The Royal Commission into Aged Care Quality and Safety (Royal Commission) noted in its Final Report, presented on 26 February 2021, that aged care ‘should be able to deliver compassionate and kind care built on respectful relationships’. Person-centred care (or ‘consumer-centred’ care) was already central to the way aged care was expected to be delivered, under the Aged Care Quality Standards which have been in effect since 1 July 2019.
Sadly, through the Royal Commission, we saw failures of person-centred care, which created risks to the health and well-being of those for whom we are supposed to be caring.
Dementia care in particular has been known to overlook the unmet needs of the person through the widespread use of restrictive practices. For example, we heard the story of Terance Reeves who had advanced Alzheimer’s disease, yet was conversant and mobilising independently at home. His experience in respite residential care was detailed by the Royal Commission in its Interim Report, which noted that no behavioural management strategies had been recorded in the care plan, and that staff ‘might not have been as prepared as they could have been to address Mr Reeves’s care needs relating to behaviours associated with his dementia.’
In the event, a combination of physical and chemical restraint was used to manage his behaviour, such that by the time Mr Reeves left the home he was unable to talk or walk without assistance and had also become incontinent. While the Royal Commission declined to determine a causal link between the use of restraints and the decline of his condition, it did determine that they ‘represented substandard care that put Mr Reeves’s health, safety and wellbeing at serious risk.’
The story of Mr Reeves is illustrative of care that was reactive and task-driven, rather than person-centred and relationship-driven.
How can we know what good quality care means for any given person? Only by understanding their perspective - through listening, looking, and ultimately delivering care in a manner that appreciates their individual needs, preferences and wishes. This is a person-centred approach, which has been described as one based on ‘acceptance, caring, empathy, sensitivity, and active listening.’
Thankfully we have seen regulatory reform towards supporting person-centred care through a recently legislated requirement for behavioural support plans under the Aged Care Act 1997 - however it is crucial that these are afforded true value through a genuine person-centred approach, rather than approached through a lens of compliance. Especially with the current abeyance of further amendments to aged care legislation, we should not simply rely on regulation to tell us the ‘right’ thing to do.
The importance of person-centred care was articulated by Commissioner Briggs in the Royal Commission’s Final Report:
“Care should begin with an understanding of the experience through the eyes of each older person. Every person’s story is different. Some people will arrive at the aged care system following a difficult life transition, such as ailing health or the loss of a partner, while others arrive with different histories, jobs, beliefs and traditions, and some will carry the burden of life’s trauma. Understanding and respecting the unique life experiences of people accessing care is affirming. The message it sends is—you are seen, heard, and you matter. Everyone has their own needs, preferences, values, feelings and expectations. These should be put at the centre of a person’s experience of care.”
Consumer-centred care is central not only to the Aged Care Quality Standards but to clinical governance itself. This is clearly set out in the National Model Clinical Governance Framework by the Australian Commission on Safety and Quality in Health Care. Understanding the person receiving care, and how to approach this, is fundamental to ensuring that care is safe and effective for them - because what is good quality care for one person may not be good quality care for another.
Learn more about consumer-centred care in clinical governance through our Clinical Governance online course.
All accessed on 21/5/22:
S. Brownie and S. Nancarrow. Clin Interv Aging. 2013; 8: 1-10. doi: 10.2147/CIA.S38589. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540911/
Aged Care Quality Standards, Aged Care Quality and Safety Commission. Accessed at: https://www.agedcarequality.gov.au/providers/standards
Interim Report: Neglect, Vol.2. Royal Commission into Aged Care Quality and Safety. Accessed at: https://agedcare.royalcommission.gov.au/publications/interim-report
Final Report: Care, Dignity and Respect, Vol. 2. Royal Commission into Aged Care Quality and Safety. Accessed at: https://agedcare.royalcommission.gov.au/publications/final-report
Part 4A, Quality of Care Principles 2014 (Cth)
Russell Kennedy Lawyers, ‘Aged care reform on hold; the Aged Care Royal Commission Response Bill no. 2 no longer proceeding.’ Lexology, 19 May 2022. Aged Care Alert | Aged care reform on hold; the Aged Care Royal Commission Response Bill no 2. no longer proceeding. - Lexology - practical know-how
M. Tan. ‘Law and clinical governance - match or mismatch?’. LinkedIn, 1 April 2022. Accessed at: https://www.linkedin.com/pulse/law-clinical-governance-dr-melanie-tan-/?trackingId=c30Db1s2RCWwLltUq9a2Hg%3D%3D
Final Report: Care, Dignity and Respect, Vol. 1. Royal Commission into Aged Care Quality and Safety. Accessed at: https://agedcare.royalcommission.gov.au/publications/final-report