As part of the BRAVE Flinders Research and Innovation lecture series, Professor Alison Kitson, Vice President and Executive Dean of the College of Nursing and Health Sciences and Foundational Director and Knowledge Translation Lead for the Caring Futures Institute, presents on the fundamentals of care in light of the Royal Commission into Aged Care Quality and Safety interim findings.

Established in October 2018, the Royal Commission into Aged Care Quality and Safety has gained widespread public interest, generating over 4000 telephone calls to the commission information line, and receiving over 6500 public submissions.

It could be argued that this major inquiry investigating the quality of Australian residential and in-home care is long overdue with media reporting and government reviews in the last decade highlighting systematic failures and an increase in notices of non-compliance issued, and sanctions imposed on providers.

The Commission’s interim report explains that the aged care system needs fundamental reform and redesign. It identifies systemic problems in aged care with a system that:

• is designed around transactions, not relationships or care
• minimises the voices of people receiving care and their loved ones
• is hard to navigate and does not provide information people need to make informed choices about their care
• relies on a regulatory model that does not provide transparency or an incentive to improve, and
• has a workforce that is under pressure and under-appreciated and that lacks key skills.

Professor Kitson and members of her team, Dr Tiffany Conroy, Dr Maria Alejandra Pinero de Plaza and Ms Alexandra Mudd have reviewed the transcripts from the Royal Commission in order to analyse and synthesise the evidence of the community’s experiences of the fundamentals of care. Their findings are consistent with the scientific literature in relation to current knowledge about the fundamentals of care and therefore place emphasis on the significance of relationship, integration and context of care.

Importantly, the approach taken by Professor Kitson’s team allows measurement of the whole care problem, providing strategic mapping and detailed quantification of the intersections of key aspects and all relevant levels of care, as well as each discrete issue considered within the fundamental care framework. With this information, they will inform new practices, policies, and recommendations of care/care models for the aged care sector.

Further development of their method can aid the creation of multilevel solutions that align goals across all individuals, networks and levels of complex care problems. Professor Kitson’s team is envisioning user-friendly and digitalised technologies to inform care, always considering those who receive, provide, manage or accredit care.

Professor Kitson says that, currently, healthcare systems are designed around a biomedical model where the focus is primarily on treating a patient’s physical symptoms/concerns. Increasingly, healthcare systems are also working under a managerial approach, where the focus is providing care at reduced cost and increased productivity and efficiency.

“Under these approaches, the focus of care becomes about executing a series of tasks in order to diagnose and cure a patient’s condition, and to do so as quickly as possible. This means that providing an individualised, holistic approach to care gets lost,” she says.

“Most acute care systems are therefore not designed for, or around the needs of, the older person and his/her family.

“The health needs of older people are often complex, characterised by co- or multi-morbidities, and require an integrated and holistic rather than fragmented approach to care.

“We can see how the current focus of our healthcare system impacts the type of care that people receive.”

Fundamental care is the care required by all persons, regardless of clinical condition or care setting, and which is crucial for physical and psychosocial health and wellbeing.

“Absolutely central is this notion of being able to develop a trusting relationship,” says Professor Kitson.

“We referred to all the extensive research around what makes a good nurse-patient relationship and found that absolutely core – without any exception – is this notion of trust. This resonates so strongly with the accounts we have heard through the Royal Commission.”

Professor Kitson outlined the ways in which we can work to reclaim fundamental care:

1. Value Fundamental Care: fundamental care is foundational to all caring activities, systems and institutions
2. Talk Fundamental Care: fundamental care must be explicitly articulated in all these arenas
3. Do Fundamental Care: fundamental care must be deliberately and systematically actioned in all these arenas
4. Own Fundamental Care: fundamental care is your, my and everybody’s business
5. Research Fundamental Care: fundamental care needs a sound evidence base.

“The challenge to every carer, and every manager of a care home is how do you know that people you’re employing can generate a trusting rapport with the relation for whom they’re caring?” Professor Kitson says.

Professor Kitson also called on aged care providers to put their hands up to be involved in research.

“We know that high performing organisations are those who are outward-looking, embrace change, are innovative and do it in partnership.”

“Join our campaign and help us to make a difference. We believe that if we get fundamental care right, we’ll never need to have another Royal Commission into aged care again.”

The public lecture also includes a panel discussion about fundamental care, with:

1. Professor Julie Ratcliffe
2. Dr Paul Yerrell (research mentioned during the lecture: Cancer Data and Aboriginal Disparities (CanDAD)—developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol)
3. Judith Leeson AM