Principle 2: Residents are informed and involved

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Provide the resident, their family and carers with timely and appropriate information when the person enters care. Continue this information flow to ensure the resident maintains choice and control over all aspects of their life.

Shared decision making is essential for person-centred care and aligns with the National Safety and Quality Health Service Standards.1

Benefits of care choices

MPS residents from Murrumbidgee Local Health District enjoy time outdoors.

Informed and engaged residents, families and carers understand the risks and benefits of care choices, leading to better quality decisions, adherence to clinical management plans and empowerment.2 This is especially important for residents with multiple chronic conditions and lower health literacy.3-5     

Information management is a continuous two-way process between MPS staff and the resident, family and carers to optimise informed decision-making.

Ease transition to care

  • Tailor and present information to suit health literacy and cultural background.
  • Provide consistent relevant information packages, accessible online and at pre-admission and admission.

      Pre-admission booklet

      Offer a pre-admission handbook to simplify the transition to residential aged care and support informed decision making. Include the following information.

      Facility overview

      • Admission requirements, e.g. Centrelink information, My Aged Care assessments and contacts, fees, support available, admission form and medication history
      • Residential care service agreement, e.g. rights, responsibilities and legal requirements
      • Facility mission, vision and values
      • Waiting lists

      Facility environment

      • Pre-admission tours, including virtual tours
      • Equipment and furniture guidelines
      • Local area information

      Facility services

      • General information, e.g. about meals, laundry, services available, activities, smoking and alcohol use, medical services, pharmacy and fees, mail, safety and security, spiritual care
      • Management of other matters, e.g. information about an advance care directive, enduring power of attorney and enduring guardianship
      • Template for the resident profile, which captures social history and work history, children, grandchildren, abilities, interests, pets, lifetime achievements, special events and cultural practices
      • Respite and palliative care

      Welcome pack

      On admission, provide a welcome pack to clarify expectations and introduce and orientate the resident, their family and carers to the facility. Include the following:

      Introduction

      • Welcome letter
      • Facility overview, including room allocation and daily routine, e.g. meals, laundry, activities, internet access, room cleaning and kitchenette
      • Available services, e.g. medical, nursing, pharmacy, rehabilitation, allied health, hairdressing and visiting services, such as dental and therapy pets
      • Helpful telephone numbers, e.g. My Aged Care, Seniors Rights Service, Aged Care Complaints Commissioner and Older Persons Advocacy Network
      • Safety and security, e.g. infection control, food safety and manual handling
      • Complaints, compliments and expectations

      Required documents

      • Forms, e.g. new resident pharmacy notification form, enduring guardianship and power of attorney, advance care directives, resident agreement and financial consent, e.g. for resident activities, hairdresser, continence aids and podiatry
      • Privacy and confidentiality statement, Aged Care Charter and Charter of Residents’ Rights and Responsibilities
      • Ageing in place (for episodes of sub-acute care)

      Daily living

      • Guidelines for managing personal possessions
      • Daily living activities and independence, e.g. personal hygiene, continence, communication methods and emotional support
      • Schedule for case conferencing and other meetings
      • The role of family, carers and friends
      • Pets
      • Alcohol and smoking
      • Resident leave

      Activities

      • Community involvement and interaction with MPS, e.g. churches and schools
      • Social outings, e.g. Probus, Rotary, Country Women’s Association, Bridge Club
      • Volunteers

      Strategies for small-scale change

      Standardise pre-admission processes

      • Develop a resident handbook.
      • Collect routine advance care directives during pre-admission.
      • Collect a profile for every resident on admission, describing who the person was and is.

      Ensure residential information is easy to navigate

      • Create an MPS website per local health district (LHD).
      • Develop a local brochure.
      • Hold public open days and barbeques to showcase the service.

      Standardise the admission process

      • Develop a welcome pack and checklist.
      • Provide fact sheets about services available, e.g. daily routine, uniforms and visiting services.

      In practice: Keeping residents connected

      Balranald MPS, in the Far West LHD, uses simple strategies to keep residents, families and carers informed and involved in care. One key initiative is the monthly residents' meeting, where all residents are invited to meet with the health services and nurse unit managers. These meetings encourage open, two-way communication, fostering shared learning and direct engagement with decision-makers.

      Another essential tool is a whiteboard with the names of staff on duty and the weekly meal plan. This is updated daily and helps residents and visitors to identify and engage with staff, especially when agency staff and students are working. This simple approach assists residents to feel more involved in their daily lives.

      References

      1. Australian Commission on Safety and Quality in Health Care. Australian Commission on Safety and Quality in Health Care. Shared decision making. Sydney: ACSQHC; 2024 [cited 2 Oct 2024].
      2. Marzban S, Najafi M, Agolli A, et al. Impact of Patient Engagement on Healthcare Quality: A Scoping Review. J Patient Exp. 2022;9:23743735221125439. DOI: 10.1177/23743735221125439
      3. Bunn F, Goodman C, Russell B, et al. Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis. BMC Geriatrics. 2018;18(1):165. DOI: 10.1186/s12877-018-0853-9
      4. Peart A, Lewis V, Barton C, et al. Providing person-centred care for people with multiple chronic conditions: protocol for a qualitative study incorporating client and staff perspectives. BMJ Open. 2019;9(10):e030581. DOI: 10.1136/bmjopen-2019-030581
      5. Søgaard MB, Andresen K, Kristiansen M. Systematic review of patient-engagement interventions: potentials for enhancing person-centred care for older patients with multimorbidity. BMJ open. 2021;11(12):e048558.
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