The prioritisation of care in residential aged care facilities: a multistakeholder approach

Background: Neglect is a prominent concern in respect of older persons living in residential aged care facilities (RACFs). This thesis focuses on unfinished care which is a specific type of neglect encompassing prioritisation (internal process), rationing (action) and missed care(outcome). When faced with inadequate resources, healthcare workers must prioritise care by deciding what aspects of care are more or less important/urgent. Prioritisation can lead to rationing of care in which lower priority tasks are traded-off in favour of higher priorities, which can ultimately result in missed care; care that is omitted, delayed or left undone. Rationale: Research on unfinished care in RACFs has predominantly focused on either rationing or missed care, with only two studies having investigated care prioritisation. In order to prevent missed care and subsequent negative consumer outcomes, a greater understanding of care prioritisation is needed. Previous research on prioritisation in RACFs has elicited the views of clinical staff members only and has not considered the perspectives of non-clinical staff members, residents and family members. Objective: In order to address these knowledge gaps, this thesis aimed to investigate the prioritisation of care in RACFs from the perspectives of key stakeholders. Research Articles: This thesis contains six articles. Article I is an integrative review that synthesised the empirical literature on unfinished care in RACFs and identified knowledge gaps that guided the research project. Article II is a study protocol that outlined the research materials, methods, data collection processes and analyses. Articles III-VI are empirical studies that explored care prioritisation from the perspectives of staff members (Articles III and IV), family members (Article V), and residents (Article VI).Methods and participants: The research involved a card sorting activity using Q methodology, a think-aloud task, post-sorting interviews, semi-structured interviews and a demographic questionnaire. Participants were 32 staff members, 27 family members and 38residents from five Australian RACFs. Research findings: Findings revealed the situations in which prioritisation dilemmas arose for staff members, the types of care that were prioritised by each participant group, how each group prioritised care, and what influenced their prioritisation decisions. Contributions of the thesis: The thesis provides insights into participants' experiences of prioritisation, unmet needs and missed care, and outlines systemic problems in RACFs that hinder safe, high-quality and person-centred care. This information led to the development often key recommendations for improving care in RACFs. The discussion chapter outlines specific contributions of the thesis to knowledge gaps, methodology, theory and practice, and presents implications for policymakers, care providers and consumers.