Our study describes the QoL of a large sample of people in the community who receive aged care services. We found that QoL varied between clients as well as between different community care service outlets. The findings identified factors that predicted QoL, including that social participation opportunities and provision of care services that meet older adults’ needs are associated with higher QoL. We further showed that validated QoL measures can feasibly be integrated into routine assessments and when stored electronically, permit risk-adjusted analyses to allow benchmarking between service providers.
Addressing the unmet care and support needs of an ageing population, and designing services and solutions centred around what older people need and want, remains an urgent public health priority. Previous studies indicating that the level, maintenance and development of high quality social support networks contribute to positive QoL[39, 40]. Our results further highlight the vital role of social participation for older adults receiving aged care services in the community, whereby interpersonal interactions and engagement in community-based activities through care service provision is a valuable influence on overall QoL.
Contrary to our initial expectations, our findings showed a relatively high QoL for community care older adults, compared to national and international samples. Clients’ QoL scores in this study are similar to older community-dwelling adults in both Australia and the UK [17, 25], but higher than social care users in the UK and clinical post-acute rehabilitation outpatients in Australia. This contrasts with earlier research that has shown that aged care services are associated with a negligible impact on outcomes[41, 42]. These findings might be at least partly attributable to the longer time for which clients in the present study had been receiving community care services (> 12 months), which may have supported clients to develop meaningful relationships with staff and other clients, allowing them to reap the full benefit of care services. Another explanation for the higher than expected QoL in our study is that a large proportion of our cohort had only low level care needs, and therefore may be comparable to the wider general population of older adults.
We found that client QoL scores were higher in outlets with the largest number of clients, with a large proportion of all clients accessing day centre services. As social interaction is often the core element of day centre services, outlets that are servicing larger client populations may be able to provide new and wider social networks. For many older adults, family and close friends can provide companionship and facilitate social and pleasurable activities, which are critical to maintaining QoL in older age. Aged care providers can build on these relationships to improve clients’ QoL by tailoring community-based activities and services to build and sustain social networks for individuals with lower levels of social participation as well as using alternative methods, such as providing access to digital technology to enhance social connectedness.
Our results show that meeting the needs of older adults through providing services that support activities of daily living was associated with higher QoL. To our knowledge, this is the first study to demonstrate this relationship. Previous qualitative studies of older adults or family carers[38, 42, 46] have identified the impact of coordination of services, access to information and preventative strategies on clinical (e.g., physical function, medication management) and QoL outcomes.
Further research is required to identify how much and what type of home care services can successfully support older adults to live independently.
This could include tailored identification of specific types of assistance and reablement that are important to each client’s QoL. A systematic review comparing different care models of non-medical home and community services for older persons found that different models (e.g., integrated care, consumer-directed care) impacted on different outcomes (physical health, ADLs, quality of life), and concluded that a focus should be on combining the successful features (e.g., case management, integrated care, consumer directed care) to maximise outcomes. Understanding how different models of service and care provision are effective in enhancing QoL among clients, as well as an understanding of the relative priorities of needs for individual clients, would be beneficial in tailoring future care plans.
Our previous qualitative research has highlighted that entering into discussions about social needs and QoL with a staff member facilitates better matching of client needs to appropriate services. Other evidence also suggests that older adults with lower QoL may benefit more from programs that involve iterative feedback from a healthcare professional and are tailored to their specific social, cognitive and physical needs. However, discussions about QoL can be emotionally difficult for staff and more resource intensive than traditional clinical process indicators. This may result in variation between outlets in whether staff use QoL assessment simply to obtain a score, or use it as a basis for a conversation to match services with client’s needs. Regardless, our experiencing has indicated that staff find such conversations valuable.
Quality indicators need to be sensitive, reliable, evidence-based and be able to discriminate between care providers. The variation we found in QoL between different outlets after adjusting for key client factors demonstrates that QoL measures have the potential to be used as a meaningful quality indicator in community aged care. We found that 21% of service outlet centres had lower risk-adjusted mean scores than would have been expected given their client population and 16% better than expected. This variation in QoL may reflect differences between outlets in the availability and types of services they offer that can meet clients’ needs and preferences. Through benchmarking these data, providers may be better able to assess which of their service outlets and client populations needs more support in these areas, and which outlets are performing well and can be champions.
Utilising data obtained from aged care electronic management systems for measuring outcomes has several benefits. Firstly, these different systems enable linkage between sociodemographic and QoL information to risk adjust and compare provider performance. Secondly, they enable providers to examine what services they are supplying to whom and evaluate whether such services are associated with improvements in client QoL. Finally, using already established organisational processes (e.g., forms embedded in client electronic systems, staff awareness and training for QoL assessments) to support QoL measurement among clients can support the regulation of aged care standards. The next stage is to ensure QoL assessments are carried out by aged care staff systematically, using QoL measures that have been developed specifically for aged care settings.
This study only examined clients who had completed QoL tools at a single point in time. Future work should include a wider client sample and evaluate the impact of services on changes in client’s QoL scores over time. Furthermore, while we adjusted for essential factors such as socioeconomic status, age and care needs, fully disentangling the impact of the service provider on QoL compared to the local environment that clients live in requires additional area-level information that was not available in this study.