Alternative staffing structures in a clustered domestic model of residential aged care in Australia

Abstract

Objective: A clustered domestic model of residential aged care has been associated with better consumer-rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. Methods: A cross-sectional study involving 541 individuals living in 17 Australian not-for-profit residential aged care homes. Results: Four of the homes offered dementia-specific clustered domestic models of care with higher personal care attendant (PCA) hours-per-resident-per-day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours-perresident-per-day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hoursper-resident-per-day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. Conclusions: An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models.Further research to determine optimal staffing structures within alternative models of care is warranted. K E Y W O R D Shealth services for the aged, nursing homes, nursing staffThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The Small House Model to Support Older Adults in Long-Term Care

“…However, this difference did not seem to negatively impact level or quality of care because residents of the small home model received slightly more care hours per resident per day than residents in the traditional LTC homes (mean = 2.66 [SD = 0.35] vs. mean = 2.58 [SD = 0.44]; P = 0.006). 42 This finding is in line with another study that reported that small house model staff outperformed staff from larger homes, spent 3 times to 6 times more time in personal care situations, and spent significantly more time in task-oriented interactions than traditional home staff. 26…”

“…35,40,41 In the 2 studies that reported on wages -conducted in the US and Australia -wages did not differ significantly between the small house models and the comparator traditional LTC homes. 32,42 Although the homes based on the small house model are staffed with the same assortment of caregivers (i.e., job descriptors), numerous studies reported that a higher proportion of staff hours in the smaller homes tended to be from those in positions requiring less formal training (i.e., a higher proportion of certified nursing assistants providing care as opposed to registered nurses). 14,32,[42][43][44] In a direct comparison of 4 Australian domestic-clustered homes with 13 traditional LTC facilities, Harrison et al (2018) found that care providers in homes based on the small house model spent significantly fewer hours per resident per day compared with the traditional model: degree-or diploma-trained nurses (mean = 0.23 [SD = 0.10] vs. mean = 0.85 [SD = 0.17]; P < 0.01) and allied health staff (mean = 0.02 [SD = 0.01] vs. mean = 0.15 [SD = 0.1]; P = 0.042).…”

“…32,42 Although the homes based on the small house model are staffed with the same assortment of caregivers (i.e., job descriptors), numerous studies reported that a higher proportion of staff hours in the smaller homes tended to be from those in positions requiring less formal training (i.e., a higher proportion of certified nursing assistants providing care as opposed to registered nurses). 14,32,[42][43][44] In a direct comparison of 4 Australian domestic-clustered homes with 13 traditional LTC facilities, Harrison et al (2018) found that care providers in homes based on the small house model spent significantly fewer hours per resident per day compared with the traditional model: degree-or diploma-trained nurses (mean = 0.23 [SD = 0.10] vs. mean = 0.85 [SD = 0.17]; P < 0.01) and allied health staff (mean = 0.02 [SD = 0.01] vs. mean = 0.15 [SD = 0.1]; P = 0.042). The authors also reported that personal care attendants provided more hours per resident per day in the domestic-clustered homes compared with the traditional LTC homes (mean = 2.43 [SD = 0.29] vs. mean = 1.74 [SD = 0.46]; P < 0.001).…”

“…15 The other Australian study offered perspective on training costs, reporting higher training costs for a small house model compared with a traditional facility (mean= AU$1,492 [SD = AU$259] vs. mean = AU$989 [SD = AU$928]; P < 0.001). 42 Although it is expected that the build costs for the small model homes are higher due to the larger footprint and required area, 33,45 an Australia publication reported the cost is comparable to that of a traditional larger LTC home when presented as a ratio of gross floor area. 46 One opinion article originating from Canada championed the use of small house models in future LTC development, claiming that operational costs are lower and projects currently under construction in Manitoba have half the costs of traditional home builds.…”

People living in residential aged care need to BE outside not just SEE outside: associations between quality of life and outdoor access: a cross-sectional study

“…As well as having design differences, including housing for smaller groups of residents and independent access to outdoors, the home-like model of care incorporates a different staffing structure, with higher direct care hours and investment in staff training [35]. Dutch studies have also indicated that small-scale living environments have the potential to benefit residents and that factors other than just the physical design, in particular staffing factors, have a role in optimal use of outdoor areas [16].…”