What does client ‘engagement’ mean in aged care? An analysis of practice

Abstract

Client engagement is an important part of contemporary aged care. However, the extent to which decisions are delegated to the older person, and the scope of issues about which decision making occurs, vary. The types of engagement that are offered to, and taken up by, aged-care clients have implications for the extent of power and influence older people hold. This paper reports on a qualitative study conducted in a large Australian service provider. It identifies the forms that client engagement takes in the aged-care context, the roles for staff and older people that are enacted through these activities, and the implications these have for power relationships and older people's influence. An inverse relationship was seen between the depth and scope of client influence, but a desire to address this suggested potential spaces for greater empowerment. A relationship was evident between the retention of control by staff and the perceived effectiveness of existing engagement strategies, highlighting the limitations of traditional power dynamics in engagement practice. An expanded model of engagement in aged care is proposed that recognises the foundational role of connection building as a facilitator of greater empowerment for older people. Implications for theory regarding engagement in aged care, and the practice of engagement in aged-care organisations, are discussed.

Older People in Long-Term Care Institutions: A Case of Multidimensional Social Exclusion

“…While volunteering activities may take place both inside and outside care homes, political activities are more likely to occur exclusively outside them. Indeed, when it comes to considering civic engagement among older people living in care homes, one should not overlook residents' councils as well as other similar mechanisms grouped under the label of client engagement (Petriwskyj et al 2018). Enabling older people to voice grievances, and be heard in decision-making processes affecting their care environment, may even constitute important manifestations that can connect to wider political engagement.…”

“…Finally, client engagement refers to initiatives allowing older people "…to have a voice -and control -in the services they receive as well as the policy that guides these" (Petriwskyj et al 2018(Petriwskyj et al , p. 1351). These initiatives vary, both in scope, from participating in decisions about one's care to being involved in the management of the facility, and in depth, from mere consultation and discussion to collaboration, co-production, and true empowerment of residents.…”

A intervenção do/a assistente social com pessoas idosas que residem em estruturas residenciais: Um estudo qualitativo a propósito das lógicas de projeto de vida

“…Embora estejamos a tratar da operacionalização de construto que goza de influência do ambiente, autores existem que reforçam a narrativa assente na determinante pessoal (e.g., Chapin & Cox, 2002;Mondaca et al, 2018;Petriwskyj et al, 2018;Schenell et al, 2020). Tal significa, que este não é somente um construto que tem de ver com o engajamento das pessoas idosas em atividades de carácter físico, social e político, mas também com a liberdade, possibilidade, capacidade e ferramentas que lhes são dadas para escolherem e decidirem ativamente como se querem envolver nas dinâmicas relacionadas com o envelhecimento.…”

“…Invocando alguns estudos no seu trabalho, Mariana Almeida (2016) acrescenta que não se conhecem ainda investigações portuguesas de carácter mais abrangente que incidam em iniciativas e ações de participação especifica para pessoas idosas, concretizadas, por exemplo, ao nível local e com demais públicos (e.g., pessoas idosas com psicopatologias e/ou com mobilidade reduzida). Mais se acrescenta fundamental que as vozes de todos os interlocutores, independentemente das características (e.g., funcionais, cognitivas, culturais) têm de ter peso igual naquilo que é o processo participativo (Petriwskyj, Gibson & Webby, 2018). Dos vários significados, sentidos e conotações atribuídos à noção de participação, eclode outra fragilidade ocorrida em múltiplas arenas no campo da Gerontologia, que trata precisamente do presumível paternalismo invalidante e rigidez da atuação, ainda que o uso da componente da participação ativa e cívica dos públicos seja mencionada.…”

A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

“…Beyond organizational factors, working relationships between RACF care staff and residents are likely to be central to the success of CDC and improvement of resident QoL. Positive interactions between staff and residents can build trust and give residents a sense of respect and acknowledgment, which, in turn, can be the foundation for the ongoing collaboration needed to support residents’ involvement in their care [ 16 ]. Additionally, meaningful relationships, as determined from both the resident and staff perspectives, are expected to improve both resident quality of life [ 17 ] and staff job satisfaction [ 12 , 18 ].…”