‘It’s about commitment’: Board leadership sets the tone

As conversations on advance care planning touched on several key areas of importance, Eldercare Chief Executive Officer Jane Pickering pinpointed one necessary strength: board and executive leadership.

With a combined 25 residential aged care and retirement living sites across South Australia, Eldercare is one of the state’s most prominent aged care service providers. 

Speaking at the Advance Care Planning Australia National Symposium, Ms Pickering said all members recognise the organisation’s role in supporting older people. This extends to how they enable effective advance care planning. 

Ms Pickering said Eldercare’s model of care features core elements that support the advance care planning process, including embedded resident collaboration and quality processes such as a case management model with clinical expertise.

“It shouldn’t be driven by legislation, compliance or ticking boxes. The most important thing for me is leadership,” Ms Pickering said.

“It’s about commitment and having the right culture in place. You can have all the toolkits and the education but unless you have leadership, resource allocation, systems and processes you won’t have an organisation that’s committed to it through all levels.

“We don’t want any of the residents to suffer due to not having good processes in place and it all adds up to having a successful organisation.”

One hypothetical example shared by the executive highlighted how easy it is for poor processes to negatively impact resident care. 

“Think of a Friday night when there’s one registered nurse on. There’s an acute episode and perhaps the registered nurse is an agency person. They can’t get hold of the family and don’t know what to do [in line with resident wishes].

“So what happens? They call the ambulance and the person ends up in an emergency department. It goes downhill from there. 

“Have that pre-planning in place, know what the resident wants and have it well documented and available on a clinical system so it’s easy to find. That stops that panic when something happens and it stops the ambulance being called at the wrong time,” Ms Pickering added.

The emphasis on board leadership stands out with Eldercare’s approach to palliative/end-of-life care. All facets of the organisation’s model of care are underpinned by a clinical governance framework and an equally important mind, body and spirit well-being approach taps into social and personal needs. 

This is evident in the fact that 87% of residents have advance care plans in place, according to Ms Pickering. Additionally, just 24% of residents have an emergency department admission over a rolling 12-month period while 97% of residents die on-site rather than in a foreign hospital setting.

“If you have good governance in place this is easy. It is part of the identified outcomes you want to achieve for the organisation,” she said. 

“We measure everything. We’ve got quite a structured clinical governance process in the organisation that reports on outcomes and the outcomes become the story. When talking to residents, families and staff you can talk about it in detail.”

Another critical element is ensuring that buy-in occurs at all levels with staff supported to be conversation nurturers even when advance care planning is not their specialty.

“Advance care planning conversations are not floating organic conversations. They are structured, they are purposeful. A care worker needs to understand their role, their scope, what conversations they can and can’t have and when to ask for help,” Ms Pickering added.

“Leadership, resource allocation and having good structures, systems and processes will help people understand their roles and where they can go for help. 

“You want a care worker to respond to a cue from a resident or a family member and know who to refer it to within the organisation so that’s not a missed opportunity for a conversation.”