When having a voice is not enough: Acting upon older people’s expressions of evaluation as a pathway to strengthening accountability in aged care settings

• In Event: Centering participants in third sector research

Abstract

A review into the Australian Aged Care sector, the Royal Commission into Aged Care Quality and Safety, highlighted an urgent need for aged care providers to strengthen accountability toward their service recipients. Considering this, and in support of increased social equality and pluralism, this research explores ways older people within nonprofit aged care settings are communicating their evaluation of services received, and how (or if) those evaluations are heard and responded to. The research specifically addresses the question, how can aged care recipients’ expressions of evaluation be heard and addressed, so as to enhance service providers’ accountability toward those they seek to support?

The research drew upon the theoretical perspectives of an ethics of care which contrasts the rights-based focus that tends to dominate understandings of accountability within non-profit organisations. The research case studied an Australian residential aged care facility, where interviews and focus groups with older people (residents) and staff, were supported with document analysis.

Findings have enabled a better understanding of the views of aged care recipients on their own evaluative needs. Here findings suggest older people have an evaluative voice which is heard within their residential aged care setting, however that voice is often not responded to. This leaves some residents feeling disempowered and upset in relation to their lack of ability to impact upon services effecting their quality of life. Therefore, whilst resident’s expressions of evaluation and processes of expressing were identified as important within this study, findings emphasised the prominence of developing ways older people’s expressions of evaluation can be responded to and addressed.

To support the addressing of their evaluations, older people suggested having a person to regularly talk to (individually and face to face) who can support them to resolve their needs, for example, an independent person/representative appointed for this role. This arose as important because interviewees openly spoke to the researcher about their concerns but were either reluctant to speak to staff or felt they had done this and were ignored, or their concerns overlooked. In the face of systemic power asymmetries, there appears to be a need for an internal yet independent third party supporting older people, to have their expressions taken seriously. This can assist in ensuring accountability is authentic rather than remaining a mere right, and more toward a situation where care is genuinely integrated into aged care services.

The research highlights the importance of not only listening to the evaluative expressions of service recipients within nonprofit organisations, but of also acting upon those voices. Practice and policy improvements are enabled through understanding older people’s evaluative needs within organisations and the significance of developing approaches to social performance evaluation that places older people, rather than organisations, funders, or regulators, at the centre of a care-based accountability practice.

Authors

• Kylie Kingston, Queensland University of Technology

• Belinda Luke, Queensland University of Technology