Rosemary Fisher*, Antony Linden*, Tanya Linden**, Kim T.C Le*

*Swinburne University of Technology; **The University of Melbourne

Quality of life for the elderly is a global concern. Unfortunately, the most vulnerable group of our population was at the centre of media campaigns, and government and community concerns due to the substandard care they were experiencing. In response to these concerns, in 2020 aged care nurses and consultants Christine Brodrick and Diana Cooper developed Tell Touch, a digital application designed to address problems with the quality of care provided to residents of aged care homes (ACHs). Tell Touch enables aged care service providers to ensure their complaints and feedback processes comply with or exceed the Aged Care Quality and Safety Commission (ACQSC) Standard 6. The app uses principles of cultural inclusion, accountability, accessibility, and streamlined feedback to collect feedback and complaints from residents of ACHs and their family members or carers. It also produces reports that identify opportunities for improvement in the quality of care provided to residents.

An independent pilot evaluation of the app was conducted in ten ACHs to assess its effectiveness. The project contextualised the well-accepted Technology Adoption Model adopted by Holden et al [1], to explore the user’s experience of implementing Tell Touch in ACHs by examining perceptions of ease of use, usefulness, social influence to use, training received, technical support provided, perceived usefulness for consumer care, social influence of consumer’s family to use, and demographic variables.

The results of the evaluation were positive, with mean results above the midpoint on all questions. Perceived ease of use, satisfaction with the app, social influence to use the app, complete use of app functions, and intention to utilise the app were all above five on a 7-point scale. Thematic analysis of interviewee data provided additional insights into why and how staff perceived using Tell Touch to be satisfactory. In addition, it captured some suggestions for potential improvements to the app.

Overall, the evaluation concluded that Tell Touch is an effective information technology (IT) communication platform for complaints and feedback handling in ACHs. This suggests the app's guiding principles were meaningful to users and successfully implemented. Furthermore, the evaluation supports suggestions that utilising real-time data gathered from feedback apps could contribute to transforming the aged care service delivery model, making it more accountable, consumer-centred, and compliant with government legislation. 

Lessons learned from the implementation and use of Tell Touch include:

1. Users cannot be assumed to all have the same level of IT literacy skills
2. A ‘go to’ person is needed in each organisation to train new users
3. Clients need to be regularly followed up after onboarding to ensure they are using and are aware of all features.

This pilot evaluation highlights the potential for technology to improve the quality of care provided to elderly residents of ACHs. The use of Tell Touch has enabled these ACHs to streamline their complaints and feedback processes. This has enabled the identification of opportunities for improvement in the quality of care provided to residents. By collecting real-time data, ACHs can become more accountable, and consumer-centred as well as compliant with government regulations, whilst ensuring the highest quality of care is delivered for their residents.

The successful implementation of Tell Touch demonstrates the potential for technology to transform the aged care service delivery model. By prioritising cultural inclusion, accountability, accessibility, and streamlined feedback, technology can support the provision of high-quality care to elderly residents of ACHs. As the global population ages, it is essential that we continue to develop and implement innovative solutions to improve the quality of life for the elderly. Tell Touch is a promising solution that can help achieve this goal.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Professor Lily Xiao

College of Nursing and Health Sciences, Flinders University

In Australia, 37% of older people were born overseas; 18% of them speak a language other than English at home and 6% (or 245,000) do not speak English well or cannot speak it at all. [1] Moreover, older people, who speak English as a second language and live with dementia, will experience language reversion to their native language when they develop dementia. Informal carers from culturally and linguistically diverse (CALD) backgrounds play a crucial role in maintaining people with dementia from CALD backgrounds at home for as long as possible and relieving the disease burden on the health and social care system. However, they usually experience more difficulties in accessing and participating in dementia care education programs compared to their counterparts from the mainstream culture. Language barriers and cultural differences are main factors contributing to the disparities in dementia care.

The World Health Organization (WHO) iSupport program is a skill training program for informal carers of people with dementia. The program promotes best practice in home-based dementia care. It includes five learning modules: Introduction to dementia; Being a carer; Caring for me; Providing everyday care and; Dealing with changed behaviours. The program has been adapted to the Australian social context for carers from an English-speaking background. The Australian iSupport program includes a new learning module, ‘My engagement in consumer-directed care’, to meet carers’ learning needs in managing aged care services for their loved ones.

Engaging carers from CALD backgrounds in the iSupport program is an opportunity to address the existing dementia care disparities. Chinese Australians are the largest CALD group in the Australian population. This CALD group also holds a strong filial piety belief and views the care of older family members as their duty. Thus, home-based dementia care is more common in Chinese-Australian families than in the mainstream culture. Since 2021, we have been working with the Chinese-Australian community in the iSupport program through three strategic stages: 1) the cultural adaptation of the WHO iSupport program, 2) trialling the iSupport program and 3) embedding the iSupport program into community aged care services.

We received funding from the Australian Government via the National Foundation for Australia-China Relations to work with our partners in Greater China, where our Chinese migrants are from, in the iSupport program. The cross-national collaboration generated synergy in the translation, cultural adaptation, resource development and training of staff and facilitators. Three Australian Chinese-ethno-specific aged care organisations including Australian Nursing Home Foundation Limited (ANHF), Chinese Australian Services Society (CASS) and Chinese Welfare Services of SA Inc. (CWS) participated in the program. We gained great support from carers, frontline staff, and the organisations in the research. 

Recently, our team from Flinders University, ANHF, CASS and CWS won an ARIIA program grant to embed the iSupport program in the routine aged care services of those three industry partners. We expect that the technologies used in the iSupport program will improve the reach and representativeness of Chinese-Australian carers in the program and the impact of the iSupport program on the health and wellbeing of carers and those they care for. These technologies include web-based interactive learning activities with instant feedback for carers, and the use of audiobooks, e-books, and hardcopies to disseminate the iSupport program. We anticipate that our engagement with Chinese carers in the iSupport program will engage Australia’s diverse communities in developing multilingual versions of the iSupport program and make our dementia and aged care services more inclusive. 

The resources we developed via the Chinese iSupport program are freely accessible via these weblinks listed below. We welcome carers, dementia and aged care stakeholders to use and introduce these resources to Chinese carers of people with dementia.

Links to access the Chinese iSupport program resources:

1. Australian training and support manual for carers of people with dementia: Simplified Chinese (澳大利亚失智症照顾者培训和支持手册: 简体中文版)：https://researchnow-admin.flinders.edu.au/ws/portalfiles/portal/60428427/iSupport_handbook_Simplified_Chinese.pdf
2. Web-based Australian iSupport for Dementia program: simplified Chinese (澳大利亚失智症照顾者在线支持: 简体中文): http://43.135.6.171:8080/support_cns/
3. Australian training and support manual for carers of people with dementia: Traditional Chinese version(澳大利亞失智症照顧者培訓和支援手冊: 繁體中文版)：https://researchnow-admin.flinders.edu.au/ws/portalfiles/portal/60434110/iSupport_handbook_Traditional_Chinese.pdf
4. Web-based Australian iSupport  for Dementia program: Traditional Chinese(澳大利亞失智症照顧者在线支持: 繁體中文)：http://43.135.6.171:8080/support_cnt/

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.