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.

John Perkins

CEO and Founder of Checked in Care

Can you imagine the banking, retail, media or finance and insurance industries telling you that you can only contact them between 9am and 5pm Monday to Friday, and if you can get through to someone, that the likelihood that they can answer your question is less than 50%?

Why is one of the most common complaints about aged care that the sector is confusing, and people do not know where to start or how to navigate the system? However, in reality, is the aged care system more complex than the numerous other industries that give you access to what you need to know, when you need to know it, 24x7?

Will we see in our lifetimes the aged care industry enjoying similar benefits from technology that other industries have been enjoying for more than a decade?

The good news is yes, with the major shift starting to be experienced is where technology is moving the power from the funders (governments) and the providers to the consumer.

Over the last 10 years, companies have started to focus on technology that drives the consumer experience, enabling first time users to be able to utilise technology in ways they never thought possible. However, adoption has been a major issue.

My company’s, Checked in Care (CiC), recent study with Queensland University of Technology, on the efficacy of CiC technology to reduce depression, showed very promising results in both uptake and the effect of technology in improving mood and reducing social isolation and loneliness.

The key to uptake is to design technology where the user interface (UI) and user experience (UX) is designed to that targeted market, that is first time users, and senior users with challenges such as sight impairment. This is achieved by designing multi-channel communications to suit the user’s technology preference (smart device, email, SMS, etc.), as well as enabling decisions to be made seamlessly between the senior and/or their nominated support person. By this approach, we have seen adoption rates significantly increase over the last seven years, with adoption rates now typically being:

• 90% in retirement living - 65–80-year-olds
• 70% in home care (where half the users are the family) - 70–85-year-olds
• 75% in residential care (where 95% of the users are family assisting with the informed decisions).

Such adoption rates have enabled the further emergence of customer (and staff) experience platforms, which are now helping the aged care industry to enjoy similar benefits of other industries. The typical benefits we are seeing are:

1. Customer satisfaction (customer satisfaction score [CSAT] and net promoter score [NPS]) improvements are directly related to those customers using the customer experience solutions.
2. Decrease in operational costs, as clients (and their families) can self-service, accessing the information they want 24x7.
3. Increase in revenue per client, as the customer experience increases both actual budget as well as discretionary budget spending.

In summary, with the emergence of customer experience platforms in aged care, we are seeing similar benefits in aged care starting to emerge, that have been experienced by other industries for over a decade.

*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.

About the author

John has 30 years’ lived experience in both the care and technology sectors. See linkedin.com/in/checkedincare and www.checkedincare.com.au

Emeritus Professor Anthony Maeder

Former Chair in Digital Health Systems, Flinders University

Telehealth is the provision of health care services remotely via electronic media such as phones or the internet. Telehealth offers the appeal of convenience and flexibility for all parties by enabling live ‘synchronous’ patient-carer interactions under less restrictive organisational constraints than needed for simultaneous collocated physical presence. Positive experiences with immediacy, personalisation and continuity of care provision lead both parties to find value in the approach. Numerous studies in a wide variety of care settings internationally have established the general acceptability of telehealth by both subjects of care and their health practitioners, who have been repeatedly reported as enthusiastic and engaged.

The last few years have seen a much broader adoption of telehealth across Australia than previously, partly in response to ever more stretched healthcare resources (especially workforce constraints), and partly due to the need for physical distancing and other infection control precautions during the COVID-19 pandemic. Health Minister Greg Hunt famously claimed ‘ten years progress in ten days’ from the rapid step-change increase achieved in telehealth services at that time. This phenomenon also swept aside lingering doubts about technological and human capabilities limiting the feasibility of scaling up telehealth.

But now questions are being raised in public and professional circles on the long-term effectiveness and sustainability of increased telehealth usage. These two issues have been made more prominent and immediate by the impending review of Medicare, along with discussions of broadening the base of health service delivery workforce members who can be properly engaged in telehealth. Both issues are highly relevant to considerations of how telehealth can assist in aged care, and so deserve consideration within that specific context.

Effectiveness or ‘doing good’ can be assessed through multiple perspectives. The associated clinical effectiveness of a unit- or program-of-care delivered by telehealth as compared with normal care provides a baseline view. Beyond this level, the efficiency of related service delivery and satisfaction of participants in the process add enhancement. At an even higher level, long-term service design and management decisions with attendant cost-benefit-risk analysis provide extended effectiveness criteria.  We can imagine effectiveness as the clarity of the ‘window’ through which patient and practitioner experience care delivery, with a two-way process of personal interaction at its core.

Sustainability or ‘keeping going’ is partially dependent on effectiveness but is also highly dependent on the service ecosystem and its various administrative and economic constraints. On one hand, practical sustainability depends on the extent to which the components of telehealth-based service delivery can be integrated with existing workflow and infrastructure. Ideally, it becomes seamlessly embedded in numerous delivery processes and therefore subject to the same continuous improvement and cost containment expectations as the whole system. On the other hand, corporate sustainability is closely linked with how the overall health system evolves and new models for service delivery and payment emerge. The current approach of treating telehealth as ‘special’ and needing differentiated attention to support in areas such as training, management, and billing, is unlikely to lead to this form of sustainability. We can envisage sustainability as the ‘doorway’ through which many care delivery activities must pass, in a streamlined and unhindered manner.

Measuring and influencing these multiple factors affecting effectiveness and sustainability is more challenging in the aged care setting, due to the highly individual nature of care situations and subjects, with often imposed complex care settings. It is further confounded by the mix of workforce members and how their skillsets and qualifications might impact on their ability to deliver care properly using telehealth. Introducing or extending telehealth in the aged care arena requires a thorough analysis of associated delivery needs and pathways to allow appropriate and flexible service design. Thoroughly inclusive co-design approaches and large-scale survey- and interview-based implementation studies might offer more informative insights for effectiveness and sustainability in these circumstances than more conventional methods.

Both effectiveness and sustainability influences can also be identified upfront to some extent by gaining an understanding of the readiness or ‘maturity’ of the intended telehealth delivery environment. Frameworks for this type of analysis typically distinguish characteristics of all the different collaborating agents and channels involved, supporting ‘window’ and ‘doorway’ perspectives rather than a one-track outcome-driven appraisal. Undoubtedly experiences gained from ‘window’ and ‘doorway’ thinking in other examples of aged care service design and delivery will inform telehealth innovations and lend momentum to its incorporation.

*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.