Consumer Directed Care and Resident Quality of Life: How Leadership and Organizational Factors Impact on Success.

Previous studies have demonstrated inconsistency in the effectiveness of staff training programs in consumer directed care (CDC) as a means of enhancing the quality of life (QoL) of residents. The aim of this study was to investigate why this might be the case. We analyzed disaggregated cluster-by-cluster resident QoL outcomes after nursing home staff completed a CDC training program. In total, 33 nursing homes (11 clusters) participated in the study. As with previous studies, the outcomes across nursing homes were inconsistent - QoL improved at some sites but at many it remained stable or declined. Analysis of facilitator notes from the most and least successful clusters indicated that a lack of organizational support, for both the training and subsequent practice of CDC, was potentially the key barrier to effective implementation of training and so improvement in resident QoL. These findings demonstrate that all levels of aged care organizations - on the floor staff, managers and senior staff - need to fully support a CDC model of care to optimize outcomes for residents. Staff require training in CDC as well as long-term culture change within the nursing home so that training can be translated into practice.