Tri‐focal Model of Care Implementation: Perspectives of Residents and Family

The advent of consumer-focused care is having a profound effect on service delivery in health care. The shift to individual patient- and resident-centered approaches has, in part, been driven by government policy and standards for care (Australian Commission on Safety and Quality in Health Care, 2012; National Health Service Executive, 2000; Victorian Department of Human Services, 2003). In Australia, for example, the National Safety and Quality Health Service Standards, against which health services are measured for accreditation purposes, include a standard for "Partnering with Consumers" (Australian Commission on Safety and Quality in Health Care, 2012). This standard requires consumer involvement in service planning, measurement, and evaluation, and is intended to ensure health services are responsive to consumer input and need.This shift has also been a key driver in promoting consumer participation in care decisions. In the United States, patient engagement is enshrined in law for the Centers for Medicare and Medicaid Services. The U.S. Patient-Centered Outcomes Research Institute was created through law to fund research to assist consumers to make informed decisions about their health care. Similarly, in Europe, the Picker Institute was established in 2000 as a not-for-profit organization to capture the experiences of consumers and identify areas of priority for delivery of high-quality care.Alongside this shift, many countries are experiencing changing demographics, resulting from increased life expectancy, with a corresponding larger older population and a relatively smaller working population, rising costs, and expectations for quality care provision. The ageing phenomenon is placing pressure on publicly funded health and social services, including long-term care (LTC; Taylor, 2011). Thus, health system performance is under considerable pressure and scrutiny, mainly due to the demands of an ageing population, rising costs, and expectations for quality in care provision.The World Health Organization (WHO, 2015) identified population ageing as one of the major public health challenges. Additional challenges to aged care provision include changing societal models with a reduction in family carers, increasing expectations for well-coordinated care services, and changes in technology (Organisation for Economic Co-operation and Development, 2011). Older people living in LTC are a highly dependent and frail population requiring complex, individualized care. Increased demand for aged care services combined with community expectations for high-quality LTC has led to a need for targeted education to promote capacity building among the LTC workforce (Ansell, Davey, & Vu, 2012; Cook & Halsaw, 2011).To deliver LTC in accordance with best practice, models of care need to combine teaching, clinical care, research, and service delivery (Barnett, 2014). Barnett describes education of the multidisciplinary workforce and students as a defining feature of such models. Teaching comprises that delivered through university partnerships, and clinical teaching and supervision initiated within the practice setting itself. Such models ensure high-quality care through integration of evidence-based practice and person-centered care.The LTC sector in many countries is under pressure to adopt person-centered care policies and practice. A concept analysis of person-centered care identified key attributes as: recognition of personhood, evidence of a therapeutic relationship, respect for individuality of the person, care that reflects professional ethical standards, identification and reinforcement of the individual's strengths, acknowledgement of the person's lived world, and empowerment of the person to make his or her own health decisions (Slater, 2006). The Institute for Patientand Family-Centred Care (n.d.) in Europe defines person-centered care as: "An approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. …