Ambassadors in Aged Care may reduce incidences of violence and aggression against workers

A pilot trialling the use of resident ambassadors in an aged care setting has shown reduced incidences of violence and aggression against care workers.

The idea for this pilot came from a working group from Queensland’s Health and Community Services Industry Sector Standing Committee.

In partnership with WorkCover Queensland, Churches of Christ at its Crows’ Nest Residential Aged Care Facility conducted the trial in early 2022, drawing specifically on the experience of care and clinical staff employed in the facility’s Memory Support Unit. The pilot was aimed at addressing unmet needs and challenging behaviours of residents, which have been found to contribute to incidents of violence and aggression against staff in care settings.

The project involved upskilling four staff with strong interpersonal skills as well as prior experience of the unit to take on the new role of Resident Experience Ambassadors. By learning to identify resident triggers, how to identify unmet needs and apply appropriate interventions, Ambassadors became equipped to, in a worker’s words, “de-escalate behaviours before they got worse” and potentially cause injury to unit staff.

Key to the success of the pilot was plain clothes. When rostered specifically for an Ambassador shift, staff wore casual clothes instead of their uniforms. This immediately signalled they weren’t on the floor to deliver clinical or personal care but assist as “extra eyes on the floor and someone specifically for understanding and dealing with behaviours”, as one worker put it.

As a result, “the residents were fed quickly and they were looked after better.”

On the surface, the interventions made by the Resident Experience Ambassadors appear simple. Ambassadors set about discovering the life stories of residents and developed resources based on these, as well as drawing on behaviour logs to understand patterns of behaviour and any potential triggers. By seeking to understand the residents better in a biopsychosocial sense and apply the right diversion strategies at the right time, care staff reported they felt safer and more supported at work.

In fact, the pilot found that while Resident Experience Ambassadors were rostered on and active, there were zero incidents of violence or aggression reported against staff.

“Residents’ behaviours were managed by ambassadors, allowing more time for staff to complete work.”

Care and clinical staff could get on with their jobs and focus on providing quality of care, instead of having the additional and challenging task of managing aggressive or violent behaviour.

The reduced workload, increased role control and increased support, all known to mitigate psychosocial hazards that can cause psychological or physical injury, resulted in all Memory Unit staff reporting they would like the work of the Ambassadors to continue beyond the pilot.

In fact, unit workers suggested Ambassadors should be rostered at all times and especially at peak periods such as morning or afternoon shifts and during mealtimes, as well as when new residents arrive, to support their entry to the unit.

It’s clear from the pilot that by focusing on staff health and safety, as well as delivering quality of care for residents through introducing a specialised staffing resource, there are benefits for workers and their employers.

The pilot team acknowledge that while it’s still early days and while the Ambassador role is one part of a broader system managing the risk of occupational violence or aggression, there remain some promising takeaways for trialling this initiative in other aged care or residential settings.

In particular, the trail found that the training delivered was fit for purpose. It also found that suitable Resident Experience Ambassadors are those with clinical or care experience in disability, aged care, healthcare and the mental health sectors, yet also possess excellent interpersonal skills. In addition, Ambassadors should wear plain clothing to distinguish their role from care or clinical staff. This improved de-escalation outcomes, compared to uniformed staff applying the same or similar behaviour management techniques.

Most importantly, the presence of a Resident Experience Ambassador on shifts and their role during this pilot led to nil work health and safety incidents. This meant there weren’t any lost time or work injury claims, during this period at this facility.

Being proactive in this way and in the words of a staff member involved in the pilot, “intervening before incidents actually happen” has been a win for everyone involved.

In partnership with WorkCover Queensland, as part of the Injury Risk Reduction Initiatives (IRRI), this pilot was conducted from March to May 2022 on site at The Cooinda wing, a memory support unit within the Churches of Christ (CofC) Residential Aged Care Facility (RAC), Crows Nest, Queensland.