How can Older Australians get 5-star treatment in a nursing home?

Is it really impossible to imagine that our older Australians could get 5-star treatment in a nursing home? All the ingredients are there – it requires a mind shift and a focus on innovation, needs and choices.

As the 'baby boomer', property-rich generation reaches retirement age, there is a growing expectation of improved standards of residential care among this group and their families/friends, as well as for facilities and services designed with their specific healthcare requirements in mind. Baby boomers understand quality – they know what 5-Star means.

Across Australia, more than 186,000 older Australians live in nursing homes. The price of nursing home accommodation is increasing all the time, newly listed companies like Regis Aged Care and Japara Healthcare are the darlings of the stock exchange – there must be a reason - is that reason quality care?

There is much talk in the aged care industry about setting standards, staffing levels and the use of nurses in management. What is missing is the cheapest and most obvious thing – an attitude towards providing an excellent service.

If we were to analyse what it takes to be a 5-star hotel, how many of these features can be provided in a nursing home? As it turns out, what makes a 5-star hotel is not dissimilar to what makes a 5-star nursing home. Importantly, many of the features and facilities don't require a huge investment by the operator. It's more about innovation than cost.

There's actually no international ratings body, so hotels can (and do) claim to be 5-star even when they are far from the standards of established 5-star luxury hotels. There are nursing homes that also claim the "5-star" rating but sadly miss the mark. This is part of what leads to scathing reviews from guests and families that complain about standards at hotels and nursing homes that list themselves as "5-star" or similar language but are clearly not.

Hilary Stockton, a leading hotel rating expert, lists what she looks for when she does inspections and reviews of 5-star hotels. What is instructive is how many of these features can apply to a nursing home – I have marked them in italics.

1. Attentive, Discreet and Consistent Service

"Quality and consistency of service is the number one differentiator between true 5-star luxury hotels and others. The hospitality industry is a tough one, often plagued by high employee turnover, so it's no small feat for a hotel to be able to deliver consistently at a high level and to recruit and retain the people that deliver on the hotel's brand promise. Any hotel can put in an elegant lobby or maintain lush landscaping--the human component is the more challenging piece. And by excellent service, I look for attentive, anticipatory and discreet, not fawning, insincere or merely reactive. While no one wishes for a problem, one of the best tests of the service level is when something goes wrong."

Recruiting and training staff in a nursing home to provide quality and consistent service is not an insurmountable task. Nursing homes also suffer from high staff turnover – but this can be improved by recruitment practices and investment in training and quality. Features like attentive, anticipatory and discreet can be trained – it's all about attitude.

Hilary Stockton says, "any hotel (read nursing home) can put in an elegant lobby or maintain lush landscaping - the human component is the more challenging piece."

2. Personalisation

"Ever noticed how the best hotels consistently greet you and your family by name, even when it's your first time staying with them? It can seem almost like magic, when it's not at check-in and it's a staff member that you've never seen before, but it really can help bridge that gap between "just another hotel stay" and feeling taken care of, particularly if the staff are genuine. It used to be said that the Ritz-Carlton records all guest preferences down to whether a guest prefers milk or dark chocolate."

How hard is it for nursing home staff to make a list of preferences for their residents? How hard is for the staff to know everyone's name and the names of sons and daughters visiting? How much extra expense is there in have a chosen colour scheme, or personalised linen and duvet cover?

3. Bedding

"It's been several years since most of the major chains seriously revamped their bedding for the better, and now even use it as a key marketing point. It always surprised me that it took as long as it did (and that many independent "luxury" 5-star hotels don't have particularly good beds) since, surprise, surprise - ultimately you want to be able to sleep as well or better in your hotel room than at home."

Why can't specialised bedding and pillows be arranged for residents in a nursing home? While hospital-type beds are commonly used, maybe beds and bedding can be looked at by an Occupational Therapist to make sure they suit the resident's needs.

4. Complimentary House Car and Transfer Services

"The best 5-star hotels offer complimentary luxury house car services within a certain radius or area. For example, at our recent stay at The Setai Fifth Avenue, we enjoyed an over 50-block ride in the Maserati house car. Very hard to beat that."

Nobody is suggesting Maserati's parked outside the front door of the nursing home but a well-appointed sedan or bus is possible. This can be used to help residents as well as family members visiting from out of town. Buses are commonly provided by nursing homes, it is more about changing how and when they are used.

5. Kids' / Family Amenities

"The way to a parent's heart is through his or her child, and the top 5-star hotels and resorts understand that well. As I wrote in What Drives Customer Loyalty in the Travel Industry one of my best family hotel stays at a U.S. hotel was at the Four Seasons Philadelphia, which has a fairly nondescript footprint as far as 5-star city hotels go, but offered a wonderful welcome to my then 1-year old son as well as us."

The needs of families visiting nursing homes are often ignored, especially families with young children. Why can't a play area be set aside, or a set of kid's games to help take the pressure off their parents while visiting loved ones? Families should feel welcome and comfortable visiting and there should be places for them to sit and chat that is not confined to the resident's room.

6. Food and Drink Quality

"While I'm not as hung up on room service as some, because I like to explore local haunts off-property, I do highly value the quality of the food and drink that is available at the hotel. While an extensive breakfast buffet can be a big attraction for some, I look for quality over quantity. For breakfast, there should be fresh squeezed orange juice, and preferably some other fresh squeezed selections as well. Particularly for U.S. and European properties, there should be some organic choices, with many ingredients sourced from local producers. Pastries and bread should be excellent and preferably baked on-site."

This is a feature that nursing homes find a challenge because it is an area of potentially very high cost. It's more about matching meals with the needs of residents than it is about offering caviar or crayfish thermidor. There's nothing quite as good as real butter with fresh baked bread, and it's the cheapest thing to produce.

7. In-Room Coffee - Nespresso

"There ideally should be an in-room coffee maker, and it should be Nespresso. And please don't offer powdered creamer - stock some small half and half containers in the mini bar."

Why can't there be a coffee machine in the nursing home room? This is more about family visitors than about residents. The fact is, this is a feature that everyone enjoys. There is nothing quite like the smell of freshly brewed coffee.

8. Bath Amenities

"For a true 5-star hotel or resort, I want to see better brand name toiletries, such as L'Occitane, Bulgari, Hermes, Aesop, Le Labo - you get the picture. Sometimes 5-star boutique hotels, such as The Champs-Elysees Plaza in Paris, which offers Hermes bath products.

Face, hand creams and deodorant are things that can be made available for residents in their rooms. Care staff are often seen giving a hand or foot rub, why not use better quality products?

9. Concierge Service

"Since I do so much planning myself I rarely need concierge service, but when I do, I want to be able to rely on it to get me a hard to score restaurant reservation or know where I can find the best local playground."

One of the main criticisms of nursing homes is the lack of care being given to residents. One study shows average hand's on care as being between 2 minutes and 22 minutes in a 24-hour period. Families want more care for their older loved ones and most are prepared to pay for it. Why don't nursing homes allow private pay care companies to support the extra care needs of residents? It makes no difference to the nursing home bottom line but makes for a better experience for residents and their families.

Ryan Van Zyl a respected writer on hotels and service talks about the things that ruin the experience in a 5-star hotel:

  • Arrogant, unfriendly or badly trained staff
  • Less than impeccable room cleanliness or facilities
  • Bad service in the bar, housekeeping, restaurants or other public areas?

Van Zyl says that these three issues cover 99% of what people complain about when staying in a hotel. Do you think it is a coincidence that 2 out of 3 are directly related to service and training? Would complaints in a nursing home follow the same trend?

"Human error, lack of training and lack of effort accounts for the vast majority of complaints" says Van Zyl about 5-Star Hotels

Would the same statement apply to nursing homes?

Providing 5-star service in a nursing home requires operators to be innovative – to look outside the box.

Cathy Cress, a leading aged care commentator in the US, has made a list of 10 features that a nursing home can apply to make their service 5-star. These are:

  1. Make a commitment to service and training.
  2. Answer the phone within 2 rings
  3. Make sure the Care Manager doing the initial assessment and care plan is there on the appointed day and follows up at least once a month. Communication with the family is also important
  4. Make sure that the Care Manager is " the best"; a nurse, educated, trained and qualified to assess an elderly or disabled person's situation and recommend and monitor needed services
  5. Follow the ethics and standards of practice of the nursing profession while offering exceptional service
  6. Offer Services/ Products that the concierge client wants and desires - example VIP Care and companionship. Use private-pay home care companies to augment services. This saves employment costs and optimises the use of full time staff.
  7. Provide rapid replies to family enquiries and questions and a high level of personal interaction
  8. Use a person-centred management platform.
  9. Care staff are more than gracious, always smiling and friendly.
  10. Care staff are impeccably dressed and cater to clients' needs and wants - directed by the geriatric care manager's care plan.

Nothing in the features that Cathy Cress has raised point to higher cost – they do, however, point to the right attitude and an enterprise-wide commitment to quality care.

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