Student participation at Helping Hand Aged Care: taking clinical placement to the next level

Abstract

Background

The Student Education and Participation Program that has evolved at Helping Hand Aged Care over the past decade is based on ongoing research and evaluation, and a highly innovative example of the teaching nursing home model has emerged.

Methods

Drawing on that body of work and findings from the national evaluation of Australia’s TRACS (Teaching and Research Aged Care Services) programme (2012–2015) an analysis of the model is presented.

Results and conclusions

Lessons learned about the challenges faced, enabling factors, the benefits generated and outcomes achieved are presented.

Keywords

aged care student education teaching nursing home Teaching Research Aged Care Services (TRACS)

Student education in aged care settings: evolution of a model

The need to train future health and aged care workforces has been a key driver of the development of the teaching nursing home (TNH) model globally, and there is a growing recognition in Australia that the aged care sector can be a legitimate source of clinical education as occurs with the teaching hospital model in the health sector. More recently in Australia, this role has been linked to the need to attract newly graduated health professionals and others into aged care by demonstrating the range of benefits associated with working in this sector and the range of clinical skills that can be developed in doing so. The TNH model received its most significant boost when the Australian government funded the Teaching Research Aged Care Services (TRACS) programme from mid-2012 to mid-2015.

Whereas the research literature is in agreement that the provision of clinical placement is a key feature of the TNH, there has been little attention paid to the range of learning experiences that it makes possible. Instead there is an assumption that the way in which student placements are designed is uniform, driven by the education partner and measured by the number of students ‘placed’ rather than by learning outcomes and other experiences gained in the process. This reflects the under-developed role of the aged care sector as an education provider, the lack of dedicated funding to support that role, and the relatively small number of aged care providers pursuing the TNH model. All three of these factors are mutually reinforcing. The TRACS programme challenged those assumptions and its national evaluation documented a wide range of achieved learning outcomes (Barnett et al., 2015).

Among the 16 aged care–education provider partnerships funded were several that built on a solid foundation of years of partnering to deliver high-quality student clinical education, and in many cases to engage in research, with TRACS funding enabling them to fine-tune that work. These were the most successful TRACS projects, while those who had received funding effectively as ‘start-ups’ struggled to achieve positive outcomes within the 3-year funding time frame (Barnett et al., 2015: 3, 35). The Helping Hand Aged Care and University of South Australia collaboration was one of the former group (involving at least 20 years of working together) and TRACS provided the opportunity to extend their student education model and trial new learning strategies.

There are a number of very good reasons for elevating the capacity of aged care providers to contribute to student learning outcomes. For students in the health sciences, developing skills to support the care of older people with chronic and complex care needs is essential, but difficult to achieve in an acute care setting (Liebig, 1986: 199) because of the type of conditions being treated and the shorter lengths of stay relative to residential aged care. For the student undertaking a clinical placement, the aged care service offers an opportunity to work with older people over an extended period of time and in a setting designed to respond to the complexities of chronic illness. The knowledge and skills gained are readily transferable to supporting older people in the acute care setting. If that aged care service offers a diversity of programmes, the student can experience a range of service provision modes and a wider spectrum of aged care needs (Annear et al., 2016; Barnett, 2014: 10, citing Katz, 2010). The earliest applications of the TNH model reflected this potential:

Conceived as a hub of services to the independent as well as institutionalized elderly, the teaching nursing home would show the student a spectrum of patient needs and services. It would bring the … student into contact with peers in other professions. Because the geriatric patient often has multiple medical and psychosocial problems, interdisciplinary training patterns would be encouraged. (Butler, 1981: 1436)

Evaluating the TRACS program

The evaluation of TRACS was formative, commencing within months of funding being provided to the 16 partnerships. An overarching evaluation framework was developed to link the evaluative effort of 16 very different projects, to ensure consistency while allowing for individual difference at project level, and to obtain agreement on the key performance indicators (KPIs) developed to measure outputs and outcomes. The framework was structured by a programme logic approach. The national evaluation methodology included the following components.

ethics approval from The University of Adelaide Human Research Ethics Committee – Approval No HP 2013 082;

a review of the literature on TNHs and a review of relevant TRACS programme and project-level documentation;

structured interviews and focus groups with key stakeholders, most of which were undertaken during annual site visits;

four KPI surveys and analysis: the evaluators designed a national online data collection tool within which projects rated progress against each KPI at 6-monthly intervals. A four-point Likert scale (the fifth point being ‘Not able to answer’) was used to structure most survey questions to enable respondents to rate progress being achieved against each KPI. The KPIs were grouped to reflect the areas of focus that define a TRACS model, and therefore involved research-related KPIs, teaching and learning-related KPIs, aged care provision-related KPIs, aged care workforce development-related KPIs (including recruitment related and training of aged care staff and mentors), communication and information dissemination-related KPIs, and partnership-related KPIs;

a survey of TRACS project partners structured around partnership-related KPIs;

a survey of students participating in clinical education, and structured around teaching and learning-related KPIs;

case studies of the 16 projects.

The Helping Hand Student Education and Participation Model

The Helping Hand Student Education and Participation Model is unique and represents the application of lessons learned during its evolution over the past decade or so. Critical to its effectiveness are five core and interdependent features:

an investment in resourcing the programme by the organisation;

a structured learning programme;

student learning opportunities that are connected to consumer care needs;

the embedding of student education in organisational practice;

promotion of continuity and consistency of student learning across the organisation.

Resource investment

Very few aged care organisations in Australia commit significant resources to student education (or to research or workforce education, the other components of a TNH model) largely because they are not funded to do so, and because many do not wish to extend their role beyond care provision (Robinson et al., 2007, 2008; Stratton et al., 2015; Xiao et al., 2012). Health Workforce Australia data identify that only 4% of Australian healthcare students’ clinical education is delivered in aged care settings (Health Workforce Australia (HWA), 2011). Those that do so, such as Helping Hand, tend to be large in size and therefore have sufficient critical mass to ensure that resourcing is not only a cost, but an investment that brings a range of returns. Helping Hand values the contribution made by students to consumer care to keeping its workforce up to date with new learnings, and the positive interaction generated between students and consumers. The constant presence of students provides ongoing opportunities for intergenerational exchange and creativity, and consumers enjoy contributing to student learning.

From a public policy perspective, a structured student education programme in aged care that is resourced with supervisors, mentors, clinical facilitators and placement managers does not normally receive a share of the funding directed to universities and vocational education and training (VET) providers to reimburse the costs incurred. Understandably, many aged care providers regard this as cost-shifting and too demanding on a resource-stretched sector. Helping Hand Aged Care is one of a minority of aged care providers nationally who invest in their role as educators, and also (in their case) as researchers, creating a valuable profile of a ‘learning organisation’ that differentiates them from others in the sector.

The student education and participation programme benefits from Helping Hand’s investment at organisational level in research, innovation and learning. A dedicated research and development unit houses the student education team, which includes a student participation manager and part-time administrative support. The model also requires investment from Helping Hand in training and supporting those who supervise and mentor students, and in backfilling the time they spend doing so. Whereas Australian government funding has provided a significant (albeit time-limited) boost to the resourcing of the model, the organisation has also invested heavily prior to, during and following those major funding injections.

The position of student participation manager at Helping Hand is a combined role that includes liaising with education providers, negotiating placement arrangements and managing the operation of clinical facilitation processes. A complex feature of the role that is central to the Helping Hand model involves designing structured programmes of learning that align with both curriculum goals and Helping Hand consumer care needs. In turn, this is supported by the system of centralised and coordinated placement planning, and is also one of the student education programme’s critical success factors.

Prior to 2005, in line with the status quo for clinical education planning, requests for placements were sent to individual residential site managers, and student learning opportunities were fragmented and site-specific. A coordinated and coherent approach was made possible with the centralisation of placements, wherein education providers log placement requests through an online portal. This system has been critically important in managing the high number of requests (typically about 3000 per annum) and in timing them to facilitate interprofessional learning across different disciplines. Importantly, it has enabled Helping Hand to move away from a reactive role, standard in most aged care placements with education providers requesting and aged care providers agreeing or not agreeing to accept students, to one that is proactive and, moreover, based on a negotiated process between the organisation and education providers. This enables Helping Hand to select student placements that will yield a strategic mix of quality learning outcomes and learning activities that enhance consumer experience.

Structured learning programme that meets both consumer care needs and student learning requirements

Unique to the student programme is the innovative suite of approaches that can be negotiated for student placement. The traditional 1:1 model of clinical placement, where student learning occurs through the supervision of experienced clinicians in 1:1 consumer interactions, is no longer the sole activity within a Helping Hand student placement. The different elements of the programme are described in the following. These have fundamentally altered the concept and role of clinical facilitation, moving beyond traditional approaches to student supervision and also involving project planning, consultation to determine unmet consumer needs, and strategic planning within the organisation to embed the student education and participation programme.

Structured orientation and induction

One of the most important components of the learning programme is its structured orientation programme that goes beyond the usual familiarisation-with-setting process. On day 1, students are guided through a centralised induction process, designed to highlight the complexity and learning opportunities within the aged care setting. The programme also incorporates activities to explore student’s interests and personal styles to further plan successful placement opportunities, as well as safety and wellness information to ensure that the health and wellbeing of students and consumers is maintained throughout the learning programme.

A key element involves an introduction to interprofessional complex case reviews, based on Helping Hand consumer care needs. This component is designed to illustrate the range of skills required in aged care services, while simultaneously addressing health sciences students’ known concerns that an aged care placement may not offer the opportunity to develop their clinical skills. Interprofessional learning opportunities feature across the student education experience, not only across different disciplines, but bringing together university and VET students. Additional units of learning in the specialty area of aged care can be added to the induction, depending on required student learning outcomes, staff requirements for clinical preparation and the type of student activity planned.

The student-led clinic

The student-led clinic is a discipline-specific learning model that involves Helping Hand and one of its university partners (noting that not all collaborations are formalised as partnerships, for example, through a memorandum of understanding) investing in a part-time position (such as a speech pathologist) that is not an ongoing or core workforce role. From a workforce design perspective, many roles (particularly in allied health) are not considered to be ‘core’ or economically viable to support other than on an ‘as needed’ contracted basis. Funding such appointments enables students from that discipline to be directly supervised while providing services to consumers, significantly developing their clinical skills in the process.

By 2017, student-led clinics had been provided in speech pathology, exercise physiology, oral hygiene, rehabilitation physiotherapy and occupational therapy. This model has been found to bring benefits for the four key TNH stakeholder groups: consumers, students, education providers and Helping Hand. In particular, a wider range of services are being provided than occurs with the contractual model. For example, speech pathologists have the opportunity to utilise their full skill-set (as opposed to those related to addressing swallowing difficulties, which occurs when they are engaged on an ‘as needed’ basis). This means that consumers receive a higher number of episodes of service and have a wider range of needs met, while students have the opportunity to develop a wider range of clinical skills. It is not surprising that both education providers and Helping Hand are willing to continue to invest in this model.

The student-led project

First introduced in 2010 as part of pharmacy, physiotherapy and dietetics placements, the student-led project involves a learning activity being designed by the clinical facilitator for the student to pursue, taking into account potential risk, safety and appropriateness, and providing a documentation trail for this. Projects can be part of placements from disciplines such as health sciences where a career working with older people is likely, to those that are non-traditional, such as law or accountancy. Student-led project activities change the nature of supervision and have seen students contributing to Helping Hand operational processes, adding value to these and a range of activities that directly benefit consumers, their families and staff.

VET student education

Funding from the TRACS programme enabled Helping Hand to further develop its placement programme for VET students studying for an aged care certificate qualification. Although the majority of the Australian direct aged care workforce is VET trained, the TNH model has continued to focus on strategic collaboration with universities. The Helping Hand TRACS project was one of three exceptions (out of 16 projects), and funding enabled the organisation to build from an already strong working relationship with the VET sector, which has continued to develop post-funding.

The Helping Hand VET student education programme is innovative for a number of reasons. One of these has involved integrating VET students into the interprofessional education strategy, to demonstrate the different contributions made by each to consumer care. The clinical education programme has also experimented with locating VET students at Helping Hand residential care sites for 3 days a week while undertaking their studies, increasing their work readiness substantially. Further collaboration with TAFESA (the government funded VET provider in South Australia) now sees Helping Hand undertaking the living classroom model, where students attend 1 day per week for a period of 6 to 8 weeks prior to participating in a block placement. Recruitment outcomes from this programme have been high.

Embedding student education in aged care provision

As the learning programme design illustrates, student education at Helping Hand is intended to offer the opportunity to be immersed in an aged care organisation, working closely with staff and consumers and contributing in a meaningful way to service provision. This stands in contrast to the more usual practice of students who ‘shadow’ staff for the duration of their placement. The embedding strategy is intended to enhance the opportunity to develop clinical skills and an understanding of the needs of older people, to increase the enjoyment of the learning experience for students and for consumers, and to ensure that consumer needs are married with student learning goals. In the process, Helping Hand seeks to engage students in the notion of aged care as a career, and has been successful in recruiting graduates who have undertaken clinical education with them.

This level of engagement is a challenge unless students have enrolled in a VET programme where they expect to work in an aged care role. The majority of university healthcare students are undertaking courses that do not have a direct pathway into the sector and most envisage careers in a health sector organisation. Many will regard a placement in aged care as limiting in terms of skill development and of little interest. Some will be afraid of working with older people in an aged care facility.

Findings from the TRACS national evaluation demonstrated that a positive placement experience can shift such misconceptions and produce more positive attitudes towards clinical education in aged care and to working with older people (Barnett et al., 2015: 24–25). Lea et al. (2016: 715–724) and Robinson et al. (2008: 101) also demonstrated positive changes in students’ attitudes following well-designed clinical education, as well as a possible interest in working in aged care following graduation.

Benefits arising from the model

Helping Hand’s evaluation of its student education and participation programme (evaluation includes ongoing monitoring by Helping Hand’s Research and Development Unit, a separate evaluation undertaken in 2016 by Kate Barnett and TRACS national evaluation findings) has identified benefits for the four key stakeholder groups in the TNH model: consumers, students, aged care providers and education providers. Those benefits, described in the following, are consistent with similar positive outcomes identified in the research literature (Annear et al., 2016; Barnett, 2014; Barnett et al., 2014; Chilvers and Jones, 1997; Gamroth, 1990; Layng Millonig, 1986; Lindemann, 1995; Mezey and Lynaugh, 1989; National Health Workforce Taskforce, 2009; Neville et al., 2006; Robinson et al., 2008; Stratton et al., 2015; Wallace et al., 2007). The identified benefits are mutually reinforcing and should be conceptualised as part of an organic whole. They are summarised in Table 1.

Table 1.

Benefits framework identified from evaluation of the Helping Hand student education programme.

Consumers	Students
A wider range of needs are met	Enhanced understanding of the needs of older people
Enhanced service provision	Increased understanding of aged care, what is involved and what is possible
Increased access to specific services
Enhanced intergenerational exchange	Broadening of opportunities to use and develop clinical skills
Opportunities to contribute to student learning	Increased insight into providing for complex care needs through an interdisciplinary approach
	Development of other skills including problem-solving and interpersonal skills
Opportunities for increased learning	Effective translation of theory into practice
Vibrant atmosphere generated by students’ presence and being part of a learning culture	Opportunity to contribute to care, staff learning and the organisation as a whole

Helping Hand	Education partners
Positive impact on profile as a learning organisation and education provider	Significant proportion of health science placements are provided by Helping Hand
Enhanced service provision and a more cost- and service-effective workforce model	Students receive high quality education that addresses curriculum requirements
Vibrant atmosphere generated by students’ presence and intergenerational exchange	The learning provided is unique and highly creative
Contribution to the organisation’s learning culture	Helping Hand provides substantial preparation of staff and consumers for the students
Contribution to operational processes through student projects and other student-led activities	Consistency of the learning experience and approach offered to students
Recruitment benefits: 70–80% of care worker graduates continue as employees	The use of an interprofessional education approach is highly valued
Volunteer benefits: significant numbers of students want to volunteer	Opportunities to develop the partnership in multiple directions, including research and collaborative tendering for funding.
Partnership with University of South Australia has brought a range of funding opportunities and enhanced ability to trial innovative learning strategies	Partnership with Helping Hand has increased placements provided by 83.5% between 2010 and 2014

Challenges

The literature identifies more positive than negative outcomes arising from the TNH model (Barnett, 2014). However, a number of challenges are also likely. Helping Hand has experienced some, but not all, of these challenges. Table 2 summarises challenges identified in the research literature and those encountered by Helping Hand.

Table 2.

Challenges faced in providing student education in an aged care setting.

Identified challenge	Source of identification
Identified challenge	Helping Hand evaluation	TRACS evaluation	Research literature
A significant culture gap between education and aged care providers, although this gap reduces over time as partners develop mutual understanding		✓	Barnett et al. (2015), Bronner (2004)
Insufficient commitment by partners (both aged care and education); lack of mutual understanding of each other’s purposes and operation; lack of readiness for affiliation		✓	Barnett et al. (2015), Mezey et al. (1997)
System-based challenges, particularly the different systems for clinical placement between schools, disciplines and jurisdictions, and a lack of consistency in the education systems, standards and organisational practices that support health and aged care clinical education	✓	✓	Barnett et al. (2015), Barnett (2014), National Health Workforce Taskforce (2009)
Frequent aged care staff turnover, a challenge experienced by early TNHs and in contemporary applications of the TNH model		✓	Barnett et al. (2015), King et al. (2012), Robinson et al. (2008)
Insufficient resourcing, affecting supervision and mentoring, physical learning infrastructure, time for involvement. Fewer professional staff to deliver services in a resource-stretched environment	✓	✓	Barnett et al. (2015), Mezey et al. (1997)
Lack of training in supervision and clinical education skills and lack of preparation for a role in teaching and supporting students; it is often the case that aged care staff feel a lack of confidence in their ability to supervise, in part because of a lack of training to do so		✓	Abbey et al. (2006a, 2000b), Barnett et al. (2015), Barnett (2014), HWA (2010), Robinson et al. (2008), Xiao et al. (2012)
Ageism, particularly when expressed as negative attitudes to older people and to working in aged care	✓	✓	Abbey et al. (2006a), Barnett et al. (2015), Bronner (2004), Fagerberg et al. (2000), Pursey and Luker (1995), Xiao et al. (2012),
University staff have been identified as believing that aged care staff tend to hold negative attitudes towards students, seeing them as a burden or challenge, and sometimes as a threat to their less trained staff members.			Neville et al. (2006)
Conversely, university staff can give the impression to their students that learning and working in aged care is less important and meaningful than working in the health sector			Abbey et al. (2006a)

Enabling factors

Table 3 brings together research and evaluation findings that identify key enablers for a positive clinical education experience. These reflect the findings of Helping Hand’s evaluations, the national TRACS evaluation and the broader research literature on TNHs. It can be seen that there is a high degree of consistency across these different sources of information.

Table 3.

Enabling factors for a positive clinical education experience.

Identified enabler	Source of identification
Identified enabler	Helping Hand evaluation	TRACS evaluation	Research literature
Adequate preparation of students prior to entry into aged care clinical placements (orientation, induction)	✓	✓	Abbey et al. (2006a), Barnett et al. (2015), Robinson et al. (2008), Stok-Koch et al. (2007)
Adequate resourcing for a structured supervisory/teaching/preceptor role	✓	✓	Abbey et al. (2006a), Barnett et al. (2015), Robinson et al. (2008)
Providing a variety of clinical experiences with older people with different complexities of need	✓	✓	Abbey et al. (2006b)Barnett et al. (2015), Brown et al. (2008)
Timely and objective feedback on performance	✓		Abbey et al. (2006a), Robinson et al. (2008)
Structured and regular opportunities to debrief and reflect during and after the placement	✓		Abbey et al. (2006a), Robinson et al. (2008)
Learning infrastructure (dedicated study space, internet and computer access, etc.)		✓	Barnett et al. (2015), Stok-Koch et al. (2007)
Interdisciplinary learning opportunities provided	✓	✓	Stok-Koch et al. (2007)
Embedded learning culture in the aged care organisation	✓	✓	Barnett et al. (2015), Stok-Koch et al. (2007)
An effective aged care: education provider partnership to support knowledge translation	✓		Cheek et al. (2009)

Findings: outcomes from the model

In 2016, Helping Hand provided education for 315 university students, 229 VET students and 58 secondary students, and its programme is larger in number and broader in the diversity of disciplines involved than most aged care providers offer in Australia. Apart from the VET programms that provide a qualification leading directly to employment in aged care, Helping Hand provides education to the full range of disciplines that require skills and knowledge needed for working directly with older people: nursing, physiotherapy, speech pathology, dietetics, occupational therapy, exercise physiology, podiatry, psychology, pharmacy, social work and medicine. Unlike most aged care providers, the range of learning opportunities extends further with the ‘Taste of Aged Care’ programme, which has involved students from law, business, marketing, human resources, interior architecture and computer science.

National evaluation of the TRACS programme included a survey of students who had participated in a placement with an aged care organisation receiving TRACS funding. The survey was structured around five-point Likert scales where students rated aspects of their placement. These ratings corresponded to an agreed set of KPIs (developed by the evaluators in collaboration with TRACS partners) and were triangulated against separate surveys with project leads and partners. There was a high degree of agreement across these three groups of stakeholders and a generally positive assessment of the TRACS student placement experience.

Data relating to the Helping Hand students participating in this national survey were analysed separately and are summarised in Table 4. The highest rating possible was ‘4’ (as a rating of ‘5’ represented a ‘Do not know’ or ‘Not applicable’ response). As the Table 5 indicates, Helping Hand students provided a very positive assessment of their education experience, with the lowest rating being ‘3.0’ (expressing an interest in working in aged care) followed by 3.2 (assessing direct care staff’s level of preparedness for the placement). The highest ratings (3.7, 3.6) were applied to the impact made on students’ knowledge and skills for working with older people.

Table 4.

Students’ ratings of the Helping Hand clinical education experience.

Survey item	Students’ average rating	Number responding
Preparation
Aged care staff seemed well prepared for my placement	3.2	37
Mentoring and Supervision
I am satisfied with the quality of mentoring received	3.4	30
I am satisfied with the quality of supervision received	3.3	38
Consumer and staff response to students
In general, aged care residents were positive about students	3.5	38
In general, aged care residents had confidence in my clinical skills	3.4	38
In general, aged care staff were positive about working with students	3.3	38
Impact on skills and knowledge development
My understanding of caring for older people increased	3.7	38
My understanding of aged care services and how they operate increased	3.6	38
My knowledge of the needs of older people increased	3.7	38
My knowledge of specific ageing-related conditions increased	3.6	38
My skills in meeting the care needs of older people increased	3.7	28
Impact of attitudes to working with older people, working in aged care and aged care organisations’ legitimate role in student education
A positive and useful experience	3.3	38
I have developed more positive attitudes towards working with older people	3.2	38
I am now interested in employment in aged care	3.0	38
Aged care services can provide a high quality learning environment	3.3	38
Aged care services should have a recognised role in student education	3.3	38

Note: the rating scale used for these items was: 1 = Strongly disagree, 2 = Disagree, 3 = Agree and 4 = Strongly agree. The response ‘5 = Do not know or Not applicable’ was excluded when calculating the average.

Conclusion: lessons learned about student education in aged care

The model developed by Helping Hand Aged Care’s Research and Development team represents at least 10 years of action research and evaluation, and ongoing improvement. In the process, the team has identified a number of lessons and critical success factors for their student education and participation programme. Distilling information from structured interviews undertaken with this team for evaluation purposes showed that the following factors are critical (and in no order of importance):

Learning-related factors

an effective clinical facilitator, skilled in adult learning principles and with highly developed interpersonal ability to support the different stakeholders involved;

choice of supervisors and mentors, based on supervision and mentoring skills, commitment to student education in aged care, and with effective interpersonal skills; supervisors must be able to achieve the correct balance between autonomy and monitoring of students;

a well-structured learning programme that simultaneously addresses consumer care needs and student learning requirements (that is, beneficial to consumers but linking theory to practice for students);

a learning programme that pays close attention to the orientation and induction phase, preparing students while demonstrating the range of skills able to be learned in caring for older people;

the application of interprofessional education principles, grouping students from different disciplines (university and VET) to address complex care issues;

Collaboration-related factor

strong and effective strategic collaboration between aged care and education providers, based on mutual trust and respect, shared values and supported with regular communication;

Infrastructure related factors

a centralised student placement system to ensure a coordinated education programme, to support interprofessional learning opportunities, and a negotiated process with education providers;

an effective student education manager with skills in organising and managing placements as well as in liaising and negotiating with education providers;

a workforce model that enables the employment of allied health and other professions that are typically outsourced, to provide effective supervision and the creation of innovative learning and service provision opportunities;

resourcing that supports this infrastructure and other inputs required for student and workforce education.

Key points for policy, practice and/or research

Effective application of the teaching nursing home model requires attention to factors associated with learning, partnerships between education and aged care providers and educational infrastructure.

The learning programme must be well structured, addressing consumer care needs and student learning requirements, with close attention paid to orientation and induction. The programme requires dedicated resourcing for skilled clinical facilitation, supervision and mentoring.

Partnerships are the core of the teaching nursing home model. The partnership between aged care and education providers requires investment in time and purpose-designed communication procedures and governance structures, but also relies on mutual trust and respect. Each partner must be cognisant of the contribution brought by the other so that there is balance in the partnership.

Most aged care facilities are unlikely to have a dedicated teaching infrastructure, and resourcing for this is essential. Students must have learning spaces that also support digital communication.

The teaching nursing home model is most effective for students from the health professions if the core workforce includes allied health as well as nursing professionals, enabling supervision across a range of disciplines and supporting interprofessional learning.

Footnotes

Acknowledgements

Helping Hand Aged Care (Helping Hand) is a large not-for-profit organisation that was established in South Australia in 1953. It offers a wide range of services that include home care services, retirement living and residential care to more than 7,000 people living in Adelaide and regional South Australia. Helping Hand is also recognised nationally as an innovator in service design, student education and research. In addressing all three areas, it is also one of Australia’s leading examples of the TNH model.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethics

Ethics approval was given from The University of Adelaide Human Research Ethics Committee – Approval No HP 2013 082.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Helen Loffler, RN, is the Manager of Student Participation within the Research and Development Unit at Helping Hand. She specializes in the creation of innovative student activity within the aged care setting through collaborative partnerships with education and training providers. Drawing on more than 20 years in clinical and educational roles, Helen has developed sustainable Interprofessional Education programmes within the aged care setting that are designed to meet the needs of older residents while providing quality learning experiences for students.

Kate Barnett has worked as an ageing policy and aged care researcher since the mid-1980s. Previously Deputy Director of the Australian Workplace Innovation and Social Research Centre at The University of Adelaide, Kate established Stand Out Report, a writing business specialising in ageing and aged care, in 2016. Kate led the national evaluation of the TRACS (Teaching Research Aged Care Services) program – Australia's first funded Teaching Nursing Home initiative. In 2014 she received a Churchill Fellowship to study the TNH model in North America.

Megan Corlis is the director of Research & Development at Helping Hand Aged Care. She has previously worked in a diverse range of roles both clinical and management across the acute and aged care sector. The R & D Unit has a unique and innovative approach, keenly engaging with consumers, families and staff. Megan's work focuses primarily on ‘age friendliness' and Active Ageing, and she is passionate about optimising partnerships which are creative, value-add and can be sustained over the longer term.

Sara Howard is research fellow at the Australian Industrial Transformation Institute, Flinders University and was a member of the team undertaking the national evaluation of Australia's first funded Teaching Nursing Home initiative – the TRACS (Teaching Research Aged Care Services) program. Sara has an extensive background in quantitative research methods and has managed a diverse range of research projects coordinating both quantitative and qualitative methodologies. Her key areas of expertise are ageing, health, particularly primary health care and mental health.

Jan Van Emden has a background in physical therapy service provision, management and education. He has worked in acute health care facilities, aged care residential and community based settings, within urban metropolitan areas as well as rural and remote locations in Australia and the USA. He has a particular interest in supporting the health, welfare and quality of life of older people, especially those with dementia-related illnesses. Jan recognizes the importance of an appropriate balance between medical care, physical fitness and cognitive stimulation.

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