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Blackwell Publishing, Ltd.

ResearchHow resident committees function in aged care

How resident committees function in low-level residential aged care facilities

Leah Wilson and Neil KirbyDepartment of Psychology, University of Adelaide, Adelaide, South Australia, Australia

Objective: To investigate factors affecting the functioning of resident committees in South Australian low-level residential aged care facilities (RACFs).Methods: Observation of two consecutive resident committee meetings in 18 low-level RACFs.Results: Most meetings were informal. Only one-third had an agenda, and although all had minutes, only half provided them to residents. Most meetings were scheduled monthly, but because of postponements, meetings were held on average every 7 weeks. Many meeting rooms did not allow residents to see and hear comfortably. Most chairpersons were staff and only one chairperson had formal training in conducting meetings. Only 21% of first meeting topics, which mostly focused on resident complaints, resulted in solutions at the second meeting. Resident dissatisfaction was evident with meeting environments, procedures and outcomes.Conclusion: There is considerable scope for improving a number of environmental and procedural factors affecting the functioning of resident committees.

Key words: decision-making, group processes, group struc-ture, homes for the aged, resident committee membership.

IntroductionAustralian residential aged care facilities (RACFs) are legallyrequired to provide residents with opportunities to participate indecision-making and control [1]. Although an effective residentcommittee has been considered sufficient to fulfil this require-ment [2], few studies have assessed the functioning of such com-mittees across a range of aged care facilities. Instead, studies havefocused on individual or small numbers of committees [3–6].

Wilson and Kirby [7] surveyed managers of South Australianlow-level RACFs and found only 65% of 106 facilities hadresident committees. Moreover, the major suggestion made bymanagers for improvement was increasing resident partici-pation. These results suggested that relatively few residentcommittees were providing resident participation in facilitydecision-making and control.

The present study investigated how resident committees func-tion in South Australian low-level RACFs. Because of the lack

of research on resident committees, committees were assessedin terms of recommendations in the research literature foreffective committee meetings in general organisations. Inde-pendent evaluation was used as there can be a discrepancybetween the reported aims of resident committees and theiractual functions [3].

MethodTwenty low-level RACFs with resident committees were ran-domly selected from a survey of 106 facilities in South Aus-tralia [7]. Eighteen agreed to participate. All were located inthe Adelaide metropolitan area. The average number oflow-level residents at each facility was 45 (SD = 22.07), with aminimum of 14 and a maximum of 88. Two facilities specifi-cally catered for an ethnic population and their residentcommittees included interpreters.

In each facility, the senior author attended two consecutivemeetings to allow observation of the extent to which decisionswere subsequently implemented. In one facility, only one meet-ing was observed because of cancellations. Data were collectedbetween May 2000 and November 2001.

Managers felt tape-recording would be inappropriate, butwere comfortable with notes taken outside the view of resi-dents. Managers were assured that notes would not be takenif residents seemed uncomfortable. This occurred in two facil-ities at both meetings. At one facility, the chairperson invitedthe senior author to sit at the front, and at the other, a residentseemed suspicious of the note-taking. These meetings wererecorded immediately afterwards using the chairperson’s min-utes. Some comments in other meetings indicated awareness ofthe senior author: ‘We better be on our best behaviour,’(resident) and, ‘So let’s demonstrate how productive ourmeetings can be and not just talk about food’ (chairperson).However, this awareness was less evident as meetingsprogressed and at second meetings.

A 257-item checklist was developed using research concerningeffective meetings in aged care and general organisations[4,6,8,9]. Topics included the setting, resources, meeting proc-esses, resident participation, committee positions, actions ofthe chairperson and residents, and communication within thefacility. Resident participation was assessed in terms of thenumber of residents who participated verbally by raising atopic or adding meaningfully to its discussion. Each meetingwas attended 15 minutes early to record the nature of theroom, time of arrival of participants, and interactions betweenresidents before the meeting. An unobtrusive seating positionwas chosen, usually at the back of the room.

Correspondence to: Dr Leah Wilson, Department of Psychology, University of Adelaide. Email: leah.wilson@psychology.adelaide.edu.au

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At the first meeting, the chairperson introduced the seniorauthor who then explained her study, asked if residents hadany objections to her being there and taking notes, and invitedquestions. There were no objections or questions; only occa-sional comments that they were happy for her to be there andhoped they could be of help. At the second meeting, the seniorauthor was just welcomed by the chairperson. The role adoptedinvolved attendance but no participation [10].

Because of the slow pace of the meetings, a verbatim recordwas possible in most cases. Following the meeting, any remain-ing checklist items were completed. Although chairpersons,managers, staff and residents were not formally interviewed,comments made to, or answers to questions from, the seniorauthor in conversation were noted.

Results

AimsAlthough a meeting’s aims should ideally be indicated at itscommencement [11], this only occurred in three of the 18facilities. Although all meetings were observed to serve a vari-ety of functions, the most common function was for residentsto express their grievances to staff. This was observed in all35 meetings. Moreover, in 15 of the 18 RACFs (83%), residentgrievances were the main observed function of the meeting.Examples of chairperson and resident frustration over thisfocus on complaints included, ‘They’re (the meetings) not justfor complaints, we’re also here for praise and suggestions,’(chairperson) and, ‘This is my home and I won’t have anyonerun it down’ (resident). Other functions included the chairpersonor staff presenting information (37%), decision-making (37%),problems needing solutions (31%), and giving praise (17%).

FormatFourteen facilities (78%) had ‘all-can-attend’ policies. Mostmanagers preferred this format as it included everyone andreduced favouritism and potential abuse of power. Forexample, ‘They can’t complain that they don’t know what’shappening’ and ‘There are no issues of favouritism.’ Althoughthis format tends to result in less active committees, it doesmost broadly represent residents [3], and residents tend toprefer it because it requires less commitment [4].

Zwick [4] suggested that in larger facilities, it might be moreeffective for a small group of elected residents to make deci-sions and report back to ‘all-can-attend’ meetings. Two facili-ties in the present study alternated ‘all-can-attend’ with electedformats. This was designed to allow the elected group to focuson decision-making. However, both managers thought theelected format was ‘a waste of time’ that did not fulfil theintended decision-making function and it was replaced withina year by ‘all-can-attend’ meetings.

Two facilities held meetings with elected representatives. Wordof mouth was used to report back to residents, but it was notclear how successful this was.

FormalityAlthough all managers classified their meetings as ‘residentcommittees’, only one facility had all the characteristics ofa formal committee (elected members, agenda, minutes andformal meeting procedures). Five facilities had informalmeetings available to all residents with no agenda, minutes, orformal procedures. Nine committees combined formal andinformal characteristics and two had one informal meeting andone combination. Manager reasons for informal meetingsincluded, ‘So that the residents are not intimidated’ and ‘I don’twant to stress them out.’

Although most managers wanted meetings to be informal,residents were heard to comment that they preferred socialis-ing before or after more formal meetings so that meetings werenot disrupted by conversation. One facility conducted theirmeetings immediately following lunch so all residents werealready congregated after enjoying a social hour and thisseemed to work very well.

SettingThe most common settings were activities rooms (37%) anddining rooms (31%). However, only 51% were private, andonly 57% were quiet and away from staff. One meeting washeld in the staff room with a ‘staff only’ sign on the door.In another meeting, residents seemed uncomfortable makingcomments because an open door meant that they could easilybe overheard, particularly by staff.

Nearly three-quarters of the rooms seemed welcoming witha comfortable temperature. However, six facilities hadaccess problems for wheelchairs or walking frames. Room sizerestricted access in two facilities, and in the others chairs weretoo close together.

Although residents in only one facility commented to thechairperson that seats were uncomfortable, residents at fiveother facilities had obvious difficulties getting into and/or outof chairs because the chairs were too low or too close together.At seven facilities, a variety of seats enabled residents to choosechairs most comfortable for them. Inadequate numbers ofchairs meant residents at four facilities had to go and get chairsor sit on their walking frames.

Poor seating arrangements tend to hinder the effectiveness ofmeetings in general organisations [8] and this occurred in thepresent study. The most successful seating arrangement forparticipation, which occurred in 10 facilities, was a circle of chairswith the chairperson slightly in front. In the four facilities wherethe two meetings were held in different rooms, those with a circulararrangement promoted greater resident participation. How-ever, this arrangement was difficult in unusually shaped roomsor with very large groups. In four facilities, some participants hada restricted view, usually because they were behind others.

Marked distractions occurring in 57% of meetings includedthe chairperson’s mobile phone (four facilities), a dog (four

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facilities), and PA system announcements (four facilities). Thephone and PA systems were particularly distracting as theyoften stopped conversations or led to comments being missed.

A major problem in 12 facilities was residents complaining thatthey could not hear. In many cases, this led to the chairpersonmissing resident comments and subsequently losing control ofthe meeting. This made residents feel ignored, as indicated bycomments to other residents that no one ever listened to whatthey said. The negative effect was made worse by the extrane-ous talking of those who could not hear the main discussion.

In four facilities, a microphone appeared to assist hearing, par-ticularly for the hearing impaired. Zwick [4] did not find thisbenefit, particularly in settings with high background noise.The importance of effective technical equipment was demon-strated in one facility where residents with hearing aidscomplained that the microphone made hearing more difficultbecause of its ‘booming sound’. A microphone also had theadvantage that chairpersons tended to summarise each conver-sation to ensure all residents understood it. This enabled thechairperson to check their understanding of comments and itprovided a more definite conclusion to each conversation.

ResourcesDevitt and Checkoway [3] found that RACFs rarely soughtexternal assistance to improve meetings. Only one chairperson(a resident) in the present study had enlisted outside assistanceand that was from the Aged Rights Advocacy Service. Residentcomments on this free service indicated that it made themaware of their rights, showed them how to conduct a meeting,and improved their participation. These meetings were observedto be amongst the most effective and positive.

TimingOf the 35 meetings, 24 (69%) were held as scheduled, with theremaining 11 (31%) postponed. Reasons were rarely given forcancellation, other than it was inconvenient for the chair-person. One facility had five cancelled meetings. Four meetingswere only held because of the arrival of the senior author.

Only about half the meetings (49%) started within 10 minutesof the scheduled time. Late meetings were on average 17 minuteslate. Ten of 18 late meetings were caused by chairpersons (whooften had lost track of time), six were delayed while residentswere brought to the meeting, and two were caused by staffmembers coming late. More meetings may have started late ifnot for the senior author whose arrival reminded the chairpersonof the time.

Adhering to scheduled meeting dates and times emphasisestheir importance and may increase participation [12]. How-ever, no meetings were held at the same time and day of themonth and very few were well advertised or announced overthe PA system and/or at the meal or morning/afternoon teaprior to the meeting. Staff and residents often commented thatthey had forgotten the meeting until reminded.

Although most meetings were scheduled monthly, because ofpostponements, they were held on average every 7 weeks. Thiswas less than the monthly meeting recommended by Zwick [4]and Grossman and Weiner [6], and less than in studies byDevitt and Checkoway [3] and Moos [13]. In the present study,less frequent meetings not only increased the time residents hadto wait for answers, but also made it more difficult to rememberprevious issues.

The average meeting duration was 43 minutes, ranging from10 to 90 minutes. In three facilities, both meetings exceeded1 hour and in two facilities this occurred for one meeting. In sixfacilities, meetings seemed too long, as a number of residentsappeared to lose interest or concentration. Although Zwick [4]recommended a slower pace to assist impaired residents, moreboredom was evident in slower paced meetings. Shorter morefrequent meetings may be preferable. In three facilities,chairpersons abruptly ended meetings (e.g. ‘I must be going. I’llclose the meeting’) despite residents indicating that they stillhad more issues to raise.

MembersAn average of 36% of facility populations attended committeemeetings compared with only 20% found by Devitt andCheckoway [3]. Seventeen residents (40%) on average attendedthe 29 ‘all-can-attend’ meetings, whereas seven residents(12%) on average attended the six meetings with electedformats.

Consistent with Devitt and Checkoway [3], there were nomeetings for residents only. Staff or management or bothattended all meetings. Fifteen facilities included staff in addi-tion to the chairperson, and two facilities specifically encour-aged staff to raise issues. Gibbs and Salkeld [5] found thatresidents felt more comfortable and confident without staffpresent and this was evident in the present study where staffsometimes disagreed with residents who were then reluctant topursue issues further. One possibility is for staff to attend onlythe latter half of the meetings, once resident issues have beenaddressed. Residents were a clear majority in 15 facilities andwere observed to be more willing to participate than in thethree remaining facilities where this was not the case.

Family members regularly attended meetings in only twofacilities. This low level of family involvement was consistentwith Zwick [4]. Wells et al. [14] suggested that this may bedue to facilities assuming that families are not interested inparticipating, although their findings on families were contraryto this.

ChairpersonsIn 14 of the 18 facilities (78%), the manager established thecommittee and chose the chairperson. Consistent with previ-ous research [3,5], the manager acted as chairperson in thelargest percentage of meetings (34%). Other chairpersonsincluded activity coordinators (26%); board members (11%);lodge managers (9%); and a family member, resident and

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minister. The role usually involved receiving complaints andanswering queries. Consistent with Zwick [4], it was evidentthat providing answers was particularly important if residentswere not to become frustrated. Although a manager as chair-person facilitated answering queries, it made it difficult forthem to be impartial. Residents in Zwick’s study suggestedhaving a non-management person as an impartial chairpersonwith the manager attending only part of each meeting toanswer queries. The chairperson could then also raise residentissues with the manager if residents did not want to confrontthe manager directly.

In three facilities, a resident acted as co-chairperson with a staffmember. Although it has been argued that residents should bein leadership positions to balance staff influence [3,11], theresident co-chairs in this study did little more than open andclose the meetings. Residents did not really listen to them orregard them as a chairperson. In 14 facilities (78%), managers felta resident chairperson was inappropriate: ‘They aren’t capableof it. The others would feel like they are being favoured’ and‘They are a bit like children and there would be issues offavouritism.’ Having residents as effective chairpersons mayrequire training from an organisation like the Aged RightsAdvocacy Service.

In eight facilities (44%), the chairing of meetings by differentpeople was observed to be detrimental to residents who had toadapt to different chairperson methods and levels of seniority.

When responding to residents, chairpersons tended to beeither business-like (e.g. ‘Okay, I’ll put that on the agenda’) orrelaxed and encouraging (e.g. ‘That’s a very good point. That’snot good enough is it?’). However, there were some undesirablebehaviours, particularly at four facilities where chairpersonsignored various residents, strongly forced their own opinions,showed favouritism, or spoke crossly to residents. Examplesincluded, ‘I had the fish today and it was fine’ (in response toa complaint about a meal); ‘I’ll tell you what I’ve learnt, youjust can’t please everyone’; and to an interpreter concerning aresident’s complaint about staff coming late, ‘Tell him he’s verylucky if they come at 9:30, because they’ve got a lot of workto do.’ Negative behaviours of this kind clearly made residentsless comfortable about participating. Information from theprevious survey [7] indicated that only one-third had experi-ence in formal meetings and only one had received any formaltraining, indicating a clear need for training in how chairpersonsshould behave at meetings.

Agenda and minutesOnly six facilities had agendas at both meetings and two hadthem at one meeting. Five agendas were specific and the otherswere the same for each meeting. Only two facilities provided acopy to residents. In the other facilities, the agenda was merelya guide for the chairperson.

All 18 facilities had minutes, but only nine provided them toresidents at both meetings and two facilities provided them at

one meeting. However, in eight of the 11 facilities providingminutes, residents had difficulty reading them because thewriting was too small or congested. Chairpersons took min-utes at both meetings in seven facilities and in one meeting atthree facilities. In another seven facilities, a staff member tookthe minutes. Other minute-takers included a resident, a familymember, and a volunteer.

ParticipationParticipation was assessed in terms of the numbers of residentswho raised topics or contributed to their discussion or both.The numbers of residents at ‘all-can-attend’ meetings corre-lated negatively with the numbers participating in this way(r = −0.57, P = 0.02). Average participation declined from87% in the eight meetings with nine or less residents, to 55%in the 11 meetings with 10 to 12 residents, to 49% in the ninemeetings with 13 to 18 residents, to 31% in the seven meetingswith 18 or more residents. Although size would not matter inmeetings providing information, resident contributions tothe meeting are likely to be higher with fewer residents. Thedifficulty for ‘all-can-attend’ formats is that although theymaximise potential participation, they may reduce this kindof active participation.

TopicsOf the 200 issues raised by residents in 35 meetings, the mainissues concerned food and dining (41%), and facility mainte-nance or the need for new appliances (28%). Other issuesincluded activities (8%), staff complaints (7%), complaintsabout residents (5%), and personal queries (5%), with thosebelow 5% including facility rules, praise of staff, need forinformation about facility procedures, thanks to other residents,notification of resignation from the committee, and a requestfor a pet.

The 133 issues raised by chairpersons concerned activities(21%), maintenance (19%), rules for residents (16%), policiesand facility routines (14%), food and dining (9%), requestingresidents’ opinions regarding a change (8%), and staff (5%),with those below 5% including relating to others in thefacility, meeting procedures, thanks to residents, and inquiringabout a resident’s health.

Other staff raised 38 issues concerned with activities (32%),maintenance and environment (18%), facility rules (18%),food (11%), staff (11%), praise for residents (5%), a suggestednew committee member, and an inquiry to an individualresident.

Family members raised four issues, three about the need formaintenance or facility upgrades and one complaint about apolicy.

Typically, chairpersons raised their issues after the businessarising section and then residents raised their issues. This wasgenerally the final section of the meeting. In six facilities, thechairperson asked each resident at both meetings whether they

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had any issues to raise. In two facilities, residents were askedat one meeting.

Only 53% of the 375 issues were raised by residents. Reasonsgiven by chairpersons for this low participation included, ‘tooscared to comment’, ‘wanted it taken no further . . . too scaredto face them’ (manager or nurses), and ‘they’ve got no idea.’

OutcomesOf the 89 issues dealt with in the first meetings of the 18 facil-ities, 65 were minuted (73%). Positive outcomes includedsix solutions during meeting one, 10 solutions imple-mented between meetings one and two, and three issueswith a satisfactory solution at meeting two to be implementedlater. Thus, only about 20% of topics raised at the first meet-ing resulted in satisfactory solutions. Sixteen suggestionswere rejected as not viable by the facility or chairperson atmeeting two, and six issues raised in the minutes werereported as ‘ongoing’. Forty-one issues (46%) from meetingone were not raised at meeting two.

Some resident comments demonstrated their reluctance toraise issues because of lack of satisfactory outcomes: ‘I’ve told(manager) and she doesn’t listen to anything you say. She justsays okay and forgets’, and ‘I don’t have to talk. It makes nodifference anyway.’ Similar resident frustration was reportedby Gibbs and Salkeld [5] and Zwick [4].

Summary and recommendationsThis study suggests that there is considerable scope for improv-ing a number of environmental and procedural factors thatinfluence the functioning of resident committees in aged carefacilities. Factors included the physical aspects of the meetingenvironment, formal meeting procedures, and the way inwhich meetings were conducted.

In terms of the environment, the meeting room needs to becomfortable, private and large enough for a circular arrange-ment of participants allowing all of them to see and hear. Anadequate number of comfortable and accessible chairs needs tobe arranged an adequate distance apart if all residents, includ-ing frailer residents, are to be encouraged to attend. An effec-tive microphone would help to ensure that all residents canhear what is being discussed. Switching off mobile phonesand PA systems would also help reduce distractions.

Meeting procedures that could have been adopted with advant-age in many cases included regular dates and times for meet-ings that are advertised and announced over the PA system toremind residents, an agenda with a positive focus that is circu-lated to give residents time to consider the issues to be raised,minutes that are circulated in an easy-to-read format, andrelatively short meetings. With respect to minutes, all issuesshould be minuted and, where appropriate, raised at the nextmeeting, even if they are just reported as ongoing, as promptresponses can help increase the success of committees [11].Having an ‘all-can-attend’ or elected format might depend on

the committee aim, but in the former, the results of this studysuggest that greater numbers are likely to be associated withlower active participation.

The need to improve the conduct of resident committees wasevident from the emphasis on complaints and the relativelyfew issues resolved adequately. Meetings could have beenimproved if the chairperson had begun with a positive state-ment about the aim of the meeting [8]:

The aim of today’s meeting is to discuss what is workingwell at the facility and what could be improved. I will alsoprovide some information about upcoming activities.

A positive aim like this, which could be included in the agenda,might encourage participation and more positive commentsand suggestions.

Resident participation was discouraged by negative and pat-ronising behaviours of some chairpersons and staff. There is aneed to address resident fear and perceived intimidation inmeetings, and staff opinions of resident incompetence. Thechairperson needs to ensure that staff are careful about object-ing to, or contradicting resident opinions. Before closing ameeting, chairpersons should ask if there are any other issuespeople would like to discuss then or at the next meeting. Onlyone chairperson had received formal instruction in how to con-duct meetings. The fact that residents found this to be very use-ful, and that it was associated with more effective and positivemeetings, suggests that aged care facilities should seek suchassistance to improve the conduct of resident committees.

Key Points• Most resident committee meetings were conducted

informally in rooms where conditions made itdifficult for many residents to see and hearcomfortably. The focus of most meetings was onresident complaints and there were relatively fewsatisfactory outcomes.

• The functioning of resident committees could beimproved by ensuring meeting rooms are set upto allow residents to see and hear comfortably,adopting formal meeting procedures, and trainingparticipants in how to conduct meetings.

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