Change the narrative about aged care. Take off the shackles. Polish the diamonds.
These were some of the key messages that speakers at Aged Care Insite’s International Best Practice in Dementia Care seminar hoped attendees took away from the event.
Opening the presentations, Dementia Australia chief executive Maree McCabe said the work in the dementia care space around the world is challenging, rewarding and inspiring. “Australia is in a position to contribute and influence so much of what is happening and what is needed.”
Still, McCabe said there is more work to be done to best support people living with dementia, their families and carers. She said each group must be included at every level of the system, not just on the receiving end as the resident or the patient, and also spoke of the need for entrenchment of person-centred care thinking and to bring about a transformational shift in culture within aged care.
Professor Henry Brodaty, from the Centre for Healthy Brain Ageing, said there are many examples of good and bad residential aged care but the sector as a whole gets bad press.
“We never see good news stories,” Brodaty said. “There’s a lot happening in residential aged care. It’s a matter of being creative, of bringing the community into the home and the people in the home into the community.”
He walked attendees through the SMILE study focussing on humour therapy, which resulted in a 20 per cent reduction in agitation among residents, and zeroed in on the idea of group homes, which typically sees fewer than 12 people living within a single site, as well as dementia villages, including De Hogeveyk. The village was pioneered in the Netherlands and its successes and failures informed some of what we will see when Glenview Community Services’ Korongee village opens in Tasmania in 2019.
Glenview chief executive Lucy O’Flaherty discussed the provider’s desire to also pass on the research, learnings and mistakes of its journey to develop Korongee. She also spoke of plans to partner with the nearby MONA art gallery to have an artist in residence at Korongee, plus the work Glenview is doing with the wider community – including the transport industry – to increase awareness of dementia and how best to support those living with it.
“To get different outcomes we need to think differently,” O’Flaherty said.
On a trip to the Netherlands to meet with aged care leaders who have gained international attention for their approaches to dementia care, Marie Alford, head of implementation at HammondCare’s Dementia Centre, said she noted that even a much-lorded site like De Hogeweyk has its problems.
While being chaperoned around the facility, Alford realised that many of the innovations that caught the eye of international media, such as a fully-functioning supermarket, were being used more by staff than by people with dementia.
“A lot of work goes into implementing new models of care, new ways of doing things, but it’s easy to slip back into old habits,” Alford said. “It’s about sustainability.”
Dr Maggie Haertsch, an international consultant in health, aged care and arts in healthcare, cautioned against taking a good idea and running with it before going to the developers and drawing on their experience and knowledge.
She also suggested that those introducing a new idea or innovation create a checklist of risks involved and put in place strategies to counter them.
Haertsch said cost, time and resourcing can be underestimated. “When you’re thinking of this great idea, have you got the resources to fully implement it within your own organisation? What manpower or womanpower will it take?”
Unlearn the medical model
Throughout the event, provider representatives discussed the importance of recruiting staff with the right approach to working in the space and who demonstrate more of the soft skills that align with the organisation’s vision.
Presenters and audience members also brought up the notion of aged care workers as ‘homemakers’. The term signifies a shift away from staff like AINs focusing on duties and instead on opportunities to make life more comfortable and enjoyable for residents.
Group Homes Australia chief executive Tamar Krebs said one of the most important lessons she has taken from her overseas travels, and has embedded into the Group Homes Australia model, is an approach to staffing in which daily activities and cares are dictated by the person with dementia, as opposed to a more task-focused approach.
Krebs also spoke of the need to hire the best staff, and train and empower them to make decisions that are in the best interests of residents.
Helen Blayden, Mountain View Aged Care Plus Centre manager with the The Salvation Army, also identified shifting workplace culture as a key challenge when it began rolling out a UK-pioneered dementia care model, The Butterfly Project.
Blayden said the Butterfly Project requires a flexible and adaptable approach to focusing on residents’ individual needs and preferences and that at its core, the model involves getting to know the person’s history, interests and what promotes their self-worth, dignity and respect.
She explained that the challenge for providers and carers is to unlearn behaviours that are controlling when interacting with a person with dementia.
“Nurses typically have a very clinical way of thinking,” Blayden said. “This is the exact opposite requirement of this model.”
To dismantle this approach, the Salvation Army Aged Care Plus team put in place additional training and support for all staff, including sending centre managers to the UK to learn directly from Dementia Care Matters, the group behind the Butterfly model.
The team also set up new recruitment processes and instituted a no-uniform policy which saw staff wear everyday clothing to work.
Alford discussed the lack of uniforms within HammondCare’s services but also recounted a trip to a facility in Queensland during which she discovered residents were routinely telling staff that they preferred the use of uniforms because it provided a sense of comfort, highlighting the need to avoid a ‘drag and drop’ approach to innovation.
As such, she said: “This journey of learning becomes a journey of changing our minds to meet residents’ needs.”
This ties into the notion of person-centred care but Alford earlier questioned whether all providers who believe they are demonstrating that are truly doing so.
Break the shackles
Truly focussing on the resident might mean fighting against the risk-averse culture often seen in aged care. Alford said: “Be prepared to [challenge] the Quality Agency, to say I don’t have a fire extinguisher in my home, I’m not having one in my care home,” she said. “There are ways to pitch arguments to get around some of these things that we see as barriers.”
Krebs said Australia is a very risk-averse society. “There’s a lot of red tape about what we can’t do. The accreditation system tells us a lot about what we shouldn’t be doing or should be documenting but doesn’t necessarily embrace or celebrate people’s lives because it’s quite stifling.”
She added often the focus when caring for a person with dementia is placed on the disease instead of celebrating the individual.
One of her takeaways from a trip to the Netherlands to meet with Humanitas Foundation chief executive Dr Hans Becker was his ‘yes, can do’ approach to aged care in which he often asked the question ‘why can’t we?’. She recounted one example in which Becker arranged for an elephant to visit a nursing home – generating a lot of discussion and excitement among residents – and letting people smoke if it gives them enjoyment, rather than focusing on the obvious health drawbacks.
While speakers discussed the ways in which they have looked at international innovations, and modified and extended ideas that might improve the lives of people with dementia, O’Flaherty reminded attendees that innovation is happening in Australia all the time. She gave the example of De Hogeweyk, as the operator’s trip to Western Australia to visit Juniper 25 years ago helped start the project.
Alford echoed the notion, saying: “Australia is actually a world-leader in the provision of aged care. We just don’t talk about it like other people do.” She argued that it should be seen as a “privilege” to work in aged care, and that we should be working to make the sector an appealing, and even “sexy”, career option to attract the best candidates as the next generation of aged care workers.
O’Flaherty said: “There is innovation in Australia and we just need to polish the diamonds.”Do you have an idea for a story?
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