Meeting Residents’ Expectations in Aged Care Homes

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One of the biggest challenges for providers of Aged Care Facilities is meeting the expectations of residents and their families. From my perspective, as an Aged Care Placement Consultant, I perceive that many families expect their loved ones to receive one on one attention 24/7.  Of course, this is unrealistic as sometimes the other residents will need the attention of the staff. This can’t be helped in accommodation where there are a number of residents with varying levels of care needs to be met.

Clients always ask me about staff ratios, which has become a hot topic in aged care. This is a difficult question to answer since the introduction of Ageing In Place, because most Aged Care Homes now have a mixture of high and low needs and staff numbers are rostered according to care needs and work load at any given time. The most helpful question to ask of an Aged Care Facility is the availability of Registered Nurses on each shift, including overnight, as well as the availability of Doctors on weekends and overnight.
The quality of food is the other big issue in Aged Care Homes and I understand why it’s so important. Apart from the nutritional value, food plays a major role in the daily life of a resident. The anticipation of meals is an important focus and having a good feed leaves them satisfied. Everyone enters a home anticipating the food will be up to standard and palatable; some are disappointed at the quality, while others find the meals delicious.

Earlier in my career when I worked in Aged Care Facilities I was amused that it was often the people who had lived alone surviving on toast or crumpets who complained the most about the food. I would hear the complaints the Chef received and they were often contradictory, some thought the soup too hot, some too cold, some found the gravy too thick, some too thin. I realised how difficult it was to deliver meals for such a large and diverse population, also taking into account medical conditions, and still please everyone. I can assure you there are many residents who do enjoy their food.

In my experience, the people who choose to enter Residential Aged Care and embrace their new lifestyle thrive and are mostly content. And, like anything else, those who look for the bad will always find it and will probably never be happy.

ABC Four Corners Program & Royal Commission into Aged Care

orlando aged care

With the airing on Monday (10 September) on ABC’s Four Corners of the first instalment of its two-part series into the treatment of the elderly in aged care homes massive attention has been drawn to the sector. Followed by the announcement by Prime Minister Scott Morrison to call for a Royal Commission into aged care concern is now at a high level.

The sector was quick to condemn the gaps in care the whistle-blowers spoke of in the program. Comments by Pat Sparrow, Aged & Community Services Australia chief executive and Ken Wyatt, Minister for Senior Australians and Aged Care, reflected the dismay felt by the community at stories of neglect and poor care. Mr. Wyatt assured all that these stories “have highlighted the importance of the reform agenda we are implementing to increase the regulatory oversight of Australia’s aged care sector.”

Reading all the articles that have come out since the Four Corners program I was encouraged to read many responses from people assuring that there are good places that care for people appropriately. As an Aged Care Placement Consultant I visit many, many facilities and check them out thoroughly for my clients, I also visit my clients after they have settled in to check everything is to their satisfaction. So, I know the facilities in Victoria very well and I know which ones to recommend to clients. There are some I avoid. Despite the gloomy picture portrayed in the current media stories there are facilities that offer a high level of service and their residents feel safe and content.

I’m glad to report that my clients are very satisfied with the facilities I help them find and I’ve received many wonderful testimonials confirming that. Where there are any problems I advocate on behalf of my clients to resolve them.

I am a member of the Association of Aged Service Professionals (AASP) and this organisation will be submitting feedback on the terms of reference for the Royal Commission. The Association’s hope is that the Royal Commission will weed out those using bad practices. I think the real question is how much funding is needed to provide high quality care for older Australians and where will it come from?  It may mean that we pay more for aged care in order to get the quality of care everyone wants. If this is the finding of the Commission and the government acts upon it, all this attention and concern will have a very productive outcome.

 

 

Minister Visits A New Model of Residential Aged Care

 

 

De Hogeweyk village in the Netherlands.

A Flinders University study found that clustered, home-like models of residential aged care led to better quality of life for residents at a comparable cost. The study found that residents were less likely to be admitted to hospital emergency and 52% less likely to be prescribed potentially inappropriate medication. As an Aged Care Placement Consultant I am always interested in innovations in residential aged care.

The Minister for Aged Care, the Hon. Ken Wyatt AM, MP, recently visited a facility, NewDirection Care in Bellmere, Queensland, which not only has clustered houses but is a microtown™. He described the residences as  “Aged Care that is totally person-centred, with seven people per house with a care companion who works with each home’s resident.”

The Minister toured the microtown™, which resembles any small town in Australia with a corner store, café, cinema, hair salon, barber shop, music room, wellness centre, dental and GP facilities. This alternative model focusses on non-institutionalised schedules, independence, interaction, lifestyle options and freedom. The Minister for Aged Care decided to see the facility first hand, having heard it highly praised.

The facility features elegant seven-bedroom homes designed and styled by Shaynna Blaze. Each bedroom has an ensuite and spacious built-ins. The open plan kitchen is functional and showcases the latest in appliances. The family dining room, cosy sitting rooms and private gardens create a family home atmosphere.

Each home is designed with a unique style, be it country living, modern urban, traditional or progressive, featuring the finest details.

To house like-minded residents together the aged care facility uses a cutting edge profiling tool that draws out an individual’s social world view and personality traits. Residents are placed in houses according to who they are as individuals and their lifestyle and not according to their cognitive diagnosis.Registered Nurses are on call 24/7 to make private visits to the homes and the onsite clinic provides professional services such as Doctors, Dentists, Podiatrists and Massage Therapists.

With the demand for aged care increasing rapidly, in my role as an Aged Care Placement Consultant I think it’s great to see new models like this emerging.

 

The Benefit of Pets in Aged Care Homes

The Animal Welfare League of Australia has undertaken a survey of aged care facilities and so far 90% of respondents to the survey have stated that having pets at the facilities is either very or vitally important for residents. As I source appropriate aged care facilities for my clients I sometimes receive requests for pet friendly aged care homes and found this report very relevant.

Directors of successful pet–friendly aged care facilities report that pets contribute to community feeling, encouraging friendships between residents. One of the benefits to the pet owner is the social interaction with other residents and staff as they stop to introduce their pet.

The Directors say that complaints about pets have been minimal where clear guidelines were adopted and expert community volunteers have provided the needed support and advice to pet owners. The overall benefits to residents who are bonded to their pets when they can reside with them in the aged care facility should not be underestimated states the AWLA. Residents who have a strong bond with their pet and are unable to have them stay experience profound grief, which is layered on their sense of sadness and loss when adjusting to moving from their own home into an aged care facility.

Studies on pet ownership have shown very positive outcomes. Researchers in a US study conducted in 2011 found that pet owners experienced greater self-esteem, had healthier personalities, were less fearful, depressed or lonely and were happier than people without pets whilst a German/Australian study in 2017 found that pet owners were physically healthier than those who did not currently own a pet. Some of the health benefits proven for pet owners are lower blood pressure, lower stress and better survival after a heart attack. Compelling reasons for residents in aged care facilities to keep their pets.

 

 

 

 

The Leisure Seeker Film Opens Up a Moral Discussion on Dementia

It was good to read Phillipa Byer’s review of the film The Leisure Seeker on 12th July in the Sydney Morning Herald. She pulled no punches about her opinion of the ending and its message. The story is about a retired teacher who has dementia and his wife who has cancer. They embark on a journey in their motor home. Spoiler alert – the finale involves the wife giving her husband a drink that brings about his demise then she commits suicide. The husband had earlier said to his wife that when the time came for him to go to one of “those places” (meaning an aged care residential facility) she should equip him with a rifle and remind him how to use it (on himself).

Phillipa was furious at this ending and I can understand her emotion. I am an Aged Care Placement Consultant and help elderly people find suitable accommodation, this includes people living with dementia and I take a keen interest in aged care facilities that support those with dementia. Philippa volunteers at a dementia specific residential facility, has a relative with dementia and is a research associate at the Australian Catholic University’s Plunkett Centre for Ethics and is currently working on a dementia project.

She states “The belief that residential aged care facilities are so bad that killing or suicide are reasonable preferences is apathetic and alarming.”  She points out that there are surely alternative moral imperatives, such as advocating for more funding as a minimum. She also has issue with the wife administering the death juice but not informing the husband that’s what it is. Surely, he has the right to decide in that moment. She is concerned, that as people with dementia live amongst us, we can’t loosen the moral bonds of honesty with them just because it may be uncomfortable or difficult. A new village being developed in 2019 in Hobart reflects the philosophy that, after a full life making their own decisions, people with dementia can have a valid opinion on their day to day life. Koongee Village allows people with dementia to live, roam free and have all the facilities they need in a safe setting.

The butterfly model being introduced to many aged care facilities in Australia is a new culture of care for people living with dementia and focuses on emotional intelligence. People live in smaller homes, are not treated as patients and are involved in daily activities in the home and garden and also learn new skills. There are good news stories about people living with dementia and, as an Aged Care Placement Specialist, I’m pleased to share them.

Read Phillipa’s Review.

Study on a New Home-Like Model Aged Care Facility

A study recently published in the Medical Journal of Australia looks at a new type of aged care facility.Both here in Australia and internationally there has been a move towards smaller living units that are more like homes, with staff focused on providing flexible and adaptable care. One of the key findings of the Flinders University study was that the clustered, home-like models of residential aged care led to better quality of life for residents at a comparable cost. Being an Aged Care Consultant my interest was spiked by this report.

Some of the findings were very positive, such as residents being less likely to be admitted to hospital, presenting to an emergency department, and 52% less likely to be prescribed potentially inappropriate medication. The report is part of the Investigating Services Provided in the Residential Care Environment for Dementia (INSPIRED) study, comparing patient-reported outcomes and resource use for over 500 residents of 17 facilities across four states.

Dr. Stephen Judd, chief executive of HammondCare, who runs this model of aged care, noted that the success of home-like models is not simply due to the physical environment but also the social model of care and approach to staffing.  The clustered domestic models included in the study had small living units of 15 or fewer residents and independently accessible outdoor areas, with care staff allocated to specific living units, meals were cooked in the units with staff supporting residents’ self service of meals and participation in meal preparation.

“The issue of quality in aged care is always close to the community’s heart and this study suggests there should be increased access to alternative models of residential aged care, particularly those that have evidence of better outcomes for the residents” study lead Professor Maria Crotty said. Many of my clients would agree, I am sure. When assisting them to find an aged care facility in my role as an Aged Care Consultant, some would be more content in one of these clustered, home-like models, whilst still benefitting from daily support staff.  it is pleasing to see studies such as this one exploring diverse models of aged care.

 

 

Jillian Slade Case Studies For Suitable Aged Care Accommodation

Jillian Slade with a happy client.

Looking back on some Case Studies of clients I have been able to successfully place in suitable aged care facilities I am so pleased I was able to help these families. I recall the story of two desperate brothers who were under pressure to move their father into aged care within a week! The brothers had found facilities that were close to them were either too expensive, charged additional service fees, were too depressing or had long waiting lists. Both worked full time and were exhausted from searching. I was able to arrange a tour of 5 facilities which met their criteria and when they favoured one I spoke with my contact there about the urgency; within days they had chosen a room and their father settled in very well.

Another situation concerned a couple who were going along quite well in their own home with the husband as main carer for his wife, who was in the early stages of dementia. Then he had a serious fall resulting in a head injury which left him unable to walk again. The family now needed to find him a place in residential care quickly. They were introduced to me as a Placement Consultant and my brief was to find an aged care facility they could afford, be accommodated together as a couple and move in at the same time.  Not an easy ask in Bayside Melbourne! I secured them a place in a lovely facility where they had a couple’s suite and I was able to negotiate an affordable price.

Two sisters who received a nasty shock when told by medical staff that their father’s condition  made it dangerous for him to go back home and live alone came to me for help to find permanent aged care accommodation for him. He had been living alone but began to have falls due to sudden drops in blood pressure and ended up in hospital after a major fall. The daughters had visited what they thought were all the available facilities in the area but there were no vacancies. I suggested a facility I knew of that provided great care where I had a good relationship with the management.  I was able to secure the next vacancy and reduce ongoing costs by $50K. The sisters were very grateful and told me “We couldn’t ask for a better facility for Dad.  It’s very quiet, light and cheerful and the staff are very friendly”. Stories like these make my role as an Aged Care Placement Consultant very rewarding.

 

 

 

 

Exciting New Research On Dementia

Dr. Sarang Kim

Would you have thought that the number one concern facing people with dementia and their carers was social stigma? Researcher Dr. Sarang Kim from ANU conducted a national survey on people’s attitudes to dementia which showed that the general public have negative views and wish to avoid people living with dementia. Dr. Kim was the recipient of the 2016 Alzheimer’s Australia Hazel Hawke Research Grant in Dementia Care and has concentrated her research on the social effects on a person with dementia.

Following the survey Dr.Kim is developing a Dementia Stigma Reduction Program (DESeRvE), which is based on the idea that contact with people living with the condition and education is the best way to reduce stigma. She will use frequently asked questions about people living with dementia sourced from focus groups to have short video clips produced. They will feature people with dementia and their carers answering the questions. Dr. Kim is hopeful that this ‘virtual contact’ and education will help to reduce the level of stigma.

Many of my clients are people living with dementia who reach a stage where they need the level of care provided in an aged care facility. I have noticed that my services as an Aged Care Placement Consultant are being called upon more often by young people with dementia. Most of these clients are in their fifties or sixties and have been living with the condition for about ten years, so the onset was quite young.

Hope for a reduction in the effects of dementia is being offered by the research undertaken by Dr Rebecca Nisbet from the Queensland Brain Institute, who has discovered a feasible treatment. “One of the main causes of Alzheimer’s disease and frontotemporal dementia, two of the most common forms of dementia, is the aggregation of the protein tau within neurons. In our study we generated an antibody specific for tau (RN2N), and investigated its efficacy in clearing tau in a mouse model of frontotemporal dementia,” Dr Nisbet said.

Dr. Nisbet went on to explain that the presence of a blood–brain barrier has historically made delivery of treatment drugs to the brain difficult, but she had found that by using ultrasound, which transiently opens the barrier, that RN2N could be delivered resulting in improvements to memory. Alzheimer’s Australia also provided funding for this important research project, which still has several years to go before it could be offered as a treatment to humans.