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.

Aged Care Apartment Style Living

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I visited the newly built Benetas The Views at Heidelberg recently and I thought it was a beautiful facility. Not only are the buildings and fittings very nicely and tastefully finished but the concept of care here is a bit different. They have what they call aged care apartment-style living which consists of 13 aged care apartments, each with 7 or 8 residents. Each apartment has its own kitchen, lounge and dining areas.

Residents each have their own private room with an ensuite. As I visit many facilities in my role as an Aged Care Placement Consultant it is encouraging to see innovative styles of aged care being adopted.

A primary care team is available within each apartment, fostering relationships that provide a more personal and engaging level of care. The care team will know of each resident’s personal preferences, likes and dislikes and their daily routine. Registered and enrolled nurses are available 24/7 for clinical support where required as well as visiting medical and healthcare specialists.

I was heartened to hear that residents are supported and encouraged to continue pursuing their hobbies and interests. There is a lively activities program available that includes a happy hour, bus tours, fitness programs and movie screenings. A café and sports bar, arts and crafts room, hairdressing salon, wellness centre/day spa, cinema and library are also onsite for resident’s use.

Qualified chefs cook nutritious meals using fresh ingredients and cultural, religious and dietary needs are catered for. With great views, lovely courtyards and a pet friendly environment this new style of aged care looks extremely promising. It will be great to offer this different style of aged care accommodation when looking at placement opportunities for my clients.

New Aged Care Facility in Box Hill

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Bluecross opened its newest aged care residence in Box Hill on October 22nd amongst much fanfare and a family open day with radio broadcasts, Mike Brady, games and a sausage sizzle. I had a quieter intro to this facility, being an Aged Care Placement Consultant I was invited before the opening for a preview.

The residence boasts a host of world-class facilities, including several lounges, dining and sitting rooms, activity areas, consultation and treatment rooms,

a library, hairdressing salon, private dining room, as well as a gymnasium and cinema .

I was impressed to learn they have a memory support environment for people living with dementia. With more people developing this condition as the population ages I am often called upon to find a suitable environment for my clients living with dementia.

The residence is designed with an emphasis on a homelike environment for residents, despite its state-of-the-art facilities according to Interim Chief Executive Officer Robert Putamorsi.

Bluecross Box Hill-suite

The different functional spaces like a number of smaller sitting rooms and dining areas make it more homely and a private dining room is available for residents who want to share a family meal with their relatives. The bedroom suites are generous and feature kitchenettes.

Comprising a basement and three levels, stage 1 boasts 173 rooms and another 43 rooms will be added in the stage 2 development in 2019. $64million was spent on the residence as it becomes part of the stable of 33 aged care facilities owned and managed by Blue Cross across Victoria. With a growing demand for high quality aged care homes in Victoria I welcome this new addition as I source suitable aged care residential places for my clients.

 

The Gap For Older People With Behavioural Problems

Arcare lauriston

This week I was asked to assist two sisters to find accommodation for their 67 year old mother, Doreen.  It was one of the most heart wrenching experiences I have had as an Aged Care Placement Consultant for some time. Doreen had recently been diagnosed with dementia, although the sisters were aware she had been in gradual cognitive decline for some time.

One of the daughters, Rosie, and her 3 year old had moved from Queensland 5 months ago to live with her mother and be her carer.  When I went for the initial visit I found that Rosie and her child had been sleeping in the car in the driveway for the past 2 weeks because Doreen had been screaming at them, banging doors and talking to imaginary people every night.

Doreen was not eating or sleeping and was wandering. Rosie was getting calls from local shopkeepers worried about her mother, but she was unable to stop the behaviour and could no longer cope. So the daughters spoke with Doreen’s neurologists and it was decided to initially admit Doreen to a private hospital for a medication review.

I took Rosie and her sister Kate to visit 4 aged care homes that had dementia care.  They chose a home which they felt was the best fit; flexible and in a great location for friends and family to visit.  The plan was to admit Doreen there once her medication had been sorted at the hospital.

Just as they breathed a sigh of relief they got a call from the hospital saying they could not accommodate Doreen’s behavioural needs and suggested that she be admitted to a psycho geriatric hospital.  Despite frantic calls the sisters found there were no beds available for their mother in a pyscho geriatric hospital and Doreen’s condition was worsening.

There has always been a large gap in our system for older people living with dementia and exhibiting difficult behaviours or psychosis. Aged care homes are fearful of danger to current clients and there are very few psycho geriatric hospitals, leaving very few options for an ever increasing number of people suffering this way.

Having heard the desperation in Rosie’s voice when I called to check in on Doreen I decided there might be one more avenue I could try. Drawing on my many years of experience as an Aged Care Placement Consultant and my knowledge of the aged care system, I contacted the aged care facility they had selected and explained to the manager that the hospital medication review was not going to happen and the daughters’ current circumstances.  I asked her to consider admitting Doreen to the facility in the dementia support section and, if she became unmanageable, transfer her to an appropriate hospital.  This type of transfer is easier to arrange by a manager of an aged care facility than for family.

The great news is that management did not dismiss this out of hand and agreed to Doreen moving into the facility immediately.

The Royal Commission into Aged Care: Looking For Answers

resident and nurse

The upcoming Royal Commission into Aged Care Quality & Safety has twenty past reviews to draw upon and still there are inadequacies in the provision of suitable care in some aged care facilities. It is highly desirable that the Commission be designed so that outcomes will provide:

  1. Improved consumer choice and control in aged care.
  2. Services in all aged care facilities that meet individuals’ needs.
  3. Services that are affordable for consumers and taxpayers alike.

Currently aged care homes in Australia are expected to meet 44 accreditation standards and they receive either a pass or fail for each one. These standards are being updated in 2019 with new aged care quality standards, but a pass or fail for each standard is still the criteria. With this system it is nearly impossible for consumers to assess the quality of each provider, do they excel or just scrape through?

In England a different system was introduced in 2014 by the Care Quality Commission (CQC). When each aged care home is inspected by the CQC five questions are asked: is it safe, is it effective, is it responsive, it is caring and is it well led? Ratings are given for each. They are: outstanding, good, requires improvement, or inadequate. The aged care facility is also given an overall rating. These ratings must be displayed, by law, within the facility and on its website. As my role, as an Aged Care Placement Consultant,  is to assess the quality and suitability of aged care facilities for my clients I would certainly find this rating system of tremendous help if it was introduced in Australia.

It is part of a whole system however, with the CQC drawing attention to poor care through reports it produces about the standard of care, such as its annual State of Care report. They also have strong enforcement and legislative powers and can shut down providers or bring criminal charges. In comparison Australia’s Quality Agency has to refer providers to the Health Department for any action.

As I’ve stated before there are many very good providers and I am pleased to report I find suitable aged care accommodation for my clients on a regular basis in Victoria. I follow up to ensure they are being well cared for and are happily settled in to their new homes. But, as the recent media attention has highlighted, there are some facilities that are inadequate. So, it’s important the Royal Commission can provide answers to how the government can ensure all people who require the support of a suitable aged care facility will be cared for at a standard acceptable to them, their families and society in general.

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.