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.

Latest in Technology Helps Those Living With Dementia

 

Some aspects of technology in our society can be concerning, however it is certainly here to stay and some of the innovations it is introducing to help those living with dementia are truly encouraging. As an Aged Care Placement Consultant I often help clients that live with dementia find suitable aged care accommodation and I see first-hand the difficulties they face in everyday life and receiving the level of support they need.

DRESS

A new assistive technology prototype called DRESS is being developed right now to help people with dementia dress themselves. It is designed for those who struggle with remembering how to perform day to day activities and will hopefully give them more independence and privacy.

dressing bedroom

The prototype – designed by NYU Rory Meyers College of Nursing, Arizona State University and MGH Institute of Health Professions with experts from gerontology, engineering, social sciences, nursing and psychology – uses a mixture of sensors on clothing and a set of dresser drawers. The drawers contain one item of clothing per drawer, in accordance with the Alzheimer Association’s dressing guidelines. It also combines automated vocal prompts recorded by the carer, to help correct dressing errors such as wearing a shirt back to front.

The carer initiates the sequence via a mobile device and the recorded voice prompts the dresser to start to dress, with red lights and prompts activated if the person dressing makes a mistake. Stress levels are also measured with an inbuilt soother if they rise too high.

Recorded messages

Using similar technology to the automated voice prompts reminders can be recorded on a device in the home and then played back out loud at the appropriate time. Messages can be set by time or activity, for example, a message can remind a person to take medication at a certain time or when a person leaves their home, a reminder message could tell them to lock the front door.

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Using this recorded message system can help people living with dementia to remain independent yet safe.

Home care robots

 

With Japan’s ageing society facing a predicted shortfall of 370,000 caregivers by 2025, the Japanese government wants to increase community acceptance of technology that could help fill the gap in the nursing workforce. One of these is a simple robotic device that helps frail residents get out of their bed and into a wheelchair, or that can ease senior citizens into bathtubs.

japanese robotics

The government sees a wider range of potential applications that could be developed to assist. Dr Hirohisa Hirukawa, director of robot innovation research at Japan’s National Institute of Advanced Industrial Science and Technology, said the aims included easing the burden on nursing staff and boosting the autonomy of people still living at home.

The Aged Care Workforce

worker helps elderly lady

The demand for aged care workers is growing rapidly with the number of people requiring some form of aged care set to double in Australia by the year 2050. Back in 2010 the then Department of Health and Ageing estimated that the aged care workforce would need to increase between two and three times before 2050 in order to provide care to the growing number of aged care residents.  A study by Adelaide University on the Attraction, Retention and Utilisation of the Aged Care Workforce published in April, 2018 conducted qualitative interviews with aged care workers that revealed three common key drivers that encourage attraction into the sector.

First, many current workers reported having a direct interest in aged care work. Their work was seen as being rewarding and offering opportunities to fulfil an interest in working with older people. In addition, many nurses considered that the sector provided challenging and diverse work including dementia and palliative care. For some workers aged care was seen as providing an initial stepping stone into a future career (often within the broader healthcare sector). The availability of work within the aged care sector was a second key driver of attraction, particularly for male workers, new hires and CALD workers who had experienced difficulties securing work in other chosen occupations. A third key driver centred on perceptions of the convenience and flexibility of aged care work; the working hours and shift patterns were seen as offering good work-life balance.

Conversely, factors which discouraged attraction into the aged care workforce were raised, with many workers expressing concerns that aged care work was seen in a poor light both within the general community and other health and care sectors and was widely perceived to be a low status job which offered poor rates of pay. The recent media exposure of poor practice within the aged care sector had added to these negative perceptions. In addition, aged care work was often viewed as lacking clinical and technical expertise and providing limited career pathways, which could hamper the attractiveness of the sector to nurses and nursing graduates. As a consequence of these factors, other health and care sectors were perceived to offer more attractive employment than aged care.

Addressing these perceptions, Melanie Mazzarolli, Regional Business Manager, Residential Services at Benetas states in a recent article –

“It seems to me, a significant barrier to the engagement of a robust, professional and sustainable workforce is the stigma of working in aged care. The recent announcement of the Royal Commission into aged care has resulted in the industry getting a lot of negative attention.  And rightly so, when distressing examples of mistreatment and abuse are exposed. However what is not portrayed is the thousands of examples of outstanding care, warmth and connection between the carer and resident or customer.

For me with a nursing background, there is no other industry like aged care. Supporting a person’s journey to death is a privilege – much like the privilege of child birth. In aged care we are able to develop a strong bond over months or even years with those in our care which can rarely be matched in other professional nursing roles. For me, transitioning to the aged care workforce is not the end of a career, but the beginning. Almost everyone I have ever come across is here because they are as passionate about the care of older Australians.”

Sources:

Agedcare.health.gov.au

Aged Care Online

 

 

ACAT Assessment and Specialist Dementia Care Program

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ACAT Assessment

The Australian Government Department of Health has in recent times received a number of enquiries from providers of aged care about when an Aged Care Assessment Team (ACAT) assessment is required. The department states that “A subsidy cannot be paid to an approved provider for providing care to a person, unless the person is approved under the Aged Care Act 1997 (the Act) as a care recipient.

An ACAT assessment is required if a person is seeking access to aged care services that are funded under the Act, such as:

  • Residential Care
  • Flexible Care in the form of Transition Care or Short-Term Restorative Care
  • Residential Respite Care
  • a Home Care Package. “

 

New Initiative Rollout 2019

One of the Department of Health’s new initiatives – the Specialist Dementia Care Program (SDCP) is beginning to roll out.

This program will provide care for people exhibiting very severe behavioural and psychological symptoms of dementia (BPSD), who are unable to be appropriately cared for by mainstream aged care services.

The SDCP will offer specialised, transitional residential support, focussing on reducing or stabilising symptoms over time. I have, at times, been in the position of finding suitable accommodation for people exhibiting behaviour that cannot be managed in the aged care residential service in which they reside. It is a difficult situation and, as an Aged Care Support Consultant, I applaud the introduction of specialist services to accommodate people in this position.

The department has advertised a targeted grant opportunity for a prototype SDCP service, with the next round of 14 SDCP grant opportunities to be advertised early this year. This first phase of specialist dementia care units is expected to be operational in early 2020 with a full rollout in 2022-23. It is expected that there will be at least one specialist dementia care unit (within a broader residential aged care service) operating in each of the 31 Primary Health Networks.

One of the objectives of the SDCP is to generate evidence on best practice care for people exhibiting very severe behavioural and psychological symptoms of dementia that can be adapted for use in mainstream settings to benefit all people with dementia.

Source: Australian Government Department of Health website.

 

The Ins and Outs of Dementia

 

Interesting face

Dementia in Australia has some worrying statistics, such as it being the leading cause of death among Australian women and the third most common cause of death among men, it is estimated to cost Australia more than $15 billion this year and by 2025 the total cost of dementia is predicted to increase to more than $18.7 billion.

The brain controls everything we do and generates instructions to our body, as well as facilitating our complex behaviours, such as personality and cognition (our ability to think, understand and do things). When a person has dementia, neurons in various parts of their brain stop communicating properly, disconnect, and gradually die.

Dementia is caused by progressive neurodegenerative diseases, with the disease starting in one part of the brain and spreading to other parts, affecting more and more functions in the body. Dementia is caused by different diseases and depending on the cause different parts of the brain will be affected, resulting in differing symptoms depending on the part of the brain being affected. Memory loss is often associated with dementia and it is one of the most common symptoms and usually the first symptom people notice. When neurons in the part of the brain called the hippocampus degenerate and die memory loss is experienced.

Dementia is not caused by old age but ageing is a high risk factor for the condition. When the frontal cortex of the brain is affected by dementia behaviours will change and often socially unacceptable behaviour is exhibited.

These symptoms often mean that people with dementia will require care in an aged care facility where they will be safe. The care of residents with dementia has often been challenging but new ways of caring are being developed to enable those residents to have a better quality of life. Construction has just begun on Korongee, a new concept dementia village in Glenorchy, Tasmania. The design of Korongee is based on a typical Tasmanian cul-de-sac, and is intended to encourage people living with dementia to continue to take part in normal, everyday activities. Households with eight bedrooms set in the village and a café, supermarket, beauty salon and gardens will all create a delightful, safe living space.

When I have clients living with dementia who need to find  suitable aged care accommodation I search for facilities that have  innovative programs to care for their needs and I would love to see a village like Korongee built in Melbourne.

 

 

Respite Care in Aged Care Facilities

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Respect is vital

Caregiving can be a highly demanding and stressful responsibility. Whilst allowing their loved one to remain in the home, it takes a lot of dedication and focus to continue to provide the level of care they require. Sometimes a caregiver needs a break, either a holiday to rest and recuperate from their ongoing responsibilities or due to their own health problems or other matters they need to attend to.

Respite care provides a short-term break for caregivers that can relieve their stress, renew their energy and restore a sense of balance to their lives. It gives them a period of freedom from caregiving duties, knowing their loved ones will continue to receive the care they require in a safe, caring and professional environment.

Another reason an elderly person may go into respite care in an aged care facility is to try out the facility. It gives them an opportunity to experience the high level of professional care, social activities and companionship an aged care home can provide. They will generally only be in respite care for a few weeks and quite often they enjoy their time there so much they ask to move in permanently.

Caregivers commonly use respite care when:

  • They need to travel.
  • They need a break.
  • Their loved one wants a trial for a senior community.
  • Their loved one needs a change of pace.
  • The need to help their loved one ease into permanent senior living.

The term “respite care” is not covered under the NDIS, this has caused stress to some caregivers who need to have a break and whose loved ones are receiving an NDIS package of support. Carers Victoria spoke to the NDIS who assured them they do support carers; their CEO Rob de Luca said “As part of the NDIS, we understand the importance of providing carers with the opportunity like all families to take a break from time to time – to sustain their capacity to provide informal supports to NDIS participants. Supports funded in NDIS plans include Short Term Accommodation (STA), in-home supports, community access and personal care – all of which are designed to support participants and reduce the demands on carers.”

I am an Aged Care Placement Consultant and have seen clients of mine go into respite care either to try it out or to provide their carer with a break and enjoy their time there so much they decide to move to an aged care facility permanently. These people usually transfer very successfully to their new home.

 

Delicious Introduction To Brain Food vs Dementia

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I recently attended a networking lunch hosted by Home Instead Brighton held at The Crescent in Brighton with guest speaker author Ngaire Hobbins. I found Ngaire’s presentation very informative as it highlighted the role of food for the older person living at home or in residential care. We were treated to a lovely tasting lunch with recipes from her book ‘Better Brain Food: eat to cheat dementia and cognitive decline.’  The Chef at The Crescent prepared the dishes from Michelle Crawford’s delightful recipes used in the book.

Ngaire Hobbins, APD, BSc., Dip. Nutrition and Diet, is a dietitian and researcher with a special passion for geriatric nutrition. She is committed to ensuring that the frail elderly have the very best food possible available to them. Most people – be they frail or fighting fit – are unaware that public health messages which are ideal for younger adults can instead be unhelpful, even harmful, for those entering their senior years.  In the science section of the book Ngaire offers insight on the importance of the gut-brain axis and looks at the pros and cons of the latest ‘superfoods’ and diet trends. She also advises what food should be eaten in each decade as a person ages to boost brain health.

‘Better Brain Food’is an important read, especially for anyone involved in aged care residential support as it discusses the science of nutrition and cognitive health and provides seventy tasty recipes based on this science, making it easy to follow Ngaire’s advice. Having visited many aged care facilities in my time as a Placement Consultant I know how important food is to the residents. For their ongoing health and well-being they should be served delicious meals that are nutritious and boost their brain health. This book will be an invaluable resource to this end.

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.