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.
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.
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.
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 anAged Care Placement Consultantare 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 Australiaalso provided funding for this important research project, which still has several years to go before it could be offered as a treatment to humans.
Reporting on an aged care forum held recently with seniors in the eastern suburbs of Melbourne facilitated by Aged Care Minister, Ken Wyatt AM, and Member for Chisholm, Julia Banks MP, Ms Banks said “In the electorate of Chisholm, residents aged 65 and over make up 16 per cent of the population and this is set to grow to more than 25 per cent by 2050.”
She made reference to the Aged Care Diversity Framework that was released by the federal government in December as a perfect example how barriers that may exist to accessing appropriate aged care can be eliminated. She spoke of the diverse backgrounds of her electorate saying
“We have welcomed a large number of people from culturally and linguistically diverse backgrounds who contribute so much to the fabric of our local community. We are committed to ensuring that all Australians have access to safe, quality and respectful care and that the diversity of race, religion, language, sexuality and gender is reflected in the care options available.”
With three aged care action plans being drafted under the Diversity Framework, designed to help guarantee equity of access to care, Mr. Wyatt once again stated that people are living longer than ever before and his vision for ageing and aged care was unwavering. He further stated the government’s aim is to consistently deliver quality aged care that is accessible, affordable and sustainable and that forums like this helps the government understand what is working and what needs to be improved.
Aged care is currently somewhat of a mixed bag and, as an Aged Care Consultant, I constantly seek the best options for my clients moving into aged care facilities. Thankfully the standards are lifting across the board and the government’s reforms will hopefully enshrine the best possible standards of care for our elderly Australians.
This month new laws were passed in Victoria which legalise advance care directives under the “The Medical Treatment Planning and Decisions Act”. I highly recommend that my clients and any elderly person take advantage of this new legislation, as it will give them peace of mind should they need health intervention at a time when they are unable to give the decision for treatment themselves.
Under the Act Victorians can:
Create a legally binding advance care directive where they can specify treatment they consent to or refuse.
Also create a values directive where they state the values they hold that may affect medical treatment, for example, religious views.
Also appoint a medical treatment decision maker, a trusted person who can make medical decisions on their behalf if they are unable to make decisions, adhering to the values stated in the values directive.
To help a person make decisions they can also appoint a support person who can assist by gathering and interpreting information and help in communicating decisions.
The advance care directive and values directive are to be made whilst the person is able to make decisions and requires two witnesses, one of which must be a medical practitioner. A person cannot refuse palliative care as part of an instructional directive but can include statements about palliative care in their values directive, such as it is more important for them to remain lucid than completely pain-free at the end of their life. A treating physician must adhere to the advance care directive or gain a decision from the appointed medical treatment decision maker prior to treatment if their patient is unable to make decisions. This applies whether it is a temporary situation or permanent. There are some extenuating circumstances, such as an emergency, where this may not be required.
In our rapidly changing society we could go from the present situation where aged care facilities are the biggest construction growth sector to not needing aged care facilities at all! With the recent news that Australian scientists have helped turn back the body clock for elderly mice and their hope of producing an anti-ageing pill for humans, everything could change. Their findings were reported in the Cell journal and Sydney Morning Herald this week
In a five-year study where the elderly mice became as fit and as strong as the younger ones, scientists from Harvard, Massachusetts Institute of Technology and the University of New South Wales fed a compound to elderly mice that increased muscular blood flow, enhanced physical performance and endurance. The compound called nicotinamide mononucleotide (NMN) is a form of vitamin B3 that is naturally produced by the body.
The study’s lead author Dr Abhirup Das, anti-ageing researcher at the University of NSW, explained that “NMN can make the old cells healthy, and it can increase capillaries and blood flow.” This is very important, because as people age, their body largely stops building capillaries and blood flow slows down. Cells are starved of oxygen and nutrients, resulting in weakness and frailty. The best way to slow this process is by exercising but the body’s response to exercise declines with age. This is where the compound comes in; it is virtually exercise in a pill.
Past attempts at producing an anti-ageing pill failed as the compounds used had to pass through the digestive system, which broke it down before it could be effective. The MNM compound converts to something called NAD+ which doesn’t go through the digestive system. Human trials have shown that this compound is safe for consumption. Later this year more human trials will test its effectiveness in the human body.
Currently I am immersed in helping elderly people and their families to find the most suitable and comfortable residence for their golden years when it’s apparent they need a higher level of care than their present circumstance provides. I take great care to investigate the best possibilities for my clients and sometimes even negotiate a better deal for them in their selected aged care facility. However, I would happily give away my career if this pill becomes widely available and reverses the effects of ageing. It would be wonderful to see my clients and other elderly people enjoying a younger, fit body to carry them through their later years, staying at home and remaining independent.