Relationship Centred Dementia Care Online Presentation

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The Dementia Australia National Symposium Series 2020 – Dementia care is quality  was delivered as an online series of six weekly virtual events, commencing 4 August. It had originally been intended to be delivered as an in person event in Sydney.

Dementia Australia CEO Maree McCabe said about the series “Offering the webinar series for free is our contribution to supporting the aged care sector through this difficult time to enable a greater level of engagement than would have been possible with the original event.”

Hospital, hotel or home? What does relationship-centred quality look like and how do you know you’re delivering it? was presented by Dr Lisa Trigg, Assistant Director of Research, Data and Intelligence at Social Care Wales (UK), on 25 August.

“A relationship-centred approach to quality is the best type of quality, where the person needing care is treated as an individual with his or her own personality, regardless of their health issues,” Dr Trigg said.

“It is being cared for by someone in a compassionate and supportive reciprocal relationship – even though someone may be in the late stages of dementia, they are still a person with their own individuality and personality.”

Dr Trigg has studied quality improvement in long-term care and currently supports people working in care in Wales with evidence and research to inform policy and service design. At the symposium she explained the concept of relationship-centred quality and gave delegates the opportunity to reflect upon the quality of care in their own organisation and how well it is being achieved.

Relationship centred care focuses on enhancing the care experience for residents together with family and staff, where relationships between them are built upon and nurtured. Residents feel a sense of security, feeling safe and receiving knowledgeable and sensitive care whilst staff feel safe from threat, working within a supportive culture and families are supported to feel confident in providing good care. A sense of belonging is established, residents are supported to make friends within the setting, family maintain valued relationships and staff feel like they are part of a team.

Residents have the opportunity to develop and meet goals, giving them a sense of achievement, which is shared with family and staff. A sense of continuity is built with residents receiving care from staff they know and staff have consistent work assignments. A shared sense of purpose is also achieved with the help of family in activities where residents have meaningful, purposeful functions and staff help with clear, shared goals. Importantly, residents feel valued and recognised, staff feel like their work matters and family feel valued by staff.

You can tune into the last two webinars in the webinar series:

Tuesday 1 September at 4pm Reconsidering Person-Centred Dementia Care: Can we make this an everyday experience for those living with high dependency needs and dementia? Presented by Professor Dawn Broker

Tuesday 8 September at 11 am Leadership and the Challenge of Change by Ita Buttrose AC OBE and Addressing Leadership Blind Spots to Staff Engagement by Dr James Adonis

Dementia Advocate closing by Keith Davies.

Jillian Slade is a Placement Consultant.

 

Visitors to Aged Care Homes

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The Prime Minister went on national television last Tuesday to tell aged care facilities in Australia to go easy on their lockdown measures. He said the recommendation from the national cabinet was for a maximum of two visits per resident per day in the resident’s room. He was concerned for the welfare and health of residents in aged care if they were not receiving regular visits from their families.

Several things have come to my notice as an Aged Care Placement Consultant about the situation. Aged Care Facilities seem to vary from one to another with how they are dealing with COVID-19, as mentioned in my last blog. When it comes to visitors some are in strict lockdown, others are following the government recommendations. Staff are busier than ever, as they don’t have the help of volunteers and other support services; for example, they are having to conduct all the activities to keep residents occupied.

General Secretary of the NSW Nurses and Midwives Associations, Brett Holmes, said the government needed to provide additional staff to aged care facilities so they could screen visitors before allowing them in. I agree with this and can understand the difficulties aged care homes will face in monitoring visitors, I’m aware that even at the moment where families are allowed to visit their loved ones in palliative care, in some facilities it is only for 15 minutes, yet when asked to leave they ask for another 5 minutes, then another 5 – this all takes up staff time, adding an extra burden. There will be further calls on staff time when the directive starting in May that visitors must have the up to date flu immunisation comes into effect, as this will need policing.

Brett Holmes went on to say “There are qualified nurses out there looking for work and if the Commonwealth Government wants to open up the aged care facilities, then that should be done in the safest possible way.That should also mean of course the additional resources of PPE to allow that screening to be undertaken in the same way that our public health system is responding to this risk of people from outside the facility bringing in the COVID-19.”

I have noticed when that some aged care facilities are contacting families and asking them if they are content with the precautions the facility is taking and, to my knowledge, most families are generally understanding why the facilities have taken those precautions and that it is for the protection of residents.

Last week I placed a gentleman in an aged care facility and his wife was upset that she couldn’t visit him over the weekend. As I have said before, each facility is dealing with the situation differently. The same goes for retirement villages. I am helping a client to find a suitable retirement village and one place we were interested in would not allow a site visit but also won’t allow a resident to move in unless they have seen the facility in person. Another retirement village will allow a site visit, but only one person at a time.

I am finding that only people in an emergency are now seeking aged care accommodation as they don’t want to self isolate within the facility for 14 days once they move in, they don’t like the idea of no visitors and don’t want to spend the money and make a monumental move to a home site-unseen. Trying times indeed!

 

 

How Aged Care Facilities Respond to COVID-19

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With the corona virus pandemic now in Australia there are changes to how aged care facilities are able to operate.

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In my role as Placement Consultant I help clients find suitable accommodation in aged care facilities in Melbourne. I’m currently getting frequent updates from aged care facilities on changes to their protocols. Fortunately most aged care facilities still currently taking new residents and, in some cases, respite residents. There seems to be a general requirement for new residents to self isolate for 14 days when they move into their new home. However, the need for this varies from facility to facility, with some making it mandatory for all new intakes, whilst others have made it only for those who answer positively to questions about their symptoms and/or exposure to COVID-19 or carefully check on resident’s health upon intake.

I had a client recently who I had trouble placing into a facility as she was unable to do the 14 day isolation due to memory loss. Fortunately I was able to find another suitable facility whose policy is if a new resident comes from home they will have their temperature taken and be monitored. As my client was coming from home she was accepted. However, this facility requires new residents to self isolate for 14 days If coming directly from hospital. Some facilities can no longer accept people living with dementia or people that wander as they are unable to provide care for them with the social distancing restrictions now in place.

Restrictions around visitors also vary between aged care facilities with some putting in place a total ban for visitors, with some allowance when residents are in palliative care, and others allowing minimal visitors as per the government guidelines of no more than two at a time, once a day.

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Most visits to inspect facilities are now virtual with a range of sophistication there; some have film crews do a professional video tour whilst others film the facility themselves. Some facilities will meet with you and show photos and some will even allow a personal tour but with strict cleanliness and health protocols in place.

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It is challenging keeping up with all the different protocols in the various facilities and another reason my clients find my services so helpful  as I sift through these frequent updates to keep them informed.

 

 

 

 

Aged Care Placement During The Corona Virus Pandemic

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As we all face the effects of the COVID-19 virus in our community, it is of particular concern in aged care facilities, where the most vulnerable people reside. Ever more draconian restrictions are being put in place in the wider community to try to control the spread of the virus. Aged care facilities are particularly at risk and so they have to be even more restrictive. The government has introduced a two person only visit limit to each resident and have restricted gathering in communal areas. Some facilities have put in even stricter limits, such as only allowing family to visit or completely locking down, allowing no visitors.

Despite the new regulations, social distancing and self isolation in the wider community, there will still be those elderly people who have a fall or get very ill with heart attacks, strokes, dementia and other health problems who end up needing to go into an aged care facility. Also, due to the self isolating or lockdown situations now being enforced there are elderly people, particularly those living with dementia, who will no longer have the level of care they need. I had three such cases last week that all required emergency placement in an aged care facility.

The first was an ‘at risk 93 year old woman’, living with dementia, alone in an apartment in Docklands,. Her son lives in the USA and her sister in law in Albury, NSW. As she now needed to move into a facility the family wanted accommodation in Albury so she could be near her sister in law. They asked me to find a suitable facility and organize the transfer. I found a suitable facility and the son had to make the decision sight unseen, trusting my judgment. With the help of a case manager and a private carer I arranged for transportation. Due to the changing directions coming from the government, the facility was changing its protocols daily which delayed her being admitted and resulted in her staying a night in Albury and the private carer taking her to the facility, where she had to start a 14 day isolation. Very difficult circumstances for an elderly lady living with dementia. Happily, she is settled and doing well.

The second was a gent with dementia living with his wife who had serious health issues. His behaviour had exacerbated and she was concerned about keeping him locked in the house if the lock-down got worse, which it has. This was a difficult process as her children thought she should keep him at home as she had signed up for ‘better or worse’.  He also had to go in without her looking at the room and undergo social isolation for 14 days.

The third was another woman living with dementia in a fully independent, serviced apartment in Carlton.  This was also an urgent situation as there is no one to go in and check on her and she is living alone and isolated with dementia. Fortunately I have been able to place her as well.

There has definitely been a rise in demand for help in finding suitable aged care.The service I provide means I source a facility that is suitable in terms of location, programmes, affordability, staffing levels, type of accommodation, services offered and outings. Because I research the facilities, visit most of them and know many of the managers I have an inside knowledge about how they operate and how suitable they will be for my clients.

These are challenging times for us all, and for an elderly person living with dementia having to move from their home it is extremely stressful. . I am grateful that now, more than ever, I can be of assistanceto ease this distress, fear and anxiety as I have a counselling qualification, which gives me the skills to really help people going through this transition.

 

This Year in The Aged Care Sector

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The year 2019 has been a very important one for the aged care sector. I am an Aged Care Placement Consultant and have shared many of the issues, developments and opinions that are helping to shape the future of aged care in Australia.

Developments in the treatment of dementia have featured quite prominently. In January the Specialist Dementia Care Program (SDCP) was beginning to roll out. Offering specialised, transitional residential support for people exhibiting very severe behavioural and psychological symptoms of dementia (BPSD), which focuses on reducing or stabilising symptoms over time, the program will provide care for those who are unable to be appropriately cared for by mainstream aged care services. The first specialist units are scheduled to be operational in 2020, with a further roll out in 2021-23.

Assistive technologieswere being developed through the year. One example is a prototype called DRESS to help people with dementia dress themselves. The carer initiates the dress sequence via a mobile device and the recorded voice prompts the person to dress themselves, correcting mistakes. Japan is heading to a workforce crisis in numbers with a rapidly aging population, so the government is encouraging the use of technology in aged care. An example is a robotic device that helps frail residents get out of bed and into a wheelchair or ease them into bathtubs.

And talking robots, I met my first robot in May this year, Lamson, when visiting a newly built aged care facility, Trinity Manor in Greensborough. It delivers medicine and meals, takes laundry and can even use lifts. Also, Griffith University has been using social robots to interact with people with dementia.

Ikkiworks has developed a robot called Ikki, who is a companion and a clinician and will eventually be used in aged care. Ikki can take a patient’s temperature and identify medication and alert the patient if the medication is incorrect.

Another approach to dementia care is the Montessori Inspired Lifestyle ® (MIL) developed by Dr. Cameron Camp. “Within this new paradigm, abilities, interests, and preferences will be respected, encouraged and maximized. Providing choice throughout the day is central to all interactions. Central to MIL is the creation of meaningful activities and social roles within the context of a community.” said Dr. Camp.

The aged care workforce was a subject that kept coming up, particularly the need for more nurses to be on call within facilities. I reported on an interesting study by Adelaide University published in April 2018 into the attraction and retention of staff to aged care. There were many reasons why working in the sector was attractive but the perception of this work as low level and underpaid was a negative.

In defence of the work Melanie Mazzarolli, Regional Business Manager, Residential Services at Benetas wrote in an article about the privilege of supporting someone on their journey to death, similar to supporting birth, and that relationships can be formed over long periods, rarely matched in other nursing roles. She also mentioned the passion of those employed in this sector. With the increase in the aging population more workers will be needed in the sector but finding and retaining them will be an ongoing challenge.

The Royal Commission into Aged Care was prevalent on the news for much of the year and painted a very negative picture of the sector. Clearly improvements across the sector are needed and a statement by the AMA this month spoke of using technologiesto assist meet the demands for care for the elderly. These technologies are already being developed and support for more development is needed.

Ending on a bright note the touching and beautifully produced documentary series The Old People’s Home for 4 Year Olds aired on ABC in August and September took a look at an experiment in an intergenerational program. This experiment is the first of its kind conducted in Australia with structured activities used to encourage interactions between the children and adults as they worked together to achieve particular goals. Health measurements were taken before and after the program and showed positive outcomes. Professor Susan Kurrle, who oversaw the program, believes the implications of this successful trial could be huge.

I look forward to a more positive focus on aged care in 2020, with improvements and developments that will assist the sector to deliver a high level of quality care to all our older residents.

New Aged Care Facility Sparkles in Templestowe

 

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A delightful new aged care facility opened in Templestowe, Melbourne earlier this year. Its official opening date was April 4th. I have since placed four of my clients there, who are very happy with the facility. It is a single storey residence, has lovely, large suites including double suites for couples.

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This is good news for me because, as a Placement Consultant, I often have requests from couples for a double suite and, in the past, it has been hard to place couples in suitable aged care accommodation where they can share a room. Thankfully we can see in the new facilities being built there is more awareness of the need for couples’ accommodation.

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Intimate dining and lounge areas create a cosy feel for residents and there is a separate dining room where residents can invite their families for a meal. A boutique café caters for casual snacks and drinks through the day and food is cooked fresh daily for meals. There is 24/7 nursing care for all residents.

Feeling good about yourself is important and the hair dressing salon onsite ensures residents can have a bit of pampering and lovey hair styles. Entertainment is at hand with a good sized billiards table, movie room and a wide range of activities and outings.

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During the year residents visited the Heide Museum of Modern Art at Bulleen and Montsaalvat in Eltham where one of the residents commented on how the building was constructed in the 1930s by its then residents, mainly out of recycled materials.

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Picture from Arcare Templestowe website.

Lifestyle coordinator Noelene said, “It important that our clients to come out on these bus trips, as they enable the clients to feel connected to the community and encourage the clients to socialise with each other. It always so interesting to hear the conversations that come from our outings; the clients have so many quirky stories, history and knowledge that come out.”

Arcare Templestowe also incorporates The Marsden sensitive care unit, a secure area which specifically cares for clients who are living with progressed dementia or Alzheimer’s disease.

I have over twenty year’s experience in aged careand a good knowledge of the facilities available in Melbourne and surrounds. If your client or family member needs support in finding the most suitable facility please contact me.

 

The Rise of Robots in Aged Care

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The rise of technology has led to it being used increasingly in health and aged care settings. Infra-red vein finders, nurse-specific smart devices and various monitoring tools are being introduced on wards whilst Skype and iPads and other devices are helping to keep families connected to loved ones who are in aged care. And across the world we are seeing the rise of robots in care.

Lamson, a robot currently being used in residential care in Melbourne, delivers medicine and meals, takes laundry and can even use lifts. I met this robot recently when visiting a newly built aged care facility, Trinity Manor,in Greensborough that opened its doors to residents in May this year. As a Placement Consultant, helping find suitable aged care for clients, I have the privilege of visiting new aged care facilities to assess their suitability for my clientele and I have to confess this was the first time I had seen such a robot in action.

These robots will become more common. The latest innovation are telepresence robots which are controlled by a remote user, in the case of Lamson it was staff, but many used in other places are actually controlled by family members of the resident. A study of these robots in Finland found that for the elderly, telepresence provides benefits over non-mobile video connections as they can interact with it in a more natural manner. The robots also help the elderly to feel secure, as they feel that their relatives or carers can keep an eye on them virtually and interact with them.

Griffith University has been using social robots to interact with people with dementia, and a new start-up out of Sydney has been experimenting with robots that can help patients take their medicine.

Ikkiworks’ new robot, ikki, is part companion, part clinician. Trialled primarily with children living with cancer, ikki can take the temperature of a patient, as well as identify medication and alert the patient if the medication is incorrect. What a boon that would be for elderly people that forget to take their medication. Ikkiworks plan to develop the robot so it could eventually be used in aged care, providing companionship whilst monitoring health.

Wendy Moyle from Griffith University sees the next innovation in robot technology being the development of assistive robots integrated with smart homes, assisting elderly adults to stay home longer.“These are multifunctional robots that are voice activated, can assist a person with activities of daily living, monitor wellbeing and report wellbeing to healthcare professionals and family and can virtually connect the person.” she said.

We are certainly living in the technological age and it’s encouraging to see how these developing technologies can help our ever growing aged population to enjoy better care.

New Aged Care Facility in Greensborough

 

Trinity Manor Greensborough frontAs an aged care Placement Consultant I am, at times, invited to visit new aged care facilities prior to their opening. Recently I was invited to visit Trinity Manor Greensborough to view the facility before it opened its doors to residents yesterday (16th May, 2019).

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There are 112 beds, including 12 in the Memory Support section for those living with dementia needing a secure and safe environment.  They offer these residents a specialist dementia care support program. All residents have access to care by qualified registered division 1 nurses, available 24 hours.

The chef prepared a lovely lunch for me so that I could sample the standard of meals that will be served to the residents. They will have a plentiful supply of food throughout the  Trinity Manor Greensborough meal

day, with a continental and hot breakfast followed by a main meal at lunch with offerings such as Rogan Josh, roast leg of pork with apple sauce, crumbed fish and beef and shiraz pie served with a varied range of vegetables daily followed by desserts such as mango panna cotta and apple strudel. A soup is served in the evening followed by a light meal and dessert. Cakes, devonshire tea or biscuits are served at morning and afternoon tea and supper.

It was intriguing to see a robot in action in an aged care facility; its role is to take the load from carers and kitchen staff. Able to deliver to rooms and various departments, the robot accesses the lift to reach different floors.

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The robot stops when a resident is near and plays music as it goes along. In my role as a Placement Consultant I have to confess this is the first time I’ve seen a robot in aged care. The facility is using the Lamson Robo, which is easily operated with an IOS mobile app, allowing the operator to call and send the robot via a mobile device. Whilst I was visiting they were mapping the building with the robot. The new residents will be involved in naming the robot, with a competition for its name.

The facility has many great features, with a hairdresser,

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massage room, gymnasium, cinema,

 

private dining rooms for family meals, outdoor bar b q, multiple dining and lounge areas and balconies and terraces off rooms. The décor and furniture is all modern and tasteful.

Is The Banking Sector Age Friendly?

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Image by Andreas Breitling

Following on from my last blog Aged Care Services Not Age Friendly (12th April 2019 ) in which I wrote about the Financial Capability of Older People report by the University of SA, examining how the aged in home care and the banking and finance industries were not age friendly, this blog will look at the banking and finance sector. This sector came in for criticism too for not being age friendly, with researchers finding older people faced numerous problems in their financial dealings. This ranged from having trouble understanding foreign voices at overseas call centres and reading tiny print on documents to complicated terms and condition, poor communications by staff and high pressure sales techniques.

The researchers believe both the in home care and finance/banking sectors were in need of an age-friendly revamp with more older-customer focussed services and better staff training.

So it is encouraging to read an article from the Canberra Times that Alzheimer’s Australia has begun rolling out “dementia-friendly” banks with a pilot program beginning in Beyond Bank branches across Canberra.

The bank has begun making changes to its physical environment, considering things like colours, lighting, signage and even the type of fonts it uses to make the branch environment less intimidating. Staff will receive special training to learn about the various obstacles those living with dementia face when doing their daily banking.

Beyond Bank state manager Chris Blight said they wanted to make it easier for people with dementia to stay independent.”We’re working towards having really clean spaces and that welcoming personal tailored solution to help them access their funds,” he said.

The full report The Financial Capability of Older People can be read at: unisabusinessschool.edu.au/financial-capability

Aged Care Service Not Age Friendly

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Extraordinarily, Australia’s aged home care sector has come under some strong criticism for not being age friendly according to a report from the University of South Australia . Older Australians have been left feeling disempowered and lacking in confidence due to its complexities. Research explored the ability of people aged 65 plus to select and financially manage their home care packages;

“Home-care packages support people to stay in their own homes for longer, so they are a really appealing option for people as they age or become less independent,” said lead researcher, Braam Lowies “But our research found that older people felt insecure about their capacity to manage home-care packages to their best advantage and we wanted to understand why.”

What they found was that, although the government had recently increased total aged care spending to $662 million, including the release of 10,000 additional home-care packages, the environment in which the packages are provided was so complicated that many older Australians were unsure of which options best suit their personal situation.

Clients of mine are currently dealing with this very situation. A 96 year old couple are in need of support, having stayed independent until this year. The husband had a bad fall and is now in a rehabilitation unit and will probably need my help as a placement consultant to find accommodation in an aged care facility. However, his wife is keen to stay at home with support. She has found she needs help from her family to even begin the first step of applying for assistance. Without their support she would not be able to access the service on her own.

“We found a host of problems from a general lack of confidence and lack of knowledge of the system among older people, to overly complicated communications, high staff turnover and inadequately trained staff providing in home care, inconsistencies in package administration, confusing fee structures and even inaccurate billing processes” Dr Lowies said “Unfortunately, the more complicated and inaccessible the programs are, the more it creates a lack of confidence and motivation for older people accessing services.”

The banking and finance industry was also examined in the Financial Capability of Older People report and it came in for criticism too for not being age friendly.