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.

 

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.

Behind The Scenes of The Old People’s Home for 4 Year Olds

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A recent interview by Aged Care Insite with Professor Susan Kurrle, director of the Cognitive Decline Partnership Centre at the University of Sydney, who worked on the recent ABC documentary The Old People’s Home for 4 Year Olds, provides some interesting insights to the program. (Photo from Aged Care Insite)

This experiment is the first of its kind conducted in Australia and Professor Kurrle believes the implications of this successful trial could be huge. The ABC show follows the progress of a group of aged care residents taking part in structured activities with a group of pre-schoolers who visit their aged care home on a regular basis.

The resident-to-resident relationship building that has arisen as a result of the experiment has obvious benefits to health, Professor Kurrle said. It was a surprise side effect of the experiment and those relationships have continued in a healthy way. Some residents felt quite lonely and isolated prior to the trial.

Allowing young children day-to-day contact with their elders can also combat ageism she said. The children who took part also benefited growing in their confidence and interactions and developing of empathy. One particularly touching moment was when one young child, whose parents described him as a “soft soul”, showed empathy for a depressed resident who was not participating or speaking and had his eyes closed, by going up to him and being with him, drawing the resident out until he broke into a beaming smile.

This experiment was the first time that structured activities were used to encourage interactions between the children and adults as they worked together to achieve particular goals. Other intergenerational programs with pre schoolers have not been structured in this way, with the children simply playing side by side with the residents. Professor Kurrle pointed out that humans are pack animals and crave the companionship of family. For residents whose families are far away or unable to visit life can become lonely. This program allowed them the opportunity to interact with young children, as they would with their grand children. The health benefits were proven by standardised health tests before and after the program.

Professor Kurrle assured the interviewer that the children weren’t encouraged by producers on the show to behave in certain ways to develop the story. All behaviour on the show was spontaneous. The only people in the room were the participants, the instructor and some of her assistants to help with the children. The cameras and microphones were hidden.

Suggestions coming out of the success of the program about how to do more intergenerational programs in aged care facilities include encouraging playgroups to set up their activities within aged care facilities. Another was for aged care providers to consider building childcare facilities within their buildings when building a new facility or upgrading an existing one.

Trailer for the ABC program

 

Participants Can Register Online for Dementia Studies

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Were you aware that dementia is the second leading cause of death in Australia? More research is needed to better understand this insidious disease and its effects upon an ageing population. However, finding willing people for trials and research can be difficult for academics with a preliminary review of the Australian and New Zealand Clinical Trials Registry finding that of terminated dementia clinical trials, three in five ceased due to recruitment difficulties.

Now a new website has been developed that matches participants and researchers. Using a similar approach as dating apps participants are matched to researchers based on features that academics need for their studies, such as age, location and diagnosis. The site is called Stepup for Dementia Research. Its program director is Yun-Hee Jeon.

Jeon has seen trials fail first hand and believes that the stigma surrounding dementia is hindering recruitment, hurting those who need help the most.“In my own experience I have seen trials delayed by over a year and budgets blown out due to an inability to find the right research participants. StepUp for Dementia Research is set to change this,” she said.

StepUp for Dementia Research is supported by funding from the Australian Government Department of Health under the Dementia and Aged Care Services Fund. It is delivered by the University of Sydney and was developed in partnership with the University of Exeter and University College London.

When researchers register their studies, they define the kind of people they’re looking for and the StepUp for Dementia Research system matches that description to the information provided by registered volunteers. Researchers can only see participants’ details that match their criteria. If they deem a registered participant is suitable they will contact them direct to explain the research and ask if they would like to participate.

Anyone over the age of 18 can register, whether living with dementia or not. Health and aged care providers are encouraged to refer suitable people to the website and a range of promotional materials, such as brochures and posters will soon be distributed by Sydney University.

Jane Thompson was a carer for her husband Alan who had Alzheimer’s. She found the experience very challenging and difficult and now advocates for more research into dementia. She said “I would really encourage people to participate in research studies – and also to consider contributing to the research process more broadly to help ensure that the focus is on areas most likely to impact the lives of whom the research is about.”

For more information call 1800 – STEP – 123 (1800-7837-123) or email stepup.research@sydney.edu.au or visit the website.

 

Thanks to Aged Care Insite.  Listen to their interview with Yun-Hee Jeon.

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

Improving the Quality of Life for Residents in Aged Care

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Many approaches are being tried in aged care facilities to improve the quality of life for residents. As a Placement Consultant I like to know that my clients will enjoy a contented and engaging life once they move into an aged care home, that not only will their physical needs be taken care of but their emotional, spiritual and intellectual needs too. Some fine examples of programs that help provide a good quality of life are discussed below:

Music therapist Heather Seyhun at ACH West Park Adelaide, brought in her own collection of drums from Africa and Brazil to begin a music trial she devised. Three months on, she says she’s amazed at how the group has evolved and the positive changes she has witnessed.

“When we started out, people were a bit unsure, because most had never hit a drum before, and felt outside their comfort zone,” she says. “Now they’re loving it, and they’re getting really good.”

Heather has seen improvements in wellbeing, socialisation, self-confidence and mobility. “You can see the enjoyment, the new friendships – playing music with others creates a special bond.” she says “Watching people with physical limitation participating, growing in confidence and supporting each other is so rewarding.”

A Zen Garden has been created at St. Patrick’s Green, Kogarah, NSW, based on the philosophy that a bit of nature is good for the soul and will allow residents to relax and meditate, among the sounds of a water feature and rustling palms.

Other wellbeing rooms are the Spa Room and Reflection Room. Residents can enjoy a soothing massage experience, complete with lavender essential oils, calming music, facials and other beauty treatments for a complete pamper experience.

The Reflection Room provides a tranquil space for residents to reflect on life, away from the bustle of communal areas. It also acts as a private space for residents to meet with the manager of Spiritual and Holistic Care if anything is troubling them.

Some therapies that research have found to be effective are:

Animals and pet therapy;Aromatherapy; Art therapy and craft; Behavioural activation and pleasant events; Bright light therapy; Cognitive behaviour therapy; Cognitive and memory skills interventions; Companion robot; Dance and movement;Dementia care mapping; Humour therapy; Laughter yoga; Life review; Life review therapy; Massage; Music and singing; Person-centred care; Restorative approaches; Simple reminiscence;Yoga.

More indepth information is available in the studyWhat works to promote emotional wellbeing in older people: A guide for aged care staff working in community or residential care settings. Melbourne: beyondblue by Wells, Y., Bhar, S., Kinsella, G., Kowalski, C., Merkes, M., Patchett, A., Salzmann, B., Teshuva, K., & van Holsteyn, J. (2014).

 

 

 

 

 

Montessori Method Helps Those Living With Dementia

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American Montessori expert Dr. Cameron Camp has developed a new approach to caring for persons living with dementia. This new approach is known as The Montessori Inspired Lifestyle ® (MIL). It is based on the philosophy and methods of Dr. Maria Montessori, the first female M.D. in Italy and world-renowned educator.

“Within this new paradigm, abilities, interests, and preferences will be respected, encouraged and maximized. Providing choice throughout the day is central to all interactions.” Said Dr. Camp “Central to MIL is the creation of meaningful activities and social roles within the context of a community. This helps to ensure that residents are engaged in life, have a feeling of belonging, have a sense of purpose, have access to meaningful activity, and can have a sense of control and independence.”

Having done a 3 week course with Omnicare Alliance to learn about Montessori and apply the principles and methods in her own home where she resides with her husband who lives with dementia, Susan was blown away by his progress.

“We have a bunch of signs around the house with cartoon pictures for Jim now that ask him questions. ‘Have you taken the bin out?’ or ‘Do you have your house keys?’ she explains “This actually gets him to think and engage with himself which is a big part of learning.” She has realised that if she communicates in a simple way with her husband he will understand and be able to help with chores. Rather than tell him to cut carrots into cubes, for example, she now models instructions, showing him how she wants them cut. He is then perfectly capable of carrying out her request.

The Montessori Method utilises simple, modifiable and practical tasks that utilise everyday items to re-engage individuals and help to retrain skills that may have diminished due to dementia. A person’s abilities are closely tied to their life experiences and passions, and identifying these passions and harnessing them to rekindle and engage a person is the essence of what makes Montessori training and learning effective. For instance, if a woman grew up playing the piano, music may be the key to her learning and engaging, but if she enjoyed gardening instead, then heading outdoors and incorporating seeds and plants into her activities, may be the key in helping her rediscover some old skills.

As an Aged Care Placement Consultant I would love to see this method used in more aged care facilities. With the current strong focus on the quality of care I hope providers are taking note of Dr. Camp’s new approach.

 

 

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

 

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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.

 

 

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.