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.

 

Aged Care Minister Colbek’s Response to Covid 19

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On Friday 22nd August the Senate Select Committee on COVID-19 in Aged Care Facilities interviewed the Aged Care Minister, Minister Colbek, for the second time.

He began well by thanking all workers in aged care facilities – personal carers, nurses, cleaners and cooks. He stated that they deal with confronting situations, that they can be scared for their own health but continue to turn up to work.

He said “We need them. They are at times unfairly scrutinised.” He went on to claim that the government …” can always do better.We will continue to work to be prepared to have resources as best we can, particularly to support the Victorian government to get the community transition under control.”

Then he stumbled. As he was being questioned about whether his department was doing its job protecting the elderly from COVID-19 in federally funded and regulated nursing homes the Senator was unable to answer how many residents had died in Victorian aged care facilities and how many current active cases there were.

Eventually a staff member told the inquiry that as of 8:00am on Thursday, 20 August 254 residents in aged care facilities had died due to Covid-19, there were 1811 active cases, with 239 recovered.

According to Anne Connelly of the ABC in her report today the Prime Minister claimed in Parliament Question Time on Monday (24th August) that of the 126 nursing homes affected by Corona Virus in Victoria only 16 have experienced a “significant” impact from COVID-19; four have had a “severe” impact and, as of yesterday morning, the number that have been “significantly impacted has been reduced to three”.

She also reported that Prime Minister Morrison and Aged Care Minister Colbeck spent yesterday’s Question Time arguing that the many plans, emails, guidelines and webinars which were sent to the aged care sector equated to effective preparation and that high levels of community transmission were to blame.

This was obviously in response to the question on Friday in the Senate Hearing where Minister Colbeck was quizzed about what support the federal government gave the aged care sector to help it prepare prior to the community spread of the Corona Virus outbreak.

Minister Colbeck mentioned at the hearing that the federal government were spending $171M for the aged care response to Covid-19 and they had set up a Disability Response centre in Victoria with $15M in funding split between the federal government and Victorian government.

The lives of those most vulnerable in aged care facilities must be given the respect and care they deserve. Ensuring the aged care providers have sufficient information, easy to follow guidelines, staffing support and adequate protective equipment is the job of the government. Both State and Federal governments have a critical role to play and they must work together in harmony to protect the elderly under their umbrella of care.

Jillian Slade is a Placement Consultant for aged care.

 

 

 

 

 

Roller Coaster Ride Placement in Aged Care

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Since earlier in the year when Covid-19 made its way to Australia it’s been a roller coaster ride in my job as a Placement Consultant for Aged Care Accommodation. In Melbourne all went quiet with families tending to keep their loved ones at home during the original lockdown in March and April and then it got very busy when restrictions were lifted in mid May. I was suddenly fielding multiple enquiries and arranging tours again as most aged care facilities had recommenced showing their homes to potential residents. They had also relaxed the isolation period for residents entering care on either a permanent or respite basis. Then lockdown restrictions were again enforced on 9th July.

Up To Date Information

Gathering information for my clients about care and fees for each aged care facility and arranging tours (when available) has became more labour intensive as each facility has different procedures for touring and admissions during these restrictions.  As the health restrictions change so do the facilities’ procedures, making it an ongoing task. For prospective residents it is very difficult to navigate and they rely on my gathering the correct information and providing advice.

Of course they wonder if the different procedures will guarantee that they will be safer and less likely to catch Covid-19. It is very difficult to assess the likely outcome between the different procedures in each facility. One can only make an educated guess based on the Health Experts’ advice.

More Seeking Aged Care Accommodation

During this second lockdown I am finding there is a big difference in the number of enquiries I am receiving from families needing to place their loved ones in aged care. I think families held off from having their loved ones admitted to an aged care home during the first wave, and now that we have a second wave they can’t continue to hold out until we are Covid-free, as there is no knowing how long it will be.

However, with such a large developing number of aged care homes in Victoria reporting cases of Covid-19, clients who had chosen their new home last week are now questioning whether it is safer to stay at home until aged care homes are clear of the virus.

Screening Process 

All aged care homes have a similar screening process for residents before entering a home. Everyone must show evidence of a current flu vaccination, submit to a temperature check and answer questions relating to general health and whether they’ve had contact with someone who might have Covid-19.

Restrictions on Touring Aged Care Faciilties

As Victoria is now in Stage 3 restrictions, most aged care homes have suspended all ‘meet & greet’ appointments for tours. Meetings can be arranged so that a client can speak to the staff over the phone, via Skype, Zoom or Face Time. Intending residents can view photos of the home’s interiors and suites and have virtual tours. There are still some aged care homes that provide restricted tours allowing viewing only of the resident’s proposed new bedroom with no interaction with other residents in the home.

Professional Help

I’m finding that now, more than ever, people are seeking my help as a Placement Consultant to find the most suitable aged care facility for their loved one or a client. With so many variables to consider now and a changing landscape it is a comfort to many to be able to use a professional to assist them.

 

 

 

 

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.

 

Bereavement Can Be A Risk Factor

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We know Shakespeare’s tragic story of two young lovers who both lost their lives through bereavement. Romeo and Juliet are the quintessential lovers, forever in love. In their tale they took their own lives due to the grief of losing their loved one, but studies have found that a bereaved person is actually at a higher risk of dying due to health problems. Following the loss of a loved one it has been found that often a person will experience increased heart rate, blood pressure and blood clotting, as well as increases in symptoms of anxiety and depression. The expression dying from a broken heart takes on a clinical meaning.

A randomised clinical trial at the University of Sydney lead by Professor Geoffrey Tofler looked at a total of 85 people and showed that it is possible to reduce several cardiac risk factors during this time, without adversely affecting the grieving process. The oldest person in the study was 85 years of age with the average age of all subjects in the study being 66.

Following on from previous studies on cardiac health risks, increased depression and anxiety after bereavement Professor Tofler noted “However, there have been no interventions to address this with the goal of lowering cardiac risk, so we aimed to provide this with an approach that does not adversely affect the grief process.”

Forty-two subjects received low daily doses of a beta blocker and aspirin for six weeks, whilst the control group of 43 were given placebos. Heart rate and blood pressure were carefully monitored, and blood tests assessed blood clotting changes.

“The main finding was that the active medication, used in a low dose once a day, successfully reduced spikes in blood pressure and heart rate, as well as demonstrating some positive change in blood clotting tendency,” Tofler said.

The investigators also carefully monitored the grief reaction of participants.

“We were reassured that the medication had no adverse effect on the psychological responses, and indeed lessened symptoms of anxiety and depression.”

Professor Tofler advocates the use of this therapy as a risk prevention strategy in those recently bereaved. He also encouraged the medical profession to give extra attention to the health of recently bereaved people,rRobson-and-Jeromeeople, as well as family and friends, who should provide social support and report any health symptoms to medical practitioners.

 

 

Opposition Leader’s Vision for Aged Care

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Pictured Leader of the Opposition, Anthony Albanese

The release in recent weeks of the interim report on the Royal Commission into Aged Care has raised responses from both the Federal government and the opposition. Leader of the Opposition, Anthony Albanese spoke this week about Labor’s response. Firstly, he reaffirmed Labor’s pledge from their last election campaign to enact a dental plan for pensioners and also spoke of funding better pay for the aged care workforce. He also said that the ACAT (aged care assessment system)won’t be privatised under his leadership.

COTA chief executive Ian Yates agreed with the Opposition Leader’s assessment that older Australians are a diverse group of people who cannot be treated all the same.

“They require a diverse policy response that addresses issues across employment, health, finance, care, welfare and industrial relations, which I expect Labor’s proposed Positive Ageing Strategy would address” said Mr Yates. He did disagree with Mr. Albanese on one point, however, the characterisation of the Federal Government’s response to the interim report with a planned single aged care assessment system as ‘privatisation’. “A single consumer-focused professional national assessment service with many local access points has been recommended for years by successive reviews and by COTA and the National Aged Care Alliance. This is an essential front door for a reformed aged care system” he said.

Mr. Albanese also spoke highly of the experiment on intergenerational aged care, as documented on the ABC program “ Old People’s Home For 4 Year Olds”. It has given him a vision for the future of elderly people who live at home with their families going to daycare with kindergarten children on a regular basis, brightening their days and, with the proven physical and mental health improvements shown in the experiment, keeping them healthier.

After all my years working in the aged care sectorI am thrilled to atlast see some positive responses coming out of this long, drawn out Royal Commission. We have heard so many sad stories so it gives me a sense of hope that governments will take a strong lead in ensuring aged care is of the highest quality, providing a positive and enjoyable lifestyle for older Australians whether living at home or in an aged care facility.

Aged Care Assessments Put To Tender

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Aged care assessments are soon to be put to tender and there are concerns about potential conflicts of interest arising from assessors aligned with single organisations or modes of care.

As a Placement Consultant I was very interested in claims made by HelloCare magazine that voices in the industry have raised concerns with them that conflicts of interest may mean vulnerable older people miss out on the care they need.

According to the Department of health website “Under the new arrangements, a single assessment workforce and a network of assessment organisations will assess eligibility for access to all government-funded aged care services. The new single assessment workforce will replace the two current assessment workforces:

  • the Regional Assessment Service (RAS)
  • Aged Care Assessment Teams (ACATs).”

The Health Department states that under this new arrangement assessments will be quicker, enabling older Australians to access Commonwealth Home Support Programme (CHSP) services, Home Care Packages and residential care faster.

Assessment organisations will be selected through a national tender process which will take place in 2020. The new arrangement will come into effect in April 2021.

The concerns raised are that assessors may be tempted to refer customers only to their own service rather than present a range of options to choose from. In particular, if home care providers do assessments they may encourage the elderly person to stay in their own home when perhaps residential care would be a more suitable option for them.

In these situations, consumers may potentially not receive the most sound advice and level of care they need, putting them at risk. Therefore it is of great concern and importance which types of services are allowed to assess people for aged care.

A statement from the Department of Health to HelloCare received on 9 January 2020 said processes will be put in place to ensure that aged care providers will not be able to benefit from assessments they perform.

“The Government will ensure that companies that run aged care services are not advantaged by being associated with an assessment organisation,” the statement said.

An update on the development of this new aged care assessment arrangement will be held as a webinar by the Health Department on Wednesday 12 February 2020.

As participants will have the opportunity to ask questions I highly recommended anyone in the industry or interested in aged care attend the webinar. More information here 

Fires Force Evacuation of Aged Care Home

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On New Year’s Eve mega fires near Mallacoota, in the East Gippsland region of Victoria, forced approximately four thousand holidaymakers and locals onto the beach as a last refuge. Fortunately all survived.

The intensity and speed of the fires was far worse than predicted – and they were soon moving north at a great pace, towards the popular tourist towns of Eden and Merimbula in New South Wales. The fire became known as the ‘border fire’.

People in Eden sheltered on the wharf as they watched the town’s chip mill catch fire. Pictured above: wood chips burn at the local timber mill in Eden (Image:AAP).

The people of Eden were told to leave and evacuate to the next town, Merimbula.
Evacuees flooded into Merimbula’s bowling club (known as the Sapphire Club or the “Bowlo”). After the first day, 3 January, the club was totally full, with 1000 people. The Bega Valley Shire Council then also appointed the town’s other club, the RSL Club and the nearby Country Club, as evacuation centres to take in more evacuees.

Emergency services advised that residents of aged care facilities in Eden should be evacuated and some were moved to the RSL Lifecare aged care facility in Merimbula. They were the fortunate ones as there was room available for them. Others were moved to a newly constructed aged care facility in nearby capital city Canberra that had not yet opened, three hours travel away, whilst the overflow were looked after at a makeshift medical centre at the evacuation centre at the bowling club. A nurse was on duty to attend to those at the evacuation centre.

Whilst the fires in the area have been contained following milder weather conditions and an influx of resources, such as helicopters, planes, the army and extra police, they are not yet out and continue to be a threat to the region. As a precaution many of the Eden residents still remain in the Merimbula aged care facility.

I am a Placement Consultant. My job is to find suitable aged care accommodation for clients. I know how stressful it can be finding the right accommodation for a loved one and my role is to minimise the stress, time and cost to my clients. I feel for all those involved in the bushfire regions and send my best wishes and support for both the aged residents needing to be evacuated and those entrusted with their care and the responsibiity for evacuating them to suitable accommodation.

 

 

 

 

 

 

 

 

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.