Adapting models of care for better dementia outcomes

Jul 16
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Life in Residential Aged Care (RAC) is often associated with living in an institution, and for those with dementia it is even more restricted. While Person Centred Care (PCC) has tried to address some of the issues, residents are still expected to work around our task based routines, from morning showers, to set meal times, activities and bed time to name a few. Yet, we as individuals all shower at different times, eat when we want, and go to bed when we choose! Thus, how can a model of care deliver individualised choice, dignity and wellbeing in a dementia setting? 

While the physical environment within a dementia setting is typically designed to ensure resident security, creating a neighbourhood setting can provide a familiar environment. Minimal clutter and noise are encouraged as are large, open, yet secure areas to allow resident movement.

For the model of care, residents should be allowed to rise, shower, eat and sleep when they choose to. Specific staff assigned to certain neighbourhoods to create familiarity further supports the physical and social environment. Meanwhile, engaging and meaningful activities should be established that suit the individual versus traditional activities.

Guidelines for staff and shifting culture works best as an inter-disciplinary team and staff slowing down to the residents’ pace. Staff should be engaged in particular during sundowning, and allowing residents to go to bed when they want.

Designing and conducting specialised training for staff needs to move from a task based system of “to-do” lists, to a greater focus on service and residents’ involvement in decision making. There should be an inter-disciplinary focus from catering, to allied health professionals, nursing, laundry, and cleaners.

To support more Person Centred Care, residents’ days shouldn’t revolve around tasks and to-do lists. Instead, various Allied Health activities such as Physio, Occupational Therapy and leisure therapies should be individualised and offered at a range of times throughout the 24 hour day. To enable this, care staff should be trained and empowered to engage with residents in meaningful activities after-hours.

Achieving good dementia care will ultimately ensure improved quality of life provided such residents are not institutionalised. It relies on a shift in thinking, staff education, a neighbourhood model and a cohesive inter-disciplinary team.

Criterion’s series of Aged Care conferences cover topics including Choice & Control, Dementia, Retirement Living, Residential Aged Care and more. View upcoming events here.

Aged Care conferences

Submitted by Alasdair MacDonald and Sofia Venuti

Alasdair MacDonald is General Manager Business Innovation & Quality and Sofia is Therapeutic Leisure & Lifestyle Manager, Eastern Suburbs, Sir Moses Montefiore Jewish Home.

2 thoughts on “Adapting models of care for better dementia outcomes

  1. Anyone who has looked after the elderly has often experienced feedback from individuals who may ‘grumble’ about getting up or being woken to be examined in a hospital ward, however, try the alternative, that is, leave the medication for an extra 10mins to enable sleep and you will soon be told off otherwise. Getting older does not necessitate constant observation and change however regardless of age and condition, quality care starts with respect and observation – basic communication skills.

    Quite often routine breaks up the day – waking up, medical visits, breakfast, showering, family and friends visitations, leisure all before lunch.

    Having delivered community meals to elderly residents provides a form of independence allowing people to remain in their own homes surrounded by their own things while acknowledging they may require a little assistance in the form of community assistance that can include nursing, housekeeping or other support. Communication builds trust and security that is paramount particularly for the elderly that often have limited contact with supportive networks such as family and friends that may be due to physical isolation. Having said this, too much exertion that includes options can tire and annoy the individual that can be detrimental to wellbeing. Too many options means confusion.

    Rather than focusing on ‘additional services’ that can confuse and tire out elderly customers, the concentration should be on respect for the individual, that is treating them as a person, not a number or a time slot that Allied Professionals include on their daily schedule. That requires listening to what the customer is saying and sometimes that does not occur, rather another Policy outline documents new changes rather than refining the current formations, that not only upsets but confuses dementia patients.

    Allowing patients to go to bed when they want – how does this work for those involved in shift work and penalty allowances that are slowly disappearing in the era of digital technology? Do patients get their own technical device in care to make their own decisions (remembering some have dementia) to call someone when they want breakfast, a bed change or medication?

    Innovation may outline company KPIs, however, effective communication networks are key to understanding patients and what is possible for professionals to achieve in one day. Ever made an appointment with an elderly person only to turn up on the ‘new allocated time’ and they do not remember the alternative date or time, or they decided today was not a good day for them to receive visitors? (If not you have never looked after an ill relative, standard practice and likewise I have observed this behaviour carried out in hospitals. A battle of wills between the patient and Allied Professional is not effective communication rather a detrimental relationship that will not be placated by ‘you tell me a time when I can come back’).

    Care should not be competitive, rather should be delivered with compassion (regardless of service) and sincerity. The professionalism of Allied Care should not be determined by cost factors alone which is what alternative services in policy quite often amounts to – user pays! Once implemented becomes standard procedure, even for those that never requested Consumer Directed Care additions.

  2. Hi Sofia,
    I have been provided by Cathy Hill, OT an abstract of your pilot study titled ‘The effects of integrated cognitive and sensory program on people with dementia’. What a fantastic piece of work. Do you have the completed research article? or other resources on this topic. We have a cognitive assessment unit at Nambour hospital for people with dementia and this program is what I have been looking for. Thank you for you time and for your reserach into this area.

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