Rural Northwest Health

Warracknabeal

4 types of dementia care in

residential care

•1. Prison type

• 2. Hospital type

• 3. Hotel type

• 4. Home like

Supporting the person

Supporting the environment

The Capability Model focuses on:

The focus of Montessori Methods for Dementia is on the • abilities, needs, interests and strengths of people

living with dementia. • these methods focus on creating worthwhile roles,

routines and activities for the person, while also supporting the person’s environment.

Montessori

WATTLE

CRESCENT 15 Bed Memory Support Unit

•Medications

•Staff

• Pacing and wandered aimlessly

• Physical aggression

• Verbal aggression

Staff survey results

June 2011

Agree

3. There is a homely feel to the place. 8%

8. I would like to live here if I had dementia. 8%

18. Challenging behaviours are inevitable with

dementia

62%

33. In my workplace residents are given opportunities to perform

tasks according to their abilities.

38%

34. The life history of the residents is formally used in the care

plans we use. 31%

38. Residents are offered the opportunity

to be involved in individualised

everyday activities.

38%

Leadership and Organisational Culture Principle

Top down and bottom up ownership of the culture change

Staff meetings that focus on support, mentoring and resolving and discussing challenges

Communication plans with families, staff, Board of Management, GP‘s , the community

Staff ownership of changes that are occurring is encouraged and supported

Regular communication to the top governance group

The right people with the right skills are placed in key positions, including trainers and consultants.

Support and development of key leaders is provided to drive the change and improve and innovate when necessary

A project manager is essential

Investment

For training/mentoring

For physical environment changes and equipment

For research

For spending time with families and stakeholders

Continuous Improvement

Development of an action plan where steps are evaluated regularly

Maintaining the focus on the other requirements ACFI, accreditation.

Resident and Family

Background principle

We work together with families and carers and volunteers to develop and provide meaningful activities and roles that reflect the person‘s likes, history and dreams

We recognise and value loved ones and their contribution to the person‘s wellbeing

Families and carers contribute to the development of digital stories

We offer a range of opportunities that include art and music therapy and getting your hands dirty with gardens and chickens

The competency matrix is continually reassessed to ensure that the organisation has the right skill mix available to provide care

We value every person‘s contribution and say ‗Thank you ‗

Resident and Family

Environment Principle

Montessori principles are utilised to improve and enhance the environment

Do something to the environment, small changes can make it better

Indoor/outdoor/quiet tranquil and busy spots need to be found in each area

The focus is still on doing what you can so the environment needs places to rest and stop, help you to stand and sit

Resident and Family

Ability and capability focused principle

Montessori principles and activities are embraced and practiced by all staff. The principles are to enable

individuals to be as independent as possible, • to have a meaningful place in their community, • to possess high self-esteem, and • to have the chance to make meaningful contributions to their community.

Activities, roles and events reflect an individuals history of likes, dislikes, skills and dreams

Memories are made and shared, loved ones contribute to activities and events that occur in the aged care facility. Storytelling and picture boards allow all to share what is happening

The environment supports people to remember what to do and provides physical aids and memory cues to assist them physically and cognitively and the culture supports staff to allow the individual to do what they can.

Meal times are quiet with flexible times and residents having the ability to chose their own food

Assessments undertaken focus on capability not disability , including reading, sensory capability, life skills, safety and risk and the focus is on quality of life as well as legislation requirements

Resident and Family

Capability Model

Fundamental Principles for

success

Abilities and Capabilities

Background – focus on the individual

Leadership and organisational culture

Environment – physically stimulating, welcoming and ability focused

At the start of the development of the model

• 78% of residents were on psychotropic drugs, the model

has allowed us to cease 99% of this drug administration

• 67% of residents were on sedation and only now 22% of

residents are on sedation.

• Behaviour of unmet needs have reduced significantly from

occurring hourly or daily to one or two times a week to

never occurring.

• Improvement in Psychogeriatric Assessment Scale

Scores

• Improved family satisfaction and engagement

Staff have understood what we are

trying to achieve • For assessing how we are travelling on changing the

culture we have used the

• Person-centred care Assessment Tool (P-CAT)

• Tool for undertaking Residents needs as individual

Persons (TURNIP)

Comments from family members to

the senate inquiry • Mr Brown: Here they were always doing courses and keeping

up with what is going on. Some of the girls have even gone back to do the nurses training.

• Senator MOORE: That kind of knowledge adds to the atmosphere, doesn't it?

• Mr Brown: Yes. They are just so happy because the staff calls them by their first name. It is not 'Mrs'. Some days they laugh and joke with them. It is just great.

• CHAIR: A good atmosphere.

• Mr Brown: Yes, and I think that makes them feel better.

• Dr Smith: The staff seem to like working in the dementia wing more than the others.

• Mr Brown: That is right.

• Dr Smith: Because you could see the improvement in the residents. It is rehabilitation they are doing here, not just caring. It is actually making them better than when they came in.

Comments from family members to

the senate inquiry • The other thing is the activities they have with the school, the

kindergarten. They take them down to see the little ones—her and Pat, who I know, and one of the other ladies—and as soon as you get here she will tell you all about the day that she has had with the kids. Apparently, on the first time she went there, one little fella came up and wanted to give her a kiss; she let him, and she tells you about that all the time. Now she has a photo of this little bloke, although she doesn't know his name. But having the interaction with others outside, and their families, I think is a magic process—the garden, the chooks, just everything. The other day I brought over some little yellow ducks and it was just magic, a great afternoon.

• As I said, they have still got feelings. I think that is one of the things we have to remember—they are still human beings, they are still part of our families. We have just become a bigger family now. As I said, having them off drugs is better. She is very proud of her room, too; it is private, she can take you in there. She loves it in the lolly shop, which is another thing—making the brain work. Just everything about it is a pleasure.

Results for staff as part of the HWA

project • Have you changed how you work with residents?

• We are now working with residents better and have a

better understanding of dementia

• We are no longer rushing to do things and we are taking

more time to support residents continuing to be

independent

• We work to create an activity which might interest the

resident rather than them sitting there and doing nothing

• Staff now ask residents to do something with them for

every activity. We can‘t go to the front office without taking

a resident with us.

Have you seen any changes in

residents since they became

involved with the project? If so, what?

• Yes, massive changes, it is a very happy unit. We have to have the right skills/skill mix.

• Generally there are huge changes e.g. dexterity work with a resident who had a stroke has

• built this strength back up so he can now feed himself.

• From 20 years ago it is the biggest leap.

• Was pessimistic but I can see the benefits.

• Yes, definitely. Residents are happier.

• When I am working in Wattle half the time I don‘t know they have dementia and it is only later when doing the pills and there is a problem.

• Before the residents would have been sitting and doing nothing. It was very limited in previous ―world‖ and residents are more engaged and doing activities of daily living e.g. folding, ironing. Residents definitely seem happier and there is more communication between them.

The Care Environment Pre

implementation Agree

Now Agree

1. The environment supports residents to express their personal identity

24% 100%

3. There is a homely feel to the place. 8% 100%

6. There is a pleasant atmosphere. 40% 100%

8. I would like to live here if I had dementia.

8% 80%

The Care Organisation Pre

implementation

Agree

Now Agree

23. It is necessary to hurry residents to accomplish all that has to be done

33% 0%

25. This organisation prevents me from providing person-centred care.

31% 7%

29. I simply do not have the time to provide person-centred care

31% 13%

Staff member’s attitudes

towards dementia

Pre

implementation

Agree

Now Agree

15. People with dementia should be allowed to form sexual relationships.

34% 47%

The Content of Care Pre implementation

Agree

Now Agree

31. Residents are involved in care decisions when they can.

69% 100%

32. We have formal team meetings to discuss residents’ care

46% 93%

33. In my workplace residents are given

opportunities to perform tasks according to their abilities.

38% 100%

34. The life history of the residents is formally

used in the care plans we use. 31% 93%

35. Assessment of residents’ needs is undertaken on a daily basis.

46% 100%

36. Residents can wake up and start the day when they prefer

54% 100%

37. Residents have a variety of foods to choose from.

38% 100%

38. Residents are offered the opportunity to be

involved in individualised everyday activities.

38% 100%

39. Residents can choose between interacting with others and being alone.

62% 93%