Download - Victoria Jacques - Villa Maria - Transitional Care: An Emotional Journey from Home to Care
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Moving into aged care- not a cause for celebration?
Victoria Jacques General Manager Residential Services
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Decision has been made
• No happy campers • Visit to the site • Measure up the room • Does the furniture fit? • The reality • I am old!
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Admission
• Warn families that it can take up to 2-3 hrs for admission • Guilt is heightened during admission- reality sinks in • Resident fuels the situation • Blames the child if they have forgotton something • Not unusual to see mocking of the child
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Transition Experience
• First 6 weeks normally traumatizing for new residents and families
• Guilt, Grief, loss • Packing up memories • Deciding what to keep and what to take • Financial considerations- sell the home • Bond or daily accommodation fees- New fee structure in
July 2014 • Taking my mother away from her own home ‘and her cats’
was the most trauma7c and saddest event I have ever had to cope with in my en7re life (adult child)
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Having Friendship is important
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Villa Maria/Swinburne Program
• New facility in Wantirna admitted over 220 residents in a period of 12 months
• Experience of staff – feedback that they felt overwhelmed by the emotional needs of residents and families
• Centre Manager developed family groups where debriefing took place –sharing of guilt and grief
• Individual counselling for residents specifically referred for depression and complex needs
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Villa Maria/Swinburne Program
• Swinburne/Villa Maria program • Identify Residents with depression and dementia • Encouraged staff to look at complex residents and family
issues • Offer One on one counselling • Quality of life indicators measured • Cornell scale for depression • Nursing staff referred to the social worker and then screened
for suitability to the program
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Villa Maria/Swinburne Program
• Residents did not oJen miss their appointments • A chance to talk to someone for an hour • Gave staff an alternaOve to drugs/lifestyle DATA Number of counselling appointments made= 64 Number of counselling appointment kept=61 Number of counselling appointments per resident (on average)=8.7 1 Amount of counselling Ome provided (in total)=3660 Amount of counselling Ome provided per appointment= 60 mins
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Villa Maria/Swinburne Program
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Resident Baseline Post-treatment
VM 3 2 MM 16 9 RC 18 8 Average 12.33 6.3
Preliminary evaluation of benefits to clients, as perceived by staff and by the client
Cornell scale for depression
Alexopoulos, G. S., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23(3), 271-284. doi: 10.1016/0006-3223(88)90038-8
These results show that depression severity reduced by half by the end of counselling, compared to the start.
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Counselling Feedback
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Enabled me to accept my situaOon to be able to talk through my situaOon I’m in” “To have a conversaOon with an independent person knowing it was confidenOal”
•The Quality of Life Scale – Alzheimer’s Disease (QOL-‐AD) Logsdon, R. G., Gibbons, L. E., McCurry, S. M., & Teri, L. (2002). Assessing Quality of Life in Older Adults With CogniOve Impairment. PsychosomaOc Medicine, 64(3), 510-‐519. • 66% of residents had an improvement in quality of life indicators
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Dementia and Carers -what helps?
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Acknowledge the emotional impact of the transition into Aged Care on the carer and the person with dementia by using a person-centred approach to care.
• Provide education about dementia to carers of residents with dementia as well as all staff working in the facility.
• Instigate consumer groups within each facility to hear the voice of the carers and/or support carers to join dementia carer support groups in the community.
•
I don’t think it could have been improved; the social worker made my job very easy and the staff in the home also helped make the move less stressful (carer)
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Villa Maria Interventions to reduce hospital admissions and minimize risks
• Provide nursing and medical expertise in the home- • All staff trained in dementia specific skills and clear dementia
strategy • Difficult discussions made • Futile interventions are avoided • All residents are encouraged to have an End of Life
discussion
Villa Maria rate – 60% of all residents have an ACP across four facilities. This is unusual across aged care.
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