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An aged care resident wept when staff at his nursing home served his meal for the first time on a plate he could eat from independently, without having to use the plate guards that had previously made him stand out from all the other residents. At Aged Care Royal Commission hearings earlier this month, Lindy Twyford, hospitality manager with the Royal Freemasons’ Benevolent Institution, told this story, explaining how improvements in the way food is served in aged care can make a world of difference to residents, not only enabling them to retain their independence when eating, but also preserving their dignity and self-respect. HelloCare reached out to Ms Twyford, to find out more about the plates, and her approach to serving meals at RFBI, where she has worked for 27 years.   Plastic guards on plates ‘embarrassing’ Ms Twyford explained that sometimes plastic guards are put around plates for residents who need help eating their meals. These guards can leave residents who need them feeling stigmatized, embarrassed, and ‘different’ to the other residents.  But Ms Twyford said she has found a way around using the plastic guards with specially designed crockery. Comfort plates provide ‘invisible’ assistance “We have found a comfort plate that is a bit higher at one end that allows the resident to feed themselves without looking different, without being singled out as having to have assistance,” she said. “One gentleman, when he used it, he cried and said how he wasn’t different any more. He felt special,” she said. The plates are part of Tomkin’s Schonwald Donna Senior range, and they offer a range of different formats to address different needs in residential aged care. They have a wide rim which makes them easy to pick up, and the raised edge helps diners pick up food more easily, even if they have weak or unsteady hands. As well as having a lip on one side, they have a ring around the inside which helps residents see how much food is on their plates. The plates are used throughout RFBI’s Lake Haven facility, where Ms Twyford works, and they have been so popular they have now been rolled out to other facilities too.  The plates are made from good-quality china, which creates a sense of occasion around meal time and lets the residents know they are important.  “It’s made the lives of our residents really special for eating time,” Ms Twyford said. The same range is used for all residents, so everyone feels the same, with modified plates used for those who need them - however, the difference is invisible, so there is no stigma associated with using them.  The modified crockery enables the residents to feed themselves. Brooke Hutchens, representing the royal commission, asked Mr Twyford, “How important is it to those residents to be able to maintain the independence of eating through the use of those types of those aids? “Very important,” Ms Twyford replied. Innovations that promote dignity and independence are helpful  “Anything that improves and promotes independence is a great idea,” Cherie Hugo, dietician and founder of The Lantern Project told HelloCare. “In a climate where there is pressure on staff, anything that promotes independence and reduces the burden on care staff sounds like a winner,” she said. Innovations that promote residents’ dignity are always positive, she said. “Plate guards have served their purpose, but to normalise dining sounds like a good innovation,” she said. Other innovations: shawls, and mugs for the sight impaired Ms Twyford told HelloCare she has also introduced other meal-time innovations at RFBI Lake Haven. “I’m always looking for ways to improve their dignity,” she told HelloCare. She has introduced new clothes protectors which are designed to look like shawls. Ms Twyford said she doesn’t like the look of the plastic bibs that are often used in aged care, and she said residents often become dependent on them. In the same crockery range, RFBI uses cups that have coloured spots to enable sight-impaired residents to know where to put the cup so it won’t spill. The cups also have a higher lip.  She’s also looking for new cups, and would like to use glass. She said people use glass at home, so why shouldn’t they use glass when they’re living in a nursing home? Prize-winning innovations The innovations Ms Twyford has introduced at RFBI have contributed to her being nominated for - and winning - a number of high-profile awards.  She was the 2018 national winner of SoupedUp’s Hospitality Manager award. In 2018, she also won first place at the Hospitality and Lifestyle Aged Care Awards for her outstanding commitment to improving the quality of resident care. She was also a finalist in the catering innovation category. Of course, what works for one may not work for others, but Ms Twyford’s innovations are certainly improving the lives of residents at RFBI. By seeing where problems lie, and proactively setting about finding a solution, she is the changing lives of the aged care residents where she works for the better. What successful innovations have you seen introduced at your nursing home?  

The post Comfort plates: the crockery that helps residents to eat independently appeared first on HelloCare.

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The title of this year’s Victorian Healthcare Week Great Debate was: Do We Need Mandated Staffing Ratios in Aged Care? Are we better off focusing on the quality outcomes for older Australians rather than mandated staffing ratios? Lisa Giacomelli (Chief Operating Officer YMCA NSW) and I (Director, Aged Care Matters) received an invitation to speak on the opposing team. We were told we had been specially selected based not only on our expertise but also our ability to marry humour with intellect. Lisa presented a strong case to show that mandating ratios does not guarantee quality.  Lisa used examples from the childcare industry, an industry that has mandated ratios. “I have worked in the child care industry for nearly a decade. Ratios are mandated there and services are audited and checked by the regulator to ensure they are 'in ratio'. "When something occurs in a service when things don’t go to plan, the first question asked is always: 'Are we in ratio?' And I can tell you the answer is almost always 'yes'. "Being in ratio does not prevent poor practice, it does not prevent care standards being upheld, or staff taking their eye off what they are meant to be doing, or clients acting in a way that wasn’t anticipated, or allergic reactions to medication or accidents, nor does it prevent policies and procedures being breached. "In fact, ratios can have the opposite effect. The need to be ‘in ratio’ (a golden term in the children’s services industry) causes all kinds of stress for coordinators and directors who spend their time finding staff and managing rosters rather than focussing on quality of care, listening to the voices of children and dynamic educational leadership. It’s hard to be inspiring when you are struggling to ‘stay in ratio’. "Mandated ratios result in a higher reliance on agency staff which, due to the inconsistent nature of agency staff who do not understand the service or know the children, can create inconsistency of care, lack of commitment to the service and the role and undermine the safety that children feel in a familiar and consistent environment. Agency staff, whilst doing their best, just cannot have the same engagement with service and organisational culture, or with clients than long serving staff can. "They also create a false sense of security. It is not difficult to envisage services believing that as long as we are ‘in ratio’ we are offering good quality, engaged and inspired care. Management and leadership can take their focus off what staff are doing to focus on how many staff are doing it. Leadership becomes more about rosters and less about staff development, more about regulation and less about client experience, more about ‘not getting caught out’ and less about the very people that aged care services are there to serve. This is the danger of ratios and they can be dangerous. "If you want to mandate quality care – mandate engagement with clients, families and communities. Ensure that staff culture is positive, resilient and empowering. Train the best and brightest and pay them that way.” Sarah began by asking the audience to raise their hands if they wanted all older people living in all aged care homes to have the best quality of life possible. As you would expect, there was a sea of raised hands. “I am a public health researcher and aged care advocate. My research shows there are good aged care homes. However, anybody who has paid even the slightest attention to the Royal Commission on Aged Care Quality and Safety knows that not all aged care homes are good. "In any profit-based system that relies on government subsidies, like pink batts, private colleges and aged care, there are always some shonky providers. These shonky providers thrive because of systemic and regulatory failures. "Will the systemic problems in aged care be miraculously fixed by mandating staff ratios? The answer is indisputably 'No'. A shonky provider will make up the numbers with the cheapest, most unqualified staff possible. "My colleague has presented a strong case to show you that mandating staff ratios in childcare centres does not guarantee quality. To the opposition, I say: 'Be careful what you wish for'. "The opposition has used the same arguments that have been shouted for years. These arguments regularly appear as memes on social media. In response, the peak bodies for providers tweet their own memes. The memes and tweetsgo back and forth but nothing changes. "It is unusual for an aged care advocate not to support mandating staff ratios. Other aged care advocates get very exasperated with me. They tell me it is simply 'common sense' that more staff on duty = better service. This was certainly not the case at my local café last Friday when 2 regular, experienced, competent and cute waiters were sick. They were replaced with 2 agency staff who knew nothing about how the café operated – not even how to use the coffee machine or where to find the tomato sauce. They did not improve the quality of the service. In fact, they reduced it. "To address the systemic issues in the aged care sector, we desperately need ethical leadership. We need someone with a kind heart and open mind who can see past the vested interests. We need a Nelson Mandela, Jacinda Adhern or Greta Thunberg. "During the past few years, the usual suspects have shouted for staff ratios. The other usual suspects have shouted for more government money. There has been a lot of noise but no leadership. "Good leaders bring people with diverse views with them. They build consensus not division. "So what should an aged care leader do? "Firstly, they should listen to all key stakeholders – not just those with the loudest voice. They would also listen to staff, families, community members and, most importantly older people themselves. They would then bring all key stakeholders to the negotiating table. "A good leader would put something achievable on the negotiating table – something that all key stakeholders may agree on. I propose we start with staff transparency. "Yesterday, Rebekha Sharkie re-introduced her Private Members Bill that requires every aged care home to disclose and publish quarterly staff/resident ratios. "Shonky providers will lobby against this legislation. However, good aged care homes with high numbers of well-trained staff have nothing to fear from staff transparency. "When we have accurate staffing data we can perform the research needed to develop evidence based staffing guidelines. "Rather than Staff Ratios that cause division, Staff Transparency is a much better place to start.” By Lisa Giacomelli and Sarah Russell. Please note: This article represents the authors' views, and does not necessarily reflect the opinions of HelloCare.  

The post Do We Need Mandated Staffing Ratios or Staff Transparency in Aged Care? appeared first on HelloCare.

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Europe has regularly inspired us with its creative and compassionate approach to aged care, and Scandinavian countries are known for their high-quality government funded public services. At last week’s Criterion Designing and Developing Retirement Living and Residential Aged Care conference, those in attendance heard how the Danish city of Allborg is combining the two - a state-of-the-art, government funded nursing home reflecting all the latest thinking in aged care. Lars Nohr, Chief Advisor Quality and Innovation at Aalberg’s Department of Care of the Elderly, told those at the conference that when the municipality first began to develop the home, they knew from the start they wanted to do things differently. “We spent a lot of time thinking about this,” he said. “We included a lot of people in the planning over three years. We had a lot of ideas and dreams and fantasies.” https://youtu.be/hglB444kpLA Three years of planning Citizens, seniors, family members, staff members, and management were all involved in the planning of the nursing home, which has now been open for five years. Fremtidens Plejehjem, or in English, ‘The Nursing Home of the Future’, is a 75-room facility located on the banks of the Aalborg River in Denmark. The highly sought after riverside location in an area that is being gentrified was chosen so residents were most likely to feel part of the community, and that they belonged. A more away from small communities In contrast to some of the newer developments we are seeing in Australia with small cluster homes, at Fremtidens Plejehjem there is a shift towards enabling older people to navigate larger facilities. Traditionally Danish nursing homes are built in small clusters of apartments, but what the developers found was sometimes residents didn’t connect with their 8-10 neighbours. [caption id="attachment_13843" width="238"] Inside an apartment. Image: Fremtidens Plejehjem.[/caption] Mr Nohr said, “I’m convinced that we can’t be a new family for a person. That person has to be their own person. We have to give them the opportunity to live a normal life.” “We are not doing them a favour by excluding them from normal civil life.” “What we thought was, we have to build units with more people.” So the decision was made to build one home with 75 apartments, and then build a range of rooms and services that residents can access, just as they would have before going into care. Fremtidens Plejehjem has smaller living / theme rooms, kitchens, libraries, a dentist and a doctor, a conservatorium, all of which residents can visit whenever they choose. “We want to use the eldery’s network even more than we have, because we know now that they are very important for the elderly and the solutions,” Mr Nohr said. The four phases of life in aged care Fremtidens Plejehjem can cater for residents in the four phases of their life that were identified in the planning phase. Crisis: a lot of people come to aged care in crisis, Mr Nohr said. “It may be their life’s biggest crisis,” he said. “When they come into a nursing home they’re saying goodbye to a lot of things, their apartment, their house, their family, their neighbourhood, furniture - everything.  “You have to attend to that crisis before anything else,” he said. “We hope to heal them so they find a way of reviving.” The four phases are: healing, revival, refuge, and then hospice. “You are going to die, that’s true and you have to talk to people in the nursing home about dying,” Mr Nohr said.  “That’s very taboo in Denmark, but now there are courses for staff to help them with that.” What are the apartments like? Fremtidens Plejehjem is 8,000 sqm in total, and consists of 75 apartments. This is about average in Denmark, where nursing home are usually around 60-100 apartments. Every apartment has two rooms: a bedroom and a living room. Residents furnish the rooms themselves, bringing favourite pieces from home. Usually the bed is new, as residents usually require a special bed. [caption id="attachment_13847" width="263"] Apartment plan. Image: Fremtidens Plejehjem.[/caption] The rooms have:
  • A bidet, so residents can wash and dry themselves. Mr Nohr said bidets improve hygiene and encourage independence.
  • Storage space inside the apartment, rather than down in a basement.
  • Hoists, so only one person required for lifting a person.
  • Pressure sensitive floors that alert staff with an alarm if there has been a fall. When a resident gets out of bed at night, the bathroom light automatically comes on, staff are informed on their iphone.
  • Free wifi in every apartment.
  • A swinging washbasin than can be moved, making it easier to access which is good for hygiene, and can also be moved to create more space when needed.
  • Every resident is given their own iPad, which are used for communication, daily activity information.
  • Facilities are available for residents to wash their own clothes if they wish.
[caption id="attachment_13846" width="300"] The swinging washbasin. Image: Fremtidens Plejehjem.[/caption] Assistive technologies saves two staff members every night, Mr Nohr said. “That’s a lot of money”, he noted. Though the cost to instal is high, Mr Nohr said it took the nursing home only two years to recover the cost. Asked about the lack of balconies from the apartments, Mr Nohr said their research found residents don’t use their balcony. One large balcony is for common use, he said. He also noted the Danish climate is not as suited to sitting on balconies as in Australia.   High quality staff that tend to each individual   Mr Nohr said staff are “very, very important” to the success of the facility.  Fremtidens Plejehjem employs 70 healthcare providers of all kinds, including nurses, caregivers, physiotherapists, OTs, social educators, and dieticians. “You can build a new building, but if the staff don’t know how to use the building in the daily care and nursing, just stop it,” he said.  Staff need to understand the individual. They need to know what the person did before, who were they married to, and all about them. Some staff are given special training to offer increased services to residents. For example, because the cost of providing physiotherapists is quite high, the home has educated caregivers already working at the home to rehabilitate residents every day in their room.  “We don’t have to have the physiotherapists every day,” Mr Nohr said. “That saves us a lot of money.” Residents and the public can move freely around the large facility  The residents have to be motivated to move around the nursing home. There is a library where you can go to read the newspaper or a book, a conservatorium where you can enjoy the view, and smaller, more intimate kitchens, dining and living rooms where you can help to prepare food and eat. [caption id="attachment_13841" width="300"] Communal balcony looking over the river. Image: Fremtidens Plejehjem.[/caption] “They are living in an open society, just like us,” Mr Nohr said. If there are concerns about getting lost, residents wear a GPS device, he said.  “Everyone is welcome,” Mr Nohr said. All the rooms are unsecured. People can go wherever they wish - even the public can come in.  Some at the conference asked about safety and crime. Mr Nohr said in the five years the faciity has been open, nothing has been stolen. He said if the public strays into an area that is private, they know to immediately retreat. “It hasn’t given us any problem at all, and it gives the residents a feeling of belonging, a feeling of being connected to the local community,” he said. Other unique features Fremtidens Plejehjem has been designed to exist within a community, and to give something back to the community. Accessible not only to residents in the building but also to the general public is a fitness centre, health centre, dentist surgery, cyber café, public restaurant, thematic rooms within the home, and the public library. “The restaurant is quite successful,” Mr Nohr said. Fremtidens Plejehjem has a suction and compression waste system “that’s really god for residents, that’s really good for everyone, because it stops smelling,” Mr Nohr said. Innovation is ongoing A unique feature of Fremtidens Plejehjem is a ‘living lab’, where residents, specialists and citizens can work together in creating, developing, and testing new aged-care related technologies. The team at continues to work with universities on projects to improve the lives of older people, especially those living in residential care. “We have 15-20 projects on (at the moment)”, Mr Nohr said.  Projects are currently underway on digital rehabilitation, video communication with health professionals, a new type of medicine dispenser, and virtual reality rehabilitation. Lead image: Kårehed Photography.  

The post Taking a look inside Denmark’s state-of-the-art nursing home appeared first on HelloCare.

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  Bed rails are being used less often in aged care because there is tighter regulation of their use and a greater awareness of their risks. But the alternative practice - of placing residents in low beds with sensor mats beside them - has its own problems, according to an expert in the field. According to Professor Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, older residents can’t get up out of the low beds and can become “incontinent, immobilised, and frightened” in them.  Our investigation of this topic came from a reader’s concern This investigation began when a reader commented that aged care is now so regulated, staff are not using bed rails and are instead using sensor mats to detect falls from bed. This seemed unreasonable, so HelloCare decided to take a look at the issue. What we found was there are real dangers associated with using bedrails.  “Some like them (bed rails), and others don’t,” said Prof Ibrahim. Bed rails can cause serious physical and psychological harm, and even death, though they are necessary in some circumstances. Bed rails can cause strangulation, injury Prof Ibrahim said in the early 2000s, there was a lot of concern about strangulation of older people from bed rails, and aged care residents being injured from trying to climb over them. More recently, discussions of physical restraint, which bed rails are considered to be, has tightened regulation of their use. Royal commission, new laws restrict bed rail use According to the Aged Care Royal Commission report, “Restrictive Practices in Residential Aged Care in Australia’, using physical restraint “may be necessary to mitigate risks to a resident or others in an emergency”. But the report says there is evidence to show that physical restraint (of all kinds) can cause death, “fear, shame, anxiety, loss of dignity, agitation, depression, lower cognitive performance, bruising, direct skin injuries, pressure injuries, contractures, respiratory complications, urinary and faecal incontinence and constipation, undernutrition, reduced mobility and increased dependence in activities of daily living, impaired muscle strength and balance, reduced cardiovascular endurance, and serious injury”. The recent changes to Quality of Care laws mean, before bed rails can be used, aged care residents have to be assessed, alternatives have to be considered, and the resident has to give their consent. Getting rid of bed rails through tighter regulation has been seen in the industry as a “great success”, Prof Ibrahim said. But the solution to the bed rail issue - putting residents in “low, low” beds with sensor mats beside the beds - has created a whole new set of problems, Prof Ibrahim said. Older people lack strength to get out of low beds Older people, whether they be at home, in hospital, or in residential aged care, can not get out of low beds because they lack the muscle strength, according to Prof Ibrhaim.  As a result, in low beds older people can become “incontinent, immobilised, and frightened”. More research is needed So, what’s the solution? Prof Ibrahim said the industry needs to find a “middle ground” between using standard beds with bed rails and low beds with sensor mats. “There’s no easy answer, and there hasn’t been the debate with people who know enough about the topic,” he said. “People are doing the best they can with the knowledge they have,” he said. Professor Ibrhaim said it would be helpful for aged care staff to have more information about what options are available for residents in a range of different circumstances, so they can make better informed decisions. HelloCare contacted the Department of Health for a comment on this article, but at the time of publishing had not yet received a response.  

The post Is it better to use bed rails or low beds with sensor mats? appeared first on HelloCare.

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  Bed rails are being used less often in aged care because there is tighter regulation of their use and a greater awareness of their risks. But the alternative practice - of placing residents in low beds with sensor mats beside them - has its own problems, according to an expert in the field. According to Professor Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, older residents can’t get up out of the low beds and can become “incontinent, immobilised, and frightened” in them.  Our investigation of this topic came from a reader’s concern This investigation began when a reader commented that aged care is now so regulated, staff are not using bed rails and are instead using sensor mats to detect falls from bed. This seemed unreasonable, so HelloCare decided to take a look at the issue. What we found was there are real dangers associated with using bedrails.  “Some like them (bed rails), and others don’t,” said Prof Ibrahim. Bed rails can cause serious physical and psychological harm, and even death, though they are necessary in some circumstances. Bed rails can cause strangulation, injury Prof Ibrahim said in the early 2000s, there was a lot of concern about strangulation of older people from bed rails, and aged care residents being injured from trying to climb over them. More recently, discussions of physical restraint, which bed rails are considered to be, has tightened regulation of their use. Royal commission, new laws restrict bed rail use According to the Aged Care Royal Commission report, “Restrictive Practices in Residential Aged Care in Australia’, using physical restraint “may be necessary to mitigate risks to a resident or others in an emergency”. But the report says there is evidence to show that physical restraint (of all kinds) can cause death, “fear, shame, anxiety, loss of dignity, agitation, depression, lower cognitive performance, bruising, direct skin injuries, pressure injuries, contractures, respiratory complications, urinary and faecal incontinence and constipation, undernutrition, reduced mobility and increased dependence in activities of daily living, impaired muscle strength and balance, reduced cardiovascular endurance, and serious injury”. The recent changes to Quality of Care laws mean, before bed rails can be used, aged care residents have to be assessed, alternatives have to be considered, and the resident has to give their consent. Getting rid of bed rails through tighter regulation has been seen in the industry as a “great success”, Prof Ibrahim said. But the solution to the bed rail issue - putting residents in “low, low” beds with sensor mats beside the beds - has created a whole new set of problems, Prof Ibrahim said. Older people lack strength to get out of low beds Older people, whether they be at home, in hospital, or in residential aged care, can not get out of low beds because they lack the muscle strength, according to Prof Ibrhaim.  As a result, in low beds older people can become “incontinent, immobilised, and frightened”. More research is needed So, what’s the solution? Prof Ibrahim said the industry needs to find a “middle ground” between using standard beds with bed rails and low beds with sensor mats. “There’s no easy answer, and there hasn’t been the debate with people who know enough about the topic,” he said. “People are doing the best they can with the knowledge they have,” he said. Professor Ibrhaim said it would be helpful for aged care staff to have more information about what options are available for residents in a range of different circumstances, so they can make better informed decisions. HelloCare contacted the Department of Health for a comment on this article, but at the time of publishing had not yet received a response.  

The post Is it better to use bed rails or low beds with sensor mats? appeared first on HelloCare.

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In a recent interview with HelloCare, Janet Anderson, the head of the Aged Care Quality and Safety Commission, spoke candidly about how recent changes that were made to the residential aged care quality standards provided a shift in focus, and would now place more importance on a residents preferences regarding their own care.  While this has been welcome news for the majority of Australians, there can be no doubt that this will add further complication to an environment that was already struggling to cope with expectation, because added choice, also means added risk.  A number of aged care providers are currently in the midst of finding the right balance between safety and encouraging their residents to exercise personal freedoms, and one subject that has become a recurring theme is the risk associated with elderly aged care residents wanting to lock their doors.  Surprisingly, there are currently no solid rules or regulations regarding door locking in residential aged care facilities, and a statement provided by the Department Of Health highlights why some providers are currently struggling to navigate this issue. “The issues surrounding whether residents are able to lock their doors in residential aged care is a complex matter. This is a matter for aged care providers to negotiate with consumers individually, taking into account any risks and any relevant jurisdictional laws, and the consumer’s needs and preferences.” There are a number of different methods currently being used by aged care providers to combat this issue, all of which come with their own varying degrees of risk and impact on a resident's personal privacy. Some providers allow residents to lock their doors but provide staff with a key in case of emergency, others allow residents to lock their doors but only provide keys to certain staff members, some facilities have locks but will only lock the doors when a resident will be away from their room for an extended period of time, and there are even some providers who don't have locks on their doors at all. Privacy is a large part of an individual's personal freedom, and living in a shared community environment like an aged care facility can provide limited opportunity for private time - but is privacy more important than the potential of risk and ensuring safety? And if so, who should make that call? Emeritus Professor from La Trobe University, Rhonda Nay, has dedicated a lifetime to improving the care outcomes for elderly Australians, and according to Rhonda, the best way to approach this issue is trialing it. “I think it’s entirely appropriate that residents can lock their doors provided they have the capacity to unlock them and get out,” said Rhonda. “You can trial it and ask the person to see if they can get themselves out, obviously you don't want them locked in there if they can't get out. Every home has a master key so if there was a fire and you really had to get in you could, but your everyday normal person couldn't walk in if that resident was having sex or something.” “People have the right to do whatever they want in their own room, and provided they have demonstrated that they can get out, then I don't see any problem with someone wanting to lock their door.” Despite the seemingly simple nature of the request, a locked door could prove to be the difference between life and death in some situations. In the event of a fall or medical emergency, an open door increases the chances of drawing attention to a problem, while a locked door could result in a resident not being found until someone comes knocking. Despite the potential severity of the outcomes in these types of situations, Professor Nay believes that the dignity of choice should always be upheld as long as the resident or their appointed guardian can accept the risk involved. “There is a dignity associated with choices at any age. These choices must be respected and supported as far as possible. Common sense and clinical judgment have to be used.  Before taking risks the person needs to know possible adverse consequences and accept them,” said Rhonda. “Privacy is a real issue in aged care at the moment. The level of privacy provided to aged care residents is poor, there might be signs saying ‘please knock before you enter’ but then, there are a lot of staff who knock and go straight in - and this can take a toll on a person's dignity.” “People with dementia have varying of dementia can have varying degrees of ability to make choices and I think that we need to maximise their capacity for choice and to have a voice regarding what happens to them.” Choice and voice are the two number one concerns for elderly people. They want to have a voice regarding what happens to them and they don't want other people deciding what is best for them, and that applies to dementia - their motto is ‘nothing about us, without us.’

The post Should Residents Be Able To Lock Their Doors In An Aged Care Home? appeared first on HelloCare.

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Receiving a diagnosis of a serious illness can be devastating. Obviously, for the person concerned there might be suffering, and uncertainty and fear about outcomes. For family, concern for their loved one, coupled with the prospect of taking on the responsibility of caring for them, can be extremely daunting. Unless family have medical experience, they may never have delivered the type of care required when someone is seriously ill.  They may have little to no knowledge of managing medications, they may not understand medical language, and they never have been in the role of ‘carer’. And yet, family may be expected to make themselves available to care around the clock.  For people will other responsibilities, such as a job or children to care for, or who themselves are older or not completely well, managing caring responsibility can be overwhelming.  Organising and getting to doctor's appointments and scans, lodging payments for refunds, administering medication, and other care responsibilities, can leave little time to ‘just be’ with a loved one, or simply to do the things you enjoy doing together, in what may be their final days. Juggling the two very different roles of being a wife, daughter, or spouse, with the role of carer can take its toll - to the point that people feel they are not doing either role well.  Hired care is often available in the home for those who need it, but the logistical challenges  of overseeing the care still usually falls upon family. The challenges when family provide care  One family found themselves in such a situation when the youngest of five sisters was diagnosed with breast cancer at the age of 30. With three young children, a busy husband, and chemotherapy treatment, her family kicked into overdrive to do their best to provide the help she needed. One sister was doing the paperwork, another was taking care of Medicare claims. The other sisters were organising appointments, while the woman’s mother was looking after the children with the help of friends in the community. Her husband continued to go to work. Simply coordinating all the tasks, on top of getting everything done, became overwhelming, and it didn’t take long before all the family were exhausted. One of the sisters was a friend of Kate Spurway, founder of NurseWatch, and the family approached her for help. “Chasing doctors appointments and pathology reports, making sure you’ve got follow up appointments, keeping an eye on clinical signs after a bout of chemotherapy, and all the protocols with toileting following chemo, all these bits and pieces take time and expertise to organise,” Ms Spurway said. NurseWatch is made up of a team of experienced registered nurses who were able to take over the heavy administrative requirements associated with caring for someone who was undergoing chemotherapy treatment, and all the tasks associated with her care. They even took over the children’s school pick-ups and drop-offs.  Having this level of support relieved the woman’s family of the responsibilities of caring, and enabled them to simply enjoy their time with their loved one, and concentrate on being present for her and her children. Outsourcing end-of-life care in the home End of life care is particularly challenging for family to manage for a loved one, both in terms of the physical and clinical aspects, but also, of course, emotionally. Palliative care is a specialisation in itself, and for loved ones is usually more than they can manage on their own unless they have medical experience. A professional woman in her 70s, after returning to Australia after living abroad for much of her life, found herself in a challenging situation when she was diagnosed with a terminal illness.  The woman didn’t have children, and her remaining family, a brother and sister, both had busy professional careers and were elderly themselves. They weren’t able to provide the care the woman needed to remain living at home. The woman had a clear idea of what she needed. She wanted quality care, with intelligent staff, who were able to do the critical thinking required to care for someone at the end of their life. She wanted to be able to have some control over the end of her life. The woman approached Ms Spurway and asked her to ‘project manage’ her end-of-life care. “She was able to have the death she wanted” NurseWatch’s experienced palliative care nurses were able to step in and provide the necessary care. They could pre-empt the woman’s clinical pathway because they understood the nature of her disease. The registered nurses were able to organise pharmacy scripts and equipment, take care of nursing needs, and organise the protocols of schedule eight drugs. “Her brother and sister, who were both in their 70s, were relieved that we managed the care for them and they could enjoy being with her as a sister and connect with her, rather than running around.  “The responsibility was taken off them,” Ms Spurway said. Ms Spurway said the family were also relieved because the woman was able to have the death she wanted. Relieved from the burden of caring, you are free to just ‘be there’  We don’t often use language such as ‘project management’ around the delivery of care; it sounds business-like and clinical, when a softer approach is usually what is expected.  But there is a side of caring for someone who is seriously ill that requires hours and hours of work, often alone, and sometimes with little thanks. It can be highly skilled work and requires expertise and experience. Of course, a compassionate and warm manner is also always expected. Putting care into the hands of professionals can not only ensure the best care possible is delivered, it also relieves family of the burden of caring, and gives them the opportunity simply to be with their loved one, and enjoy their time together in what may be their final days. To find out more about NurseWatch, call (02) 9331 3344 or admin@nursewatch.com.au.

The post Dealing with the burden of a family illness appeared first on HelloCare.

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The Australian Nursing and Midwifery Federation (ANMF) is calling on Federal MPs and Senators to support the Private Member’s Bill to be introduced into Federal Parliament today by South Australian Independent Rebekha Sharkie – mandating a requirement for aged care providers to publicly disclose their staffing ratios. The Parliamentary Standing Committee on Health, Aged Care and Sport, chaired by Trent Zimmerman MP, previously recommended the adoption of Ms Sharkie’s Aged Care Amendment (Staffing Ratio Disclosure) Bill 2018 as a‘first step’ in increasing transparency in Australia’s aged care system. With no current national laws to ensure that providers employ the right numbers of staff with the right mix of skills, ANMF Federal Secretary Annie Butler said the Bill would be crucial in giving nursing home residents and their families information about exactly how many nurses and carers are on duty in aged care facilities across the country. “Chronic understaffing continues to result in episodes of missed care, neglect, abuse, preventable illness and injury and even death,” Ms Butler said today. “The disgraceful situation we witnessed just last week with the chaotic closure of the Earle Haven aged care facility on the Gold Coast, demonstrates how urgently aged care reform is needed. Such a situation, which placed the safety of 70 elderly residents, and the single registered nurse on duty on the final day, at extreme risk, should never have been allowed to happen. The government must stop ignoring its duty of care to elderly Australians; their failures continue to see the elderly in this country suffer. “Fortunately, the Queensland Premier AnnastaciaPalaszczuk is prepared to take responsibility for the duty of care they have for elderly Queenslanders, immediately announcing that they will introduce new Legislation requiring private aged care providers to publicly report their staffing levels. The Palaszczuk Government will also introduce mandated staff to resident ratios in the State’s 16-publicly-owned aged care homes. “Today, the ANMF welcomes the Member for Mayo’s Private Member’s Bill being introduced into Federal Parliament and we call on all politicians to take responsibility for their elderly citizens and stop ignoring their duty of care by supporting this Legislation which will start to bring much needed transparency into the sector and assist older Australians and their families in making informed decisions about their choice of nursing homes.”

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The federal government has launched an independent investigation and the state government has mandated staff ratios in the wake of the emergency evacuation of residents from Earle Haven Retirement Village last week. Minister for Aged Care and Senior Australians, Richard Colbeck, announced an independent inquiry today into the forced evacuation last week of nearly 70 frail residents from the Earle Haven Retirement Village. Minister Colbeck said he was “angered and appalled by the terrible and unprecedented events” that took place. “Residents should not have been put in a situation where they were forced to be relocated because they were left without the care they so rightfully deserved,” he said. The government has appointed Kate Carnell AO to lead the investigation. Ms Carnell co-conducted the Carnell Patterson review on aged care. “I look forward to Ms Carnell’s report,” Mr Colbeck said. The announcement came only hours after Queensland premier Annastacia Palaszczuk revealed her government will make minimum nursing hours mandatory, and by the end of the year the figures will be published online and made available to the public. The Queensland government has moved to mandate a minimum 3.65 nursing hours per resident, extending hospital nurse-to-patient ratios to the aged care sector. The premier said mandating staff ratios in aged care is the first scheme of its kind in Australia. QNMU “thrilled” Queensland Nurses and Midwives’ Union Secretary, Beth Mohle, told HelloCare the union was “thrilled” by the premier’s announcement. She said the government has agreed to mandate that aged care facilities have 30 per cent RNs, 20 per cent, ENs, and 50 per cent AINs or PCAs. Minimum staff ratios should “comfort” families Ms Palaszczuk said, “Revelations at the Royal Commission into Aged Care and recent events at the Earle Haven retirement village on the Gold Coast have demonstrated how important it is for residents and their families to have comfort and confidence in the care they receive. “We brought in mandated nurse to patient ratios for Qld hospitals. Now our 16 state-owned aged care facilities will all publish their ratios of nurses to residents by the end of this year.  “It should bring confidence and comfort to aged care residents and their families,” she said. Private aged care providers encouraged to follow suit The premier is asking private aged-care facilities to voluntarily report staff numbers and contact hours. "I want to see a public register so families and friends can have a look at that, that dictates very clearly (which) facilities (are) offering minimum contact hours," Ms Palaszczuk said. Those who don't provide the data, will "have to explain to the residents and to the residents' families why they have chosen to hide that data." The premier is also calling on the federal government to mandate staff ratios for private aged care operators, of which there are around 400  in Queensland. “We will be urging private aged care homes to do the same, but as they are the responsibility of the federal government, only it can introduce a mandate for the sector. I’m calling on them to act as we have,” Ms Palaszczuk told media. "Aged care sector is booming" “Let me make something clear. Our aged care sector is booming, and our elderly residents are not getting the full care they deserve," the premier said. “How do I know this? Because people have spoken to me directly about it. I had one woman who held my hand and said you have to help us. She said to me she could not breathe properly and it took over one hour for someone to come and see her.” Ms Palaszczuk said people living with dementia often don’t “have a voice” and some elderly residents do not have family or friends to “check up” on them. “I want to see a public register so family and friends can have a look at that facility, and there’ll be a transparency about it that shows clearly that the nursing home is offering minimum contact hours.” One nurse to 70 residents at Earle Haven According to the QNMU, one registered nurse was left to look after 68 residents on the day the Earle Haven Retirement Village aged care crisis unfolded.  Residents at Earle Haven received an estimated 2.73 hours of care a day - rather than the recommended 4.3 hours.  QNMU Secretary, Beth Mohle, said off-duty nurses and other staff rushed to the facility to help residents and provide support as the evacuation took place.  “This was a crisis not of their making, but once again vulnerable residents and hard-working staff bore the brunt of critical flaws in the regulation of aged care,” Ms Mohle said. “Earle Haven nurses... should be commended for their efforts,” she said. Operators should not “cry poor” Ms Mohle said private aged care providers often “cried poor”, but Australia’s approximately 900 aged care providers receive around $18 billion from the government every year.  They also receive a deposit of up to $500,000 per resident, per bed, and up to 80 per cent of each resident’s pension, or up to $800 per resident, per fortnight.  “They do not have to publicly report how a single cent of taxpayer or resident funds are spent or ensure that funding is spent on direct care for residents,” Ms Mohle said.

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  Loneliness is sometimes called the epidemic of our times. One in four Australians are lonely, according to a recent study by the Australian Psychological Society and Swinburne University of Technology.  Lonely Australians are known to have worse physical and mental health, and are more likely to be depressed, the study found. Loneliness is particularly common among older people, due to the fact they they often live alone and are more likely to have physical and cognitive impairments that make it more difficult for them to get out and about and connect with their social networks. The loneliness scourge is just a problem in Australia. It is a serious, and growing, problem around the world.  Scientists and academics are looking closely at the topic, and developers are building innovative new technologies.  But what if the answer is right under our noses? Checking out might take a little longer... That’s the approach taken by a Dutch supermarket, which has introduced a program to create more opportunities for a good old chat while out shopping at the local supermarket. ‘Jumbo Supermarket’ has launched two initiatives: ‘All Together Coffee Corner’ and ‘Chat Checkout’. All Together Coffee Corner is a meeting point where older people can meet locals and volunteers in a safe and welcoming space. Volunteers can help the older people, not just by providing company, but also by helping with the shopping, and even further afield, such as lending a hand at home or in the gardens of the people they meet. At the Chat Checkout, customers can queue up and check out with a cashier who will take their time to talk to the person. Checking out might take a bit longer than usual, but perhaps that’s the point. In supermarkets, technology is replacing humans at the checkout to improve efficiency, and in a similar way, automation in aged care is reducing the opportunities for human contact. It’s easier to give residents a pet robot than to spend time with them Dr Rodney Jilek, principal advisor with Aged Care Consulting and Advisory Services, told HelloCare, “In aged care, time is the one thing we don’t have because time costs money. It’s easier to give people a robot cat than it is to spend time with them.” “Maybe it would be better to take the person outside, to get some vitamin D, just go out into the garden and smell the fresh air,” he said. Shopping a great way to make community connections Many years ago, I worked in a small local cake shop. Every day, a woman in her eighties came in, immaculately dressed, and she would buy a single croissant.  She came for the pastry, there’s no doubt about that - the croissants were good - but I suspect she also came for the company. She’d chat while she chose her croissant, chat while handing us her money, and then chat a bit more while she remained in the shop and we served other customers. It was clear to us she was lonely. I never asked, but I guess the woman lived alone, and her daily walk out into her local community, and her simple transaction at the cake shop may well have been the only human contact and conversation she had all day. The chat checkout and coffee corner are great initiatives that are easy to create and cost little to implement, especially if volunteers are happy to help.  Have you seen something like a Chat Checkout here in Australia? Would you like to see something like this here? Image: Jumbo.

The post Supermarket launches ‘chat checkout’ for lonely customers appeared first on HelloCare.

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