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Aged care: a checklist

4/9/2020

8 Comments

 
PictureDutchCare’s Victorian homes provide a model of aged care, writes Sophie Cuttriss, in her guide to what you should look for.
By Sophie Cuttriss

WHEN I was teaching aged care, I took my students to visit an aged care facility operated by Dutchcare. The facility's manager was very happy for us to visit because they were proud of their facility and their staff and the wellbeing of all their residents.

My students were fascinated to see the comfortable practical rooms that felt like home, not a luxury hotel or hospital, and person-centred care based on the Eden Alternative Principles which acknowledge and address the three plagues of residential aged care: loneliness, boredom and helplessness.

They had small dining rooms and kitchens for small groups of residents, home-cooked, high quality meals, a dog who lived there (and had its own care plan), a family-friendly workplace for staff and a big dementia-friendly garden.

The facility was more home-like than any I have seen and proved that great aged care is possible.

There are wonderful examples of building design that support home-like care in The Netherlands, Denmark and Germany – we don’t have to reinvent any wheels.
Yet many aged care facilities in Victoria are large, institutionalised rabbit warrens that do not resemble anyone’s home. Gardens are tiny and poor quality – it drives me crazy when a facility is called “Twilight Gardens” and the garden is little more than a tiny paved courtyard.
​

Dining rooms are sometimes huge noisy Coles cafeterias where music is played or the television is on (sometimes both), often with no regard to the preferences of the demographics of the people who live there.
Picture
The burden of care
Aug 13, 2020 - Despite the rosy ads, something has gone amiss in Australia’s aged care system. writes Sophie Cuttriss in the first part of her series.

Aged care is one of the most important purchases you will ever make, and may be the second most expensive after a home, so don’t rush into it.

When people visit an aged care facility to enquire about accommodation, they are usually in a state of stress, tying to find care for a loved older person who can no longer live at home. Families may feel very guilty about this decision. Often they feel they are breaking a promise to their loved one.

Very few people approach aged care in the same way they would make other major purchases. Most leave it till the last moment, when they are faced with limited options and will accept whatever is available.

Families will often be stressed and overwhelmed and may focus on cost and urgency. They will be easily persuaded by the manager/ salesperson who gives them the guided tour.

Few people seeking residential accommodation have any previous experience or knowledge of the sector. People are often swayed by superficial designs such as a luxury foyer, chandeliers and extras such as a bar, café, cinema. I’m not saying these aren’t welcome, but beware – often all that glitters is not gold.

The following is a guideline to what you should be asking and looking for.
  1. What are the staff ratios? How many registered nurses per shift? Does the doctor have geriatric training? Where did the Certificate 111 staff do their training? Where does the food come from? Is there a dementia friendly garden that can be accessed by the person with dementia whenever they wish?
  2. Can family and friends visit any time that suits the resident’s routine? Can they share meals with them, bring in the dog, take them out for a walk/drive/visit?
  3. Do they practise the Eden principles as these are intended or is there merely a token gesture such as a bird in a cage?
  4. Can residents access other health professionals such as a dietitian, speech pathologist (crucial when there are difficulties with swallowing and eating), occupational therapist, physiotherapist, diversional therapist?
  5. Are there meaningful activities available for all residents including people at various stages of dementia?
  6. Are extra trained staff employed during late afternoon/early evening so people who are sundowning can be given purposeful activities and distractions?
  7. Have staff completed extra current dementia training with reputable educators?
  8. Can they access support and expertise from Dementia Australia and Dementia Support Australia for (formerly Dementia Behaviour Management Advisory Service)?
  9. What are the organisation’s philosophies regarding sexuality and intimacy needs? Yes, this always goes down like a bomb!! And the topic deserves its own article one day.
  10. If the facility is a secure lock up, does it have subtle security measures or does it feel like a prison?
  11. Do they understand and uphold advance care planning and enduring powers of attorney and guardianship?
  12. What care is provided when someone is at the end of their life? Are the family able to stay with their loved one who is dying? Do they have enough staff on every shift who are authorised to administer the appropriate medication for all symptom relief? Or will they die in pain and discomfort, as reported by one of my students, who watched a screaming resident and was told “We’ve done everything we can”. 
Next issue: We need to be more honest and courageous sooner about the realities of ageing and the inevitability and normality of death, writes Sophie Cuttriss in the final part of her series on aged care. ​Sophie has had a nursing career of more than 40 years, including many years working in aged care. She worked as an aged care educator at Chisholm Institute’s Bass Coast campus for 10 years.
8 Comments
Felicia
4/9/2020 03:44:21 pm

Thank you very much, Sofie. Ishall keep all the points you write about but does a facility with the correct answers to your question exist?
Several of us are planning to form our own mini care home. Would that work?

Reply
Sue Packham
8/9/2020 09:20:13 pm

That idea sounds interesting Felicia. How many people do you see being part of it?

Reply
Ben
4/9/2020 07:26:22 pm

Beautifully put Sophie Cuttriss.

Reply
Linda Cuttriss
5/9/2020 10:54:52 am

This is such a practical and helpful article Soph. I hope readers who have ageing parent/s still at home take Soph’s advice and quietly have a look around at the options in their area with Soph’s checklist in hand WELL before circumstances are suddenly upon them and they’re stressed, overwhelmed, guilt-ridden and in urgent need of aged care accommodation for their loved-one. Even though I knew I had Soph’s expertise on hand I allowed my denial and guilt to paralyse me (and Soph respectfully didn’t interfere). I don’t think anything would have taken away the grief and stress but it would have really helped to have done some homework in advance. As Soph says, we need to be more honest and courageous sooner.

Reply
Linda Gordon
5/9/2020 02:54:46 pm

Sophie, you have written really well about what good aged care looks like. When I worked in a large aged care home I was trained in the Eden Alternative and then asked to train up all staff from the manager, nursing and care staff, to the kitchen, laundry and maintenance workers. And it did have an impact. Sadly when the home's management changed the top down support so necessary for such a big structural shift was no longer a priority. Aged care, specifically dementia care in my case, was a tough but enlightening gig for me. Tough for the reasons you've pointed out and an education because I was challenged in every possible way, every shift.

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Margaret Lee
5/9/2020 04:08:58 pm

Thank you Sophie for highlighting what our Aged Care system needs to be like.
I worked in Aged Care in the late 1980s when they took registered Nurses out of the system. As a weekend Supervisor for another 12 months I was horrified at the downturn in care and spent all my weekends trying to get essential medical Care to people who had been neglected during the week. I also had worked in Palliative Care for many years and am pleased to see that you have highlighted the need for specialized end of life care. Our current system is badly broken and needs immediate attention. Thank you

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Hilary Stuchbery
14/9/2020 10:09:28 am

What a clear statement you have made Sophie. I would think you (or everyone!) could do worse than put this case before our politicians so that funding is increased to help more education and possible modelling on European models of operation. Brav

Reply
Peter Lynch
15/1/2021 07:57:34 am

I love the comment - “we don’t have to reinvent any wheels”! So true.

Speaking personally as a now senior citizen, the prospect of moving into aged care as a result of declining independence simply terrifies me.

The beautifully scripted and illustrated advertisements for some of the privately operated for profit aged care establishments look too good to be true, and the impact of pandemic on aged care generally in this country suggests that the advertising is optimistic to the point of being downright misleading.

Overall, the pandemic came quickly, unexpectedly and with drastic consequences. In this country, so far we have got off very lightly compared to many other nations. Our often harangued state and territory leaders are to be applauded for guiding us through this catastrophe so effectively.

Yet the federally controlled aged care sector has not coped nearly so well. Despite countless royal commissions, hugely expensive investigations and expert reports the kindest comment one can make is that the aged care industry was utterly unprepared, underfunded and understaffed for any crisis, let alone a pandemic. Yet, if you’ll pardon the pun, our PM has largely deflected attention from his own governments incompetence and got off Scott-free.

Sophie’s article clearly demonstrates that aged care can and should be done well, rather than merely profitably for the canny investor/party donor.

Reply



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