AS WE age, we all face inevitable change; for some, this means reduced health and independence.
Most of us hope we can continue to live at home, with the people and in the environment of our choice. However, depending on the severity of our health conditions, level of frailty, and the care and support available, this isn’t always possible,
Or we may need to find residential accommodation for loved ones who can no longer manage at home. We often don’t have much time or guidance to make the best decision. We may also feel guilt, grief, fatigue, fear, depression, anxiety, relief – a variety of emotions that make it harder to be objective.
There may be a sense of panic and a need to make quick decisions because our elderly parent or partner is very frail and struggling to live at home or waiting in a hospital bed.
Like most difficult and confronting decisions, choosing aged care accommodation is best done before you are FORCED to make a choice. Perhaps not everyone’s idea of a pleasant day out, but I recommend that you visit a variety of facilities – and, initially, without making a booking.
You can tell a lot about a place by the way they manage a “drop in”. Of course, staff may be busy and not able to provide the full tour, or the manager may not be available to meet you. This can be arranged by making another appointment.
However, you should be welcomed to call in without notice. This lets you judge how staff respond and communicate in a more “warts and all” situation than during an official grand tour. It can also give an honest snapshot of the facility when it is not on show. Good quality service should be evident, without notice or appointment, even if you only get to view the foyer and reception desk.
All that glitters is not gold
While some older people might want five star resort accommodation, chandeliers and grand pianos don’t necessarily equate to good care. A facility may be a little shabby and old, but still homely and cosy, which may actually be more like your idea of “home”.
Remember, this will be home for you or your parent. The question to ask yourself is – what does home mean to me? What do I want from this new home? Are my expectations and care needs going to be met as I grow frailer and more dependent on the care of others?
Research aspects of best practice in aged care. The Eden Principle and Montessori approach were developed to address the three plagues of residential care: loneliness, boredom and helplessness.
Ask if the facility practises the Eden Principle and request evidence of this. Compare your idea of “home” with what is offered.
Are there gardens where you can walk, sit and work? Vegetable gardens to potter in? Shady spots to sit on a hot day? A Men’s Shed? A barbecue area? Private dining areas if I prefer not to eat in a communal dining room? Access to games, TV and radio programs of my choice? Musical instruments that I can play if desired?
Do children and adults of various ages visit the facility?
Are there dogs, cats, chickens, guinea pigs, rabbits, fish? Are there pets that live in and belong to the facility? Can I continue to work? Can I cook, clean, shop if I wish to? Can I continue with the hobbies and pastimes I enjoyed at home? Can I maintain existing social connections with the community? Can my family and friends visit me at any time of the day and share meals and social events and celebrations? Will my religious, spiritual and cultural needs be provided for?
Will they permit my husband/wife/partner to visit anytime or stay the night with me? After many years in a relationship, it can be very distressing for couples to be parted and to lose all opportunities to continue intimate and, if desired, sexual relationships.
Quality of care
Ratios of staff to residents can vary considerably between facilities. The team should include Division 1 registered nurses (with a Bachelor of Nursing) and enrolled nurses (who have a Diploma of Nursing) and personal care workers.
The minimum qualification required to work in aged care is a Certificate III in aged care but there are huge variations in this qualification. Some care workers may have completed a course that includes three days of
class attendance a week for six or 12 months plus 120 hours of work experience; others may have completed an online course. Some courses run for as little as six weeks. As a result, many care workers are poorly trained, without the knowledge or skills to care for frail, vulnerable people with complex health conditions.
A high-care facility should have a registered nurse for every shift but it’s more expensive to employ registered nurses than care workers and sometimes the staff mix won’t include enough nurses to provide necessary care.
Ask whether a registered nurse will be available if you require pain management, wound care, palliative care, dementia care or complex health care. Ask where the care workers did their training.
Also ask about medical care. Will it be the doctor of your choice or will it be limited to whatever local GP is willing to visit the facility? Does this GP have the skills to manage geriatric care? Is there a geriatrician (a specialist in care of older people) available?
Allied health team professionals are essential members of the aged care team. Is there a physiotherapist to assess mobility and recommend mobility aids/lifting machines and exercise programs? Is there an occupational therapist to maintain indepence with daily living? A diversional and music therapist to provide meaningful activities every day (not just Monday-Friday)? A speech pathologist to assess swallowing problems and appropriate management? A dietitian? A podiatrist? A hairdresser?
How does the facility manage advance care planning and end-of-life wishes? Residents are approaching the last stage of life so it is imperative that these issues are discussed and guidance provided.
If you are looking for a residential accommodation for someone with dementia, do some research so that you understand the progression of this condition and the care required in the later stages.
Alzheimer’s Australia has fantastic resources. There is also a fabulous free online course, Understanding dementia, run by the University of Tasmania and Wicking Trust. I recommend this for anyone looking after someone with dementia.
If you have an idea about good-quality dementia care, it will equip you to ask the right questions. Does the facility liaise with Alzheimer’s Australia to ensure care is of best quality and up to date? Do staff use current best practice for management of behavioural and psychological symptoms of dementia?
What meaningful activities and therapies do they offer to with people with dementia.? Do they use sensory activities, pets, doll therapy (for males and females), music, dancing, exercise, access to fresh air and gardens?
People can be reluctant to be assertive. They may feel intimidated and fear that if they ask too many questions, they will miss out on a much-needed bed in a local facility.
All consumers have the right to know what they are buying and a reputable facility will answer your enquiries. Caveat emptor. Buyer beware.
If managers and other staff are defensive and unwilling to provide specific information, explain that you are not being a trouble maker – you are a potential client who wishes to ensure your expectations match what they are offering.
And remind them that one day they may be doing this for someone they love – or for themselves.
Sophie Cuttriss is a registered nurse who has worked in hospitals and aged care. She currently teaches the Certificate III in Aged Care at Chisholm TAFE and is a home and community care assessor with the aged and disability team at Bass Coast Shire.