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ROYAL COMMISSION: Aged care industry doesn’t support innovation

Day 5 into the third series of the Royal Commission into Aged Care Quality and Safety was a lot lighter than previous hearings, with a panel of aged care representatives explaining to the Commission how they provide care to residents, and those with dementia, the best ways to provide good practice care and changes needed in the industry.

Brightwater Care Group CEO, Jennifer Lawrence, was among three other panelists talking about the aged care industry and what needs to be changed. [Source: Aged Care Royal Commission].

The panel consisted of Co-Chief Executive Officers (CEO) from Group Homes Australia, Tamar Chayen Krebs and Jonathan Gavshon; Brightwater Care Group CEO, Jennifer Lawrence; and Glenview CEO, Lucille Claire O’Flaherty.

Touching on different topics that had been raised to the Royal Commission, each panel representative explained how community, compassion and family involvement shaped their care models.

Another standout factor from the hearing was the obvious improvement of care through adequate ratios. All of the facilities staff members are in the hundred or thousands, as either carers, registered nurses, homemakers or other similar positions.

The three facilities, Group Homes Australia, Brightwater Care Group, and Glenview, are organisations that are more progressive and innovative in how they deliver care to their residents and clients.

Commissioner Richard Tracey AM RFD QC was happy with the outcome of the hearing due to its more pleasant nature, compared to evidence provided over the last two weeks.

“We have heard a lot of challenging stories in nursing homes. I must say, it has been refreshing to hear how a bit of innovative thinking can produce good outcomes,” says Commissioner Tracey.

What do people with dementia need?

Following the introductions of each representative and their organisations, the first topic of the panel was around what people with dementia need when it comes to services and how their facilities have provided services to residents.

CEO of Brightwater Care Group, Ms Lawrence talked about the organisation’s hands-on approach to providing personalised care to their residents.

She says environmental factors are incredibly important, which is why the facility has been designed around “wayfinding” so people with cognitive decline can still orientate themselves.

Ms Lawrence says, “It is really important to understand we try to have dementia inclusive environments rather than be dementia specific.

“There needs to be a focus on enabling someone with dementia to feel at home and to understand what that person needs, particularly if they are anxious or agitated.”

CEO of Glenview, Ms O’Flaherty outlined a client liaison role at Glenview, where the staff member creates links between the hospitals to support discussion on what the resident needs and wants.

Co-CEO of Group Homes Australia, Ms Krebs agreed with both Ms Lawrence and Ms O’Flaherty, saying that people with dementia need to be humanised, which required attention to relationships and trust between carers and residents.

Counsel Assisting, Ms Brooke Hutchins, asked whether aged care services were currently “one size fits all” centric, which all of the panellists agreed and said they were not adhering to that general view in the industry and are instead customising the provided care.

All of the panellists also highlighted the extensive recruitment process they went through, only hiring people, not only with experience, but with the emotional intelligence to work in their facility.

The representatives outlined that the culture in their facilities was personal care centric compared to other aged cares that are very regimented, routine based and clinical in how they provide care.

Special plans for residents

The next topic focussed on special plans for residents and how they are implemented in the representatives' facilities.

Panellists presented a more holistic approach to creating care plans for their residents.

Ms Lawrence outlined “dignity vs risk”, which is allowing a resident to continue something they enjoy, even though they may struggle or have difficulties with it.

She says this stems from support and in-depth talks with the family and residents about what they want to achieve in the facility.

Mr Gavshon, Group Homes Australia, says they work hard within their local community to make it more dementia friendly, including training local coffee shop staff about how to handle customers with cognitive issues. Glenview has also implemented similar programs.

All of the panellists commented that their organisations had implemented building and environmental changes to make the spaces more ‘home-like’ rather than having a feeling of being ‘institutionalised’.

Ms O’Flaherty mentioned Glenview worked with the University of Tasmania to create questionnaires that would help place an individual into six different lifestyle categories that suited their needs.

Group Homes Australia had the same approach, identifying similar lifestyles and hobbies of other residents and placing them into a house of six to ten residents, allowing for meaningful relationships to be created.

Ms Hutchins inquired about whether resident on resident aggression happened in their facilities, the panellists admitted it did, however, their staff were always looking for ways to mitigate the risk.

Ms Krebs says, “It does occur from time to time due to the complexity of the people we deal with. It comes back to triggers of a person and being mindful of what might trigger behaviour, managing that is more proactive rather than reactive.”

Ms O’Flaherty backed that claim, saying Glenview’s staff skills and training make all the difference when it comes to severe behaviour responses from residents.

Use of chemical and physical restraints in the panellists facilities

The most shocking revelations that arose from previous Royal Commission hearings has been the widespread use of chemical and physical restraints, which all panellists said had been used as a last resort in their facilities.

Ms Lawrence pointed out that Brightwater only use restraints once every other practice has been exhausted. Families would be involved in the process and chemical restraints would only be used for a short time, trialled and reviewed regularly.

A common phrase used for dementia patients who walk around is “wandering”, which in previous case studies over the last week resulted in restraint use.

However, the language used by Glenview and Group Homes is different, preferring to say “going for a walk”.

The facilities encourage their residents to walk around the gardens, and even into the community, and don’t discourage it.

Ms Krebs says, “It is quite distressing for people with dementia to have regiments and institutionalised routine. The industry calls it exit seeking, I would say it's normal when living in an environment that is none conducive to themselves.”

Characteristics of good practices

The panellists believed that the best practices to be used within facilities include leadership that understands dignity, empowering team members, embracing an individual model and getting the right staff with the right skills to create the best culture possible.

“A culture that respects and builds trust with an older person is important to care,” says Ms Krebs.

Ms O’Flaherty says she believes leaders at facilities need to have a background in the work and everyone has to have an appreciation for its complexity.

The panellists concluded that a focus on independence for residents and empowerment of staff is important for good practices in care.

Reasons for substandard care

The panel discussed why substandard care seems to be occurring at some facilities around Australia.

They indicated that poor culture among staff as well as recruiting the wrong people may be resulting in substandard care.

“I must admit, I have been stunned of what I have heard. I struggle with how these instances have happened in most cases… Culture drives performance, the wrong culture will not drive what you need,” says Ms O’Flaherty.

Ms Lawrence backed up Ms O’Flaherty, adding that good systems and processes would reduce problems.

Mr Gavshon mentioned his response was going to be controversial, however, he says the “industry has not been supporting innovative models... If we can’t embrace innovative models, we can’t raise the bar of the delivery of care.”

Future changes to encourage best care

The area of innovative practices and models flowed into the next topic about encouraging future best care in the aged care sector.

Ms O’Flaherty and Ms Lawrence concurred with Mr Gavshon that good innovation is not been incentivised or supported by the Government.

“The industry is structured. We are funded for medications, showering, meals we provide… We're not funded for how happy a resident is or how we reduced their sleep medication because their happier and sleeping better,” says Ms O’Flaherty.

The general consensus among panellists was that funding was going towards the wrong health care plans and that innovative best care options needed to be better supported.

Additionally, Ms Lawrence believes fluidity and communication between hospitals, families and GPs, as well as a transparent system, will result in seamless care for residents.

One issue raised involved more pushes for allied health professionals and students to learn about aged care and view it as an attractive alternative for a career.

Ms O’Flaherty mentioned job applications for registered nurses are always low compared to other positions available at aged care facilities, which needs to be addressed.

The hearings will recommence on Wednesday, May 15.


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