workforce
wellbeing, on supporting their personhood,
their choice and their decision-making, and
giving them a quality of life that you and I
would wish to have.
That sounds relatively easy, but why
aren’t we doing this already?
Well, it’s just that when anybody comes into
some sort of system, usually the system is
the focus of what we do. So, for example, if
we have 50 people living in one aged care
home, it’s understandable that we would
probably try to ensure that everybody is
able to have a meal within a certain period
of time, that everybody’s able to have
personal care within a certain period of time,
and that they’re able to live a life that they
wish to live within the constraints of that
care environment.
What we do with person-centred care is
to think about, well, if our services need to
be supporting the individual needs of that
person and their aspirations, we need to
rearrange how we offer those schedules
of things like meal times and care routines
– any other activity that occurs to meet
the need of the individual rather than the
individual need to fit into the schedules of
the home.
What it means is that we have to really get
together as a team and work at how we can
ensure that everybody is able to be provided
with an individualised type of service rather
than them having to feed into the service
that exists.
You mentioned that person-centred
care is a belief that personhood can
be maintained. How do we do this for
people who can’t articulate what they
want, such as those with dementia?
In that case, we usually work very closely
with the family and their other loved ones
and find out exactly how the person
lived their life. What was the routine that
they normally followed? What are their
preferences? What are the things that make
them feel happy and in a state of wellbeing?
How can we really shape our services to
meet their particular needs and aspirations?
If we work closely with those people,
we can get the voice of the person to plan
their care and can monitor that as we go.
As people with dementia change, as the
dementia condition continues on, those
needs and aspirations might change. What
we have to do is to look very carefully at
how the person responds to what we’re
doing with them and for them.
If they’re responding in a way that
indicates they’re not in a happy state, then
we adjust things, and we work with the
family and with the staff who provide the
face-to-face care every day. They get to
know the person really well, and they will
know what is going to be a good approach
for that person as well as the family and
loved ones.
We also reflect on how the person is
responding to the situation and monitor that
very carefully, so that at every stage we really
are trying to address their particular needs.
Do we need to build a staff screening
tool to make sure that we have the staff
who are capable of this sort of care?
Any person who’s employed to do a
particular job needs to have the right
attributes, abilities and training to do that job,
and that needs to be an ongoing process of
monitoring and adjustment.
If we have people coming into work in
aged care, I think the first thing we need to
do is make sure they’re happy and capable
of doing the work they’re expected to do.
It’s a very demanding job because
they need to use a lot of intuition, a lot
of intelligence, creativity, and goodwill to
be able to care for people with cognitive
impairment who are not able to express
their needs.
So we need to be able to get into the
mindset of that person, and that takes quite a
lot of skill. Good training, good supervision,
ongoing monitoring, and adjustment of the
staffing mix and the staffing type is really
important in this setting.
We can’t have people caring for very
unwell, older people with many impairments
and expect them to do a good job, unless
they’re properly supervised and trained. That
process is monitored very carefully.
How do we redesign an industry to
make patient person-centred care
possible? Do we need to work it into
policy frameworks?
Definitely. Policy has to drive this because
the individual person might do a very good
job, but they’re really battling the system.
The whole system has to rethink what is
most important.
When residential care was first developed,
it wasn’t for people with dementia. It was
generally for people who were older and
frailer and who chose themselves to come
into care because they knew that they
needed extra support which their families
couldn’t provide. The whole system and
the population group that are now living
in aged care are at the end of life. They’re
extremely unwell.
A lot of them have cognitive impairment
and many other impairments as well, and we
need to adjust the models and the policies
to address that. We can’t continue with
the old way of thinking: “It’s okay to have
one staff member for six residents or eight
residents.” That model needs to be adjusted
according to need.
If you’ve got people with high impairment
levels, you need to adjust that way of
thinking, and that’s where government
policy, government funding, and taxpayers’
understanding of what is needed have to
change. We can’t really continue with the
system as it has existed up until this point.
After the royal commission, how do we
keep telling the public and government
that these things are important and need
to happen?
We need education on a broader platform.
For example, when you see the government
and the health departments putting out
lots of advertisements about things like
diabetes, skin protection, smoking and brain
health, all of those big campaigns have
been very effective in reducing some of the
risky behaviours that people indulge in. It’s
now the same with dementia. We have to
educate the public on understanding that a
person who needs to come into care or who
has care at home, they need very particular
levels of support, and this is the type of
support they need, and it’s going to cost
us money.
As a society, we have to put our hand
up and say we are willing to go down and
provide this level of support through our
taxes and in other ways, such as community
support and putting into community
and putting into helping those who are
struggling at home caring for someone
with dementia.
In other countries, this is mandatory.
In some of the Scandinavian countries,
for example, it’s mandatory that every
community provide community-based
support for those in need. It’s something that
I think Australians have to get their heads
around, that we all have a responsibility to
help others, and it extends to residential
care as well.
Coming in as a visitor, helping to feed
people, helping to have conversations with
people, helping to provide recreational
activities, helping to make sure that people
have somebody that just visits them so that
they’re not alone – this all helps staff to
ensure the person has some social contact,
that they feel part of the world. That in itself
will actually improve the quality of care. ■
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