practical living
Group thinking
Group Homes Australia chief executive talks small scale living .
Tamar Krebs interviewed by Conor Burke
Making aged care homes more liveable for older Aussies will be a key feature of any changes to the sector , and as over half of all aged care residents have a dementia diagnosis , thinking outside the box when it comes to our care homes will be important .
This is reflected in the final report of the royal commission .
“ Where older people live affects their sense of security and their quality of life ,” the report reads .
“ Accommodation that is well designed to meet people ’ s needs can improve their lives and their wellbeing .”
And small scale living is one model many believe is better suited to residential care .
“ Without wishing to limit innovation , we consider that the small household model is one way in which residential aged care can adopt dementiafriendly and accessible design principles ,” the commission ’ s report continues .
Tamar Krebs is another advocate for this model of care . A former RN , she is now founder and co-CEO of Group Homes Australia .
Krebs joined Aged Care Insite to discuss small scale living and its particular benefits for people with dementia .
ACI : Tell us a bit about your early career in the sector and your life as an RN . TK : I ’ ve been in the sector for about 23 years now . I started as an Assistant in Nursing , and worked in some really terrible nursing homes . I then became a registered nurse and was managing nursing homes , hostels , retirement villages and dementia care units , and specialised in geriatrics . My passion really became dementia . But these facilities were becoming bigger and bigger and more excluded from society .
After about 15 years in the industry and working in these big institutions , they felt like human warehouses where people were taken away from the things that were familiar to them and things that were meaningful to them . And we use words like person-centred care and inclusivity , but it was nothing like that .
Tell us how you came upon the small scale model . Everybody wakes up at seven , breakfast at eight , bingo nine , toilet at 10 . And so , I started asking questions like why , when people are the most vulnerable , do we take them away from the things that are familiar to them ? Why can ’ t people live in a small home environment of six to 10 people with 24 hour care ?
I started looking at this model around the world in 2009 . In the Netherlands , America and in the UK this model is very popular . It ’ s been around since the 1960s . In America , there ’ s 10,000 of these small scale homes of people in a small home environment in their community .
In Australia we have something similar called group homes for people living with a disability , but we don ’ t have it in aged care .
In 2012 we started with six residents living beyond the diagnosis of dementia . And I guess the focus is living with dementia , not suffering with dementia . And it was really about celebrating people in their communities .
Are there indicators where you see that depression is lower or the standard of living is much better ? Are there outcomes that we can look at and point to ? Absolutely . The Greenhouse Project in America did a lot of research on this , and in Australia we ’ ve done a lot of research as well . Richard Fleming is one of the champions of the small-scale model in terms of research showing that people have better quality of life , less depression , less admissions to hospital , they live and they ’ re able to do a lot more living in a small environment .
And besides just the residents , we see a lot of staff satisfaction for the workers in these homes .
The Royal Commission Final Report states that service is highly correlated with size : small residential care services with fewer than 30 beds performed better than larger services . What do providers like you do , beyond just having fewer people , that helps people with dementia , and what sort of special care are you able to give ? They choose when they want to wake up in the morning . There ’ s no institutional , rigid routine . Residents get involved in the cooking and gardening and shopping and going out into the community .
They ’ re living life like you and I in the community . And yes , they live with the diagnosis , but the homemakers , who are the staff , adapt the environment as the person progresses through their journey . So , the resident isn ’ t compromised at any time . They get all the care that they need .
It ’ s not a model focusing on a disability , it ’ s a social model that focuses on what they can do , which is a really , really important approach .
In what way are your staff different to those in these bigger homes ? First of all , they ’ re trained to be a universal worker . That means that they learn how to cook and bake , they do the cleaning , they do the caring , they do engagement .
In nursing homes , you have cooks and cleaners and carers and diversional therapists . In our homes you have homemakers , and homemakers are there to create a home . They do all the different things with the residents , or for the residents . And so we up-skill our staff , whether it be in cooking skills , whether it ’ s budgeting skills and rostering . They ’ re not just focusing on showering and toileting
24 agedcareinsite . com . au