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Deinstitutionalising dementia care

on Tuesday, July 29, 2014

A Victorian aged care provider has partnered with Alzheimer’s Australia Vic to develop a supported living program that enables dementia residents to lead more meaningful and fulfilling lives.

TLC Aged Care (TLC) became major sponsors of Azheimer’s Australia Vic on July 16, with an agreement to contribute $120,000 in funding over the next two years.

In addition, Alzheimer’s Australia Vic will advise TLC in dementia-friendly design and best practice care across their nine secure units, as well as provide specialist training for staff and family members.

At Altona North’s Marina, the learning journey began 18 months ago when general manger Jane Elliott identified the need to improve Beach and Seascape, the facility’s two dementia care units.  

Ms Elliott quickly gathered together a multi-skilled team of staff who were passionate about providing positive and engaging outcomes for their dementia residents.

The taskforce had nurses, personal care attendants, lifestyle staff, chefs and maintenance staff working under the guidance of Alzheimer’s Australia to systematically identify areas for change.

“We actually went through the whole of Beach with post-it notes and asked ourselves what was wrong and how we could fix it,” Ms Elliott said.

Problem areas were divided into three separate categories; physical environment, dining experience and family involvement.

Physically, the environment has evolved from sterile and clinical to bright, homelike and of course, dementia-friendly.

TLC chief operating officer Neville Watson said they have acted on basic recommendations to assist with daily living, like adding brighter lighting and revising the courtyard areas to provide an extension of the internal living environment.

“To help them identify their room, we allowed the residents a choice of colour for their door,” Mr Watson said.

“There is now a whole rainbow down the corridors.”

The blitz garden makeover involved bringing in three chooks, a cubby house, a men’s shed and clothes line.

“Anything to encourage our residents to get out and about,” Ms Elliott said.

At mealtimes, residents are given greater choice and involvement, with their own kitchen to prepare breakfast and lunch.

“The process took us back to the basic question of how you like your toast in the morning,” Ms Elliott said.

“Everyone is different.”

While nutrition and hydration are often sore points of dementia care, with residents tending to forget about, or show disinterest in food, the Marina kitchen has been going through more produce than ever.

 “They used to only eat three loaves of bread in the morning, now they eat four,” Ms Elliott said.

Residents not only serve themselves, but assist in all areas of meal preparation, from cutting vegetables to setting the table.

“It has become a community where the residents take care of each other,” Ms Elliott said.

Meal preparation is an example a Montessori-based dementia programme, which TLC has adopted in pursuit of a more relaxed approach to care.

With guided repetition and gradual task breakdown, a Montessori-based physical activity is one that the resident completes on their own.

Simple tasks such as making coffee, filling vases with flowers, fixing a torch or polishing shoes can promote engagement, mobility, hand-eye coordination and dexterity.

“We have always been very good at caring for residents, but I think we care too much and take away their independence,” Ms Elliott said.

“We need to take people back to the skills they have retain from their earlier years because these are some of the last skills that they lose.”

Mr Watson said feelings of self-worth expressed by the residents cannot be underestimated.

“One resident was in tears most mornings, now she is smiling,” Ms Elliott said.  

For families, it has been equally rewarding to see their loved ones engaged in meaningful activities.

Lifestyle staff now e-mail their calendars to all the family members so they have a better idea of what to expect during visits.

Going forward there will be onsite information sessions for families of TLC dementia residents provided by Alzheimer’s Australia Vic.

“These are designed to elevate understanding and demystify dementia for the family member,” Mr Watson said.

“The families go through various aspects of grief over loss of their loved one, in terms of cognitive ability.

“This is about supporting and educating them, so they are still integral to the care.”

Within the next 12 months, the supported living program will roll out to TLC’s remaining nine homes, using Marina as the prototype.

Far removed from the hushed and hidden stereotype of the “dementia ward”, Marina’s Beach is now guiding best practice across the organisation’s full suite of residential care.

Image: TLC CEO Lou Pascuzzi with Alzheimer's Australia Vic CEO Maree McCabe. CONTRIBUTED.

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