Multipurpose Service Collaborative
LHD Consumer Advisory Councils July 2016
Jenny Preece, Rural Health Network Manager
Rural Health Network
Principles of Care for Living Well in
Multipurpose Services
60 MPS
Background
MPS are ‘hospitals’ providing Community Health, Emergency and
Inpatient Care, as well as Residential Aged Care for people who call
MPS ‘home’.
National Safety and Quality Healthcare Standards Accreditation
Homelike Environment
Role of the person in their own care (person-centred)
Cognitive Impairment
Hydration and Nutrition
Leisure activities and Lifestyle
Project Objectives
Principles of Care for Living Well in MPSs
To enhance Quality of Life, lifestyle and wellbeing
for people who call MPSs ‘home’.
To support staff capability in providing
individualised care and a person-centred culture
for residents within MPS.
MPS sites visited Local Health
District MPS Build Status
Inpatient
Beds
Aged
Care
Total
Beds
Co-Located
Services
Mid North
Coast LHD Dorrigo
Operational 1998 – Rebuild
6 21 H/L 30 Government
Access
Southern NSW Braidwood
Operational 1993- Refurb
5 27 H/L 32
Murrumbidgee Gundagai
Operational 2012- Rebuild
12 18 H/L 30 MOU manage
private RAC
Western NSW Warren
Operational 2000- Rebuild
12 30H/L 42 GP
Western NSW Grenfell
Operational 2001- Refurb
7 28 35
Northern NSW Nimbin
Operational 2004- Rebuild
7 11 18 GP
Far West NSW Balranald
Operational 2010- Rebuild
8 15 23 GP
Murrumbidgee Berrigan
Operational 2008- Rebuild
4 10 14 Private RAC
HNE LHD Manilla
Operational 2011- Rebuild
12 40 H/L 52 GP/Health
One
HNE LHD Tingha
Operational 2008- Rebuild
0 8 8 No Acute
Baseline Data – Survey Results
More people are being admitted into high care due to the increase in
community support strategies.
Almost 25% residents in all MPS have dementia
76% MPS have either a Diversional Therapist or Activities Officer (from
8 – 30 hrs per week)
66% have external Medication Review Process
Majority of MPS had Allied Health up to 8 hrs per week, but none had
designated hours for the Residential Aged Care Section.
30% of the MPS had an Aboriginal resident (1 or 2 residents)
0% of MPS had a structured Aged Care Specific Education calendar.
Workforce – Nurses find it difficult to move between acute and RACF
(focus of care on clinical need)
Diagnostic Feedback – 5 themes
1. Person Centred Care
Care Delivery
Family Involvement, independence and choice, access to
medical care, staff respect, resident meetings, links to community
Access to outdoor space
Care Planning
A need for standardised documentation sets - aged care
assessment and care planning
LHD forms and care plans are acute - not appropriate for aged care
Social Profile and Advanced Care Directives
Pre-admission information - Resident Handbook, Welcome Pack
Outdoor environment
2. Leisure and Recreation
Diversional Therapist/Activities Officer hours are limited
Recurrent theme of general ‘boredom’
Lack of transport availability/access for outings
There is difficulty recruiting volunteers due to LHD policy and
aging population
There are limited or no activities offered on the weekends
3. Food and Nutrition
Pre-packaged food has a low level of satisfaction
Only 3 of the 10 MPS cooked meals on-site!
Residents, carers and staff report ‘home cooked meals’ are best
Flavours, aromas, textures and choice perceived as lacking with
pre-packaged meals
Often excessive waste reported with pre-packaged meals
Restrictions on outside food being brought in for residents
No BBQs
Menus have little variation and rotate on a fortnightly basis –
“same old every week”
3. Food and Nutrition
Pre-Packaged Foods
Jams and Sauces
3. Food and Nutrition
Which meal is
home cooked?
4. Access to Multidisciplinary Services
1. Staff resources
Limited allied health services
Physiotherapy – mobility assessments, exercise groups
Dietitian – Dietetic review for Residents
Social Work – Bereavement support
Pharmacist – Medication Review
2. Model of Care
Staff have difficulty changing from acute ‘clinical ‘ care to a
‘well’ aged care focus when working across the MPS
5. Workforce
3. Aged Care Expertise
Limited or no Aged Care specific Education
There is general anxiety around dementia care for
residents (risk)
4. Networking between MPS sites
Benchmarking and sharing of resources
Professional Development (case studies, grand
rounds, journal clubs)
A Private RACF: Reflections
All staff are required to undertake a minimum Certificate III in Aged
Care (TAFE)
A strong family-like environment, pet friendly, care plans reviewed
every 3 months
Emphasis on Diversional Therapy and bus outings
High level of satisfaction with meals (cooked on-site)
Similar Issues to MPS’s:
Workplace Health and Safety Policy: Food Safety
Meal time routine too restrictive:
“breakfast too late at 8am / dinner too early at 5pm”
Principles of Care
The Resident is respected as an individual
The Resident is informed and involved.
Regular Case Conferences and family involvement
Consistent rostering – build 1 on 1 relationships
Cultural shift away from acute ‘clinical’ care to individualised ‘wellness’ care
Marketing and Promotion / LHD MPS Websites
Develop generic Welcome Pack on admission / Resident Handbook pre-
admission
Resident’s meetings
Principles of Care
The Resident participates in Assessment and Care Planning
The Resident lives in a homelike environment.
‘Living’ Care Plan – Activities of daily living
Introduce top 5
Develop common data set (aged care assessment, Social Profile, Advance
Care Plans)
Ready access to outdoor spaces
De-institutionalise environment (daily routines): language of ‘home’
Address physical layout of facilities to create a welcoming atmosphere
Streamline Volunteer recruitment process
Principles of Care
The Resident can access meaningful recreational and
leisure activities.
The Resident has an enjoyable dining experience
Share activities calendars (between MPS or with private RACFs)
Maintain links to community and community transport
Certificate IV in Leisure and Health (AIN or AHA)
Meal Presentation – tablecloths, condiments on the table, smaller tables
Flexible meal times – choice and control (kitchenettes, snack cart)
Bring back the BBQ!
Principles of Care
The Resident has access to multidisciplinary services
MPS Leadership enables expertise in Aged Care
Access MBS Item Nos
Access Private Providers (Priv. Health Insurance)
Increase uptake of Telehealth (Referral and Peer support)
Quarantine Allied Health hours for Residential Aged Care
Strengthen the profile of Aged Care as a Speciality - Build capability:
Minimum Cert 111 in Aged Care
MPS Network streams – Aged Care leadership and education
Build relationships with private RACFs
Where to from here?
Toolkit
MPS Principles of Care
Resource Guide
Self-Assessment Tool
Evaluation Package
Broad Consultation July
Implementation - Clinical Innovation Program $$
- Collaborative EOI September
Living Well in an MPS: A Collaborative Improvement Process
A collaborative is a process to spread and adapt existing knowledge to multiple settings to achieve a common aim. Sites leverage off each other’s learning to achieve a greater collective level of improvement.
AIM:
To deliver patient centred care and enhance lifestyle, independence and wellbeing for people living in an MPS, and their families. To support staff capability in providing individualised care and a person-centred care culture within MPSs.
EOILearning
Set One
(3 days)
Learning
Set Two
(1.5 days)
Learning
Set Three
(1.5
days)
Write up &
share
successful
strategies
Plan
DoStudy
Act Plan
DoStudy
Act
Action
Period (3
months)
Action
Period
(3
months)
Community of Practice
Web-based PDSA Sharing
Monthly Reporting
Fortnightly site support calls
Up to 20
sites
recruited
Living Well in an MPS