Moving into aged care- not a cause for celebration?

Victoria Jacques General Manager Residential Services

5/29/14   1  

Decision has been made

•  No  happy  campers  •  Visit  to  the  site    •  Measure  up  the  room  •  Does  the  furniture  fit?  •  The  reality    •  I  am  old!  

5/29/14   2  

Admission

•  Warn families that it can take up to 2-3 hrs for admission •  Guilt is heightened during admission- reality sinks in •  Resident fuels the situation •  Blames the child if they have forgotton something •  Not unusual to see mocking of the child

5/29/14   3  

Transition Experience

•  First 6 weeks normally traumatizing for new residents and families

•  Guilt, Grief, loss •  Packing up memories •  Deciding what to keep and what to take •  Financial considerations- sell the home •  Bond or daily accommodation fees- New fee structure in

July 2014 •  Taking  my  mother  away  from  her  own  home  ‘and  her  cats’  

was  the  most  trauma7c  and  saddest  event  I  have  ever  had  to  cope  with  in  my  en7re  life  (adult  child)

5/29/14   4  

5/29/14   5  

Having  Friendship  is  important  

Villa Maria/Swinburne Program

•  New facility in Wantirna admitted over 220 residents in a period of 12 months

•  Experience of staff – feedback that they felt overwhelmed by the emotional needs of residents and families

•  Centre Manager developed family groups where debriefing took place –sharing of guilt and grief

•  Individual counselling for residents specifically referred for depression and complex needs

5/29/14   6  

Villa Maria/Swinburne Program

•  Swinburne/Villa Maria program •  Identify Residents with depression and dementia •  Encouraged staff to look at complex residents and family

issues •  Offer One on one counselling •  Quality of life indicators measured •  Cornell scale for depression •  Nursing staff referred to the social worker and then screened

for suitability to the program

     

5/29/14   7  

Villa Maria/Swinburne Program

•  Residents  did  not  oJen  miss  their  appointments  •  A  chance  to  talk  to  someone  for  an  hour  •  Gave  staff  an  alternaOve  to  drugs/lifestyle        DATA  Number  of  counselling  appointments  made=  64  Number  of  counselling  appointment  kept=61  Number  of  counselling  appointments  per  resident  (on  average)=8.7  1  Amount  of  counselling  Ome  provided  (in  total)=3660    Amount  of  counselling  Ome  provided  per  appointment=  60  mins  

5/29/14   8  

Villa Maria/Swinburne Program

5/29/14   9  

Resident Baseline Post-treatment

VM 3 2 MM 16 9 RC 18 8 Average 12.33 6.3

Preliminary evaluation of benefits to clients, as perceived by staff and by the client

Cornell scale for depression

Alexopoulos, G. S., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23(3), 271-284. doi: 10.1016/0006-3223(88)90038-8

These results show that depression severity reduced by half by the end of counselling, compared to the start.

Counselling Feedback

5/29/14   10  

Enabled  me  to  accept  my  situaOon  to  be  able  to  talk  through  my  situaOon  I’m  in”      “To  have  a  conversaOon  with  an  independent  person  knowing  it  was  confidenOal”  

•The  Quality  of  Life  Scale  –  Alzheimer’s  Disease  (QOL-­‐AD)  Logsdon,  R.  G.,  Gibbons,  L.  E.,  McCurry,  S.  M.,  &  Teri,  L.  (2002).  Assessing  Quality  of  Life  in  Older  Adults  With  CogniOve  Impairment.  PsychosomaOc  Medicine,  64(3),  510-­‐519.        • 66% of residents had an improvement in quality of life indicators

Dementia and Carers -what helps?

5/29/14   11  

Acknowledge the emotional impact of the transition into Aged Care on the carer and the person with dementia by using a person-centred approach to care.

• Provide education about dementia to carers of residents with dementia as well as all staff working in the facility.

• Instigate consumer groups within each facility to hear the voice of the carers and/or support carers to join dementia carer support groups in the community.

•

I  don’t  think  it  could  have  been  improved;  the  social  worker  made  my  job  very  easy  and  the  staff  in  the  home  also  helped  make  the  move  less  stressful  (carer)

Villa Maria Interventions to reduce hospital admissions and minimize risks

•  Provide nursing and medical expertise in the home- •  All staff trained in dementia specific skills and clear dementia

strategy •  Difficult discussions made •  Futile interventions are avoided •  All residents are encouraged to have an End of Life

discussion

Villa Maria rate – 60% of all residents have an ACP across four facilities. This is unusual across aged care.

5/29/14   12