• 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






    Beds Co-Located


    Mid North

    Coast LHD Dorrigo

    Operational 1998 – Rebuild

    6 21 H/L 30 Government


    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


    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-


    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?


    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.


    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.


    Set One

    (3 days)


    Set Two

    (1.5 days)


    Set Three



    Write up &






    Act Plan




    Period (3






    Community of Practice

    Web-based PDSA Sharing

    Monthly Reporting

    Fortnightly site support calls

    Up to 20



  • Living Well in an MPS

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