At two Whiddon memory support homes, daily one-on-one time is changing how residents living with dementia connect with the people caring for them.
One resident wouldn’t let anyone get close. Staff at a Whiddon memory support home knew the pattern well. If they approached, she pushed them away. She could become quite physical in making it clear they should stay back, and if they offered help with showering, the day could turn into a standoff.
“Staff go, ‘Oh, I’m not going to go near that lady because she gets upset if I do,'” says Karn Nelson, Executive General Manager, Research & Positive Ageing at Whiddon.
Then one of her main carers, newly trained in a program called RBC Enrich, started sitting with her. There was no agenda and no task. She simply gave her time.
“Very quickly, this lady started to open up,” Nelson says. “She was more sociable. She was taking part in activities. She was assisting staff with her personal care. Nobody could quite believe that. And now she’s walking around hugging people.”
It wasn’t only one carer making the difference. The home’s manager was also trained, and sat with the resident herself to understand what was happening. “She couldn’t quite believe it,” Nelson says.
In the same home, a man who was almost always asleep and rarely spoke to anyone was paired with a carer. She began sitting with him and holding his hand, even while he slept. When he woke, she listened.
“He is now awake all the time,” Nelson says, “engaging in conversations.” He also raised something that had clearly been on his mind. He wanted to talk about whether he was afraid of dying.
Nelson is careful about how these stories are told. “They sound subtle, but they’re not subtle. They’re big changes.”
RBC Enrich is a pilot Whiddon is running at its Easton Park – Taylor House and Maclean care homes, in partnership with US-based organisation Memory Bridge. It builds on the relationship-based care approach Whiddon has been embedding for about a decade.
That approach, which is about really knowing each resident and responding to them as an individual, worked well across most of Whiddon’s services. It worked less well in its memory support homes.
“There was a missing piece of the puzzle,” Nelson says. “How do you really meet the emotional needs of people who may no longer be able to communicate in traditional ways?”
She explains that most daily contact with residents living with moderate to advanced dementia is about doing things for them: personal care, meals, making sure they have what they need. Staff can do it in a person-centred way, but it is still a transaction.
“It’s not about a real human connection,” she says.
Nelson says people living with dementia can miss out on that connection entirely. “Even though they may have cognitive impairment, we all have these needs, and they are people, and they need those things as well,” she says. “You have all sorts of other needs being met, but not the emotional.”
The idea reached Whiddon after a recommendation from the CEO of St Christopher’s Hospice in the UK. When someone from Memory Bridge later came to Australia to run workshops, Nelson and two colleagues went along. What they heard about reducing emotional isolation for people with dementia resonated.
Under RBC Enrich, each resident has one or two consistent staff buddies who spend structured one-on-one time with them every day. The buddies are trained to sit and be present, and the resident leads.
That can be harder than it sounds for people who work in care, because the instinct is to fix things.
“We’re all fixers,” Nelson says. “Would you like some orange juice? Are you too hot? Are you too cold? All of those things have to go to one side.”
Sometimes the time together involves talking. For a resident who likes to talk, Nelson says, “it may not make sense to you, but it’s about the talk.” It can also involve touch and eye contact. Residents might cry, or share a theme they return to again and again.
Nelson gives one example. A resident would talk and then reach a point where she would say, “and then the men came and took it all away.” With gentle questions, such as what happened and what the men did, staff can begin to understand what lies behind it.
Nelson is clear that carers aren’t acting as therapists. The aim is to help people express themselves, and it isn’t only about hard memories. Joy comes up too. Over time, staff begin to understand how a person’s life experiences shape how they are today. It moves practice away from managing behaviour and towards asking why a person is distressed.
“If you are living in an environment where no one ever talks to you about those feelings or gives you a way to express those feelings, you bottle them up and you become very withdrawn,” she says.
Nelson says many staff already do some of this instinctively. What they often lack is confidence, or a sense that they’re allowed to.
“We’re saying yes, you absolutely do have permission to do this,” she says. “In fact, we expect you to do this as part of your practice.”
She says the principles aren’t complicated. “It’s not rocket science,” she says. But staff need a framework, and Memory Bridge’s training provides one. Coaching sits on top, so staff have someone to turn to when they hit a problem or aren’t sure how to approach something.
The earliest feedback came from the clinical nurse coordinator at the first pilot home. Nelson says she told her it happened very quickly: staff began to see residents as people with feelings like their own. They came to work and talked about residents that way, and about why they might be acting in certain ways. Before, Nelson says, they might have seen someone who needed care.
Nelson says the home has felt the difference more broadly too. “You can provide much better care when you really know people on that level,” she says, and more residents want to join in and are able to.
Staff are also taking the skills home. “I use this with my children,” is something Nelson hears. “I use this with the older people in my family.”
For her, the heart of RBC Enrich is a belief that emotional connection belongs with the basics.
“We all need food, we all need water, but we also all need emotional support,” she says. “If you take away one of those, you can’t really function.”
Carving out daily one-on-one time is the biggest challenge. Nelson points to growing compliance demands and the unintended consequences of care minutes, which mean staff are spending more time on documentation and less on care that isn’t task-based.
That is why the pilot is testing how sustainable the approach is as closely as it tests outcomes. A community of practice will link coaches and buddies across the pilot sites so they can share notes and build their skills together.
“What do we need to change to incorporate this as daily practice?” Nelson says. “You’ve got to trial it. You’ve got to see what works and what doesn’t.”
Asked what she would say to other aged care providers who want to try something similar, Nelson says it starts with belief.
“You have to have a belief in relational care,” she says. “If you don’t have that within your culture, that’s your first thing.”
Many good providers are already working towards this in their own ways, she says. But where the culture isn’t there yet, it has to shift towards relationships, because that is how real quality care is delivered.
The next step is looking hard at how a memory support home actually runs, including its systems and environment, and making space for this kind of time. Staff also need the support to deliver it.
“You can’t just add something like this on,” she says. “You’ve really got to support it, otherwise it will fail.”
It isn’t a program, Nelson says, so much as a change in culture and practice. “It’s a lot of work, but it’s so rewarding,” she says, “because the results that you see are almost immediate.”
She believes the need reaches well beyond memory support homes. Many older people, whether in aged care or in their own homes, are emotionally isolated and lonely. “This is something really relevant to all of us,” she says.
