Person-centred care is seen as one of the best ways forward for aged care – it puts the person first in decision-making and treats them with dignity and respect. But often those decisions are impacted when cognitive decline occurs.
As aged care becomes more personalised there are calls for greater emphasis on the individual and their ability to make choices, especially for people living with dementia.
The Green House Project (GHP) is an American not-for-profit aged care provider promoting the small house model of care: fewer residents live in each building and trained staff perform a number of different tasks, including cooking, personal care and cleaning. Australia’s first residential aged care home based on GHP principles will open later this year in Adelaide.
Susan Ryan, the Chief Executive Officer (CEO) of GHP, said it’s common for aged care professionals to view people with dementia by their diagnosis and not as an individual. So when she discovered almost 85% of their residents were living with some level of cognitive impairment, she wanted to do more.
“Our Best Life approach comprehensively and holistically look at who the person is and [asks] how do we really ensure each person is living his or her best life? It’s really about seeing the person,” Ms Ryan explained.
“As it pertains to somebody living with dementia, how many times do we just focus on loss and decline and say they can’t do that anymore? We have labels and we see the label before we see the person.
“I challenge you to see who that person is. We’re going to shift beliefs.”
In shifting beliefs, Ms Ryan it’s all about breaking down perceptions, such as how we perceive a person with dementia wandering, showing aggression or ‘sundowning’ – the restlessness and agitation they show later in the day.
“We might say someone with dementia, they wander, they’re seeking. What might we say about ourselves? We were walking, I was bored, I was restless or agitated. Or we talk about sundowning and we have to think about what we have done that might be forcing somebody into daily rhythms that are not their own,” she said.
By looking at the person, you can also understand why those actions are occurring. Marie Alford, the Head of Dementia Professional Services at HammondCare’s The Dementia Centre, said they often receive referrals based on the problem, not the individual. For example, someone like Barry would be labelled as agitated, aggressive or causing trouble.
“Barry was a lifelong factory worker, he was a staunch unionist and led the union movement in his factory. In this particular care home, the staff wore white-collar shirts and carried clipboards around. Barry would see them and think, ‘Why are you looking at me, why are you following me around?’ He didn’t see them as there to help him, [but thought] they were there to spy on him,” Marie explained.
“The next thing for Barry was he’d always been on the floor of the factory so he’d always been busy. At the care home, there wasn’t a lot to do. But what they did have Barry doing, which was fantastic, he was outside sweeping and he swept and he swept.”
“But he had this really, really crusty old broom. So he’s bent over and he was actually in a lot of pain. So some of those behaviours were because he was in pain.”
With some simple insight into Barry’s past, they were able to give Barry a new broom that relieved his pain, while staff no longer had white shirts and clipboards when caring for him. They even swapped out Barry’s coffee for decaf, gave him a hi-vis vest and allowed him to run some meetings, just like in the old days. Those changes wiped out his agitation, aggression and anxiety.
“That was the importance of knowing who he was, what his story was, and what was purposeful and meaningful to him,” Ms Alford said.
Absolutely – carers need to have the time and opportunity to get to know residents’ personalities and idiosyncrasies and the time to manage how they approach supporting said residents- appropriate staff ratios are important and an understanding of the impact of low staffing levels and using agency personnel.