Oct 03, 2018

Reinventing ageing: Aged care of the Future

“I don’t want to have to go into aged care when I grow old.”

A phrase not uncommonly heard, and often punctuated by a shudder of apprehension.

Sadly, there’s a stigma attached to aged care that hasn’t made it appealing to those of us who may one day need it.

Continued reports in the media about the lack of quality care due to chronic understaffing have further fuelled our long-harboured fears of being institutionalised in old age.

Nonetheless, we’re faced with the harsh reality of an ageing population.

Currently, 3.7 million Australians are aged 65 years and over — that’s about one in every seven people.

By 2096, this number is projected to quadruple to 12.8 million.

With demand already outstripping supply and considering our reticence toward aged care, it’s past time we started thinking outside the box.

Unpacking the stigma

The Australian Centre for Social Innovation (TACSI) is an organisation that tackles complex issues in our society with innovative ideas… issues like an ageing population.

Their studies confirm what we’ve already guessed. People actively don’t want to be in aged care and it’s not what they hope for themselves in the future.

TACSI’s Principal for Ageing, Disability and Partnerships, Kerry Jones, said while aged care facilities provide shelter and care, it isn’t enough when considering what people want in their lives.

“Our current aged care system is a medically driven model and we’re used to taking a very institutionalised approach to health as we age,” she said.

“We’ve got a competitive funding market and aged care has to be a viable and profitable business. In some cases that means those who are more vulnerable and on lower incomes are not able to access our system in the same way.

“That’s why we need to look at doing things differently and consider better alternatives to aged care.”

Aged care member and AIN Michelle Flitton has witnessed the regimented nature of the industry firsthand, and said it’s a major factor affecting people’s attitudes toward entering aged care.

“There’s no flexibility to residents’ daily living and that’s why people relate it to being in a prison,” she said.

“We talk about resident-centred care but I think a lot of that isn’t being done due to staff shortages.

“I look around at the visiting families who are watching us and all they see is the rush, rush, rush. All we have time to do is put residents in the lounge room and that’s the entertainment for the afternoon.

“It just isn’t good enough and it’s not what we want for our folks.”

Building a home

In tackling this problem TACSI directed their efforts toward truly understanding the diversity of the Baby Boomer population.

In particular, they explored which groups of people were at the highest risk of not ageing well and how that could be changed.

This work was key in identifying where the greatest need for innovation in aged care was… and it all pointed to ‘home’ and the role it plays in our lives as we age.

“Our home is critical to the way we express ourselves and is a key part of our identity,” TACSI’s Kerry Jones said.

“We want to know that we can not only wake up somewhere safe tomorrow, but that we can change it to meet our needs.

“We want to have control over that space and a real sense of ownership, and that’s something you don’t have in residential aged care.”

It’s this very concept of home that’s led to the creation of a new initiative by Group Homes Australia… share housing for our elderly.

It’s the brain child of Registered Nurse and founder of Group Homes Australia, Tamar Krebs.

While share housing may sound common enough to a uni student, there’s a lot to consider when we’re talking about six to eight elderly Aussies with varying stages of dementia.

“All the research shows that people thrive in a home environment,” Tamar explained.

“Group Homes Australia sets elderly people up in a real home in a local suburb. The homes are run by homemakers who have qualifications in aged care, but critically they also know about looking after a home and purposeful, meaningful engagement with residents.”

Registered Nurses play a very different role here. They are a support person for the clinical needs of residents, but mainly aim to build rapport with residents, families and staff.

“The whole concept is underpinned by engaging in life. Even for the families it’s a completely different experience to visiting their mum or dad in an aged care facility,” Tamar said.

“When they stop in their mum might be doing some baking. And even if she’s being assisted by a homemaker you can see the model here is very much about doing things with the residents.

“We’ve put the focus back on person-centred care and it’s how we operate day-to-day.”

Breaking down the gates

This share housing concept was first pioneered by the Dutch through Hogeweyk, a nursing village located in the Netherlands.

It’s 152 residents all have mild to severe dementia and live in 23 houses (each with six to seven residents) that embody four different ‘lifestyle’ categories — cosmopolitan, natureoriented, well-to-do and traditional Dutch.

They’re looked after by caregivers who cook, take them to social events, help them go grocery shopping in the village market and watch over them for their safety.

It’s a true-blue community and residents in Hogeweyk are reaping the benefits… they’ve been found to live longer and take fewer medications.

In fact, Hodgeweyk’s model has been so successful that we’ve quickly followed suit, with Tasmania announcing plans for Australia’s first dementia village encompassing 15 tailored houses, a supermarket, cinema, café, beauty salon and gardens.

These villages have begun to break down the ‘locked door’ approach Australia has thus far employed for those with the highest care needs.

TACSI’s Kerry said Australia needs to tap into the opportunity that is in our communities.

“Research shows the longer we can be in place in the same community connected with the right support system around us and the more independent we are, the better quality of life we will have,” she said.

“We need to (metaphorically) break down the gates around our aged care facilities. That gated feeling is how we lose the richness of what it means to live intergenerationally.

“We don’t need massive state-ofthe- art facilities to care for people in the right spaces and in the right way.”

Indeed, Group Homes Australia’s share housing concept has helped residents with severe BPSD (behaviour and psychological symptoms of dementia) truly thrive.

Founder Tamar said residents who had been evicted from aged care facilities because of aggressive behaviour had unmet needs that continued to escalate.

“We’ve got an ex-tradie resident who was evicted from an aged care facility for becoming aggressive toward staff,” she said.

“When we unpacked the problem we found he was having to sit for hours playing bingo and having singa- long sessions. By the afternoon he was becoming severely agitated.

“We handed him a bucket of paint and a paintbrush, and for the next six weeks he woke up at 5am every day to paint the fence of his share house.

“He was a tradie and he desperately needed that physical activity, so rather than sit in judgement we need to pause and ask ourselves if there is a fundamental underlying unmet need, and how we move forward with that.”

The innovation age

There’s no question about it… a singalong session once a week with a man on a piano just won’t cut it for us.

Our generation will want to enter aged care armed with an iPad and a lifetime subscription to Netflix.

Fortunately we’ve seen aged care facilities both overseas and in Australia gradually begin to incorporate innovative initiatives aimed at meeting residents’ needs.

UK’s first intergenerational care home in Wandsworth integrates both older residents and children into the delivery of the curriculum and elderly care, with children able to visit elderly residents on a daily basis.

In New South Wales, The Whiddon Group’s Australian-first trial of the Hensioners initiative showed health and wellbeing benefits for residents tasked with looking after hens.

And closer to home, residents at a Gold Coast aged care facility live sideby- side with horses and cows thanks to an on-site farm tended by a local school.

While these ideas have proven successful in enriching the lives of residents, Kerry said we all need to work alongside each other to ensure innovation in this space takes root.

“The whole process of innovation can be quite challenging… a lot of ideas remain ideas and don’t quite get off the ground,” she explained.

“We’ve seen a few situations where innovative ideas imported from overseas have failed as there wasn’t an understanding of the broader context culturally and policy-wise.

“We need to bring people with entrepreneurial ideas and the aged care sector together and leverage the best of both worlds to find sustainable innovation.”

AIN Michelle Flitton said even her facility has begun to tap into the concept of home, renovating residents’ rooms to incorporate a homier feel and move away from a hospital look.

“The rooms have new timber flooring, lovely new furnishings, soft lighting that turns down, new hightech TVs and of course, internet,” Michelle explained.

“Residents and families love it. Families feel like they are visiting their loved one in their own home and it makes a huge difference to residents’ attitudes and quality of life here.

“I hope we keep moving forward in meeting the needs of generations to come.”

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