JON AMESBURY is passionate about placing the community at the heart of residential aged care facilities. Here he shares his thoughts, ideas, and initiatives that are proving successful.

“No man is an island, entire of itself, every man is a piece of the continent, a part of the main.”

This 17th century sermon by John Donne springs to mind when I think about community integration of residential aged care facilities. The simile for me is not the reference made in the later lines of the prose referring the end of a life cycle (the author was approaching his own death at the

time of writing and undergoing a self-evaluation of his own existence), but is rather the analogy centering around the assertion that no individual is totally self-sufficient due to the basic human requirement of belonging to a wider community. Indeed, Abraham Maslow when developing his hierarchy of needs classified the need for affiliation and belonging as one of his hierarchical foundations.

It is my view that this is not only salient for the health of an individual but also for the maintenance of health within an organisation. It is with this underpinning philosophy that, as an aged care facility manager, I have sought to socially integrate my facility with the goal of becoming a hub within and for the local community.

My integration strategy is based upon four platforms: education and information for the local community and the wider general public, the development of a ‘social conscience’ by being a good neighbour, empowerment of those residents who are entrusted to my care, and the greater involvement of family members in the planning and delivery of care for their loved ones. Each of these platforms has an initiative(s) that drives the philosophy as a vehicle for inclusion and development, each acting, in some way, as a supportive structure for the other three foundational platforms.

I would like to share a brief précis of these initiatives here in the genuine hope that colleagues will find some of these ideas useful and practical for implementation within their own facilities.

To give my facility its social conscience, we have adopted Plunket as our nominated good cause for fundraising activity. I purposely chose this organisation as it is at the extreme end of the generational spectrum. Fund raising for any nominated charitable organisation can focus activity and can take the form of raffles, sausage sizzles, or planned charity nights, and along the way, achieve the end result of providing much needed funds for a worthwhile charity. I have approached local businesses and suppliers who regularly donate goods and local restaurants who will host charity fundraising nights, donating part of the profits to the cause. These businesses have become our “community partners” and are willing to host further events.

Next, I focused on community education by taking a two-pronged approach. I was lucky enough to be asked by Eldernet to write a monthly blog on dementia and other issues affecting the over 65s such as social isolation and depression. The brief for these blogs was that they were informative and written in ‘plain speak’ avoiding wherever possible medical terminology so that they could be easily understood. The contact details of organisations that can provide more specific support and advice, such as Alzheimer’s

New Zealand or Age Concern, is always included. An adaptation of this initiative would be approaching local newspapers or community magazines and offering to share your knowledge in the same way. Feedback from the blogs has been positive and identified a real need for a consistent approach to education and information sharing.

The second prong to this foundation has been the setting up of a two-phase initiative entitled ‘Adopt a Grandparent / Befriend a Child’ and ‘Primary Pals’, both of which have proven to be highly successful. Most facilities will, from time to time, have local school children visit to sing songs or put on a play for their residents; however, I wished to take this idea to a higher level by developing a structured educational initiative, underpinned by experiential learning, for both the generational groups.

I approached our local primary school in Albany and co-developed a six month pilot of the scheme. Working with the school, we agreed that a class of around twenty year 6 children would be asked if they would like to participate in this innovative venture. At the same time, the idea was raised with residents in the facility’s rest home and hospital areas. Consent for participation was taken from the residents and from the children’s parents. Pre-launch education was conducted with the children, focusing on the ageing process, the life cycle, issues around death and dying, and barriers to effective communication. I did not exclude residents with some mild to moderate cognitive impairment, sensory problems or physical disabilities.

The underpinning philosophy of the initiative is based on the premise that as our society becomes more disparate, older generations are in jeopardy of becoming both socially and generationally isolated. This is, perhaps, more of a likelihood for elders residing in age-related residential care. Equally, the younger generation is at risk of not receiving the positive influence that a grandparent or much older person can bring, in helping to shape their maturing into the role of young adults and good citizens within future society. Empathy, understanding, and acceptance through education and meaningful interaction is, I believe, the key to bridging the intergenerational gap. It is also our belief that both groups can benefit significantly, on many levels, from the knowledge and experiences of the other group. By exposing the older generation to the exuberance and pure enthusiasm of technologically advanced pre-teens and raising awareness and understanding with the children of the salient issues that can affect the elderly through experiential learning, education and positive re-enforcement, we are attempting to stop that intergenerational divide becoming a chasm.

The pilot scheme ran until December 2013. Evaluations and feedback were taken from residents, children, parents, and teaching staff. The children were asked to write a one page reflective essay on what they have learnt from the experience. The results have been amazing with the children highlighting not only an increased awareness of age-related issues but also increased self-awareness and confidence when meeting older adults with the development of an advanced empathy towards the elderly. As part of the programme, the children were also taught about effective communication techniques for those with cognitive or sensory impairment, undertakenby myself and the Speech & Language Therapy Department of Massey University. The acronym ‘F.I.S.H’ was taught the children, representing: face to face communications, introducing the topic, staying on the topic, and help the other person if they forget what they were saying or became stuck. The scheme will now continue as a twice yearly event, developing the content to ensure we maximize the benefits for both sets of participants.

The next step, building on the success of this first phase was the introduction of ‘Primary Pals’. This second initiative involves quarterly correspondence from a group of students to every resident in the facility, irrespective of psychological or physical ability. The correspondence revolves around contemporary issues affecting the younger generation in

New Zealand and relating to the past experiences of the older residents. The correspondence is formatted in a traditional postcard design under the heading of “Do you remember the good old school days”and aims to instill empathy, understanding and acceptance in the children through education and meaningful interaction within a structured and nurturing environment.

To address the need for greater family involvement, I have developed the ‘Aria Collaborative Care Approach’. Initially trailed in my 18 bed specialist dementia unit but now rolled out across the whole facility, the aim of this initiative is to ensure that family members who wish to have involvement in their loved one’s care are given the opportunity to fully participate. This degree of family involvement is important as it gives us as health professionals a valuable insight into the resident’s progress from a family member’s perspective, gives a focus to family visits providing consistency, introduces the concept of structured and planned family interventions and creates an opportunity for meaningful information exchanges between professionals and families. It is my belief that the person that knows the resident best is their family. This scheme involves family members having their own set of family notes for their loved one. Family members are assisted to write family care plans, focusing on the medical or socialisation needs of the residents by providing valuable opportunities for family members to participate in the planning, implementation and evaluation of their loved one’s care. On each visit by differing family members, their care plan is referred to and followed with progress towards stated opportunities documented on a set of family progress notes. These notes are included in the multi-disciplinary reviews, forming a proactive component of the resident review process.

As part of the launch, we distributed family satisfaction questionnaires, focusing on the topic of family involvement, to every family member with a loved one in our specialised dementia care unit. Meetings were held with family members, the concept explained and care plans written. The content of these care plans range from assisting to ensure that their loved one maintains an adequate dietary and fluid intake (particularly salient for residents who, due to their illness, have reduced intakes and are prone to deliriums) to social events for residents who are at risk of isolation or loneliness. The consistency of family approaches to visiting can provide numerous opportunities for clinical interventions and ‘moments of joy’ – a snapshot in time where the resident experiences joy at participating in a pleasurable activity, irrelevant of the fact that their short-term memory loss means that they may forget the event after a short period. It must be acknowledged however, that not all families wish to have this degree of input into their loved one’s care. Participation in the project is voluntary and buy-in from differing family members varies considerably. However, this approach, for some, is a vehicle for proactively contributing to their loved one’s care and relieving some of the emotional effects of being unable to care for a loved one within the family home environment.

Lastly, I have recently turned my attention to the greater empowerment of my residents. Admission to a residential aged care facility can, for many residents, have the inadvertent effect of the individual losing a degree of choice and independence. It is with this in mind that I now include a resident representative in the short listing and interview processes for potential new staff. The rationale behind this decision is that if a resident is going to be cared for by another, then the resident should have the right to decide who that individual will be. I include in this process residents with a pronounced physical disability, speech or coordination difficulties due to illnesses such as Parkinson’s and those with a mild cognitive impairment. Not only does this scheme increase resident involvement and promote a sense of empowerment for the resident but also has the benefits of allowing me to see how potential new employees interact with my residents, giving an indication as to how they will deliver care but also reinforces the message, to staff that we are there to serve the residents and that they are, in many ways, all of our managers.

Jon Amesbury is the Manager of Aria Gardens Home & Hospital in Auckland.

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