What is dementia care like in a residential care home?

00:00:00 Kate
Welcome to Age Old Problems: New Aged Care, a podcast by Helping Hand that offers information and advice to help you find and access the right aged care services. This podcast was recorded on Kaurna Land.

00:00:22 Kate
Hello and welcome to another episode of Age Old Problems: New Aged Care. I’m your host, Kate Holland. This episode is one of three that we are devoting to dementia, a condition that an estimated 433,000 Australians currently live with. Joining me back on the podcast is Tanya McIver, who is Group Manager of Residential Services at Helping Hand. Together we’re going to explore the reasons why someone living with dementia may need to enter a residential care home and how care homes enable people living with dementia to live their best lives. Welcome back Tanya.

00:00:52 Tanya
Thank you Kate.

00:00:53 Kate
So for those who haven’t listened to the previous episode, can you just briefly describe what your role is at Helping Hand and what that involves?

00:01:00 Tanya
I work in residential services and my background is clinical and operational leadership in aged care. I’ve been in aged care for about 20 years and my current role is to oversee and support four of our residential aged care homes, and the staff, to provide high quality care and safe care to our residents.

00:01:17 Kate
In this previous episode we spoke about the different ways that you can keep someone living with dementia safe in their home and how you can make life easier for them and there are some great tips around that. But in most cases there comes a point when living at home is no longer the best option. Can you run through the types of reasons why someone might need to go into care?

00:01:34 Tanya
Sure, it does get to a point where there are some real trigger points that do require that supportive residential care. It can be the safety of the person living with dementia. If you’re unable to maintain them within the home, there may be risk of wandering, not being able to find their way home. Increased care needs, that’s when you might need a lot more assistance with your showering and with that general support, because it can become quite difficult to provide that care, and it’s sometimes very difficult for the person providing the care to be doing those tasks. Increased clinical needs, such as need for medication, support to take medications. Sometimes it’s a falls risk. So overall, the really big one also is carer fatigue. So often a carer has just spent so much time, it’s a 24 hour job, which one person can’t do. So the main trigger is, there’s going to need to be some help to look after the person with dementia and also really importantly for the caregivers that have just given so much to their person.

00:02:34 Kate
And I imagine if there’s a safety risk and there’s a worry that comes, you know, all of us worry about leaving the iron on or the stove top, but if that’s actually happening more frequently, that’s going to be a real concern both for the person living and the person caring for them.

00:02:47 Tanya
It’s an absolute concern. That safety, that potential for harm just for the person with dementia or for someone living with that person, it becomes a real concern from the safety and then a real concern for the other members of the family that want to look after both the people. So if it’s a couple living at home and one’s doing all the care, family and friends are going to be really worried about both of them.

00:03:10 Kate
So what are the benefits of a care home? Obviously it’s going to alleviate some of the issues, but what are some of the other benefits of a care home for someone living with dementia?

00:03:18 Tanya
It’s the 24-hour clinical and care at all times. It’s the support in the middle of the night that’s needed. It’s the opportunity for the carer to be able to step back and also look after themselves. We often say you need to trust us to do the care so you can go back to being the loved person and re-establish that relationship with your loved one. You know, let us worry about getting your person, your loved one into the shower, you worry about coming and having a coffee with them.

00:03:49 Kate
Yeah, you’ve got more space just to be back having that relationship again, don’t you? And you mentioned 24-7. Now again, if someone missed earlier episodes about dementia, and I didn’t know this either, that sometimes the body clock changes and people are up a lot later at night, so that is an interesting fact for people to understand. That’s why the 24-7 is really important, isn’t it?

00:04:09 Tanya
Absolutely. So if you think about someone living at home that’s having trouble with their time, which can happen with dementia, so the middle of the night is suddenly the middle of the day. As a carer, you’re having to be on task 24 hours a day. If it happens here at our care homes, we’ve got registered nurses and care staff there to guide, redirect, support. What it also means is the caregiver at home is getting a good night’s sleep and can come in and give themselves back again.

00:04:37 Kate
So the benefits to family members of residential care for someone living with that, that’s a really big part of it, isn’t it? It’s letting them rest, it’s letting them return to their original relationship and just be partner or daughter or son.

00:04:49 Tanya
The partnering is so important and when someone comes into care, the most important relationship is the staff and of course the person living in our care, the resident, but also a partnership with the family members that know this person better than anyone. So they’re the ones that need to support and guide the way we deliver care to their loved one because we vary it for each person. So it’s making sure we really partner with loved ones and that helps build the way we deliver care.

00:05:17 Kate
So does that mean you have quite an in-depth intake conversation with the person who cares?

00:05:22 Tanya
We do. It’s quite a detailed process and we want to set the person that’s coming into our care up to succeed. We want to set the staff up to succeed and give the right care to the right people. And we want to set up the family. They’re trusting us with their most important person in the world to them. So we need to make sure they’re part of that care planning. So there are assessments and planning. There’s opportunities to get to know the resident, who they are now and who they have always been.

00:05:52 Kate
Yeah, is that an important part of it, understanding who they may have been and what their life was and maybe what their career was and how that might show up in some of their behaviours?

00:06:00 Tanya
It’s vital because people present in very different ways. They’ll often present on different timelines. So they may on certain days think they’re back as a 25 year old school teacher. There’s no arguing that, it’s supporting where they are and how they’re feeling. It’s understanding what some experiences might be. I’ve looked after people that have even served in wars or been prisoner of wars. Their experience and the way we have to interact with them is very different. Someone that has been a stay at home mum is going to be busily looking for the kids at 4 o’clock. So it’s really important that our staff know all of those things about each resident and adapt. They have to meet them in their world and adapt to each person.

00:06:44 Kate
That’s great. That’s a very deep dedication you have. And I assume that part of your process is reassuring the carer that all the people who are assigned to looking after their loved one are going to have this deep understanding.

00:06:55 Tanya
It is. It’s about the staff training. It’s about the reassurance and building the trust. It’s also about them understanding that they’re coming into care because they do have very high care needs. Things will still happen. Falls may still happen because we’re encouraging some independence. So some of the things that were still happening at home will still happen in care. There’s someone there 24 hours a day to support, pick up, treat and assess. So that’s why it’s so important to be able to have that reassurance that if something happens tonight, someone’s going to be there.

00:07:28 Kate
And obviously people will come in with slightly different levels of needs. Helping Hand has 11 care homes with dedicated memory support units, or otherwise known as MSUs, I think, aren’t they, within the system?

00:07:40 Tanya
Yes.

00:07:41 Kate
Does somebody living with dementia necessarily always need an MSU?

00:07:45 Tanya
Not always. So over half of our residents in Helping Hand have got a diagnosis of dementia. It’s what brings them into care. For others, it’s in conjunction with other illnesses. The demand is huge. As we go through it, not everyone is going to present in the same way. And that’s one of the real challenges of dementia. It’s not a predictable way of presenting. It’s not a predictable timeline of how you’re going to deteriorate. Some people can live in our open areas quite safely. It’s when it’s again a risk of potentially exit seeking or leaving and getting lost. And the other real reason that we see people needing memory support is to go into a smaller, more contained unit.

00:08:27 Tanya
The world becomes very overwhelming when you’re living with dementia. You know, you think about young people travel the world. With dementia, you start to see the world needs to get smaller and smaller to cope. Often we might say to a family member, we think they’ll do really well in a more contained unit where they can cope, they can familiarise themselves. And then, you know, they find that they’re more comfortable with a smaller room, a smaller area, it’s not so overwhelming. So sometimes it’s that emotional need to go into a smaller unit, where it’s got those real specialised staff members as well.

00:09:01 Kate
And are there particular activities that are undertaken within those units as well?

00:09:06 Tanya
We try and give a really varied lifestyle program. We’ve got some incredible technology coming in as well. So obviously company, social support, chatting, engaging – everyone needs social engagement and company. But there’s also ways of supporting it. We’ve got Tovertafel tables, and I never say that correctly, but…

00:09:24 Kate
And you need to explain what they are.

00:09:26 Tanya
I like to call them a magic table. There’s some AI, it’s like a computer program. It’s a tabletop, and there’s some incredible interactive games that can stimulate cognitive and also physical capability.

00:09:38 Kate
They have music too, don’t they?

00:09:39 Tanya
Music’s a massive thing. Bubbles that go pop, but there’s also other people, they’re not able to use those. So we have to adapt to different stages, because there are different stages for people living with dementia. Some people remain really mobile, other people may lose their mobility and need a lifestyle program that’s still able to be provided. Even if they’re not able to get out of their chair anymore, we still provide the right level of lifestyle engagement to keep their social and emotional content going.

00:10:08 Kate
So that remains an ongoing focus. There are always activities that are designed and aligned to someone’s situation.

00:10:14 Tanya
Yes, we certainly adapt. We’ve got lifestyle programs, we’ve got some incredible staff. But the other thing in a memory support unit is all of our staff, whether you’re the nurse, the carer, working in hotel services, has an understanding of people living with dementia because our residents don’t know who we are. They just know how we make them feel and they know who their people are.

00:10:37 Kate
And I’ve met several people since doing some activities with Helping Hand who genuinely enjoy their time at the memory support unit. So maybe that outside perspective that dealing with people who are living with dementia is all hard work. That’s not actually true, isn’t it? There’s some real moments of joy and happiness.

00:10:51 Tanya
It’s a beautiful place to work. The staff that go in there give their heart and soul for 8 hours a day to people that they genuinely care about. We really try and put people in there that have this as their passion. We know our residents so well, we really care for them. I’ve seen care staff that treat them like family and provide the care as if they would for their own family. And I know if I had to put my person into aged care, I’d want a group of people that genuinely care and love my person. And that’s how I’m going to get respect and dignity and trust.

00:11:24 Kate
And seek out moments of joy with those people.

00:11:26 Tanya
The moments are so important. And someone living with dementia can have a really great day, can have a really great hour or a really great 5 minutes. And if we can grab that 5 minutes and a family can get that 5 minutes back of clarity with their person, that’s why we do it.

00:11:44 Kate
So can family members come and visit within the memory support unit?

00:11:46 Tanya
At any time. We absolutely support that. We like to partner with people, they can get involved in activities. So just because you live in a memory support unit, you can still come out, be in the other areas of the home, come for coffee at the cafes, come to other concerts and activities. So there’s life within an aged care home. It’s a really lively, beautiful place. It’s a community.

00:12:09 Kate
I know the government is pushing harder and harder for person-centered care, which is actually something Helping Hand has been doing for a very long time. But is there something that you can provide as an example about how you have delivered person-centered care to someone living with dementia? I think you sort of have alluded to it anyway, but is there a sort of a standout thing that you might do?

00:12:26 Tanya
It’s the life history is how we actually can deliver it. I was walking through a memory support unit last week and the first lady spoke to me about her country town. So it was important that I knew which country town that was. She thought she was there. So rather than saying, no, you’re not, it was, tell me about the main street. The next person I knew was a farmer. And he actually said to me, let’s get out there and shoot the rabbits. We encourage staff to change for each person. So it’s knowing that’s what’s important to that person. The next lady presents beautifully with bright red lipstick. First thing she said is, when are you going to get your hair done? So we can do really big projects, but it’s those small things that make a difference.

00:13:08 Kate
And understanding that about those people, is that part of that early gathering of information with their carers?

00:13:13 Tanya
Yes, it is. I’ve had ex-nurses that have come in and because I’m a nurse, I remember having one lady sitting in doing the rosters with me. She just was looking and looking for something to do. And she said, you look like you’re really busy. And I said, I need help with my rosters. She said, leave it with me. And it was beautiful.

00:13:29 Kate
So she sat side by side with you.

00:13:30 Tanya
She sat there and we did the rosters.

00:13:32 Kate
I’ve heard a similar story of a previous GP who got really agitated at the end of the day. And eventually somebody understood that was his previous life and they set him up a table in the corner and he would sit there writing scripts for hours and was really happy.

00:13:45 Tanya
So it’s meaningful engagement. So we can do wonderful activities. But it’s those meaningful moments and that meaningful engagement. Not everyone wants to sit and do rosters or write the scripts, but it meant something that person felt and the GP example would have felt they were adding value again.

00:14:02 Kate
There’s lots of reasons why it makes sense to me having chatted to you about why a residential care home would be a really valuable next step for people. But for anybody that is listening to this episode, what would be the top three reasons you would say they should start thinking about a residential care home and what are the key benefits?

00:14:19 Tanya
The top three reasons would be safety, getting the right level of care that every person deserves, and looking after the carers. And the benefits are that everyone can step back. There’s a reason why we have 24-hour care. It’s because people have care needs that require that. And it’s about supporting the carers to know it’s okay to say it’s time, it’s actually okay, and that that’s what we’re here for.

00:14:46 Kate
That would be a moment for people, wouldn’t it? There’s a sense of guilt sometimes that they are saying, this is what we need. Is that part of your role to actually assure them that that’s okay?

00:14:54 Tanya
Absolutely. The guilt when someone feels that it’s time to put someone into care is huge. I should have been able to look after them. I’ve failed them. I promised them I’d never do this. But sometimes that just has to happen. And that’s why we’re here and the conversations are very much about – you have done an amazing job, you have got your person to this point, we are really here to look after your person and we’re here to look after you. And so it is okay for it to be time.

00:15:24 Kate
We’re going to talk further about tips for somebody coping with looking after a loved one. And we’ve alluded to this now. And like you said before, by you helping them out, they can return to their previous role as a family member or a loved one and they can have the energy and attention to grab hold of those glimmers, those 5 minutes where they might get their person back. And that’s really, really important, isn’t it?

00:15:45 Tanya
It’s so important. Sometimes I’ll have a family come and say, we’ve had a great morning. And I’ll say, what a gift. What a gift you’ve got back today. Grab today. Can’t promise what tomorrow will look like, but grab what happened today.

00:15:57 Kate
That’s beautiful, Tanya. Thank you so much again for your invaluable knowledge on this area.

00:16:02 Tanya
Thank you.

00:16:06 Kate
For more information on Helping Hand and their services, please head to www.helpinghand.org.au or call Helping Hand directly on 1300 653 600.