RESIDENTIAL AGED CARE - A FEW THINGS TO BE AWARE OF
If you are looking for a residential aged care facility (nursing home) for your parents, grandparents, or spouse - this blog might contain some useful tips.
Residential Aged Care (RAC) facilities have a lot in common but there are differences that effect the lifestyle of residents if you know how and where to look. The following might help you make the best decision.
Aged Care is a business, and in Australia it is big business supported by the flow of billions of dollars from the federal government, and due to the vast elderly population. RAC’s are all required to meet the aged care standards. If they don’t, the facility can normally continue to operate under sanctions while they are brought up to standard. It sounds good, but accreditation agencies are sometimes staffed by people who previously worked in aged care and are associated with RAC managers. There is a palpable bias. An RAC saying they are compliant, does not necessarily make a RAC a good place for a resident to be. You’ve got to be able to weigh it up yourself. Look for the evidence.
Look first at the building from the outside. There is a vast difference between a multi story building and a single story building. Residents in a single story building find it much easier to get outside and into the yard. It is also easier for staff to transport residents outside and to keep an eye on them. As RAC’s are often short staffed, and staff are often people with sore backs, the residents in multi story buildings just don't get out as much, and sometimes not at all, because it is a bit harder for the staff to get them there. Multi story buildings tell us something about the owners too, as it reveals a case of “how many pensioners can we fit per square metre” type of mentality. An increase in density is an increase in profit. What is the real objective of a multi story building for elderly or disabled persons? Care or profit?. We’re not against profit - if you lose money you wont be open long, but RAC’s in a single story complex can be profitable too. Be aware that RAC’s run by non profit agencies often have several million dollars tucked away and the CEO receives an extraordinary salary for meeting their KPI’s. While the CEO’s BMW is not our business, extravagance is milked from your pocket one way or another.
Look inside the building. Families can be ‘sold a lemon’ because they see a nicely presented building and think it must be a nice place. It may or may not. Decor has little relevance to resident satisfaction. RAC’s are aware that presentation is good for sales. Don't be fooled. The satisfaction of residents is not effected by the paint or the carpet. You shouldn’t be either. Don't buy because you think it looks nice - thats not a good reason. You don't want a nice looking car that breaks down regularly.
Once inside, breathe deep. Go into a community space where the residents eat and hang out together, and breathe deeply. What can you smell? If you smell nothing it is a good sign. If the residents have been soiled for a long time and sit in urine of faeces, you’ll be able to smell it. Certainly accidents happen in RAC’s, but if it is overwhelming, lingers, or is in more than one spot - that might be a red flag.
Listen. If you hear a lot of calling out from residents then the RAC may not be a good place. Some calling out cannot be avoided. Residents who have lost the ability to talk have no choice but to holler. But if you hear a lot of constant calling out, and noises that don't make sense - why? Residents don't just holler. They are in pain, hungry, or wet. If the hollering continues, or if there is more than one person hollering out they may have been unattended to for too long. Excess hollering indicates neglect! In the opposite, listen to see if you hear any laughter from the residents, or do they at least smile, or do they seem content.
Another KPI is what station the TV is on in the shared living spaces. Music show ‘Rage’ or teeny romance ‘Love Island’ turned up too loudly is probably for the benefit of the staff. TV, music, or anything else ought be a calming sound for residents, unless the resident likes The Rolling Stones.
Look around the floor for tripping hazards. Things like electrical cords and mats should be put away and never left laying around. This will tell you about the work habits of the staff and how it might be for residents when you are not there. Look about and see if there are residents outside in the garden, and whether there are tripping hazards outside. If the residents get to water the pot plants it indicates it is their home. They participate in it's care if they can.
Do you believe the staff are authentic or patronising when they interact with residents? This is a very good indicator of what will happen when you are not there. Beware of stylised professionalism as the site manager gives you the grand tour and her thickly caked on makeup cracks slightly with each forced smile. Ask yourself how genuine this person is. Are you rushed along to get the job done, do you feel like you are in a used car yard where they just want your money? Do the staff know the names of every resident. You are looking for authenticity; a normal sort of person just like in everyday life. It creates an atmosphere where staff are also normalised and that is better for the residents.
Eat there. Most RAC’s will let you. The biggest complaint in RAC’s is usually the food. For example the RAC is not permitted to serve food so hot that the resident burns themselves eating it. While that is reasonable, it does not mean the food ought turn up cold either, or prepared in an uncaring way. The smart thing to do is to ask if you can sit down at a table in the dining area and have lunch with the residents. If they charge you for this it may be the best $20 you spend. You’ll get a feel for the food and the environment. Is the food ok? Would you eat it yourself? You’re putting someone else in there and they will have no choice.
Showering. Three showers a week is a reasonable expectation in a RAC, with a good wash in between. Each resident should have their own shower room. You can tell if this happens by having a look at the residents when you walk around. Smell them, and see if they look clean and cared for. Some residents are going to need more regular bathing if they are incontinent. There may also some cultural issues around this sometimes. Ask what you need.
Communication with families is always a conceern. Ask if there is a newsletter? Is there a welfare person like a chaplain or similar who runs a memorial service (to remember those who have died), a family support group, a chapel? Anything for families? You may not want to go to it, but if the RAC has one they are at least thinking about families as well, and not just profit, or just being lazy. The fact that they have ‘something’ will tell you a lot about the RAC, and you’ll learn if they are service orientated or self serving. Families ought be able to call anytime, phone or in person, and receive information / reassurance within a reasonable amount of time.
'Lifestyle' is usually a department within an aged care facility. Having a lifestyle department means the facility recognises that aged care is about more than getting your medication and showering (ADL’s) needs met. Residents in particular agree with this. They know they are at the last stop in life, and so instead of making RAC about ADL’s and death, it should be about life and worthiness. Ask what sort of activities they run and how do they go about it. For example if a resident likes fishing, does s/he ever get to the river or beach? He probably doesn't like fish as much as he likes getting out and having the breeze in his face. I have seen residents be given a piece of string with a magnet and they pick up 'cut out fish' off the floor like kindergarten kids. That was plain patronising and a gross misunderstanding of what ‘fishing’ actually means. A monthly BBQ is always a winner of a activity - including residents, staff, and families. So what sort of activities do they run? Do they find out what each resident needs, likes and 'responds to' on admission? Are they really listening? If the admission process only takes an hour, that is not thorough enough.
Models. Ask lifestyle (or chaplains) if they are familiar with the “senses model,” and if so how do they implement it? The senses model is when each resident is assisted to discover a sense of achievement, a sense of belonging, a sense of significance, a sense of continuity with their former life, and so on. These things can generally be achieved in simple ways and make an enormous difference. Life in a RAC can take on meaning and purpose where the senses model is in place. Or - in dementia care, do they practice the validation model? This is a way of communicating with residents who have dementia. Are the staff trained in it? If you ask and the RAC look at you strangely and don't have an answer, they are not keeping up with modern practices. That does not make them bad, but they may have fallen behind. Models ensure a better and more personal resident experience.
Dementia excellence. Many RAC’s run a dementia excellence program. It usually receives additional funding. Where does the money go, you should ask? It ought normally be invested in simple homely things that directly benefit the residents. Even if your resident does not have dementia, this is still a good litmus test. Most residents do have some degree of dementia (around 70%), even if it is not diagnosed. The money should be directed to the benefit of residents, and not patching financial holes in the organisation.
Death. How does the facility deal with death? The style of palliative care desired should be determined on admission, including medications that assist in dying. If a resident is placed on palliative care and the RAC wheel in a trolly with a incense burner and violin music - that is not palliative care. You have to ask the resident what they want; normally done on admission.
Some RAC’s are in the habit of wheeling deceased residents out the front door through a guard of honour. This has become popular. On one hand this is respectful, but on the other hand it is also depressing for other residents if a friend dies each week, especially during winter. Residents also need to be informed when their friends die - there needs to be a process in place to manage this. Regular memorial services to remember residents who have died in the last year is also a service to families. It says we care about the people, even when they are gone.
Art work and ‘way finders.’ For example, a series of pictures of different types of tractors, cows, boats or windmills - all hung low on the wall, help residents find their way back to their own room, and to move about the unit. People who get a little confused or lose memory just follow the boats. This shows thought and consideration from the RAC. Why hang way finders low on a wall? Because people on walking frames don't look up - they look down. Low hung pictures deployed as way finders are an indication of good management. It might look odd to families, but it is the resident that lives there.
There is no perfect RAC. You have to get a feel for each one and weigh up the good and the bad, and the suitability for your loved one. You are now armed with some questions and stimulus to help you make an informed choice. Effort invested in getting the right RAC, is going to be time and heartache saved in the long run. If the resident is happy, the family will be more at ease.
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