December 20, 2017

The Australian Journal of Dementia Care - Dec 2017 - Jan 2018 : Vol 6 No 6

Full text articles, DVDs,  books, Books on CD and eResoures are available to members of dementia Australia NSW by emailing NSW.Library@dementia.org.au


The Australian journal of dementia care

Building staff capacity to provide responsive care
Elizabeth Beattie introduces Dementia Training Australia’s new Responsive Behaviours Consultancy – a staff training program to help residential aged care organisations address and reduce dementia related responsive behaviours.
One of the most pressing issues in the care of people living with dementia is that of behavioural changes associated with multiple and complex factors. These factors include, for example, those related to the progression of dementia, such as changes in the ability of the person to adequately express their own thoughts and feelings.
Of equal importance are the legibility and comfort of the person’s physical environment, the effects of psychotropic medications they have been prescribed, the extent to which their expressed preferences and needs are well understood and met, and the way that staff and family involved with the person relate to them.
Building-staff-capacity-to-provide-responsive-care-dementia
Paradigm shift
The philosophy of person-centred care has contributed to a major paradigm shift in the way we think about the care of people living with dementia. An understanding by staff of how their own behaviour can be a powerful influence – both positive and negative – in determining the way in which people living with dementia respond to and experience care is central to improving care.
Yet, as noted in the recent Australian Government Aged Care Workforce report (Kostas et al 2017), considerable ongoing attention to staff training is required in the aged care sector for us to match care aspirations with care realities.
Intensive support
The Responsive Behaviours Consultancy (RBC) is a staff training program offered to residential aged care organisations or other providers by Dementia Training Australia (DTA) as part of a DTA Tailored Training Package. (DTA is funded by the Australian Government to deliver a range of dementia training opportunities to the aged and health care sectors.)
The RBC is offered after a DTA training needs analysis and discussion with a representative from the interested organisation has identified a need for intensive support to improve the way staff address the responsive behaviours of people living with dementia.
Lead And Learn
Once a RBC plan is agreed, DTA will deliver the Lead And Learn Education Program, a core element of the consultancy.
The program is delivered to care champions nominated by their organisation. It’s designed to help create a sustainable capacity-building education framework for addressing and reducing dementia-related responsive behaviours and to build a small group of care champions in a facility.
Throughout the program the champions are closely mentored by DTA staff and supported to develop as leaders in responsive behaviour care. The program content is delivered by a DTA consultant who remains the ongoing contact throughout the program.
Components of the Lead And Learn Education Program include:
•An introduction to the concept of responsive behaviours within DTA’s salutogenic framework. The salutogenic approach looks beyond problems and symptoms and focuses on factors that support health and well-being, rather than pathogenic factors that cause disease.
•An exploration of several models to assist with understanding the factors underlying responsive behaviours, for example the Need-Driven Dementia Compromised Behaviour Model (Kolanowski 1999) and the Progressively Lowered Stress Threshold Model (Hall & Buckwalter 1987).
•An exploration of individual behaviours, including assessment processes, strategies and evaluation that can be used to reduce the impact of behaviour changes on the person living with dementia. Case study scenarios are used to show how this is applied in practice.
The education involves input from experts in the assessment of the older person and dementia-related behavioural changes, stimulating video clips and realistic case study discussion sessions. Specific sessions on workplace leadership and mentoring and managing staff who are providing daily care to people living with dementia are included.
Dementia Training Australia’s (DTA’s) new Responsive Behaviours app provides a quick guide to responsive behaviours for health professionals and care staff in all settings.
The app features prompts on what to consider and tips on how to respond to 10 common responsive behaviours: agitation, apathy, anxiety, aggression, depression, disinhibition, psychotic symptoms, sleep disturbance, vocally disruptive behaviour and wandering. There is also a section on delirium.
Links to recommended tools for assessing each behaviour are embedded, and frameworks for addressing responsive behaviours (eg Need-Driven Dementia Behaviour Model (NDB) and the PIECES mnemonic) are included.
The app is based on DTA’s Behavioural and Psychological Symptoms of Dementia (BPSD) Quick Reference Cards. The app incorporates the ‘lanyard card’ checklists: how well am I communicating?; getting to know the person living with dementia; and understanding the behaviour.
The Responsive Behaviours app is free to download for phone or tablet from the App Store or Google Play Store
Henthusiasts! Bringing HenPower to Australia p 12
Karn Nelson, from aged care provider The Whiddon Group, reports on the first Australian trial of HenPower, an evidence-based and easy-to-run program that uses hen-keeping and creative activities to combat social isolation among older people, especially those with dementia, in residential care.
Three models – 1 the each resident has their own chook model, 2 farm model where residents participate in chook keeping chore, 3 chooks are located in the courtyard.
Results included a decrease in depression and an increase in quality of life.
Themes include  1. Empowerment  2. Connection 3. Physical and mental health benefits.
A response framework with untruths as a last resort p 20
Sometimes the truth causes distress, but is it ever right to lie to a person with dementia? Edward O’Connor, Ian James and Roberta Caiazza describe a practical framework which allows for ‘therapeutic lies’ as a last resort.
Four steps 1. Meet the request 2. Substitute or validate the need 3. Redirect to a new need 4. Meet the underlying need via a therapeutic lie (ie enter the person’s reality)… the truth may not be in the person with dementia’s best interest .

Creating Agents of Change p 18
Kate Laver and Monica Cations describe an initiative to improve dementia care practice with a network of Quality Collaboratives of health and aged care professionals across Australia


Supporting culturally competent care p 24
Mary Gurgone and Anne Butorac discuss a project to improve cultural cohesion within the residential aged care workforce 
*for cultural competence : have a defined set of values and principles and demonstrate behaviors, attitudes , policies and structures that enable them to work.
Have the capacity to 1. Values diversity 2. conduct cultural self-assessments 3.manage the dynamics of difference when cultures interact  4. Acquire institutional cultural knowledge and 5. Adapt service delivery to reflect diversity and cultural contexts.- access Aged Care Diversity Check audit tool
Tools
Resources
Diagnostic and Review Tools – Fortis have designed several tools to help our clients understand where they currently sit and how they can improve. One of our significant tools  the Pulse Survey (designed to assess the current diversity profile and cultural competence) – has been made available for free (click below).
Capability Development – Fortis have honed a number of award-winning tools which build and strengthen your capabilities to improve performance and productivity. Two of our foremost tools are the Culture, Communications and Relationships at Work Program (online and face-to-face) and the Keys to Diversity online program. Click below for more information.
Community Engagement and Development – we have designed tools and programs specifically for supporting and strengthening your community. Refer to our PICAC homepage for information on specific resources, tools, events etc relating to community engagement and development.
External Resources – In supporting our clients to achieve outcomes for themselves and their stakeholders, we have created a list of additional resources that can support specific issues, and overcome challenges within organisations and communities across numerous sectors.



A home away from home p 28
Jason Burton and Marlene Grogan describe how Alzheimer’s WA has transformed its day respite services with the Enabling Households model that delivers better outcomes for clients with dementia and carers . the enabling household focuses on everyday activities that interest individuals by knowing them – the model is fluid, staff don’t wear uniforms just name badges which support memory; staff and members eat together  (staff breaks are taken at other times)  and members families and volunteers are involved in planning shopping and preparation service and enjoyment; the community is an active part of the club and members are an active part of their community- engaging in everyday activities – the enabling household is owned by the clients


Helping carers rethink respite p 16
Lyn Phillipson reports on the results of a project to promote the benefits of respite to carers and improve uptake of respite services…
ReThink respite activities
ReThink respite coaching  leads to  change in knowledge and attitudes and changes in self sufficiency and changes in behavior


Empowering consumers p 15
Tiffany Jessop reports on an upcoming national campaign to promote informed, legal and ethical prescribing of psychotropic medication for people with dementia


Australian Dementia Forum highlights
The recent Australian Dementia Forum 2017: Progress on the Boosting Dementia Research Initiative (ADF2017) was an opportunity to share knowledge and information about the latest dementia research. Jo Haslam reports


A poet’s stories p 32
It is 20 years since John Killick published his first book of poems inspired by conversations with people with dementia.  Recently, he has been looking back on these formative experiences and he shares some of the poems which have resulted
We have all his books in the library ….


Improving children’s attitudes to dementia p 34
Jess Baker presents a summary of results from a pilot study of the Kids4Dementia program, which teaches primary school children about dementia..
Students in years 5 and 6 … things to do with a loved one in a residential care home include

  • Play a board game
  • Bring in a special books to look at together
  • Interview them and type up their personal history
  • Bring in ribbons and awards you have won
  • Play games on ipad with them
  • Play chess, chequers or noughts and crosses
  • Watch a favorite show or dvd with them

these are some of the books Jess Baker focus tested and are available to members of dementia Australia NSW by emailing NSW.Library@dementia.org.au

Brief notes on which books about dementia work with children and why

after focus testing this is what the kids say!
Book Notes - great books

·         Wilfred Gordon Macdonald Partridge J proactive/helping them/doing something. setting nursing home.  Not afraid - models no fear. Likes all the people.

·         The Forgetful Elephant: J Analogy to broken arm, and how can’t plaster inside his head.  Just needs help, make it fun.  Active again.  for the younger reader.

·         Striped Shorts and Flowered Pants: J Family dynamics. Addresses some fears. What can do etc.

·         Lucas & Jack:  J Old people generally.  Really like person theme. 

·         Getting to Know Ruben Plotnick: J Cool boy, good modelling. Fun. 

·         Ceila & Nonna: J Doing again.  Person Theme.  Quite like it, just helping nan and child, no-one else involved.

·         The Smell of Chocolate: Music.  Weaved behaviours into the story, e.g. wet pants, repeated himself, threw fist into cake.   Facts a bit tedious, too big unnecessary words, e.g. confabulation. 

·         Mile High Apple Pie: Describes short term memory loss versus long term memory loss.  Models hugs and fun and inconsistency.  Is a person.

·         When I visit granny Jean: Batteries running out. set in a nursing home . Person theme. Touch.


·         The Old Man Who Loved to Sing:  Not directly about dementia, but something lovely about it.

·         What’s happening to Grandpa?
Good content, but a bit tedious. 

       Why did grandma put her underwear in the refrigerator?:  . Funhouse mirror analogy- look different but same person.
  

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