Case studies

Respecting preferences and dealing with family concerns

This study examines how providers can discuss health and safety risks with people receiving aged care.

Olympia has dementia. She has been receiving home care services for several years. Her needs have gradually increased, but she can still live semi-independently. She gets on well with her care team, and her 2 children live nearby. At least one of them visits daily.

Olympia tells her care team she wants to do as much housework and personal care as possible. However, her children are concerned about her ability to make appropriate decisions. They ask her provider to also help with laundry, ironing and bed-making.

Olympia has done these tasks herself until now without issue. The care staff tell the service coordinator that this change isn’t necessary. They explain that it may make Olympia unhappy. It may also affect her confidence.

The provider must balance Olympia’s preferences with those of her family. The main priorities are her safety, well-being and respecting her wish to keep doing her daily tasks. There are also safety and hygiene issues to consider. These haven’t been an issue so far. They might become an issue as Olympia’s dementia progresses.

After this, a care coordinator experienced with people living with dementia meets Olympia. Olympia understands why her children raised these concerns. She decides that the benefits she gets from doing her own laundry and ironing outweigh the risks raised by her children. Olympia agrees to a small increase in staff supervision for these activities.

The care coordinator then explains the plan to Olympia’s children. The coordinator emphasises how important it is for Olympia to maintain a sense of independence, self-worth and purpose. The coordinator also makes it clear that the provider:

• has carefully discussed the health and safety risks with Olympia
• will continue to monitor Olympia day-to-day
• welcomes further input from the family about how she’s doing with the changes.

Supporting independent choice while meeting care needs and respecting others

This study examines how staff should be careful not to be judgemental or confrontational with people in their care.

Carlos has lived alone for nearly 10 years. Going to the races on Saturdays and meeting up with other regulars and friends at his local pub are important to him.

Carlos needs more help to look after himself properly, so he moves into a small aged care home in his old neighbourhood. He’s happy there, gets on well with his fellow residents and can keep his hobbies up. He still attends the races regularly and visits his local pub at least once weekly.

Carlos sometimes drinks too much and is loud when he goes back to the aged care home. Other residents have complained about the noise. He also has a habit of staying out later than expected. This concerns staff members as he likes to walk to and from the pub, but his mobility isn’t good. They try to convince him to get a taxi, but he’s defensive and resistant. This goes to the extent that his local pub rings the provider and asks if someone can pick him up.

The provider needs to balance their concerns about Carlos’s behaviour with:

• his health and safety
• the comfort of other aged care residents
• his right to live his life as he chooses.

They meet with Carlos to assess how they can safely meet his needs, goals and preferences. He’s given the opportunity to involve friends and family members. Carlos asks for his daughter and an old friend to be involved.

The staff in the meeting are careful not to be judgemental or confrontational. They acknowledge the importance of Carlos’s activities to him. They then raise their concerns and open the conversation to Carlos.

Carlos is initially guarded but can see other aged care residents’ concerns. He also appreciates that the motivation comes from caring for his safety rather than wanting to stop him from living the life he wants.

The outcome of the assessment is a tailored plan. It includes arrangements for safe transport home from the races and the pub at an agreed time. Carlos has responded well to having his:

• autonomy respected
• interests supported
• sense of community encouraged.

A complete approach to managing hearing loss

This study examines how you can improve someone’s quality of life through hearing assistance.

Aged care providers need to recognise that many people who receive aged care and services may have hearing loss that affects their quality of life.

Rae lives in an aged care home. She can hear better when one person speaks at a time without background noise. It also helps if the person talking to her has the right voice.

Rae finds it frustrating and embarrassing to miss so much of a conversation, so she doesn’t tend to join in. When someone asks her a question she doesn’t catch, she guesses an answer based on what she thinks she heard. She knows this makes her seem confused, but she doesn’t want to make people repeat themselves.

Joseph is another resident who has hearing loss. His hearing loss is quite advanced, and he feels stuck in his world.

With his hearing aids, he can hear enough to get by but struggles if he can’t see the person’s mouth or they’re mumbling. Joseph and his care team find it hard to put his hearing aids in and operate them. Joseph has been diagnosed with depression. This is partly because of the profound isolation he feels.

The provider gets expert advice and consults each resident, their family, and relevant staff. They put together comprehensive training based on free resources from the Deafness Forum of Australia for all staff. This is followed up with on-the-job implementation and a hands-on workshop with a hearing services provider.

As a result, staff:

• are competent and confident to recognise the signs of hearing loss
• use effective communication techniques with people who have hearing loss
• know how to encourage residents to get hearing aides
• can share government benefits available for people with hearing loss.

They also learn how to operate and maintain different kinds of hearing aids.

The provider makes 3 care team members hearing champions. These champions attend more advanced training. They also work with other staff to ensure they’re well-equipped to help anyone with hearing loss.

Staff say their job is much easier when residents can hear and respond appropriately. It especially helps when giving residents medication and other similar situations.

Rae got a hearing aid, too, and feels more comfortable in groups. She’s happy to hear the TV and follow the conversation when her grandchildren visit.

Joseph has also started feeling more connected with the world around him. Staff are now confident to use clear communication techniques and can better help him with his hearing aids. This makes makes it easier for him to live the life he chooses.

Spiritual wellbeing needs within an aged care service

This study explores how everyone has a right to culturally safe aged care and services.

A faith-based organisation runs a particular aged care home. This isn’t clear in their marketing materials, but it’s known that many people who choose this home share the same faith.

The home’s residents are diverse, but most belong to this faith. The home has a central common room for social events and faith-related ceremonies.

At a recent meeting, aged care residents from this faith suggested decorating the common room. This would give it a more suitable background for religious services.

Some of the other residents object to the idea. They say that the room would no longer be a common area. They also raise concerns about the home becoming too religious because of organised religious activities.

The management team considers the request of the faith group and concerns raised by other residents. They’re aware that no group has a greater or lesser claim to:

• culturally safe care and services
• feel accepted and valued regardless of their faith.

They also recognise supporting different faiths and preferences within their activities and available resources is challenging.

The provider offers to arrange for the common room to be decorated and undecorated for each event. The items used for decoration should be easy to transport and store. The group can decorate the common room or have faith-based community volunteers do it instead.

To recognise the diversity of their residents, the provider:

• conducts regular assessments of their preferences
• develops individual activity plans
• evaluates participation in activities.

They do this to understand whether the range of choices are meeting their residents' needs, goals, and preferences.

An early response to changing conditions

This study looks at how providers might respond to deterioration through a well-designed intervention.

Josie is in her 90s and lives in a small aged care home. Staff became concerned when she started showing signs of depression. Josie had been socially active but had slowly withdrawn from social activities. She stopped attending exercise classes and lost interest in her daily crosswords.

Her provider contacts a specialist aged care counsellor they’ve worked with before. They ask him to visit Josie.

The counsellor uses a reminiscence-based approach, which Josie responds to. She becomes more animated remembering the food she’d eaten travelling overseas and how she’d been inspired to recreate those dishes at home. This also brought up associated memories of other things that had shaped her identity, such as people, work and places.

Josie’s mood noticeably improves throughout counselling. As her energy and sense of self returns, she takes up many of her previous activities. With encouragement from the counsellor and care staff, Josie also starts recording her travel stories and recipes to share with her family.

Understanding someone’s spiritual needs after they move into an aged care home

This study examines providers' conversations with residents about what’s important to them.

Soon after moving into an aged care home, Sofia has an assessment to identify ways to help her adjust to her new environment.

In the assessment, Sofia tells the care manager that she isn’t spiritual or even sure about her spiritual beliefs. She says she used to go to church most Sundays when she could still drive. The care manager asks Sofia some open questions to determine what church means to her. She realises that the weekly services were an opportunity for her to:

• connect with her community
• see people she knew and identified with
• help others by playing the church organ
• visit and help members of the congregation who were unwell.

Sofia says she doesn’t mind missing the sermons. However, she does miss this sense of inner peace and connection she felt to something during silent prayer time. She adds that she regrets not being able to:

• keep in touch with her church community
• make contributions that gave her a sense of purpose and value.

After hearing this, the care manager asks if she can research and help arrange opportunities for Sofia stay connected with her old church. Sofia is pleased about this. The care manager also suggests Sofia volunteer her skills as a pianist to the residents’ choir. Sofia shows interest in this.

The care manager:

• introduces Sofia to the choir organisers
• takes her to see the prayer and meditation room
• gives her a program.

The program shows when regular services and meditation groups are held, and the space is free for individual use.

Meaningful activities for daily living

This study explores how people receiving aged care might deal with change, loss and grieving.

Odette and her partner recently moved into an aged care service, and Odette breaks her wrist. She attended weekly painting groups for several months before breaking her wrist.

Odette starts going to her painting group again as soon as the injury seems to have healed. She continues to work on a detailed landscape painting she began before the accident. She finds that using a paintbrush is still too painful and she becomes frustrated and upset. She drops her brush on the floor and exclaims, ‘I’ll never be able to finish it now!’

Other people in the group try to comfort her. They suggest other projects she can try, like using her other hand to create abstract work. She becomes even more upset with this and starts crying.

The activity facilitator quietly takes Odette aside and asks her about the inspiration for the painting she’s been working on. Odette shows her the photos and sketches of the scene the painting is based on. She explains that this was the property where she and her partner lived before they couldn’t look after such a big home and land. The painting was meant to be a gift for her partner on their anniversary­ — the first in the aged care service.

Odette misses their old life and has been struggling to adjust. The facilitator understands Odette’s reaction isn’t just about finishing the painting. It’s also about grieving what she’s lost as she and her partner navigate this new phase of life.

She encourages Odette not to give up on the painting but to:

• give her wrist more time to heal
• change the finish goal to Christmas or her partner’s birthday instead.

The facilitator tells Odette that the photos and sketches are lovely and deserve to be framed and displayed in their new home. The facilitator then informs the care manager that Odette is still experiencing pain in her wrist. The care manager organises appropriate assessments and pain relief

Changing spiritual needs at different phases of life

This study looks at respecting someone’s choices about how to navigate the last phase of life.

Norman has been receiving aged care services at home for more than a year. He’s very unwell, but his symptoms are manageable, and he’s still quite mobile. His 3 children are ready to take him anywhere he wants, but Norman has been going out less over the last couple of months.

Norman’s daughter shares her concerns with her father’s home care worker, Bernard. She’s worried that her father hardly goes out anymore. She’s apprehensive that he never goes to the temple anymore.

Norman still seems happy to see visitors, but he’s not as social or animated as he used to be. Norman’s daughter is worried he might be lonely and depressed. She asks Bernard for ideas on how she and her brothers might ‘get Dad out in the world and back in contact with his religion.’ Bernard says he’ll try to find out if something is stopping Norman from going out and doing things. It might be something he doesn’t want to talk about.

While unpacking Norman’s supermarket delivery the next day, Bernard brings up the topic. He mentions that unwell people can sometimes feel isolated by their condition. They might also not be up to talking about pain or other symptoms they’re experiencing. He asks if Norman might be going through anything like this. Norman says he appreciates the concern but explains this isn’t what’s going on.

Norman explains that at this stage of life, he wants to spend as much time as possible reflecting on his life. He wants to use meditation and quiet religious study to do this. Norman says his focus has shifted from the material and external world to the spiritual and internal one. He loves his family and close friends but is drawn to spend more time alone with God and his thoughts rather than in social settings. He tells Bernard that a friend comes to meditate with him regularly and that he feels spiritually supported.

After this conversation, Bernard gets Norman’s permission to talk to Norman’s daughter. He explains that the changes she sees in her father reflect his choice to navigate this phase of his life. He can also do it in a way that brings him peace and comfort.

End-of-life care planning that addresses what matters most

This study examines how advanced care plans identify a person’s values and treatment preferences.

Isabella and Henry live in their unit in a retirement community with on-site aged care services. After living there for 3 years, Henry was diagnosed with rapid form of dementia at the age of 70.

Isabella and Henry contact the provider to discuss extra services they might need as Henry’s illness progresses. The provider recognises the importance of Henry’s final months. They make sure his final months are:

• comfortable and dignified
• reflect his wishes, even when he can no longer express them.

The provider encourages them to make a formal advanced care plan.

A staff member trained in developing advanced care plans helps Henry identify his values and treatment preferences. The things that matter the most to him include staying in his home with his wife and dog, taking daily walks and looking after the unit’s small garden. He also doesn’t want any treatments that might extend his life while its quality gets worse.

Following the provider’s protocol for end-of-life planning, staff members work with Isabella and Henry to document a detailed advanced care plan. Henry is pleased everyone knows his clinical, cultural and spiritual preferences.

The provider supplied increasing services in response to his changing needs. This made it possible for him and his wife to stay together.

Henry died at home 18 months later. He received palliative care and wasn’t moved to residential care or transferred to a hospital for life-prolonging treatment in line with his requests.

Facilitating difficult discussions about end-of-life choices

This study explores how to have meaningful conversations about death to support a person’s end-of-life wishes.

Despina started living in an aged care service when her chronic lung disease became too challenging to manage without access to on-site medical services. This was over 10 years ago. Since then, she’s come to terms with the fact that it might end her life. She’s accepted that she’ll progress from aged care to palliative and end-of-life care within a few years.

Staff at the home close to Despina are concerned that her daughter doesn’t understand or want to understand how far her illness has progressed.

Despina has had many conversations with friends, doctors and staff about how she wants her care handled as she approaches the end of her life. She’s tried to raise the topic with her daughter, but her daughter always deflects the issue.

Staff have a fair idea of what Despina wants. She’s prepared to continue medical treatment up to a certain point but with limitations. Her daughter isn’t prepared to accept that there are limits to treatment and talks about remission and recovery.

Despina tells a pastoral carer that she’s concerned her daughter will never accept the end is approaching. She worries that the decisions her daughter makes about her care in the final stages of her life might be:

• completely different from her preferences
• cause unnecessary pain and discomfort for her.

After this, the pastoral care worker looks for opportunities to bring her daughter closer to the conversation she needs with her mother. They must help Despina and her daughter understand they are on the same road — from fear to acceptance. However, they might be at different stages. Once the discussion is framed in those terms, they gradually reach a point where Despina can explain her preferences, and her daughter can listen and understand.

The pastoral care worker suggests Despina writes her decisions down and review them every so often to make sure they still:

• cover all possibilities
• meet her preferences.

As Despina’s illness enters its final weeks, her daughter can be sure that:

• the choices she’s making reflect her mother’s wishes
• Despina has the reassurance she needs that the end will be as she wants it.

Commitment to complaints through open disclosure

This study looks at acknowledging and apologising when failings are identified.

Pasquale has been a resident of a small aged care home for several years. A few weeks ago, his condition had unexpectedly taken a turn for the worse. He quickly became unresponsive.

Pasquale had just been discharged from the local hospital and returned to the aged care home. Everyone at the aged care home is pleased to see him back — healthy and showing his lovely personality.

Salma, a nurse at the home, noticed in Pasquale’s record that he was given the wrong medication right before his condition deteriorated, and he was rushed to the hospital. He’d been given 10mg of Endone meant for another resident.

Salma immediately raises it with her manager. This information is disclosed to Pasquale’s family. They find it very distressing that this type of mistake was made.

The service acknowledges their mistake and apologises to Pasquale and his family. They hold an urgent meeting for all nursing staff to discuss administering medication. The provider organises additional training. They also put other procedures in place to ensure this doesn’t happen again.

While Pasquale and his family are upset at this mistake, they appreciate the service has:

• acknowledged their mistake
• apologised
• been transparent throughout the whole process.

Pasquale and his family are also pleased that additional procedures have been implemented to ensure this type of error doesn’t affect them or other residents in the future.

Getting to the bottom of complaints

This study discusses bringing a family together to build trust and collaborate on a care plan.

Over the last few months, an aged care home has had frequent complaints on a range of topics from Raymond. He’s the son of Mabel, one of their newer residents.

The manager has had several meetings with Raymond to try to resolve issues that have come up. The manager has made several changes in response to his concerns. This includes:

• moving Mabel to a room further away from the street
• providing Mabel with different meals
• arranging physiotherapy sessions to help her return to her usual mobility following a fall.

The manager and staff are satisfied that they are meeting Mabel’s care needs and preferences. Mabel is always quiet but seems happy with her care and environment.

Despite all this, her son continues to complain to the manager, staff, and other people in the aged care home, as well as other visitors. The service is concerned the complaints may affect its reputation in the small town where it’s located.

The manager recognises the need for a more comprehensive response to Raymond’s concerns. Mabel indicates she wants to involve her family so they understand what is going on in her life at the home.

The manager organises a care conference and invites Mabel’s son and daughter, the head of nursing and a staff member from the home’s parent organisation. The staff member from the home’s parent organisation is a trained facilitator. They manage the complaints system for the organisation.

They go through Mabel’s care plan item by item together. They discuss where Raymond’s expectations differ from his mother’s and why this might be. The home is transparent about:

• how they can meet expectations
• where they can’t meet expectations and why
• how they are already meeting expectations in some areas.

Through the conversation, it becomes clear that the decision to place Mabel in an aged care home makes her children feel guilty. They also clearly blame each other for not doing more or not doing things differently.

Raymond still lives in their hometown and feels this makes him responsible for overseeing the care his mother receives at the service. The facilitator:

• acknowledges Raymond’s concerns
• explains the formal feedback and complaints processes for the organisation and externally.

The facilitator keeps the conversation on a constructive and matter-of-fact path. Raymond and his sister visibly become less resentful of the home and each other during the meeting.

The provider implements a revised care plan. With the permission of Mabel, they also provide regular reports and get regular feedback from Raymond. This proactive approach means Raymond has information about Mabel's care which helps him to understand how the provider is supporting her. They continue to build trust and work together more collaboratively.

Respecting what is vital to the consumer in resolving their complaint

This study looks at tackling an issue without being judgemental to find agreed solutions.

Emilia is an independent woman in her 80s who cares excellently for her house and garden. She is injured in a bad fall and receives home care services, including cleaning.

Emilia is good-natured and grateful for the nursing and personal care she’s getting. However, she’s said she’s unhappy with the house cleaning service. Her home care coordinator discusses this with the subcontracted cleaning agency. This cleaning agency has a good track record.

The cleaning agency has tried to send different people to clean and allocated more time within the budget to Emilia. Even with all this, she still insists the results are below standard. Emilia’s coordinator inspects her house and finds that the cleaning services at the least meet the required level of cleanliness.

Emilia says she still wants to cancel the cleaning service. She says she would rather spend all day doing what she can herself. Any stress on her injuries will slow her recovery, so the coordinator takes the issue to a senior colleague.

The manager handling the complaint consults with Emilia and various staff members who look after her. She finds that Emilia has exceptionally high standards of cleanliness. On a deeper level, she finds that Emilia is anxious because she associates the relaxation of these standards with:

• discomfort
• indignity
• loss of control.

These are all things she’d been struggling with since her injury.

The manager involves Emilia directly in the solution. She asks her to help create a detailed checklist of priority tasks and minimum standards for the cleaners. After some negotiation, everyone agrees to a final version of the checklist. Emilia agrees to pay for the extra cleaning time because the final cost exceeds her care package budget.

This process has enabled Emilia to:

• identify the specific things that were bothering her
• offer constructive solutions.

Emilia may never be comfortable with someone else cleaning her house, but her attitude to the cleaners has changed. She’s also pleased to have been part of resolving the issue.

The provider now uses this experience to inform how they handle complaints that involve subjective judgements, differing expectations and complex emotions.

Responding to financial elder abuse

This study looks at how to be alert to signs of elder abuse and how to prevent it from happening.

Auntie Vinnie is a 72-year-old woman living in a small rural town. A local aged care service provider helps with Meals on Wheels, laundry and social support activities. Auntie Vinnie makes a weekly payment through a Centrepay deduction towards her Meals on Wheels. They’re delivered to her from Monday to Friday and are essential to her care and support.

Auntie Vinnie’s nephew and his girlfriend have moved into town from another community. They’re staying with Auntie Vinnie while they look for work.

The nephew sees Auntie Vinnie getting her daily meals on wheels and asks how much she pays. Auntie Vinnie explains she pays a contribution from her pension for the meals. Her nephew says she should stop paying for that and give him the money instead. He’ll shop for her and cook the meals. Auntie Vinnie likes her meals from the aged care service but agrees to stop her payment. She gives her debit card to her nephew so he can go shopping.

A few weeks go by, and Auntie Vinnie’s nephew hasn’t been buying groceries or cooking meals for her. She asks for her debit card back. Her nephew refuses to give it back and leaves town.

Meanwhile, their Administration Officer notified the local aged care service manager that Auntie Vinnie had cancelled her meal support. She visits Auntie Vinnie to talk about this. Auntie Vinnie explains the situation to the manager and asks for help so she can receive meals again.

The manager gets Auntie Vinnie to sign a new consent form to restart the payment deduction. The manager also helps Auntie Vinnie contact her bank. She helps her to cancel her old card and apply for a new one.

The manager asks Auntie Vinnie if she wants to talk to the police about what her nephew’s done. Auntie Vinnie doesn’t want to go to the police. She does want the service to help her speak with relatives in the community where her nephew lives so that they can:

• stop him from visiting her again
• tell the community what he did.

The manager contacts Auntie Vinnie’s relatives and organises a family meeting over the phone. She speaks to her relatives using the service provider’s phone.

The manager updates the Care and Case Management plan with Auntie Vinnie. They add a new goal and action to help her manage money when relatives visit. The manager also lets Auntie Vinnie’s Support Worker know about the change in her care plan.

The organisation’s training plan also includes training on elder abuse.

Supporting consumers and their families to provide feedback

This study examines how to encourage feedback from people and their families.

Jose is the coordinator of a large community-based aged care service. The people they look after are mainly from Indigenous and migrant backgrounds.

The organisation has a formal complaint system. People can complete a form and put it in the feedback box at the day respite centre. Forms can be sent in by post or given to a care worker, who will put them in the feedback box.

Jose finds that only a few formal complaints are submitted through this process. He wants to ensure people know about the complaints system and feel they can give feedback.

He makes time each week to personally visit up to 2 people to talk about the care and services they receive. He asks them if they have any questions, ideas, or concerns about their care, services or the organisation.

Jose finds this approach to be more relaxed. People who didn't want to raise issues or make a complaint through the formal system are comfortable telling him things they aren't happy about. They may be minor issues that can be quickly addressed, like variations to the Meals on Wheels menu or revising personal care visit times.

Jose also finds that family carers provide additional insights and ideas for activities their relative would be interested in. Jose records feedback in the person's progress notes and when he needs, he escalates concerns.

All feedback, including complaints and suggestions, is assessed and helps to improve the services through the organisation’s continuous improvement plan.

Supporting a person to manage changing conditions

This study looks at helping people maintain independence as circumstances change.

Uncle Charlie is a retired stockman. He lives with his daughter and her family in a remote township. He’s home by himself during the day. He's been happy with Meals on Wheels as his only support during the day.

His mobility has recently started to decline, and his daughter worries about him falling over when nobody is around to help. Uncle Charlie and his daughter talk to the nurse at the town’s health clinic about their concerns, and she helps them arrange an assessment of his care needs.

Two weeks later, Uncle Charlie receives a letter from My Aged Care to say he’s been approved for a package. He takes this to the local aged care provider. The coordinator explains he needs to wait for an assignment letter.

A few weeks later, the assignment letter arrives. It says that Uncle Charlie has been assigned a home care package. Uncle Charlie returns to his local aged care provider, and the coordinator helps him:

• activate the package
• reads him the referral report from My Aged Care.

Uncle Charlie’s daughter helps explain the information in a language he understands. With her help, Uncle Charlie learns:

• what a home care package is
• what a care plan is
• how to work with the service
• his rights and responsibilities
• how to let the service know his needs and preferences.

They identify what services and support will help Uncle Charlie live the life he chooses and how much his package will cover. They then contact a home care provider who helps document a care plan and a budget. They send Uncle Charlie a monthly statement showing how much his care has cost.

A year later, Uncle Charlie had a stroke. It reduces his ability to move around independently. While he’s in the hospital, a new assessment is completed. He’s referred for a higher level care package due to his changing needs.

The provider talks to Uncle Charlie, his family, the hospital discharge planner and the assessment team. Together they work out a plan of care for his return home.

When Uncle Charlie is home from the hospital, an aged care support worker visits him daily. They record any significant events or changes in his health, well-being, behaviour and environment on a client observation form.

The support worker also visits Uncle Charlie every fortnight to check his progress. With his consent, she keeps in touch with the nurse at the health clinic. They discuss his care needs and how each service supports him. Everyone is working together to help Uncle Charlie maintain a good quality of life and stay in his own home.

This study looks at responding to changing care needs to optimise health and wellbeing.

Auntie Flora is an Indigenous woman who lives in a remote community. She’s in her 70s, and has dementia and other chronic health issues. She receives support at the local aged care day centre from Monday to Friday. Her family care for her at home on weekends.

Auntie Flora has recently started to show behaviours that may put her and others at risk. For example, she’s started picking up things that aren’t hers and keeping them.

Recently she took a pack of medication from a relative’s house. A staff member notices her trying to open the packet in the TV room at the aged care day centre. He realised the medication wasn’t hers and immediately told the aged care manager, Auntie Sal, what he’d seen. Auntie Sal spoke with Auntie Flora and explained the medication wasn’t hers. Auntie Sal called the family member whose medication it was to have it returned.

Auntie Sal arranged a meeting with Auntie Flora and her regular carer. She wants to discuss the incident and the risks of it. With their consent, Auntie Sal also organised a meeting with:

• the family members who provide care on weekends
• other people she shares living areas with.

At this meeting, Auntie Sal discusses some risky behaviours that can occur as dementia progresses. She suggested some practical actions, such as keeping medication and valuable possessions in secure places.

Auntie Sal also invites Auntie Flora’s family carers and other family members to attend the next staff training. The toolbox talk on dementia means they can learn more about the condition and their role in supporting Auntie Flora at home. Auntie Sal also gives the family culturally appropriate information materials that explain more about how to help someone with dementia.

Auntie Sal then:

• discusses the matter with staff at the centre’s fortnightly team meeting
• documents the event in Auntie Flora’s progress notes and the incident register.

Auntie Sal also discusses the incident with the local health clinic and books a review with the visiting doctor. The visiting doctor refers Auntie Flora to a geriatrician for assessment on their next scheduled visit to the community.

Auntie Sal adds a note in the aged care centre’s quality improvement register about:

• what happened
• the changes service staff and family members have made in response to Auntie Flora's needs.

All this allows Auntie Flora to live as independently and safely as possible.

Addressing food safety concerns for people with restricted diets while recognising the cultural significance of certain foods

This study looks at how people enjoy receiving and sharing food that is meaningful to them.

The residents of this aged care home have various cultural backgrounds. Friends and family members who visit the home sometimes bring special foods to celebrate birthdays, religious festivals and other events. Many bring enough to share with others, and these treats often become the focal point of social gatherings.

People on restricted diets for medical reasons or at risk of choking are tempted to participate in these social gatherings. The provider worries about the dangers this might pose to people with restricted diets. They announce a new policy that doesn’t allow visitors to bring food in.

The people at the home object to this change. They’re upset they weren’t asked about their views before the announcement. They enjoy receiving and sharing food that’s meaningful to them and consider it their right to be able to do this.

Food plays a vital role in identity and connection with the community. The outright ban on food from outside will:

• restrict their residents’ right to make choices
• remove a source of social pleasure and interest that has become a feature of community life
• deprive visitors who want to contribute to the well-being of someone they love.

The home reconsiders its decision. They weigh up the following:

• potential risks of the food some people in the home
• importance of respecting individual choices and the dignity and rights of their residents to make these choices.

The home decides to implement a risk management protocol instead of going through with the intended ban. Visitors can still bring food, but the provider asks them to inform the staff about it in advance or when they arrive.

This allows those on duty to:

• find out what the specific foods are
• work with the visitors to educate them on the potential food safety risks
• keep a careful eye on people who are at higher risk
• arrange for storage or disposal of leftovers in a way that complies with food safety standards.

Building a culturally competent residential care workforce

This study looks at meeting people's cultural and spiritual needs leading to more informed choices.

Hakim migrated to Australia from Iraq as a refugee. His wife died, and his son returned to Iraq. He found it hard to look after himself but didn’t want to live alone. He moved into a new residential aged care home on the city outskirts.

He’s a devout Muslim who prays five times a day. Praying times often coincide with meals and other services. The staff need help understanding and accommodating this.

Hakim feels belittled by their casual comments about his religious practice. He also feels distant from others in the home as nobody shares his faith.

In his old neighbourhood, Hakim had spiritual guidance from a local imam. He’s been out of touch with the imam and his community since being at the home. This causes him great distress. His religious faith and practice are essential parts of his identity and culture. They’re also central to his well-being, but his care provider isn’t helping him to meet this need.

The doctor tells a senior manager that Hakim’s mental and physical health will likely decline if he stays unhappy and isolated. The manager acknowledges the home has excellent facilities but has found recruiting culturally competent people challenging.

The manager talks to the home’s parent organisation about the situation. She also talks to Hakim about it and emails his son.

With Hakim's consent, he's placed on a high-priority wait list for a place in one of the organisation’s other homes. It’s closer to Hakim’s old community, with more culturally skilled staff and diverse residents.

While they wait, she also contacts Hakim’s former imam. She arranges for Hakim to visit the mosque regularly and contact the imam by phone.

The Human Resources team also reviews the recruitment and training process. They organise cultural competency workshops for all staff. One of these workshops focuses on Muslim cultural practices to reflect the community they are located within. Staff are encouraged and supported to enrol in external training to increase their understanding of diverse cultures and faiths.

The home recognises that it should have been more transparent about how the culture at the service may affect Hakim’s sense of belonging. This includes:

• a lack of staff knowledge about the Muslim faith
• that Hakim would be the only person of Muslim faith in the entire home.

Providing Hakim with this information at the start would have allowed him to make a more informed choice about which home would be able to meet all his needs. This includes his spiritual needs.

Delivering services that are culturally safe, respectful and inclusive

This study looks at clear communication that helps people exercise choice.

Auntie Lou is an 87-year-old Aboriginal woman who lives with her extended family in a remote community. She receives home care services.

Over the Christmas period, many of her family go away on holiday. Auntie Lou usually stays at home. When this happens, she manages with a small amount of additional support from the aged care program.

Auntie Lou has recently been diagnosed with early-stage dementia. Her family is concerned about her being at home alone.

Auntie Lou’s daughter suggests she can go to the National Aboriginal and Torres Strait Islander Flexible Aged Care Centre (the centre) for a few weeks of rest over the holiday period. The centre is located in a nearby community and offers low-care residential respite.

Auntie Lou and her daughter talk to the manager of the centre. They’re able to secure a four-week booking. They’re invited to return a month before the booking to discuss Auntie Lou’s needs and preferences.

The manager notices Auntie Lou needs help understanding the options available to her. She uses additional pictorial cues to help her make the right choices. They complete an intake assessment together. The intake assessment identifies any health issues that staff need to be aware of, including:

• current medication
• meal preferences
• activities she enjoys
• personal care preferences.

The Manager:

• gives Auntie Lou and her daughter a tour of the centre
• answers their questions
• provides them with a respite handbook to take away.

The handbook has plenty of colourful visual cues to help Auntie Lou understand what to bring with her and what to expect when she stays at the centre.

Auntie Lou is taken to the centre by her family on the first day of the holidays. They’re invited to stay for a couple of hours to help her settle in.

Auntie Lou’s room is light and bright. It opens onto a secure garden with many local native plants and a comfortable seating area. Aunty Lou’s family leave once she’s settled into her room.

Auntie Lou has a nap when her family leaves. When she wakes up in the early afternoon, she seems agitated. One of her care staff talks to her while they walk around the garden. This reassures her.

During the intake interview, Auntie Lou mentioned she was a member of the local community choir. She also says she enjoys singing and listening to gospel music. Because of this, the care worker puts on a CD of gospel music for Auntie Lou before they leave to help someone else. The care worker hears her singing softly to herself.

People at the centre can choose from various activities after the evening meal. Some enjoy sitting out on the covered verandah and watching the community activity. Others like to watch TV in the lounge area or their bedrooms. Sitting around a fire pit and yarning is also a popular activity.

After catching up with an old friend who now lives at the centre, Auntie Lou decides to go back to her room for the night.

During her intake interview, Auntie Lou said she preferred to shower in the evening. In line with cultural needs, a female care worker assists Auntie Lou with her personal care tasks. However, that evening Auntie Lou feels too tired to shower. The care worker helps Auntie Lou prepare for bed instead. The care worker reassured her that she could shower in the morning instead.

Auntie Lou soon settles into the daily routine at the centre. She enjoys:

• catching up with old friends
• the relaxing surroundings of the centre
• the friendliness of the staff
• that staff understand and meet her needs.

When her family comes to pick her up, Auntie Lou asks the manager if she can come back again next Christmas.

Delivering services that are LGBTIQA+ responsive, inclusive and sensitive

This study looks at helping people nominate who they want to be involved in their care.

Marina has been living at a large residential aged care home for several months. Her long-term partner, Julia, is distraught that she is becoming increasingly distant, withdrawn and depressed. Marina avoids mixing with other people and has shown little interest in the outings her partner organises. Julia is concerned and speaks to the service manager about this.

A nurse hears a volunteer convincing Marina to go along with her family’s wish to return to her former identity as Andrew. This explains the reason for Marina’s agitation.

The manager confronts the volunteer about this. She says she worked with a couple of staff members to try and convince Marina to rebuild her troubled relationship with her family because family support is so important.

The home acknowledges to Marina and Julia that what happened was unacceptable. Julia’s first reaction is that she’ll have to find another place for her partner to live because so much damage has been done. Marina seems relieved that the matter is out in the open and that the home is taking it seriously. They both agree to wait for three months before deciding about moving.

The aged care home is committed to treating everyone with dignity and respect. They develop an awareness and training program with a clear goal. It ensures all staff have the understanding, skills and motivation to deliver LGBTIQA+ responsive, inclusive and sensitive services.

The home arranges a meeting with the family to explain that Marina’s identity is not negotiable. They talk about how they can work together to support her. The home reviews its policy to reflect that the person using aged care is the person who nominates who they want to be involved in their care.

Planning and managing the workforce

This study discusses the knowledge and skills staff need to provide quality care and services.

Uncle Jack is a non-indigenous coordinator of an aged care service in a remote Aboriginal Community. The people who use the service are all of Aboriginal descent. Most speak English as a second language. Many also live with extended family members and follow the cultural practices they have grown up with.

Uncle Jack recognises he must employ local community members as support workers wherever possible to provide culturally safe services.

There are few qualified aged care workers currently in the community. Staff that work in the service don’t know how to care for clients in areas such as:

• personal care
• medication support
• meal preparation.

Uncle Jack decides to conduct a skills and knowledge audit for all staff. This will help identify knowledge gaps for each staff member. He also reviews every person’s care and service plan. He notes any special training requirements that are needed to support everyone.

The skills audit identifies that many staff have basic knowledge of how health conditions affect an individual. They’re unsure how to carry out personal care tasks and don’t understand their scope of practice. Most staff employed in the service have low English literacy levels, which is a challenge for completing a Certificate III in Individual Support.

Uncle Jack discusses the training needs of the staff with the organisation’s training provider. They develop a plan to upskill staff through:

• hands-on workplace training
• mentoring
• formal training at a Certificate II level with specialist literacy support.

The orientation program for new staff includes a buddy system and a staff handbook. This supports local staff in their role. It reduces injury risks to staff and people who receive aged care. It also enhances care delivery by supporting the dignity and choice of the people who receive aged care.

If someone needs specialised support or risks, the care staff are given additional training before the service starts.

Working with consumers from culturally or linguistically diverse backgrounds

This case study examines how to address barriers to inclusive care proactively. It also looks at how you might tailor services to optimise a person’s health and wellbeing.

Jan and Elzbieta are both in their 80s. Jan has dementia, and they’ve been getting home services to help care for him. They seemed very happy with their regular care worker. After about 8 months, their care worker realised he couldn’t meet their needs anymore.

As Jan's dementia progressed he lost the ability to speak English. He has reverted back to speaking Polish, his first language. He couldn’t communicate with the care worker, making him frustrated and anxious. Elzbieta wasn’t getting respite either, as she felt she had to be there to translate.

The care worker discussed the changed situation with Elzbieta, and they raised their concerns with the provider. The provider reviewed the couple’s care plan and concluded that the language issue must be addressed immediately.

They arranged for a Polish-speaking volunteer to visit Jan and Elzbieta and their care worker as an interim solution. They then assigned an experienced Polish-speaking care worker to take over home services for the couple.

The provider recognised that an increasing amount of aged care consumers are from culturally and linguistically diverse backgrounds. As a result, they reviewed information on the first languages of the people they provide services to and adjusted their recruitment strategy.

They now recruit bilingual staff where they can. This reflects the diversity of the people they provide services to.

Working with other services to provide culturally relevant activities

This case study examines how you might partner with other services to provide meaningful activities. It also looks at how this might help people maintain their identity. It optimises their health, wellbeing and quality of life.

Uncle Rodney is the coordinator of a small, remote aged care service. He’s committed to delivering culturally appropriate services supporting the quality of life of people in the community as they age. This includes providing them with suitable activities.

However, resources limit the ability of the service to do this. Limitations include changing staff and a small amount of space to play with. Only a few people can attend the day centre at a time for respite. They usually watch TV and rest, even though many talk about how they miss doing outdoor activities.

Uncle Rodney decides to get an exercise and activity program going using external resources instead of waiting until the service has more resources.

Uncle Rodney researches and finds that the region’s primary health network has an exercise physiologist who can visit remotely twice a year. He contacts the physiologist, who said they have time to visit in a few months.

When the exercise physiologist visits, she talks with people at the service and assesses them. She works with the service to develop some activities for a weekly exercise group. They plan to run the activities in the small park opposite the day centre.

The ladies who regularly come to the day centre often talk about how they used to swim at local waterholes. They wish they could still do things like swimming and driving a car. Uncle Rodney and other staff lead a program of creative physical exercises like pretending to swim and drive. There’s always a lot of laughter during these sessions. The ladies mentioned that they look forward to their weekly exercise meet-up. They also say that they’re more active and healthier than before.

Uncle Rodney uses this example to think about how he can organise things the men have told him they want to do. These include things like going on drives and visiting fishing spots.

Uncle Rodney gets in touch with the local Indigenous Rangers program. He mentions that some men would love to join these activities. He says these men have valuable knowledge they would like to share about the area and its flora and fauna. This could all help the Rangers in their work.

Uncle Rodney and the Rangers agree on a trial activity where the Rangers will take 4 men on a trip once a month. Uncle Rodney uses an activity risk assessment to identify potential risks and plan for the activity. He talks this through with the Rangers.

The service has offered meaningful and culturally appropriate activities by listening and working in partnership with attendees.

Integrating pets into an aged care environment

This case study looks at making the environment safe and comfortable so people feel they belong.

An aged care home takes a new holistic approach to providing the best quality of life. They introduce changes to create a residential care environment that resembles a private home as much as possible.

These changes include adopting a cat and a small dog from the RSPCA. A pet is something many people miss and associate with home.

Overall, it’s a huge success. The pets are a focus of interest, enjoyment and affection. They’re also a source of comfort and make the residential community feel like a family.

Zainab is the exception to this. She’s never lived with pets and regards them as dirty. She also believes dogs can potentially be dangerous. She’s a quiet person and didn’t speak up when they were consulted about the decision to adopt. Now that the animals live in the home, she can’t hide her distress.

The home’s managers want to find a way to continue the highly successful program. They also want to help Zainab feel that the environment is safe, comfortable and that she belongs.

They must also consider whether Zainab may be happier in another home. They’re determined to explore other options first. They set aside some pet-free indoor and outdoor areas so Zainab can feel comfortable. They also encourage her to let them know when she’s interested in joining particular group activities where the pets might be present. Zainab asks the staff to inform her about the pets’ whereabouts as a measure of reassurance.

To help address her hygiene concerns, they explain the protocols and cleaning practices the home has put in place to address possible health risks from contact with animals. These protocols include always keeping them out of the kitchen and dining room. Zainab reports she now feels comfortable in the home again.

This study explores how to problem-solve with people receiving aged care. The aim: overcoming barriers to independence and mobility.

An aged care home has a keypad lock system to enter the building and a buzzer button to open the doors from the inside. People who receive aged care and their visitors are given the keypad numbers so that they can come and go whenever they want.

Carole is a resident at the aged care home, and she has a medical condition causing her mobility to decline progressively. It’s also making her increasingly frail.

Carole loves fresh air and sunshine. She’s been in the habit of taking 2 short walks a day to a nearby park. She now uses a walking frame to do this. These walks are essential to her well-being and may help slow her degenerative health condition.

Recently it’s become difficult for her to push the exit buzzer hard enough, so she can’t always go outside when she wants to. She also finds it hard to reach the keypad and worries that she might become stuck outside at some point. Carole doesn’t like causing a fuss, so she quietly gives up her regular solo walks.

One day when her granddaughter visits and they go outside together. Carole mentions how the weather has changed since her last walk. Her granddaughter asks when this was and learns about the lock situation. She phones the manager and complains that her grandmother, and possibly others, are effectively being prevented from moving around freely.

The home installed the keypad and buzzer system to help them provide a safe and secure environment for residents. The home also has an essential responsibility to:

• promote independence
• enable freedom of movement
• support everyone’s health and wellbeing.

The manager asks Carole if she would be happy to let a staff member know when she wants to go for a walk. This way, they can operate the buzzer for her. If she can’t reach the keypad, they can also help ring the entry bell below it to get in.

Carole thanks the manager for trying to help but is hesitant, as she hates to make extra trouble. The manager agrees with Carole’s granddaughter that this is not a long-term solution for her.

The manager consults the company, and they suggest reprogramming the system so it also responds to a remote control device. The remote responds to a very light touch, and Carole can keep it with her, attached to a cord so she won’t drop it. This work well for her needs.

There’s a chance others will likely have similar difficulties at some stage, so this was also a good investment for the home.