Case studies

Respecting consumer preferences and dealing with family concerns about risk

Discussing health and safety risks and finding solutions that maintain a sense of independence, self-worth and purpose.

Mrs O has been receiving home care services for several years. She has dementia and her needs have gradually increased, but she is capable of living semi-independently for now. Her two children live nearby and at least one of them visits daily. Mrs O gets on well with the care staff and makes it clear to them that she wants to keep doing as much of her own housework and personal care as she can.

However, her children express concern to the provider that she is no longer capable of making decisions that best meet her needs. They ask the provider to add laundry, ironing and bed-making to their duties, tasks that Mrs O has been doing herself until now without mishap. The care staff who look after her directly tell the service coordinator they think this change is unnecessary and risks making Mrs O unhappy and affecting her confidence. The provider has to balance the wishes of Mrs O’s family with Mrs O’s own preferences.

The main priorities are Mrs O’s safety, her well-being, and respecting her wish to keep doing her daily tasks. There are certainly safety and hygiene issues to consider. So far these have not arisen but may as Mrs O’s dementia progresses. A care coordinator with experience in dementia meets with Mrs O to talk about these issues. Mrs O understands the concerns being raised by her children and decides that the risks discussed with her are outweighed by the importance of the benefits she get from doing her own laundry and ironing. She agrees to a small increase in staff supervision for these activities. In explaining the plan to Mrs O’s children, the coordinator emphasises how important it is for their mother 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 their mother and will continue to monitor them from day to day, and welcomes further input from the family about their observations of how she is coping.

Supporting independent choice while meeting care needs and respecting other consumers

Staff are careful not to be judgemental or confrontational. They acknowledge that consumer’s activities of choice are important to them and problem solve to manage concerns.

Mr C lived alone for nearly 10 years. Things that were important to him were going to the races on Saturdays and meeting up with other regulars and friends at his local pub. As he now needs more help to look after himself properly, he has moved into a small residential aged care service in his old neighbourhood. He is happy there, gets on well with fellow residents and has been able to keep up his outside interests. He still goes to the races regularly and visits his local at least once a week. However, sometimes he has a drink or two too many and can be disruptive when he returns. Other consumers mention that he sometimes smells of alcohol. He also has a habit of staying out later than expected, which is worrying as his mobility is not great and he likes to walk to and from the pub. When staff members try to persuade him to change his ways, he reacts defensively and defiantly, to the point where the pub recently rang and asked for someone to come and pick him up.

The home has to balance its concern about the effects of excess drinking and late-night walks on Mr C’s health and safety, its responsibility for the comfort of other consumers, and its obligation to help Mr C live the life he chooses. They involve Mr C in meeting to assess how to safety meet his needs, goals and preferences, and give him the opportunity to involve friends or family members. He asks for his daughter and an old friend to be there. The staff at the meeting are careful not to be judgemental or confrontational. They start by acknowledging that Mr C’s activities of choice are important to him and that they recognise this. They then raise some of the concerns they have and open up a conversation with Mr C.

Mr C is wary at first but is able to see the point of view of other consumers and to appreciate that the staff are motivated by care for his safety rather than any desire to stop him living the life he wants. On a practical level, the outcome of the assessment is a tailored plan that includes arrangements for safe transport home from the races and the pub at an agreed time. Mr C has responded well to having his autonomy respected, his interests supported and his sense of community encouraged.

A comprehensive approach to managing hearing loss

Reducing social isolation, stress and frustration and improving quality of life through hearing assistance.

The managers of an aged care home recognise that a high proportion of residents have hearing loss that affects their quality of life. For example, Ms R can hear if one person speaks at a time and there is no background noise, especially if they have ‘the right kind of voice’. But she doesn’t join in conversations because she finds it frustrating and embarrassing to miss so much. When someone asks her a question she doesn’t catch, she guesses what they might have said and tries to give a suitable answer. She knows this makes her seem confused, but doesn’t want to annoy people by asking them to repeat what they just said. Mr J, whose hearing loss is quite advanced, feels stuck in a world of his own. With his hearing aids in and working he can hear enough to get by, as long as he can see the speaker’s mouth and they ‘don’t gabble or mumble’. But he and the care staff constantly struggle to insert and operate the aids. He has been diagnosed with depression, triggered partly by the profound isolation he feels.

After seeking expert advice and consulting with each resident, their family members and relevant staff, the home provides comprehensive training for all staff, based on free resources from the Deafness Forum of Australia. This is followed up with on-the-job implementation and a hands-on workshop with a hearing services provider. As a result, staff gain the competence and confidence to recognise the signs of hearing loss, use effective communication techniques, encourage residents to get hearing devices and advise them about the government benefits available for this. They learn in detail how to operate, clean, insert, remove and change the batteries of different kinds of devices. Three respected members of the direct care staff are appointed as ‘hearing champions’ to attend more advanced training and guide and encourage their colleagues. Having incorporated the changes into their daily routines, staff report it makes their job much easier when residents can hear and respond appropriately, especially when giving medication and other similar situations.

Ms R agreed to receive a hearing aid and now she feels more comfortable in groups and is delighted to be able to hear the TV and follow the conversation when her grandchildren visit. With staff using clear communication techniques and assisting Mr J to maintain, insert and adjust his aids correctly, he starts feeling more connected with the world around him and finds it much easier to live the life he chooses.

Dealing with different needs relating to spiritual well-being of consumers within a service

No group of consumers has a greater or lesser claim to culturally safe care and services and to feel accepted and valued regardless of their faith.

An aged care home is run by a faith-based organisation. This is not prominent in its marketing to consumers, but was an important part of why consumers who share that faith choose the home. The consumers at the home are diverse, with one faith group that make up the largest proportion of consumers. The home has a central common room used for social events and faith-related ceremonies. At a recent meeting, consumers from a particular faith group proposed that the common room should be decorated in a way that provides a more suitable background for their religious services. Other consumers strongly objected to the idea. Some said it would mean that the room was no longer a common area, and others expressed a broader concern the home was becoming ‘too religious’ because of the types of activities that were being organised.

When considering the request of the faith group and the objections of others, the management team is aware that no group of consumers has a greater or lesser claim to culturally safe care and services and to feel accepted and valued regardless of their faith. They recognise the challenge to provide support for different faiths and different preferences for activities within their service and the available resources.

The home offers to arrange for faith-based community volunteers or the consumers themselves to ‘dress’ and ‘undress’ the room before and after services, using easily portable items that can be discreetly stored. To recognise the diversity of the consumers using the service, they conduct regular assessments of consumers’ preferences, develop individual activity plans and evaluate participation in activities as an indication of whether the range of choices have met consumers needs, goals and preferences in an inclusive way.

Early response to changing condition

Responding to deterioration and restoring mental wellbeing through a well designed intervention.

Staff at a small residential aged care centre became concerned that Ms J, a resident in her 90s, was showing symptoms of depression. Previously sociable and active, she had gradually withdrawn from social activities, stopped going to exercise classes and lost interest in her daily crossword. The centre contacted a specialist aged care counsellor they had worked with before, and asked him to visit Ms J.

Responding to the counsellor’s reminiscence-based approach, Ms J became more animated when recalling the food she had eaten while travelling overseas and how she had been inspired to recreate those dishes at home. This sparked associated memories of other things that had shaped her identity, such as people, work and places. Over an course of counselling, her mood noticeably improved. As her energy and sense of self began to return, she resumed many of her previous activities and, with encouragement from the counsellor and care staff, began recording her travel stories and recipes to share with her family.

Understanding consumers’ spiritual needs after moving into residential aged care

Exploratory conversations about what is important can find a way of adding value and meaning   

Soon after moving into residential aged care, Mrs S has an assessment to identify ways to help her with adjusting to her new environment. During this assessment Mrs S tells the care manager that while she is ‘not spiritual’ and not sure what her religious beliefs are, when she lived by herself and was still able to drive she had gone to church most Sundays. The care manager asks Mrs B some open questions to find out what church meant to Mrs S personally, the and learns that  the weekly services were an opportunity to connect with her community, see people she knew and identified with, and to help others by playing the church organ and visiting members of the congregation who were unwell.

Mrs S says she doesn’t mind missing the sermons, but does miss the sense of inner peace and connection with ‘something out there’ she felt during silent prayer time. She adds that she regrets not being able to keep in touch with her church community or make the contributions that gave her a sense of purpose and value. After hearing this, the care manager asks if she can look into and help arrange some opportunities to help Mrs S stay connected with her old church. Mrs S is pleased about this and also interested in the suggestion that she consider volunteering her skills as a pianist to accompany the residents’ choir. After introducing Mrs S to the choir organisers, the care manager takes her to see the prayer and meditation room, gives her a program showing when the regular services and meditation groups are held and when the space is free for individual use.

Meaningful activities for daily living

Dealing with change and loss and the process of grieving while navigating a new phase of life.

For several months before breaking her wrist, Ms O attended a weekly painting group at the community centre near the retirement village where she and her partner recently moved. As soon as the injury seems to have healed enough, she returns to the group to resume work on the detailed landscape painting she had started before the accident. Her frustration when she discovers that using a paintbrush is still too painful is understandable but seems out of proportion. She drops the brush on the floor, exclaiming, ‘I’ll never be able to finish it now!’. When others in the group try to comfort her by suggesting alternative projects, such as using her other hand to create an abstract work, she becomes even more upset and starts crying.

The activity facilitator quietly takes Ms O aside and asks her gently about the inspiration for the painting she has been working on. Ms O shows her the photographs and sketches the scene is based on, explaining this was the property where she and her partner lived before they became unable to look after a large home and land. The painting was meant to be ready as a gift for her partner on their anniversary­—the first in their retirement unit. Ms O misses their old life terribly and has been struggling to adjust. The facilitator understands Ms O’s reaction is not just about finishing the painting, but about the process of grieving what has been lost as she and her partner navigate this new phase of life. She encourages Ms O not to give up on the painting, but to give her wrist more time to heal, and to change the finish goal to Christmas or her partner’s birthday instead. Meanwhile, she suggests, the photos and sketches are lovely in themselves and deserve to be framed and displayed in their new home.

Changing spiritual needs at different phases of life

Respecting consumer choices to navigate the last phase of life in the way that brings peace and comfort.

Mr N has been receiving aged care services at home for more than a year. He is very unwell but his symptoms are manageable and he is still quite mobile. Although his three children are ready to take him anywhere he wants to go, he has been going out less and less for the past couple of months. Mr N’s daughter tells his regular home care worker, Mr B, she is concerned about her father hardly ever going out and, in particular, never going to temple anymore. While her father seems happy to see visitors, he is not as sociable or animated as he used to be either. She is worried he might be lonely and depressed, and asks Mr B for ideas about how she and her brothers might ‘get Dad out in the world and back in contact with his religion’. Mr B says he will try to find out whether there is something in particular—perhaps some pain he doesn’t want to talk about—stopping Mr N from wanting or feeling able to go out and do things.

While unpacking Mr N’s supermarket delivery the next day, Mr B mentions to him that people who are unwell can sometimes feel isolated by their condition or not up to talking about pain or other symptoms they may be experiencing. He wonders aloud if Mr N might be going through anything like this. Mr N says he appreciates the concern, but explains this is not what is going on. He responds that at this stage of life, he just wants to spend as much time as possible in reflecting on his life and using meditation and quiet religious study to do this. 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 than in social settings. He tells Mr B that a friend comes to meditate with him regularly and that he feels spiritually supported. After this conversation, Mr B seeks Mr N’s permission to talk to Mr N’s daughter and explain that the changes she sees in her father reflect his choice to navigate this phase of his life in the way that brings him the most peace and comfort.

End of life care planning that addresses what matters most

Developing an advance care plans helps to identify consumer values and treatment preferences to maximise comfort and preserve dignity.

Mr and Mrs H had been living in their own unit in a retirement community with on-site aged care services for three years when Mr H, aged 70, was diagnosed with a rapid form of dementia. They contacted the provider to discuss extra services they expected to need as the illness progressed. Recognising how important it was for Mr H’s final months to be comfortable and dignified and to reflect his wishes, even when he could no longer express them, the provider encouraged them to make a formal advance care plan.

A staff member trained in developing advance care plans helped Mr H identify his values and treatment preferences. What mattered to him most was staying in his home with his wife and dog, taking daily walks and looking after the unit’s small garden. He did not want treatment that might extend his life while its quality deteriorated. Following the provider’s protocol for end-of-life planning, the staff member worked with Mr and Mrs H to document a detailed advance care plan. Mr H was pleased everyone knew his clinical, cultural and spiritual preferences.

Mr H died at home 18 months later. As requested, he had received palliative care only and was not moved to residential care or transferred to hospital for life-prolonging treatment. The provider had made it possible for him and his wife to stay together by providing an increasing level of services in response to his changing needs.

Facilitating difficult discussions about end-of-life choices

Having the important conversations about death support staff to understand that the choices being made reflect the consumer’s end of life wishes.

Ms G came to live in residential aged care after her chronic lung disease became too advanced to manage without access to on-site medical services. Over the 10 years since she was diagnosed with the condition, she has come to terms with the prospect that it will end her life. At this stage she is quite matter-of-fact about the expected progression, probably within a couple of years, from residential care to palliative care and the end of life.

Staff at the home who are close to Ms G are concerned that her daughter doesn’t really understand or chooses not to contemplate how far the illness has progressed. Ms G has had many conversations with friends, doctors and staff about how she wants her care to be handled as she nears the end of her life. She has tried to raise the topic with her daughter, but her daughter has always managed to deflect the discussion. Staff have a fair idea of what Mrs G wants. She is prepared to continue medical treatment up to a certain point, but with limitations. Her daughter is not prepared to accept that there are limits to treatment, however, and still talks in terms of remission and recovery.

Ms G tells a pastoral carer she is worried her daughter will never accept that the end is approaching and may make decisions about her care in the final stages that are completely different from her own preferences and cause unnecessary pain and discomfort. The pastoral care worker looks out for opportunities to bring her daughter closer to being able to have the conversation she needs to have with her mother. An important step is helping each of them understand that they are on the same road from fear to acceptance, but at different stages. Once they are able to frame the discussion in those terms, they gradually reach a point where Ms G can explain her preferences and her daughter can listen to them. At the pastoral care worker’s suggestion they decide to write Ms G’s decisions down and review them every so often to make sure they still cover all possibilities and are still what Ms G wants. As the illness enters its final weeks, her daughter can be sure that the choices she is making reflect her mother’s wishes, and Ms G has the reassurance she needs that the end will be as she wants it.

Commitment to complaints through open disclosure

This means acknowledging and apologising when failings are identified.

Mr P has been a resident of a small residential aged care centre for several years, and he has just been discharged from the local hospital and returned to the facility. A few weeks ago, unexpectedly his condition had taken a turn for the worse and he became unresponsive.

Everyone at the service is very pleased to see Mr P has returned, his previous health restored, and he is back to his lovely, bubbly, old self.

One of the nursing staff, Mrs S, is looking through Mr P’s records and notices he was administered an incorrect medication, right before his condition deteriorated and he was rushed to the hospital unresponsive. He had been given Endone 10mg, which was intended to be given to another resident.

Mrs S is very concerned this mistake had been made and immediately raises it with her manager. This information is disclosed to Mr P’s family, who find it very distressing that this sort of mistake has been made.

The service acknowledges their mistake and apologises to Mr P and his family. An immediate meeting for all nursing staff is held at the service to discuss the administration of medication. Additional training is organised for all nursing staff and additional procedures are implemented by the service to ensure this doesn’t happen again.

Although Mr P and his family are upset this mistake had been made, they appreciate the service has acknowledged its mistake, apologised and was transparent throughout the whole process. Mr P and his family are also pleased that additional procedures have been implemented to ensure this doesn’t happen again.

Getting to the bottom of complaints

Taking time to bring the family together to build trust and collaboration on the plan for care.

Over the last few months, a home has had frequent complaints on a range of topics from Mr R, the son of one of its newer consumers Mrs M.  The manager has had several meetings with him to try to resolve issues as they arise, and has made a number of changes in response to the concerns he has expressed. This includes moving Mrs M to a room further away from the street, providing different meals for her and arranging physiotherapy sessions to help her get back to her usual level of mobility following a fall.  The manager and staff are satisfied that they are meeting Mrs M’s care needs and preferences. Mrs M herself, though always quiet, also seems happy with her care and environment. Despite this, her son continues to complain to the manager, to staff and to other consumers and visitors. This seems to be affecting the atmosphere at the home and may affect its reputation in the small town.

Mrs M indicates she would like to involve the family so they understand what is going on in her life at the home. Recognising the need for a more comprehensive response to the family’s complaints, the manager organises a care conference and invites Mrs M’s son and daughter, the head of nursing, and a staff member from the home’s parent organisation who is a trained facilitator and manages the complaints system for the organisation.  Together, they go through Mrs M’s care plan item by item to discuss where Mr R’s expectations differ from his mothers and discuss why this might be. The home is transparent about how they can meet expectations, where they cannot meet expectations and, in some areas, how they are already doing so.

It becomes apparent that the decision to place Mrs M in residential care is causing both her children feelings of guilt, and that each blames the other for not doing more or not doing things differently. As he is the one who still lives in their home town, Mr R feels particularly burdened by responsibility. The facilitator acknowledges Mr R’s concerns and explains the formal feedback and complaints processes inside the organisation and externally. Mr R and his sister become visibly less resentful of the home and each other during the meeting, which the facilitator deliberately keeps on a constructive and matter-of-fact path.

By implementing the revised care plan, and with the permission of Mrs M, providing regular reports to both Mrs M’s children and seeking regular feedback from Mr R instead of waiting for raise a concern or complaint, the home is continuing to build trust and collaboration.

Respecting what is important to the consumer in resolving their complaint

Tackling the issue without being judgemental about the consumers preferences so that an agreed solution could be found.

Mrs E is an independent woman in her 80s who takes great care of her house and garden. After being injured in a bad fall, she has been receiving home care services, including cleaning. She is a grateful and good-natured recipient of nursing and personal care. However, from the start she has expressed dissatisfaction with the house cleaning service. Her home care coordinator has discussed this with the subcontracted cleaning agency, which has a very good track record. The agency has tried sending different people and allocating more time within the budget limitations, but Mrs E still insists the result is substandard. The coordinator does an inspection and finds the house meets at least the required level of cleanliness. Mrs E still says she wants to cancel the cleaning service and would rather spend all day doing what she can herself, however any stress on her injuries will compromise her recovery. At this point the coordinator takes the issue to a senior colleague.

After consulting with Mrs E and the various staff members who look after her, the manager handling the complaint finds Mrs E has exceptionally high standards of cleanliness. In addition, on a deeper level she is distressed and anxious because she equates any relaxation of these standards with discomfort, indignity and loss of control, all things she has been struggling with since her injury. To involve her directly in the solution, the manager asks Mrs E to help create a detailed checklist of priority tasks and minimum standards for the cleaners to follow. After some negotiation, everyone involved agrees on a final version of the checklist. Mrs E has agreed to provide some private funding for the extra time the cleaning takes, as the final cost is over what her care package budget allows.  This process has enabled Mrs E to identify the specific things that were bothering her before and offer constructive solutions. She may never be entirely comfortable with the idea of someone else cleaning her house, but her attitude to the cleaners has changed and she is pleased to have been in control of resolving the issue. The provider is now using this experience as a learning for handling complaints that involve subjective judgements, differing expectations and complex emotions.

Responding to financial elder abuse

Being alert to signs of elder abuse and taking steps to prevent it happening

Auntie V 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 V makes a weekly payment through a Centrepay deduction towards her meals on wheels, which are delivered to her Monday to Friday and are an essential part of her care and support. 

Auntie V’s nephew and his girlfriend have moved into town from another community and are staying with her while they look for work. The nephew sees Auntie V getting her daily meals on wheels and asks her how much she pays for this. When Auntie V explains she pays a contribution from her pension for the meals, her nephew says she should stop paying for that, give him the money and he will shop for her and cook the meals instead. Auntie V likes her meals from the aged care service, but agrees to stop her payment and gives her debit card to her nephew so he can go shopping.

A few weeks go by and Auntie V’s nephew has not been buying groceries or cooking meals for her. She asks for her debit card back, but her nephew refuses to give it to her and then leaves town. Meanwhile, the Manager at the local aged care service has been notified by their Administration Officer that Auntie V has cancelled her meals support and visits her to talk about this.

Auntie V explains the situation to the Manager and asks for help so she can receive meals again. The Manager gets Auntie V to sign a new consent form so the payment deduction can recommence. The Manager also helps Auntie V contact her bank and helps her through the process of cancelling her old card and applying for a new one. The Manager asks Auntie V if she would like to talk to the police about what her nephew has done. Auntie V does not want to go to the police but 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 and she can tell them what he did. The Manager contacts Auntie V’s relatives and organises a telephone family meeting from the Aged Care Centre. Auntie V comes in and speaks to her relatives using the service provider’s phone. 

The Manager updates the Care and Case Management plan with Auntie V, adding a new goal and action under money management about helping her when relatives come to visit. The Manager also advises Auntie V’s Support Worker about the change in her care plan. 

Training on Elder Abuse is also included in the organisation’s training plan.

Supporting consumers and their families to provide feedback

Encouraging feedback from consumers and their families, and a commitment to continuous improvement, lead to improvements in the quality of care and services delivered. 

Mr J is the coordinator of a large community based aged care service. The consumers are predominantly from Indigenous and migrant backgrounds. 

The organisation has a formal complaint system, which includes a feedback box at the day respite Centre, along with forms that consumers can complete. These can be sent in by post or provided to their care worker to place in the feedback box. However, Mr J finds that few formal complaints are submitted through this process and wants to make sure consumers are aware of the complaints system and feel able to give feedback. 

He makes time each week to personally visit one to two consumers to chat about the care and services they receive and find out what questions, ideas or concerns they have about the care they are receiving and service or the organisation providing those services. He finds this approach is more relaxed and consumers who may be reluctant to raise an issue or make a formal complaint will often let him know about things they are not quite happy with. These may be minor issues which can be easily addressed, like variations to the meals on wheels menu, or revising personal care visit times.

Mr J also finds that family carers provide additional insight and ideas for activities that their relative would be interested in. Mr J records relevant feedback in the consumer’s individual progress notes or completes a formal de-identified complaint form to escalate concerns when required. 

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

Supporting consumers to manage changing condition

Working together to support consumers to maintain their independence as circumstances change.

Uncle C is a retired stockman, living with his daughter and her family in a remote township. He is home by himself during the day, and ‘meals on wheels’ has been all the help he wanted. Recently, his mobility has started to decline and his daughter worries about him falling over when no-one is around to help. Uncle C 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 C receives a letter from My Aged Care to say he has been approved for a package. He takes this to the local aged care provider, where the coordinator explains he needs to wait for an ‘assignment’ letter. A few weeks later when the letter arrives saying he has been assigned a home care package, he returns and the coordinator helps him ‘activate’ the package and reads him the referral report from My Aged Care. 

With help from his daughter, who explains the information in language he understands, Uncle C learns what a home care package is, what a care plan is, how to work with the service, what his rights and responsibilities are and how to let the service know his needs and preferences. Together they identify what services and supports will help him live the life he chooses, and how much his package will pay for. They then contact a home care provider which helps documents a care plan and a budget, and every month Uncle C gets a statement showing what his care has cost.

A year later Uncle C has a stroke, which reduces his ability to move around independently. While he is in hospital, a new assessment is completed and he is referred for a higher level care package in response to his changing needs. The provider talks to Uncle C, his family, the hospital discharge planner and the assessment team to work out a plan of care for his return home. After Uncle C goes home from hospital, an aged care support worker sees him every day and records on a client observation form if there are any significant events or changes in his health, well-being, behaviour and environment. The support worker also visits Uncle C every fortnight to check how he is going. With his consent, she keeps in touch with the nurse at the health clinic to discuss his care needs and what each service is doing to support him. Everyone is working together to help Mr C maintain a good quality of life and stay in his own home.

Supporting consumers with complex care needs in a remote area

Responding to changing care needs and involving others to optimise the consumer’s health and well-being.

Auntie F is an Indigenous woman in her 70’s with dementia and chronic health conditions who lives in a remote community. Through a home care package, she receives support from Monday to Friday at the local aged care service provider, and her family cares for her at home on weekends. Auntie F has recently developed some behaviours that can place her and others at risk. For example, she has started to pick up and keep things that do not belong to her. 

Recently she took a pack of medication from a relative’s house. While she was in the TV room at the aged care day centre, a staff member noticed her trying to open the pack. Realising the medication was not hers, he immediately told the aged care manager, Auntie S, what he had observed. Auntie S spoke with Auntie F, explained the medication was not hers, and phoned the family member whose medication it was to have it returned. 

Auntie S arranged a meeting to discuss the incident and the risks with Auntie F and her regular carer. With their consent, Auntie S also organised a meeting with the family members who provide care on weekends, and other people she shares living areas with. At the meeting, Auntie S talked about some of the risky behaviours that can occur as dementia progresses and suggested some practical actions such as keeping medication and valuable possessions in secure places. 

Auntie S also invited Auntie F’s family carer and other family members to attend the next staff training ‘toolbox talk’ on dementia so that they could learn more about the condition and their role in supporting Auntie F at home. She also took along culturally appropriate information materials to give to the family that explained more about how to support someone with dementia.

Auntie S then discussed the matter with staff at the centre’s fortnightly team meeting and documented the event in Auntie F’s progress notes and the incident register. Auntie S also discussed the incident with the local health clinic and booked a review with the visiting doctor, who referred Auntie F to a geriatrician for assessment on their next scheduled visit to the community. Auntie S added a note in the aged care centre’s quality improvement register about what had happened and the changes the staff, service and family members had made to respond to Auntie F’s changing needs, to enable her to live as independently and safely as possible.

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

Consumers enjoy receiving and sharing food that is meaningful to them and consider it their right to do so.

The consumers of an aged care home have a wide variety of cultural backgrounds. To celebrate birthdays, religious festivals and other events, visiting friends and family members sometimes bring special foods when they visit. Many are in the habit of bringing enough to share with others. These treats often become the focal point for impromptu social gatherings. Consumers who are on restricted diets for medical reasons or are at risk of choking are tempted to join in and be a part of what is going on. Concerned about the potential risks to these consumers with restricted diets, the home has announced a new policy to prevent visitors from bringing food. Consumers have strongly objected to the change and are upset their views were not sought before the announcement. They enjoy receiving and sharing food that is meaningful to them and consider it their right to do so.

Reconsidering its decision, the home has to weigh up several competing considerations: on one hand the potential risks for some consumers, and on the other hand the importance of respecting individual choice, and the dignity and rights of consumers to make these choices. Food plays an important role in identity and connection with community.  The outright ban on food from outside will restrict consumers’ choices and remove a source of social pleasure and interest that has become a feature of community life. It will also disempower visitors who want to contribute to the wellbeing of someone they love.

Instead of going through with the intended ban, the home decides to implement a risk management protocol. Visitors can still bring food but are asked to let the staff know about it in advance or when they arrive. This enables those on duty to find out what the specific foods are and work with the visitors to educate them on the potential food safety risks, to keep a careful eye on consumers who are at higher risk, and to arrange for storage or disposal of leftovers in a way that complies with food safety standards.

Building a culturally competent residential care workforce

Being up front with consumers about how equipped the service is to meet cultural and spiritual needs may allow consumers to make a more informed choice.

Mr H migrated to Australia from Iraq as a refugee. After his wife died and his son returned to Iraq, he had difficulty looking after himself but did not want to live alone, so moved into a new residential aged care home on the outskirts of the city. He is a devout Muslim who prays five times a day. Praying times often coincide with meals and other services, which the staff find hard to understand and accommodate. Mr H feels belittled by their casual comments about his religious practice and distanced from the other consumers, none of whom share his faith. In his old neighbourhood Mr H had spiritual guidance from a local imam. Since being at the home, he has been out of touch with the imam and his community and this is causing him great distress. His religious faith and practice is an important part of his identity and culture and central to his wellbeing, but his care provider is not helping him to meet this need.

The doctor tells a senior manager that Mr H’s mental and physical health are likely to decline sharply if he remains unhappy and isolated. The manager acknowledges the home has excellent facilities, but has been finding it difficult to recruit people who are culturally competent. After discussing the situation with the homes parent organisation and then with Mr H and (by email) his son, she gets him put on a high-priority waiting list for a place in one of the organisation’s other homes. It is closer to Mr H’s old community and has more culturally skilled staff and diverse residents. In the meantime, she contacts Mr H’s former imam and arranges for Mr H to visit the mosque regularly and keep in touch with the imam by phone.

At the same time, the Human Resource team reviews the recruitment and training process. Cultural competence workshops are also arranged for all staff, including one focusing on Muslim cultural practices to reflect the community they are located within. Individual staff are also encouraged and supported to enrol in external training that will increase their understanding of diverse cultures and faiths.

In retrospect the home recognises that it should have been more transparent about how deficits in staff knowledge about the Muslim faith and the fact he would be the only individual of that faith in the home may impact his sense of belonging.  Providing Mr H 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, including his spiritual needs.

Delivering services that are culturally safe, respectful and inclusive

Commitment to treating everyone with dignity and respect means communicating in a way that is clear and enables consumers to exercise choice.

Auntie V is an 87-year-old Aboriginal woman living with her extended family in a remote community and receiving home care services. Over the Christmas period many of her family go away on holiday. Auntie V usually remains at home and manages with a small amount of additional support from the aged care program. However, she has recently been diagnosed with early stage dementia and her family is concerned about her being at home alone. Her daughter suggests Auntie V could 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 offers low care residential respite and is located in a nearby community. Auntie V and her daughter talk to the Manager of the Centre and are able to secure a four week booking. They are invited to return one month before the booking to discuss Auntie V’s needs and preferences. 

The Manager notices Auntie V has trouble understanding the options available to her and uses additional pictorial cues to help her make appropriate choices. Together they complete an intake assessment; this includes identifying any health issues that staff need to be aware of, including current medication, meal preferences, activities she enjoys, and personal care preferences. The Manager gives Auntie V and her daughter a tour of the Centre, answers their questions and provides them with a respite handbook to take away. The handbook provides plenty of colourful visual cues to assist Auntie V to understand what to bring with her and what to expect when she stays at the Centre. 

On the first day of holidays, Auntie V is brought to the Centre by her family and they are invited to stay for a couple of hours to help her settle in. Auntie V’s room is light and bright, opening onto a secure garden area that includes many local native plants and a comfortable seating area. Once she has settled into her room and finished her lunch, Auntie V’s family leave and she takes a nap. When Auntie V wakes in the early afternoon she appears agitated. One of the care staff spends some time talking to her and walking with her around the garden and this appears to reassure her. During the intake interview, Auntie V mentioned she was a member of the local community choir and enjoys singing and listening to gospel music. Before they leave to assist someone else, the care worker puts on a CD of gospel music for Auntie V and they hear her singing softly to herself.

After the evening meal, consumers at the Centre can choose from a range of activities. Some enjoy sitting out on the covered verandah watching the community activity, others like to watch TV in the lounge area or in 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 V decides to retire to her room for the night. During her intake interview, Auntie V stated she preferred to have a shower in the evening. In line with cultural protocols, a female care worker comes to assist Auntie V with her personal care tasks, however Auntie V feels too tired to shower. The care worker instead helps Auntie V prepare for bed, reassuring her that she can shower in the morning.

Auntie V soon settles into the daily routine at the Centre, enjoying the opportunity to catch up with old friends and the relaxing surroundings of the Centre. She enjoys the friendliness of the staff and the way they understand and meet her needs. When her family comes to pick her up, Auntie V asks the Manager if she can come back again next Christmas.

Delivering services that are LGBTI responsive, inclusive and sensitive

Commitment to treating everyone with dignity and respect means the consumer is the person who nominates who they want involved in their care.

Ms M has been living at a large residential aged care centre for several months, when her long-term partner, Ms J tells the manager she is very worried that Ms M is becoming increasingly distant, withdrawn and depressed. Ms M avoids mixing with the other consumers and shows little interest in the outings her partner organises. Ms J is concerned and speaks to the manger of the service about this.

The reason for Ms M’s agitation becomes clear when a nurse hears a volunteer helper cajoling Ms M to go along with her family’s wish for her to return to her former identity as ‘Andrew’, now that she is ‘out of Ms J’s influence’. When confronted by the manager, the volunteer says she and a couple of staff members have been ‘trying to rebuild the troubled relationship between Ms M and her family for everyone’ sake, as family support is so important’. The home acknowledges to Ms M and Ms J that what has happened is unacceptable. Ms J’s first reaction is that she will have to find another place for her partner to live, as too much damage has been done. However, Ms M seems relieved that the matter is out in the open and that the home is taking it so seriously. They both agree to wait for three months before making a decision about moving.

The aged care home is committed to treating everyone with dignity and respect. The home develops an awareness and training program with the clear goal of making sure that all staff, including volunteers, have the understanding, skills and motivation to deliver services that are LGBTI responsive, inclusive and sensitive. It arranges a meeting with the family to explain that Ms M’s identity is not negotiable and discuss how they can work together to support her. The home reviews its policy to reflect that the consumer is the person who nominates who they want involved in their care.

Planning and managing the workforce

Ensuring staff have the knowledge and skills to provide safe and quality care and services

Uncle J is a non-indigenous coordinator of an aged care service in a remote Aboriginal Community. The consumers are all of Aboriginal descent with most speaking English as a second language. Many of the consumers live with extended family members and follow the cultural practices they have grown up with. 
Uncle J recognises that to be able to provide culturally safe services, he will need to employ local community members as support workers wherever possible. Currently, there are few qualified Aged Care workers in the community, and those staff engaged to work in the service do not know how to safely care for clients in areas such as personal care, medication support and meal preparation.

Uncle J decides to conduct a skills and knowledge audit for all staff, to identify where knowledge gaps are for each individual. He also reviews every consumer’s care and service plan and notes any special training requirements that are needed to support individual consumers. 

The skills audit identifies many staff have only a basic understanding of how health conditions may affect an individual, they are unsure of 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 and this is a challenge for completing a certificate III in Individual Support. 

Uncle J discusses the training needs of the staff with the organisation’s training provider. Together they develop a plan to upskill staff through a combination of hands on workplace training and mentoring, and formal training at a Certificate II level with specialist literacy support. 

The orientation process for new staff includes using the staff handbook and a buddy system. This supports local staff in their role, reducing the potential for injury to both staff and clients, and enhancing the delivery of care in a way that supports the consumer’s dignity and choice. Where it is identified that a client has specialised support requirements or risks, the care staff are given additional training prior to the service commencing. 

Working with consumers from culturally or linguistically diverse backgrounds

Being proactive to address barriers to inclusive care and tailoring services to optimise consumers’ health and wellbeing.

Both in their 80s, Mr and Mrs W were receiving home services to help care for Mr W, who had dementia. They seemed very happy with their regular care worker. After about eight months, however, their care worker realised that he was no longer able to meet their needs. As Mr W’s dementia had progressed, he had lost the ability to speak English and reverted to his first language, Polish. Being unable to communicate with their care worker made him frustrated and anxious. This also meant the care workers visits were no longer giving Mrs W respite, as she felt she should be there to interpret.

The care worker discussed the changed situation with Mrs W and together they raised their concerns with the provider. The provider reviewed the Ws’ care plan and concluded that the language issue needed to be addressed immediately. As an interim solution, they arranged for a Polish-speaking volunteer to go with the care worker on his visits to Mr and Mrs W. They were able to assign an experienced Polish-speaking care worker to take over home services for Mr and Mrs W.

Recognising that an increasing number of aged care consumers are from culturally and linguistically diverse backgrounds, they reviewed information on their consumers’ first languages and adjusted their recruitment strategy accordingly. They now recruit bilingual staff where possible, reflecting the diversity of the people they provide services to.

Working with other services to provide culturally relevant activities

Working in partnership with other services to provide meaningful activities, helps consumers maintain their identity and optimises their health, well-being and quality of life.

Uncle R is the coordinator of a small, remote aged care service. He is committed to delivering culturally appropriate assistance that supports the quality of life of people in the community as they ‘age in place’, including providing suitable activities. However, the services’ ability to do so is limited by resourcing, including changing staff and a small amount of space. Only a few people can attend the day centre at a time for respite. Usually they just watch TV and rest, even though many talk about how they miss doing outdoor things. Uncle R decides that instead of waiting until the service has more resources, which might not happen, he will get an exercise and activity program going using external resources. 

Uncle R does some research and finds that the region’s primary health network has an exercise physiologist who can make remote visits a couple of times a year. He makes contact and the physiologist is able to come out for a visit in a couple of months’ time. After talking with and assessing some consumers, she works in partnership with the service to develop some activities for a weekly exercise group to be held in the small park opposite the day centre. 

The ladies who regularly come to the day centre often talk about how they used to go swimming at local waterholes and how they wish they could still do things like swimming and driving a car. Drawing on this, Uncle R and other staff lead a program of creative physical exercises like pretending to swim and drive. There is always a lot of laughter during these sessions. The ladies mention that they look forward to their weekly exercise meet-up and are more active and healthier than before. 

Uncle R uses this example to think about how he can organise things the men have told him they would like to do, such as being able to go on drives and visit places like fishing spots. Uncle R gets in touch with the local Indigenous Rangers program and says some of the men would love to be able to join in these sorts of activities. He mentions these men have valuable knowledge they would like to share about the area and its flora and fauna, which could help the Rangers in their work. Uncle R and the Rangers agree on a trial activity where the Rangers will take four men on a trip once a month. Uncle R uses an activity risk assessment to identify potential risks and plan for the activity and talks this through with the Rangers. 

Listening to the consumers and working in partnership, the service is able to offer meaningful and culturally appropriate activities to its consumers. 
 

Integrating pets into a residential care environment

Ensuring that the environment is a safe and comfortable for all, so consumers can feel they belong.

As part of a holistic new approach centred on providing the best quality of life for its consumers, a home has introduced 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, as the companionable presence of a pet is something many consumers miss and associate with home. This innovation is a huge success overall. For both consumers and staff, the pets are a focus of interest, enjoyment and affection, a source of comfort and an addition to the general sense that the residential community is like a family. The one exception to this is Mrs Q. She has never lived with pets and regards them as dirty and in the case of dogs, potentially dangerous. As she is a quiet person, she didn’t speak up when they were consulted about the decision to adopt. Now that the animals are actually living in the home, she can’t hide her distress.

The home’s managers want to find a way to continue a highly successful program while enabling Mrs Q to feel that the environment is a safe and comfortable one in which she belongs. Realistically they do need to consider the possibility that Mrs Q may be happier in another place. However, they are determined to explore other options first. They decide to set aside some pet-free indoor and outdoor areas, where Mrs Q can feel comfortable. They also encourage her to let them know when she is interested in joining particular group activities where the pets might be present, and ask the staff to keep her informed about the pets’ whereabouts as a measure of reassurance. To help address her concerns about hygiene, they explain the protocols the home has put in place to address possible health risks from contact with animals, including keeping them out of the kitchen and dining room at all times. Mrs Q reports she now feels comfortable in the home again.

Preventing security measures from restricting free movement

Problem solving with consumers to overcome 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 inside. Consumers and their frequent visitors are given the keypad numbers so that they can come and go whenever they want. One of the consumers, Mrs C, has a medical condition that is causing her mobility to progressively decline, as well as making her increasingly frail. She loves fresh air and sunshine and has been in the habit of taking two short walks a day, now using a walking frame, to the nearby park. These walks are important to her well-being and may help to slow down her degenerative health condition. However, it has become difficult for her to push the exit buzzer hard enough, so she can’t always go outside when she wants to. She is also worried that at some point she might not be able to get in, as she is finding it harder to reach the keypad. Mrs C doesn’t like causing a fuss, so she quietly gives up her regular solo walks.

One day when her granddaughter is visiting and they go outside together, Mrs C remarks on 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 potentially others, are effectively being prevented from moving around freely.

The house installed the keypad and buzzer system as part of meeting its responsibility to provide a safe and secure environment. However, it also has important responsibilities to promote independence, enable freedom of movement and support consumers’ health and wellbeing. The manager asks Mrs C if she would be happy to let a staff member know when she wants to go for a walk so that they can operate the buzzer for her and, if she can’t reach the keypad, to ring the entry bell below it when she wants to get in. Mrs C thanks the manager for trying to help but is hesitant, as she ‘hates to make extra trouble’. The manager agrees with Mrs C’s granddaughter that this is not a long-term solution for her. He consults the company. They suggest reprogramming the system so it also responds to a remote control device. This turns out to work for Mrs C, as the remote responds to a very light touch and she can keep it attached to a cord so she won’t drop it. It is also a worthwhile investment for the home, given the chance others will likely have similar difficulties at some stage.