Home' Australian Ageing Agenda : AAA Jul-Aug 2015 Contents RETHINKING THE
A more consumer-directed and focussed
approach in residential care will require a
move away from the current deficit model
that is entrenched in many facilities, says
Carrie Hayter, an industry consultant
who supports providers to implement
personalised care services.
"One of the things that the social model
brings is looking at the person in their
entirety, and even if they are coming to
the end of their life, it's about that person
living out every moment of their life to
the fullest capability that they can. If you
don't look at the social side and purely
focus on the medical, then you lose the
essence of who is the person you are
caring for and their story," says Hayter.
She says the cultural change facing
many providers will be significant.
"People think CDC is all about
individualised budgets, but it's actually
a spectrum of concepts and I think for
residential aged care, providers need to
start with understanding the person, their
supports and structuring the support
"There are massive cultural shifts
that need to happen both within the way
agencies think about older people, work
with older people and their allies and
support their staff to think differently."
Building close relationships with
residents and identifying strengths and
goals will be critical, Hayter says.
From that foundation, other elements
of choice and control can be offered
to residents such as personalising a
resident's daily routine, encouraging
resident-led lifestyle activities and
offering the choice to purchase items
such as meals externally. Other, more
radical ideas might include allowing
residents to choose who they live with
or facilitating the choice of a preferred
staff member, including allowing a
community care worker to transition
with a person once they enter residential
care, says Hayter.
Hayter says one of the major barriers to
the implementation of CDC approaches in
residential care is the financial incentive
for providers to build bigger facilities.
"Facilities with 80 to 100 beds are just too
big to make it consumer-directed," she says.
"We need to look at deinstitutionalising
care by having much smaller
accommodation living arrangements and
even smaller groupings of people."
One way providers have sought to
achieve this without compromising their
viability is by setting up small clusters
of residents within facilities that are
matched together according to shared
interests and backgrounds.
Benetas is one organisation that has
adopted a cluster model as a way of
encouraging a more homelike environment.
"Most residential homes are simply not
Case study: Reinterpreting residential care
Over the past decade, DutchCare in Victoria has adopted the Eden
Alternative, a philosophy of resident-directed aged care that aims to
place decision-making authority as much as possible into the hands
Under this model, decision-making is devolved to the resident or those
closest to them. "We have 'households' within each facility made up of
a group of 15 to 17 residents," says DutchCare CEO Petra Neeleman.
"Traditionally, the same staff work with the same elders so that new
relationships are not having to be constantly formed. They eat together;
live together -- no different to what we would have in a normal house."
As a household, residents collectively make decisions about daily
routine, activities and outings, and mealtimes. At an individual level,
residents can choose what furniture to have in their room, when to
start their day and where to have breakfast.
"It's your choice when you get up. It's your choice when you have a shower -- that might
be morning or evening and when you get up could be anytime," says Neeleman.
Residents can also choose to eat in another household or request a staff member to be
changed. Neeleman says to empower residents care staff must be given the autonomy to
make decisions with elders. "You won't get empowered residents until you get empowered
staff. That has been a big part of the learning curve and that means you have to upskill your
staff so they are responsive to residents.
"The staff working with the client are the ones making the decision with the elder and
they only bring it up the line if they think there is a risk element that we should be aware of
and then it's a case of talking with the family and with the elder about what those risks are."
Instead of resident committees, talking circles provide an opportunity for each resident
to have a say, says Neeleman.
The Eden Alternative was founded in the US by geriatrician Dr William Thomas in
the early 1990s. He was motivated to create an environment that eliminated "loneliness,
helplessness and boredom" from the lives of aged care residents, which he argued were
the "plagues of ageing".
The model has since spread to more than 200 American aged care facilities and has
been adopted by facilities in several countries such the UK, Germany, Denmark and Japan.
Reported benefits include reductions in medication usage, improved resident wellbeing
and improved staff retention rates.
Neeleman says staff that succeed with a resident-centred approach are flexible,
relationships-focussed and driven by outcomes rather than process. "I said I didn't want
professional staff if 'being a professional' means you can't get close to someone."
DutchCare facilities are the first in Australia and New Zealand to be endorsed in all
10 principles of the Eden Alternative model.
The 10 Eden Alternative principles
1. Loneliness, helplessness and boredom are the plagues of the human spirit
2. Close and continuing contact with children, animals and plants builds a human habitat
3. Loving companionship is the antidote to loneliness
4. Giving and receiving care are the antidotes to helplessness
5. Variety and spontaneity are the antidotes to boredom
6. Meaning is essential to human life
7. Medical treatment is a partner in care, not its master
8. Wisdom grows with honouring and respecting elders
9. Growth is not separate from life
10. Wise leadership is the lifeblood of thriving
30 | JULY -- AUGUST 2015 | AAA
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