Home' Australian Ageing Agenda : AAA Nov-Dec 2013 Contents "It was a very rewarding experience in Spain but we had lived
a couple of years in the States [USA] and we always had in mind
that someday we would like to live somewhere else abroad where
they speak English.
"When we arrived in Australia, Paul shared with me the idea of
replicating the Spanish model of GPs in aged care homes. He had
already done some research and he said, what do you think?"
Gracia began a program of meetings with key people and
organisations in Australia that would be important to the success
of a trial. This included the Australian Medical Association
(AMA), the Royal Australian College of General Practitioners
(RACGP), researchers, officials from Medicare and the
Department of Health and Ageing (DoHA) and others.
"It was important to meet people and understand the
Australian situation. I started meeting doctors and different
medical groups. The feedback from the AMA and Steve
Hambleton [AMA president] was all really positive. Pretty much
everyone said they'd thought
about it as a good idea, but
nobody had done it," he said.
Gracia was invited to
present the concept to the
AMA's national conference
to obtain some insights
into whether GPs would
"The AMA had done some
research on the needs of GPs
working with aged care and
trying to find a better service
model. So I knew they would
be generally interested.
"But everyone there was really very supportive. "Then we
met with the Department of Health and Ageing and people from
the Medicare Locals and Medicare. And the AMA came too. We
explained the concept and put it all on the table. They thought it
was a brilliant idea and were keen to meet again and hear about
"We've had only positive feedback," Gracia says happily.
But getting in principle support was the easy bit. As Gracia
says thoughtfully, change in general is always a challenge and
needs to be managed carefully.
"It can be scary and stressful," he says. "If you want to
make change you have to involve everyone. You need people to
And so the development of the GP model was a steady and
collaborative process that proceeded from an important premise,
"We asked, 'what will make this project successful for
everyone - the residents and the GPs and the staff of the care
home?' And then we tried to address all those things."
THE CAMPAIGN FOR JUSTICE
Gracia clearly has a talent for working with people and systems
and leading complex change -- particularly where there is a
problem that is affecting people's lives, like dementia.
"There were so many things you could do to change the
lives and the outcomes of people living with dementia and their
relatives. So I led a national dementia project for Bupa in Spain."
The national project involved a comprehensive education
campaign for all Sanitas staff from the personal carers, to the
administrative and management staff, kitchen staff and cleaners.
"The aim was to teach everyone about dementia -- what it is,
what it does to the person and to understand how they can live
and interact with the person.
"Historically, Spain has had a culture of using physical
restraints for people with dementia in aged care. The national
average was higher than 25 per cent and Sanitas was no different
when we started this program.
"But we decided we wanted to change that as a company
and we decided to aim for a zero tolerance for physical
restraints," he says.
Gracia acknowledges the program has been a major
undertaking and the campaign is ongoing. Right now he says,
while more than half the Sanitas homes in Spain have achieved
the independently validated zero target, the company average
is still eight per cent.
He says high quality training is core and must be more than
just theory. As part of the training, staff are themselves placed in
physical restraints for an hour to gain first hand understanding of
how it feels for the person with dementia.
"So partly it involves experimenting yourself about what the
consequences are," he says. "But the physical restraints issue
really goes beyond the physical restraint itself. You have to ask,
why does the person keep standing up? Are they uncomfortable?
Are they bored? Do they have a UTI?
"Trying to understand the reason behind the 'behaviours'
is essential to the culture
we wanted to implement.
The other side is providing
alternatives. That's about
having better systems to
monitor people if they might
be wandering away or when
they are about to fall.
"And using other supports
and devices that don't restrict
movement," he says. "So
rather than use a belt to
stop someone sliding out of
a chair, give them a different
type of chair, more like a saddle for instance, where they won't
be at risk of sliding off but they aren't restricted from standing.
"It's a major mindset shift for all the staff to go through, to aim
for a zero tolerance culture. But we have had the whole company
committed and all the general managers of the homes supporting
it and I feel sure we will get there."
Meanwhile, it's a case of keeping up the good fight. "We are
setting the example because other homes in Spain have started
similar programs now," he says. n
"If you want to make
change you have to involve
everyone. You need people to
ON STUDYING MEDICINE
One of the main reasons I became a doctor was to help
people. I don't come from a medical family where it was
expected of me to become a doctor. It was a deliberate choice
I made. I am a Christian and there's no better way to show
what you believe than through actions and doing things for
others. Medicine is a useful career for helping people and you
can do it all over the world.
Aged care has good professionals but often they are not
recognised as such; it's always seen as the second rate
system. So now they can think differently. We are now doing
IVs and ECGs for example. Before it was just medications.
So, professionally it is more rewarding. It's bringing back the
professionalism to aged care.
Coming from the old continent Australia feels like a young
country. There is a lot of respect for things -- like you can leave
your phone or your wallet somewhere and it will still be there or
someone will hand it in. It feels pretty safe and there are lots of
possibilities for families. The other thing is that senior people
are so much more accessible. To just ring up and have a chat
with Steve Hambleton and being able to have meetings with
the government. That would be hard to do in Spain.
www.australianageingagenda.com.au | 41
Links Archive AAA Mar-Apl 2014 AAA Spt-Oct 2013 Navigation Previous Page Next Page