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Bucklands Residential Care

Enabling Better Quality of Life
Bucklands Residential Care, North Plympton, SA

Residential - Metropolitan, 80 + beds

Award descriptors:
Health and wellbeing, Enablement

About our program
Our residential aged care facility sought to meaningfully enrich the quality of life of our residents. We offered a wide range of services to support the factors that promote quality of life, yet felt that resident participation was too low to significantly improve wellbeing for all customers.

Contemporary best practice research highlights the benefits of interventions that optimise intrinsic capacity of older adults, thereby enabling them to do more of the things that give meaning, pleasure and wellbeing in their life (WHO 2015).

We created the position of Health and Wellness Officer to specifically support resident quality of life. This staff member would identify a resident’s goal and what is limiting them from achieving this. They would design and deliver a personalised exercise program to enhance the individual’s physical and functional capacity. This could involve addressing strength, range of motion, endurance, surgery/illness recovery, mobility and many other physical or functional issues. The Health and Wellness Officer would also focus on making the exercise session an opportunity for social engagement and mental wellbeing.

We evaluated the impact of the Health and Wellness Officer by looking at overall resident quality of life and how residents are more enabled for their social relationships, psychological wellbeing, physical health, environment and empowerment, dignity and respect. Key outcomes include 93% or residents believe their quality of life has improved, data demonstrating improvements in falls, behavioural incidents and reduced risk of social isolation and many examples of residents gaining in confidence, friends, emotional wellbeing, independence and mobility.

What we did
Our Health and Wellness officer commenced in October 2014 and undertook six months of training in exercise and motivation skills. In March 2015 she commenced working with residents with a mobile exercise resource. In July 2015 she commenced management of the Wellness Centre gym and full-scale delivery to residents.

The key actions of the Health and Wellness officer are:
1.       Engage residents - Building confidence of individuals, creating an environment of no judgment and openness to express oneself, offering friendliness and enthusiasm, providing motivation, creating a membership culture and marketing. The overall aim is to create desire from residents to be part of wellness

2.       Get to know each resident – about their life and current goals. This includes interpersonal communication and formal processes such as pre-exercise screening and medical clearance and completing a goal setting tool

3.       Develop each individual a plan to optimise their physical capacity through exercise. Each plan is based on belief that everyone can do something, everyone can improve, incremental increases, supporting residents to better understand their bodies and focusing on what will enable to resident to achieve their personal goal

4.       The interventions offered by the Health and Wellness officer focus on improving balance, mobility, leg strength, range of motion, upper body strength, core strength and ability to perform activities of daily living. These are achieved using:

  • Fitness equipment (e.g. bikes, step machine, weight machines)
  • Stretching exercises
  • Free weights and balls
  • Resistance bands
  • Walking with parallel bars
  • Own body weight exercises
  • Chair-based exercises, sit to stand

The majority of  residents work with the Health and Wellness officer twice a week on their fitness goals. These are usually 30 minute sessions with 3-4 residents working in the Wellness Centre at the same time. A small group of residents access the gym facility every day of the week. These are people for whom fitness and becoming stronger is essential for their wellbeing and is part of their history and identity.

Accessing the Wellness Centre is encouraged to promote social interaction with other residents, rather than people undertaking their exercise program in their room.

Dedicated efforts are made to give residents living in the memory support unit access to the Health and Wellness officer exercise services.

A usual day for the Health and Wellness officer includes:

  • 7.30am: Administration and resident planning
  • 8.00am: Welcome the resident attending every day before his breakfast
  • 8.30am to 12pm: Multiple resident sessions. These are 30 minute sessions where approximately 3 to 4 residents attend at the same time. On average 20 to 30 residents attend each day
  • 12pm to 12.30pm: Resident record keeping
  • 1pm to 3.30pm: Multiple resident sessions or individual assessments and goal setting for new residents joining the Wellness program
  • 3:30pm to 4pm: Resident record keeping. This includes recording resident participation and what they achieved in the session, e.g. how many repetitions at what level of resistance. It also includes weekly reporting of participation and achievement of the residents (to management).

Why we did it
Our home is committed to enriching the quality of life of residents. We believe that good quality of life is possible regardless of age, health status or disability (King et al. 2012; Johansson 2003). Quality of life is a subjective experience for each person, yet there is also evidence that residential aged care can enhance quality of life for older adults (Kane et al. 2006). Key factors that create quality of life include physical health, the environment, social relationships, psychological wellbeing and empowerment, dignity and respect (Harris and Grootjans 2012, Magennis and Chenoweth 2009). These are areas our service can influence.

Our initial thought was to develop interventions for each of these domains for quality of life; however this was actually already available through lifestyle and other activities. Our real issue was that many residents were not engaging with the things that were important to them or the opportunities available.

The WHO Healthy Ageing definition is:
“Healthy Ageing as the process of developing and maintaining the functional ability that enables well-being in older age” (WHO 2015, p28)

This concept suggests that building the intrinsic/physical capacity of our residents will enhance their ability to participate in what promotes wellbeing for them. 

Therefore our aim was to improve the physical and functional ability for our residents so they could engage in more of what creates quality of life. We identified the need for a new, dedicated staff member to concentrate on this objective.

Who worked with us
The key people involved in this initiative were:

  • Management of our facility and organisation who identified the need for this intervention, developed the idea and identified a staff member to undergo the training
  • Our staff member who saw the potential of this program and volunteered to be part of it, undertook the training, embraced the philosophy and aims and now delivers it daily to our residents. In addition, we now have two more staff members who also work in the Health and Wellness officer role
  • Our residents who contributed to the development of the program, were the first to try the new offerings, spread the word to others and every person who has embraced the opportunity. There are 90 residents currently engaged with the Health and Wellness officer
  • People involved in training the Health and Wellness officer, including the registered training organisation and technical expertise from our central office support team.

What we learned
1.       Residents want and can participate in exercise
90 residents access the Health and Wellness service, over 60% of residents. 120 exercise sessions a week are provided for 66 individuals.

2.       Residents are highly satisfied with the service and do believe it has improved their quality of life

A satisfaction survey was conducted with residents in January 2016 about the Health and Wellness service. 44 residents responded and results included:

  • 63% feel more energetic and fitter since 
  • 82% of residents feel stronger 
  • 93% of residents believe their quality of life has improved 
  • 100% of residents would recommend the Health and Wellness officer to others

The Health and Wellness officer works directly on improving physical fitness, yet benefits to overall quality of life have been even greater. We believe this is because:

  • The exercise session generates social engagement, mental health benefits and sense of achievement all contributing to quality of life
  • Physical health gains enable people to do more of what creates overall quality of life

 

Social relationships outcomes
The Wellness Centre has created friendships in our facility. Residents report what they like most about the Wellness Centre includes:
“The friendliness, the social aspect and camaraderie”
“We became good friends”
“Meeting new people”
“Camaraderie, encouragement and companionship of others”
“Company and activity”
“Mixing with others and watching them improve”

Staff report significant increase in overall lifestyle activity participation and reduction in residents at risk of social isolation. We define risk as people participating in less than five activities a week. In October 2015 there were 38 people at risk; by February 2016 this had reduced to 13 individuals.
 
One of the most special social relationships outcomes was a wedding in January 2016. While the Health and Wellness officer can’t take credit for the wedding itself, it was the goal of the groom to walk down the aisle and he achieved this with support from the Health and Wellness officer.

Psychological outcomes
Many residents report psychological benefits from working with the Health and Wellness officer, including:
“Very good for emotional support”
“Lifts my mood – happy”
“A positive start to the day”
“Incentive to get some exercise and get out of my room”
“Feel more positive”

Psychological benefits are also experienced for residents with dementia. Staff report improved mood in residents after they have been to the Wellness Centre and behaviour incidents have declined; from 14 in July 2015 to 1 in April 2016.
 
Empowerment outcomes
Many residents report increased confidence since working with the Health and Wellness officer, including:
“I have a purpose”
“More confident in my walking”
“Even other people have noticed that I’m stronger”
“I have even been able to go home for a couple of weekends”

Many residents are now doing more activities of daily living independently, including:
•         Being able to self-toilet
•         Being able to put own socks on
•         Ability to turn self in bed
•         Walk to dining room on own

Physical health outcomes
Mobility outcomes from the Health and Wellness service include:
5 people moving from 1 person assist to standby assist
2 people moving from 2 person assist to 1 person assist
2 people moving from lifter assist to 1 person assist.

We have seen declines in falls incidents since the Health and Wellness officer commenced, from 42 in June 2015 to 20 in March 2016.

Many residents report improved sleep since working with the Health and Wellness officer. We believe this is evidenced by a reduction of 2663 call bells a month, predominately overnight calls.
 
Case study of quality of life impacts

Mr R started working with the Health and Wellness officer in July 2015.
Physical: Mr R’s son is impressed with his improved mobility and endurance. Mr R states that he sleeps very well these days. His physical strength has improved and he says, “I am healthy, well and super strong”. Staff report that Mr R demonstrates far less aggression.
Spiritual: Mr R is now able to go out with his son to attend church on Sundays which is important to him.
Social: Mr R has made friends in the Health and Wellness Centre and is always encouraging them to do well. He now dines out with family members at local restaurants.
Empowerment: Mr R is now about to move around the facility independently with his walking frame

More information on this program:

Sarah Baxter, sarah.baxter@southerncrosscare.com.au Phone no. (08) 8292 1800

Changed
Friday, 21 December 2018 - 6:43am