Bupa Care Services - Woodville
Embedding Person First
Bupa Care Services, Woodville SA
Residential - Metropolitan, 80 + beds
Leadership and culture, Enablement, Communication and engagement
About the program
The Embedding Person First project enables team members to implement a Person First approach when caring for our residents. Person First reflects Kitwood’s Enriched Model of Dementia Care and his philosophy of Person Centeredness. Kitwood’s model “…brings into focus the uniqueness of each person, respectful of what they have accomplished and compassionate to what they have endured. It reinstates the emotions as the well-spring of human life, and enjoys the fact that we are embodied beings. It emphasises the fact that our existence is essentially social” (Kitwood; 1997: p.135).
The program was implemented to increase quality of life and care of our residents. We used the following elements to benchmark the success of our approach
- Reduced rate of incidents
- Reduced frustration being felt by residents, resulting in potentially aggressive behaviour towards other residents and staff
- Less use of psychotropics
- Reduced rates of employee turnover
- Fewer complaints - regarding behaviour management
To embed our approach, we utilised a specialised learning and development program based on adult learning theory and focused on experiential learning, to support and encourage team members to appreciate the uniqueness of each resident living with dementia.
The outcomes of the program have resulted in increased resident and family satisfaction. One family member stated: “When we went to Alzheimer’s Australia to ask for Dementia Support, we were also recommended to go to your care home due to excellent Dementia Care.” – Katherine
What we did
We implemented Person First Foundations and Dementia Excellence education.
The Dementia Excellence Core modules were based on adult learning theory and experiential learning so team members were able to value residents living with dementia as a Person First. Students were active throughout the program with a variety of learning activities and care home based scenarios which leveraged the participants’ own feelings and experiences, and applied these to recognise the difficulties of living with dementia. It also provided insight into how residents can be best supported to promote consistent wellbeing every day.
The Foundations module is themed around ‘Introduction to Person First …dementia second’ and helps participants gain a clear understanding as to why implementing a Person First approach, when providing care and support, can promote wellbeing and personhood. This assists participants to firstly understand what it is like to live with dementia, so when they provide care, they can empathise with the resident.
The Positive Communication module helps the participants understand the impact of positive communication. It helps learners redefine what may be seen as “Challenging Behaviours” to take a more practical approach focusing on trying to discover the meaning behind what is being communicated.
The ‘Person First Needs’ assessment provides an understanding of how to deliver Person First care. It provides learners with the knowledge and skills to conduct the assessment and tools regarding how to translate those skills when delivering care. It takes a holistic approach towards care to not only understand the physical needs of residents but also support spiritual, emotional and social needs.
The ‘Meaningful Activity Module’ covers a wide range of individualised care options. It teaches us to understand the importance of knowing the individual and how to use this when providing opportunities for meaningful activities and engagement.
The ‘positive environment module’ helps us understand what a positive and supportive care environment is and how it can be created consistently everyday.
The module ‘Supporting Family and Friends’ focuses on understanding the emotions experienced by family members when a loved one is in care and how the team can enable family members to remain involved in the care of their loved one. It also focuses on building and maintaining positive relationships with family members.
The ‘Health, Wellbeing and End of Life Care Module’ helps learners appreciate the specific needs of a person living with dementia and how we can provide comfort and wellbeing.
Each module has clearly defined aims and objectives and at completion the learners are guided to:
- Identify opportunities to improve and inform their approach to improve the lives of residents
- Work together to improve the experience of the resident based on each of the core modules.
The evaluation of the program was managed via the continuous improvement plan. The plan also monitored resident and family engagement. The program was discussed at a Resident Relative meeting and the General Manager developed and implemented Person First training for the families. This enabled families to support and engage with the Person First approach.
Why we did it
According to Alzheimer’s Australia statistics (2016), 353,800 Australians are living with Dementia and that number is expected to rise to 400,000 in the next 5 years. Dementia is also considered the single greatest cause of disability for Australians aged 65 years and older. More than 50% of older people in residential aged care have dementia.
These figures also apply to our care home where the number of our residents diagnosed with dementia far outweighs the number of residents without this diagnosis.
We wanted to improve the following elements :
- Rate of incidents
- Reduce the frustration being felt by residents, resulting in potentially aggressive behaviour towards other residents and staff
- Use of psychotropic medications
- Rates of employee turnover
- Complaints - regarding behaviour management
Taking into account the above factors, and the significant needs of residents living with dementia, we looked towards developing a program which would focus on our culture and building the knowledge and skill set of our team. We achieved this through focusing on valuing each resident as a person, first. According to Kitwood (1997), using the enriched and psychological needs model to understand the experience of living with dementia means we can create a supportive culture for all residents and their families.
Who worked with us
The key partnership in developing and customising the program was with an academic partner University of Bradford who are recognised for their leadership and expertise in Dementia Care. This program was piloted with four homes that have since embedded the learning into how they care and support people living with dementia in their care homes.
In May 2014, Head of Dementia Services for our organisation in Australia underwent credentialing by Bradford University to become a Cascade Assessor Trainer to develop Person First Coaches for our homes. The key success of the program design is having a Person First Coach (PFC) who will take on a facilitation, leadership and coaching portfolio in the care home. The General Manager of our Care Home became a PFC and was instrumental in cascading the program by embedding the learning in our care home. The home now has two PFC’s who train small learning groups of team members, module by module. This has been occurring from September 2014 to the present time.
The care home planned a robust evaluation of the program using both quantitative and qualitative data. The data was collated and monitored prior to, during and post implementation, with 100% of our care team members completing the program.
What we learned
Since December 2015, 100% of our team members are now graduates of the Person First Dementia Excellence program. Our results show a significant improvement in the quality of life of our residents, an improved team culture and morale, and better quality interaction between the family interaction with their loved ones and the home’s care team.
As the team now sees residents’ behaviour as communication of unmet need, there has been a reduction in the use of psychotropic medication. One of our referrers from acute hospital stated: “When we have a patient that needs to be placed in Aged Care and the patient has complex care related to dementia, we straightaway think of this care home. We successfully placed two care recipients in this home who had been in hospital for two years due to behavioural issues following failed placements from other care homes” - Bindu
The team members are more conscious of what the residents’ needs are based on the behaviour displayed, and are able to meet these needs, ultimately reducing the number of incidents.
The care is individualised depending on the resident’s background and life history. The rate of physical aggression has reduced dramatically.
With the team being able to meet the needs of our residents, we were also able to fully understand and achieve the expectations of the families. One family member complimented the staff and stated: “I very much appreciated being welcomed in the care home which certainly helped me to feel that Rob and I were never separated by his illness. We were able to share special time together just as we did at home prior to his need for your special additional care,” – Kathy.
Morale has increased following Person First training which has resulted in reduced staff turnover. Terry (carer) stated: “Since the Person First training started, we can see a person first culture in our home. I embraced Person First which I use as a motivation to come to work every day”.
Since implementing Person First, we’ve also seen a significant decline in complaints from families.
Implementing Person First has resulted in the introduction of lifestyle programs. For example, we have a Gardening Club which is run by our lifestyle team for residents who enjoy gardening. Activities include, reading magazines and drawing pictures relating to gardening as well as actually gardening, which gives our residents a sense of comfort, occupation, and inclusion with team and other residents.
We have a resident who lives with emotional outbursts and panic episodes, who has been under the care of a psychiatric team and takes psychoactive medications. Through our Person First approach, we learned she was previously a Registered Nurse and loved walking. For two months our Care Manager dedicated 30 minutes of his day to walk with her outside and would work together to do blank assessments forms for the home. The Person First approach gave her a sense of fulfilment, importance, purpose and dignity. As a result, she now no longer uses psychoactive drugs.
We also introduced Doll Therapy as a result of Person First. We find it especially beneficial for two of our residents who live with advanced dementia. Both residents have shown signs of aggression towards other residents and team members. As a result of doll therapy, both residents are now gentle and calm and importantly, there has not been any aggression recorded since the commencement of the therapy.
One resident previously had a probability of falls. Through multidisciplinary meetings, and keeping in mind our Person First approach, we noted that arts, paintings and crafts were of interest to her. We brought Art Therapy to the home which provided her comfort, and independence. Since art therapy has been introduced, her probability of falling has been significantly reduced, with no recorded falls. The Art Therapy program has since been rolled out to the rest of the residents who enjoy arts and crafts. The sessions are conducted on a one-on-one basis with a therapist and give our residents a sense of accomplishment and dignity.
The above examples show how Person First has changed our approach to care. The approach unites our people with the purpose of providing our residents with the best quality of life in a safe, supportive and nurturing environment.
More information on this program:
Febin John, email@example.com or phone (08) 8268 8244.