Hall and Prior Windsor Park Nursing Home
Aboriginal People: Culturally Valid Care
Hall and Prior
Windsor Park Nursing Home, Carlisle, WA
Residential - Metropolitan, 80 + beds
Leadership and culture, Social participation, Diversity
About the program
Hall and Prior first implemented a specialised Aboriginal cultural care program in 2006 that has strengthened over the past 10 years with deliberate investment, development and collaboration. It has culminated today in a respectful, culturally valid care model that has been implemented at the Windsor Park Nursing Home and is delivered on a strong foundation of partnerships and trust between academic, Aboriginal, and aged care communities.
A key component of this cultural care program has been a coordinated approach to assist Aboriginal care recipients to settle into residential aged care, in the context of an urban facility and their potential dislocation from their ‘country’. Country is an important part of Aboriginal culture whereby land and their relationship to it as a being are vital for each to be sustained. Understanding the impact of this dislocation is a key first step to meaningful engagement with the resident.
To assist with this process, an Aboriginal Health Coordinator has been employed since 2014 to facilitate cultural and community needs and has led to increased involvement of Aboriginal people and staff in the care program. Staff have had the opportunity to grow and become specialists and have embraced the opportunity to learn, apply and consider an Aboriginal perspective to their work.
Windsor Park Nursing Home has embraced the challenges and has welcomed Aboriginal people from all over Western Australia and is now planning on the next stage of a purpose-built facility to cement these learnings into an environment designed specifically for the cultural care model.
What we did
Together we identified key objectives:
- To ensure that Aboriginal people in our care retain connections to family, community and culture for as long as possible in order to maintain a sense of identity and wellbeing.
- To adapt formal assessments within the organisation to be inclusive of and sensitive to the needs and preferences of cultural needs including social profile.
- To facilitate Aboriginal care recipients to be able retain their connections within their local and remote community.
- To network and collaborate with external and internal service providers to enhance provision of Aboriginal lifestyle and personhood.
- To educate staff at all levels to raise awareness of Aboriginal culture and heritage accessing external services, such as Marr Mooditj.
The organisation used a person-centred care model to identify individual needs and preferences. It adapted its internal social profiles and assessments used across all residents in the home to be inclusive of Aboriginal people. This change was evidenced in care planning, assessments and the database of resident details that recorded key information about their preferences and cultural identity.
An art project was implemented in 2013 to draw on memories and experiences of care recipients. An Aboriginal artist was engaged to use permanent art installations to promote discussion, identity and the value of Aboriginal heritage within the home.
To ensure best practice for Aboriginal care recipients, the organisation then employed an Aboriginal staff member specialising in holistic cultural needs in 2014. This role became critical for:
- advocating for individual Aboriginal care recipients
- facilitating people to attend appointments
- maintaining social and family connections including significant events such as funerals, and/or prison visits
- interpreting and assisting with phone calls
- liaising with the State Administrative Tribunal and Members, along with the Office of the Public Trustee (Administration) and The Office of the Public Advocate (Guardianship) as applicable to a person’s circumstances.
The organisation partnered with a tertiary education provider and a dementia related study centre to research and develop a tool for culturally competent assessment of Aboriginal people. A guide for health professionals to use the tool has also been developed in collaboration with this organisation, and articles have been published
Aboriginal people do not always mark time by the Gregorian calendar, so many specific dates have been lost for their life journey and it became important for staff to understand the importance of listening to the story without need for chronological order (yarning). The yarning model allows care recipients to talk about what they want to talk about, rather than steering a conversation in a particular direction.
Why we did it
There were an increasing number of Aboriginal care recipients admitted to Hall and Prior’s Windsor Park Nursing Home and as a result it was getting a strong reputation as a provider that could assist this cultural group. The increase in care recipients from Aboriginal backgrounds was partly explained by other aged care facilities in the city area refusing care recipients that had complex co-morbidities, invariable low financial circumstances and inability to pay a bond, but also was explained by the goodwill and generosity of the home observed by health providers.
The home soon identified the need to transform to become a preferred provider on the basis of expertise at caring for Aboriginal people and not just the considerable experience. This was because as the number of Aboriginal people in the care of the organisation increased, assumptions about their care were challenged.
The issue with a limited knowledge base in this area was concerning, when the prevalence of dementia among Aboriginal people is up to five times higher than the general Australian population (Smith K, 2008). Aboriginal people tend to have an earlier onset of dementia (45-64 years of age) compared to the general population (65-84 years of age) (Li S, 2014).
The organisation realised it needed to widen its networks to include Aboriginal community leaders and develop a cultural framework. There was very little research about the care of older Aboriginal people in an urban environment at the outset of the program, which needed to be addressed.
Who worked with us
Over the past 10 years Hall and Prior has worked with numerous people and developed multiple collaborations and partnerships in the endeavour of providing best outcomes for Aboriginal care recipients, which has involved:
- Academic partners
- Medical collaborators
- Financial collaborators
- Social networks
- Patronage of an artist
Academic collaborations include Curtin University and Dementia Training Study Centres, which resulted in two published works. The head researcher facilitated yarning circles and highlighted the importance of communication through this medium. The partnership with Dementia Training Study Centres continued research to develop an innovative validated tool to collect information in a way that is non-threatening and culturally safe.
Medical collaborations with Medicare Locals, nurse practitioner, geriatrician, Dementia Behaviour Management Advisory Service, community nurses, and street doctor programs has resulted in timely assessment and delivery of improved health outcomes. This has also increased awareness of the cultural care program within the home and increased the identity of the home as a provider of choice for Aboriginal people.
Financial collaborations with the Office of the Public Trustee has provided financial security where financial elder abuse was suspected.
Social network and collaborations include Marr Mooditj, ATSIG, NAIDOC, local Aboriginal elders and leaders, social workers.
The patronage of an Aboriginal artist, in association with the WA Dementia Training Study Centres (WA Dementia Training Study Centre) produced three art works that told resident’s stories and recent history of Aboriginal people.
What we learned
Hall and Prior has learned and grown far beyond its initial expectations over the past 10 years and now plans to build an Aboriginal-specific nursing home onsite in the future, accommodating health professionals with the skills and knowledge to provide the best care for urban Aboriginal care recipients within the city of Perth. The impact of this program will therefore be profound, meaningful and sustained.
We have learned to develop solutions for Aboriginal health issues within a residential aged care setting, despite the limited research or best practice guidelines to follow at the beginning of the journey. The organisation has learned to listen to Aboriginal people and to hear what they have to say regarding their own specific needs and preferences, and to act on these preferences. Windsor Park Nursing Home is now a living, breathing case study for best practice in the area of Aboriginal cultural care in the residential aged care setting, despite the limitations of this model for Aboriginal people themselves when dislocated from country and kin.
The organisation has learned to develop ongoing collaborative partnerships that have enhanced its health and care program. It welcomes and values the networks that have been formed, and applied knowledge from this program to be able to successfully provide culturally specific care to Aboriginal people in a safe environment without segregation or disempowerment.
Milestones along the way include:
- Workplace Harmonisation Program
- Training opportunities for Aboriginal student health workers at Marr Mooditj in 2013
- Aboriginal Art Project and DVD collaboration with Dementia Training Study Centre in 2013
- Reconciliation Action Plan in 2015, including policies to recognise and understand protocols around ‘Acknowledgement of Country’ and ‘Welcome to Country’ ceremonies.
- Support of Aboriginal awareness activities throughout the organisation in NAIDOC week
- Availability of specific menu options such as kangaroo stew
- As of March 2015, a total of 33 Aboriginal care recipients
The organisation has learned the art of yarning to communicate effectively with Aboriginal care recipients. This has helped staff to communicate more effectively and understand Aboriginal care recipients' needs and preferences, within a context comfortable to those they are engaging. Staff have gained knowledge of Aboriginal history, including recent history that has had a profound impact on the Aboriginal community from within and without the home, allowing them to better and appreciate the social and political context in which they come to work.
The organisation has learned that the most effective way to provide advocacy for Aboriginal care recipients is to employ people with the specialised skills and knowledge for this role. Ultimately the organisation has learned that a good framework that has values, vision and integrity is the cornerstone of providing culturally-sensitive, high-quality care and services for care recipients of a diverse culture with complex needs.
Also, employing people with the skills and knowledge to provide the leadership to guide, focus and educate staff in Aboriginal ways will result in sustainable practices in the home and the broader community.
More information on this program:
Jennifer Grieve, firstname.lastname@example.org or phone 0439 711 388.