One example of an aged care residential home taking the lead in this space is Elizabeth Knox in Epsom, Auckland. They do not have a specific dementia unit and instead cluster their residents into ‘households’ of between 12-15 residents.
Elizabeth Knox CEO Jill Woodward says between 50 and 60 per cent of the 200+ residents suffer from forgetfulness to varying degrees.
“I think the greatest challenge for people providing care, and for people who come into care, is all about meaning. Every human being has a need to be well-known and for their life to have meaning. That’s a greater challenge when you have problems with your memory. So for us, it’s about making certain that we understand the resident’s story.”
Elizabeth Knox’s care partners (or health care assistants) are closet to the residents and help to establish what their needs are and what gives their life meaning before communicating that information to the wider care team.
Staff follow the ‘Eden Alternative’ philosophy which is an approach to aged care that emphasises de-institutionalisation and culture change in our aged care sector. It covers four ‘domains of wellbeing’:
- Identity – being an individual, knowing your story
- Growth – the opportunity to evolve, develop and learn
- Autonomy – the freedom to make your own choices and have self-determination
- Security – to be free from anxiety or fear
“When these four domains aren’t provided, there is an unmet need. We have to be smarter at identifying what those unmet needs are for our residents,” she says.
A resident with dementia who walks off is ‘searching’ due to an unmet need rather than ‘wandering’, Jill explains. “They’re searching with purpose. It’s not aimless. Why does a person disappear at the same time every day? Because they’ve got a routine and they did something every day of their life at this time. We must find out what their story is and what has meaning for that resident.”
Jill believes the aged care sector should focus on de-institutionalisation in order to best serve those with dementia. “We can be a safe home but let’s not get ourselves bound up in rules like ‘you can’t go there; you can’t do this’. We should always ask ourselves ‘would we do this in our own homes?’ If the answer is no, then why should we do it in someone else’s home? These places are residents’ homes, they’ve chosen to come and live here. They haven’t chosen to come and live in our workplace.”
Staff must be given the freedom to care for residents in a way that’s instinctive for them, and intergenerational interaction is also important to create an engaging environment.
Jill says there’s often an assumption that people with dementia can’t engage in an intelligent manner or in activities they were previously passionate about. Elizabeth Knox residents with advanced dementia are still involved in all aspects of running their households – from hiring staff to choosing the seasonal menus.
“They are intelligent, educated people. There are all sorts of strategies people engage in such as remembering to follow sequences of certain things in their daily routine. But their humility, depth of perception and ability to teach us is incredible.”
Creating environments that are easy for people to use is another important aspect to consider, such as installing fully functioning kitchens that residents are welcome to use.
“I’ve had people say it’s dreadful we don’t take the knobs off the stoves in case someone with dementia turns it on and forgets it. Well, I sometimes walk away having left the element going myself. So what? The next person coming past will turn it off. And those things just simply don’t happen. I think if we build environments that are as near to home as possible, residents can absolutely continue a life as close to the life they had before.
“If there’s predictability in the environment but there’s also spontaneity, I think it’s a place people can settle into and enjoy.”