Fostering relationships between staff and residents is key to delivering an inclusive model of care, an aged care CEO tells the royal commission.
On Wednesday, the Royal Commission into Aged Care Quality and Safety featured NewDirection Care, which operates an aged care facility in Bellmere, Queensland containing 17 domestic-style homes each housing seven residents spread across six streets in a town-like setting with shops and community facilities.
Appearing via live video together, the inquiry heard from the facility’s 89-year old resident Elsie Scott and house companion Lisa Jones.
Ms Scott told the inquiry she moved to residential aged care from a retirement village because she required more assistance with daily tasks, such as cooking meals. She said she chose NewDirection Care because it was “light years ahead” of traditional aged care facilities.
“I was looking for something that was one-on-one and really caring, not en masse but personal,” Ms Scott said. “A number of the facilities were like you had a hall and all the rooms were just off the hall, and often with a shared bathroom.”
Ms Scott said interacting with facility staff was an important aspect of her care and one she enjoyed.
“The house carers treat everybody with respect and dignity. And no matter what level of dementia the residents are at, they are all treated fairly, equally, and the same amount of time is given to every resident.”
She said the staff were caring, despite how busy they were.
“Sometimes they’re really, really busy. But never once have I not had something that I needed – they would immediately help you,” Ms Scott said.
Ms Jones, who previously worked as a personal care worker in residential aged care, said she almost left the industry before giving it “one last chance” as a house companion at NewDirection Care, a role which involves assisting with daily activities including personal care, medications and domestic duties like laundry and cleaning.
“I’ve worked in [traditional aged care facilities] for many years and it took a toll on me as a person because it was really sad and quite morbid to go there. And I felt that a lot of staff were there just for a wage; they didn’t actually care,” Ms Jones told the inquiry.
Ms Jones said interacting with residents was discouraged due to time constraints when she worked at other aged care facilities. “All of the duties that we had to do in the time allocated, there wasn’t time,” she said.
Ms Jones said being able to develop very close relationships with residents and their families as well as staff played an important part of being a house companion.
“You don’t feel like you’re on your own… It’s the whole community that… support you to give the care that’s required,” she said. “We have more time to develop those relationships, and we have a genuine desire to develop those relationships. And having a good relationship with a resident and having genuine empathy is – it always makes it easier for everyone.”
Balancing care needs
NewDirection Care CEO and founder Natasha Chadwick told the inquiry their model aimed to balance meeting a resident’s care needs with providing them a home.
She said the house companion, who provides a multi-functional role, was the first key component of the model.
“The whole part of their role is about building a relationship with their residents and gaining trust so that they can then provide individual services. House companions are… trained and provide services that pretty much run the household, if you like, in conjunction with the resident,” Ms Chadwick said.
Another key component is around on dignity of risk, she said. “It’s about being able to continue to live the life that you’ve always lived… and not have someone stopping you from taking the risks that you’ve always taken as an individual,” Ms Chadwick said. “It might be as simple as someone who wants to continue smoking…Many aged care facilities don’t allow that. That’s not up to us to judge.”
Ms Chadwick said NewDirection Care looked at how to continue to support each resident to be individuals. “The point is they don’t live in a facility, they live in a community.”
Funding the approach
Commissioner Richard Tracey asked Ms Chadwick how NewDirection Care’s funded the construction of the facility.
She said she was lucky financiers at the time were willing to assist and support its development.
“We funded it through debt funding through the bank, through personal equity and equity that we had established from operating some traditional aged care,” said Ms Chadwick, who is also managing director of aged care provider Synovum Care.
“We were able to demonstrate… to our financiers that we could still provide a sustainable financially viable model that would… pay them back that debt… just like you can with a traditional aged care environment,” Ms Chadwick said.
Commissioner Tracey asked whether NewDirection Care could budget the model within the normal government resident subsidy.
She said when they initially modelled the development and started the research, they found it would be feasible to do so. However, today the income does not cover the cost due to the quite “significant reduction in the level of funding to our industry” since then and because the funding model is based on disablement rather enablement, Ms Chadwick said.
“We make that up through our other services, the local shop, the hairdressing salon, you know, the GP clinic, the dental clinic, the wellness centre and our café and all of those services are available to our external community.”
She said their model could not typically be funded standalone. Ms Chadwick called for funding mechanisms to be reviewed in light of changing community expectations.
The Royal Commission into Aged Care Quality and Safety Cairns hearing wrapped up on Wednesday. The next hearing takes place 29-31 July in Mildura, Victoria, and will focus on informal carers and family. The Brisbane hearing follows 5-9 August with a focus on aged care regulation.
To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage.
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