Make day services meaningful

Respite from caring for a loved one offers caregivers a well-deserved break and an opportunity to invest in themselves. Whether this be a holiday with a friend or just a chance to catch their breath for an afternoon, this break from the burden of caring for a loved one with increasing cognitive decline or escalating complex care needs – or both – can help the caregiver renew their energy ready to return to that task at hand. 

In contrast to short-term residential respite that requires the care recipient to invest in a minimum two weeks stay, community respite can mean anything from a couple of hours to a couple of nights. For the caregiver this regular weekly downtime can have important implications for addressing regular tasks like cleaning or shopping. 

For the care recipient, community respite can offer meaningful social engagement opportunities in a safe environment deliberately set up for adults with declining physical and mental wellbeing. However, community respite remains underutilised nationally, and research returns mixed results in relation to value and effectiveness. 

While carer benefits are clearly evident, respite care is also commonly associated with an accelerated need for permanent care for people living with dementia – which results in significant stress for all parties involved.

The link between respite and transition to residential aged care can be explained by the commonly adopted sedentary model of respite care, where clients sit all day and have few meaningful physical engagements. 

However, community respite does not need to be a sedentary drop off centre with my 2013 research showing that when twice-weekly group exercise is incorporated into a day service for older people with dementia, participants experience large improvements in lower body strength, ambulation and balance. 

At Southern Cross Care (SA, NT & Vic) we have pushed this a stage further, challenging the common model of community respite care by engaging clients during every visit in physically, socially and mentally meaningful activities. 

The innovative model incorporates the following simple principles: 

1. do with, not for
2. rest and quiet time is ok, but clients are not there to sleep
3. exercise is essential for functional wellbeing
4. laughter makes everybody’s day better. 

The model is delivered by staff who are experienced carers, passionate about positive meaningful engagement for clients with dementia and are Montessori and University of Tasmania Wicking Dementia Centre qualified. 

A typical day in a respite cottage sees a client add their name to a jobs board that can include helping prepare lunch, watering the garden or running an activity – just to name a few opportunities. They also engage in interactive crafts, games and other stimulating activities including attending a half-hour exercise session per visit guided by an experienced exercise professional. 

Once a week each cottage goes on an outing to local museums, galleries and other local destinations of interest. This model of care has significant client and carer benefits and was awarded the Better Practice Aged Care Service Australia Innovation Award (SA) in 2018. 

Under the Commonwealth Home Support Program funding model, respite cottages typically cater for clients at a ratio of one staff member to six clients. At this ratio, strict eligibility criteria is essential to ensure client engagement and safety, and staff can direct their attention in a person-centred manner. 

Therefore, as clients have a decrease in their functional capacity and cognitive wellbeing, and an increase in their care needs and behavioural fluctuations, they often become ineligible for the community respite environment. 

In many cases families are not ready at this point for their loved one to transition into residential aged care. And due to our proactive engagement model, clients are often still mobilising and undertaking several instrumental activities of daily living independently, making them ineligible for residential aged care or minimising the funding residential providers would receive. Meaning they are not considered for permanency.

For these individuals, we are trialling a new innovative model of care specifically set up for those who have more complex care needs but are not ready or eligible for permanent care. 

If more providers embraced it, more respite clients would come home with a smile on their face

Dr Tim Henwood

Supported through funding from the Department of Health and Aged Care’s Improving respite care for people with dementia and their carers program, this cottage uses a ratio of one staff member to three clients. This includes a registered nurse lead who caters for client medication, wound and other complex needs, and back-of-house staff experienced working with people with dementia, who come front of house if a staff member needs to leave the floor. 

The cottages’ common and outdoor areas and bedrooms align to the National Aged Care Design Principles and Guidelines. Clients can wander freely and safely through the outdoor setting, with both the back and front of the cottage street facing to allow community integration. 

Importantly, this new cottage model mirrors our other cottages by prioritising meaningful physical, social and mental engagement. While early days, already clients and carers are responding positively. 

Carers are talking about the reduced sundowners and how their loved one is looking forward to attending the cottage. And clients who had become socially withdrawn and experiencing fluctuating behaviours in the larger cottages with less staff are demonstrating increased compliance and engagement. 

The cottages can support up to 12 clients per day and four overnight. We are embarking on a marketing campaign to make sure the opportunity is known across Adelaide. In addition, we are assessing the impact to the client and caregiver widely to be able to accurately report on this innovative model’s value. 

Community respite can have incredible value to the person with dementia or complex needs, and the ones who care for them. However, many current programs need to break the sedentary drop off model, and embrace evidence-based practice, facilitating meaningful physical, social and mentally engaging activities. 

Our program shows the important value of this model, and if more providers embraced it, more respite clients would come home with a smile on their face. And maybe more people would want to attend, which in turn could support the extended independence of those living with dementia and other complex needs.

Dr Tim Henwood – an exercise physiologist whose PhD research focused on resistance training for older adults – is Group Manager Research and Development at Southern Cross Care

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