Special report: rethinking lifestyle in aged care

Lifestyle services can have a significant impact on resident health and wellbeing, and as the sector becomes more consumer directed, what providers offer can become a determining factor in financial viability. Jackie Keast reports.

Each year, residents from Lifeview’s facilities come together for a special event where they compete and share their talents. Known as the Positive Ageing Celebration, the event has a different theme every year selected by residents.

Each event is arranged to coincide with the Victorian Seniors Festival, but residents’ preparations begin months prior and form part of the lifestyle program.

Lifeview chief executive officer Madeline Gall tells Australian Ageing Agenda that residents eagerly anticipate the event in their calenday. Further, it has myriad benefits in terms of physical health, wellbeing and social engagement, says Gall.

“It’s not only an active or exercise piece. There’s also a very creative element to it. For those residents who don’t want to participate physically or get too actively involved there’s art, craft, the making of costumes, and preparing all the decorations,” she says.

Lifeview began the event after noticing a gap in the marketplace for “fun and laughter.”

“It’s about bridging that gap… It keeps people active without a formal exercise regime. It gives them a sense of purpose, something to look forward to,” says Gall.

The benefits of the event are recognised internationally, having been awarded Best Active Ageing Special Project at the Asia Pacific Eldercare Innovation Awards in April.

Gall believes the event breaks the mould of what aged care looks like.

“That’s really what as an organisation we’re setting out to do – it’s to change that perception. It’s not God’s waiting room. It’s just another chapter and it is there to be lived to the full,” she says.

Lifeview’s philosophy means residents determine the lifestyle activity planner so it meets their needs. Of all the organisation’s operations, Gall says lifestyle is given a clear focus.

“It is part of our strategic plan. As CEO I am involved in those meetings we have every three months. That’s how much focus it gets; it’s not seen as just the lifestyle staffs’ responsibility – everybody participates,” she says.

Times are changing

ACH Group also puts lifestyle at the top of its priorities. Its approach is informed by its Good Lives philosophy, which focuses on positive ageing.  How this works in practice is twofold, northern region residential services manager Graham Harding tells AAA.

First, there is a focus on healthy ageing. Residents are encouraged to stay active with access to personal trainers and gyms. This not only keeps residents strong and mobile, but also affords them a greater choice.

“If you can’t walk, then you don’t have access to your environment, and your choices are diminished. So even though it’s not essentially what you’d call lifestyle, it’s a really important factor in that,” says Harding.

Providing as much choice as possible is the second part of the approach. Lifestyle activities are aligned to resident’s personal goals and interests, and consistently updated.

“We shouldn’t be making assumptions, we should be asking the resident what they want to do,” says Harding. “Our lifestyle programs always change based on the people who are residing within our facility.”

At ACH, residents have the options of multiple lifestyle activities, several times per day. Harding’s two facilities provide more than 300 hours of activities a month, possible through the generous contribution of volunteers.

Many activities are designed to allow residents to continue to contribute and live everyday lives. For example, Harding recently went with residents on a houseboat holiday. Many brought along spouses who don’t live in the facility.

An intergenerational program, where childcare or kindergarten centres visit a facility, allows residents to assist in the care of children. The organisation’s art program also allows residents to contribute to the facility’s physical structure.

“We have these beautiful mosaic arches at one of the sites that were the creation of the residents with our artist-in-residence, and at the moment at Highercombe residents are building an art installation for one of our beautiful courtyard gardens,” he says.

“They’re contributing to improving the facility, which is really important.” Resident artwork is also featured in the South Australian Living Artists Festival each year. Overall, Harding says that lifestyle has to be the most important priority for aged care providers. “When you’re talking lifestyle – it’s got to be the bit that gives you the bang… the interesting bit that gets you out of bed.”

‘That model is broken’

Maggie Haertsch, CEO Arts Health Institute, tells AAA many providers need to rethink how they see lifestyle.

“What I am concerned about is that ‘lifestyle’ generally means having a designated person who controls and coordinates what goes on… I think that model is broken. That should not come to one person or one role’s responsibility,” Haertsch says.

Rather than focusing on lifestyle Haertsch says providers need to think about quality of life, and all staff have a role in enhancing it.

“We care a lot about clinical outcomes and clinical wellbeing… They’re very, very important, but they’re basic,” says Haertsch. “In an environment and culture like Australia where health standards are actually quite high, we need to be going to the higher order domains.”

Haertsch says providers need to focus on the whole person – making sure residents have control, can fulfill purpose and meaning in their life, and have a sense of dignity.

“We already do the basics well, there’s no doubt about it. But the way in which a person spends their waking hours requires greater thinking.”

Chief quality officer at Estia Mark Brandon agrees that the idea of lifestyle should speak more broadly to quality of life and the development of enriching environments.

He tells AAA providers need to move away from thinking of what happens in a facility as component parts and lifestyle as just ‘single programs.’

“As providers, what we aim for is a scenario where people wake up in the morning looking forward to their day with us,” says Brandon, who was previously CEO of the former Aged Care Standards and Accreditation Agency.

“Everyone should have that, but they don’t, because quite often on the evidence, a lot of systems and processes in health and aged care are driven towards the convenience of the service provider, rather than the needs and expectations of the residents.”

Staying viable

Haertsch says that many providers encounter a stumbling block when it comes to imaginative ways of addressing quality of life. She argues it’s not necessarily difficult, but requires change management and a shift in staff culture.

“A viable company is going to have to think about this for the future. CDC is not far away for residential care. Providers have to be much, much more flexible,” she says.

There is also further scope for providers to look at providing lifestyle experiences through additional service funding, she says. Brandon agrees that now, more than ever, residents want a say in what they do. Not only that, he says providers have a moral imperative to include residents in the design of programs.

“The key to success in lifestyle is not about giving resident’s choice of five programs. It’s about giving them opportunity to engage in developing the menu,” he says. “It’s just good practice, and it’s the right thing to do.”

Brandon says lifestyle should be driven by what providers know about resident choices. Providers can then take that knowledge and imbue elements that have been shown to promote positive ageing, like independence, control, contribution, companionship, to design programs successfully.

In this way, providers have to get their own values out of the way, and listen to residents about what experiences improve their lives, he says.

An extended version of this article appears in the current issue of AAA magazine (July-August 2016).