Residents living with advanced dementia have unmet needs related to quality of life and palliative care. A collaboration between the University of Tasmania and aged care provider Southern Cross Care Tasmania sought to address this issue and transform care for this group of residents.
We did this through implementing the Namaste Care program with the support of a translational research grant from Aged Care Research Industry Innovation Australia focused on enhancing quality of life for residents.
What is Namaste Care?
Namaste Care – to honour the spirit within – is a structured, person-centred program that promotes comfort and pleasure through multisensory activities, such as gentle massage. It includes staff, volunteers and family carers.
The group program takes place in an environment as free from distractions as possible. It offers activities of daily living using a slow, unhurried loving touch approach.
Namaste carers prepare the room in advance with attention paid to creating a calm, relaxing and welcoming environment. Gentle, relaxing sounds or music create an atmosphere rather than provide entertainment. Natural aromas or aromatherapy diffusers create pleasing smells while visual images including photos or pictures are used for reminiscence.
Kitchen staff prepare nutritious tasty snacks and beverages for residents to help stimulate appetite and increase food intake and hydration.
The program includes important palliative care elements, such as assessment of pain and promotion of comfort that address quality of life until the end of life.
International studies show the effectiveness of this low-cost and easily set up program.
Outcomes for residents include improved verbal and non-verbal interactions, appetite and weight gain and improved pain assessment and management with a reduction in agitated behaviours and antipsychotic medication use.
The increased interpersonal human contact improves interactions with staff and makes visits with family and care partners more rewarding.
Our four-stage project introduced Namaste Care into the daily workflow of two SCCTas facilities. We provided education and training to staff, family and volunteers. We also planned the daily rollout of the program with staff at the services involved, collected various data and evaluated the program over six months.
Our evaluation found similar benefits to quality of life for residents and staff, consistent with previous research. We are preparing these findings for peer-reviewed publication.
Along with the positive impacts of the program, we identified challenges that other organisations wanting to implement this program should consider.
Project learnings for wider industry rollout
Leadership for a supportive and collaborative team environment
There was an unexpected change in the leadership team of the aged care organisation during the project. This resulted in a transition to a new interim executive team.
Understandably, these changes led to shifting in priorities for the organisation. However, the facility managers played a central role in supporting the project assisted by leisure and lifestyle, pastoral care and other care team members.
We found that while middle level managers are busy with ensuring quality and safety on the frontline and attending to core business, they needed to delegate key staff to coordinate, communicate, timetable and roster the program to ensure it ran smoothly.
A whole-of-team approach is required to promote program sustainability so that it becomes part of usual care and can withstand the known operational pressures of staffing, outbreaks of Covid-19 and RSV, and regulatory visits.
At one of the services, the team included clinical and care staff, pastoral care, and leisure and lifestyle staff. As the project progressed, other staff members also supported the program as demonstrated in this comment from a participant:
“Funnily enough, even the maintenance man was involved in how we were doing things … he knew it’s because the staff don’t have the time to come and clear the room and bring the residents and reset it up. And the last person who said to me today, “Can I join the meeting?” is the rostering gentleman.”
Preparedness for change and innovation
There was a strong incentive to remodel to a more holistic palliative care approach and staff were keen to engage with the challenges of change and re-organising daily routines.
The establishment of a group of champions who believed the program was worth running was vital
Initial readiness for implementation was based on a range of enablers, including perception of adequate resourcing, access to knowledge and information and planning.
After preliminary work to ensure executive and management support, the establishment of a group of champions who believed the program was worth running was vital to its rollout. One of those champions said afterwards:
“We get so excited by the positive reactions that we experience and we often talk about it between us … there’s a lot of celebration to be had for Namaste, the program itself and I think it’s a new culture … it’s something that needs to be launched and on a wider scale. Once it is, it will definitely be very much celebrated in the broader community.”
A facility manager commented:
“We knew there was going to be a need for it; a program of this nature… For those residents with physical capacity, great, and for those that don’t, then this is the alternative for them. And, this program, the Namaste Care program, is actually where I see a lot of residents fit in.”
Ongoing commitment and flexibility with education and training
There is insufficient education and training on unmet needs of people with dementia within existing mandatory training. We found that after having engaged with the Namaste Care program, staff members had greater understanding and empathy towards residents, and recognised the opportunities for improvement. One participant said:
“Sometimes what they need more than anything is that comfort and care. I feel that the Namaste program has helped me to really learn more about dementia just by observation and the reactions to different things has helped me to look closer at the disease itself and how debilitating it is.”
Ongoing and flexible training is needed for new staff at all levels to help embed this quality care program as a model of care that provides a more holistic palliative care approach within aged care homes.
We also found a lack of confidence among staff to talk about end-of-life care. In particular, staff found it difficult to articulate the program to family members as benefitting residents approaching end of life. One worker said:
“I’ve stayed away from end-of-life care. I’ve just said that it’s a program where we can give more one-on-one care to your loved one … I’ve never mentioned to them that it’s end of life”.
Ensuring quality of life for all residents as well as care of people approaching end of life is a high priority for aged care homes and Namaste Care is a way to enhance care with a palliative approach for those who need it. This requires suitably qualified, competent and well-motivated staff who have benefitted from education to provide this.
Working with volunteers and family carers as a community of care
Volunteers are valuable social supports who contribute to residents’ improved quality of life. Initially, the project was designed to include volunteers and family carers within a community of care approach but the facilities struggled with volunteer support.
For example, one of the services had no volunteers to call upon for their 100-plus residents.
Securing volunteers in this sector has always been a challenge even before many left during Covid-19. Addressing this gap in volunteers would help support the daily running of the program.
As well, family carers can easily participate and learn ways to engage their family member in mutually enjoyable activities.
While there is growing evidence supporting Namaste Care as a low-cost, easy-to-teach and rewarding program for all concerned, overcoming organisational challenges requires skills in change management and program implementation.
As a quality improvement program without the additional hurdles that a research project needs to navigate, there are clear benefits for residents, staff and community that add value to fundamental care.
Dr Sara Karacsony is a senior lecturer and graduate research and adjunct coordinator at the University of Tasmania
Other UTAS researchers involved in the ARIIA-funded project include Associate Professor Sharon Andrews, Dr Melissa Abela and Dr Maryam Rouhi
If you are interested in implementing Namaste Care at your organisation, email sara.karacsony@utas.edu.au or view the Namaste Care International network
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