So You Work in Aged Care

Podcast Show Notes – S2 Aged Care Ep 3 PODCAST DETAILS ● 17 September 2024 ● So You Work in Aged Care ● Covid Pandemic: Have We Recovered?- Episode 3 of 6 OVERVIEW In episode 3 of the 6-part series for the So You Work in Aged Care podcast, we continue to explore the burning issues, news and trends affecting the aged care workforce in Australia today. There’s no doubt the Covid pandemic impacted the aged care workforce in a myriad of ways. While the extent of restrictions and lockdowns have somewhat eased, we are still undoubtably living and working with Covid in our midst. So how is this impacting our wellbeing? We’ll also discuss a local movement that is gaining traction globally called ‘Open the Doors 2030’ which aims to unite people across the world to come together to discuss and share ideas and strategies to improve the lives of those living with dementia. KEY TOPICS Working on the frontline with Covid today [2:52] Since the early days of the pandemic back in 2020, the vast majority of the aged care workforce have experienced the challenges of supporting clients with Covid. While the lockdowns and PPE may not be as extreme as they once were, we are still faced with regular outbreaks that require isolation of clients, which has far-reaching effects on both the residents and staff. To some extent, Covid has been normalised in society, however for those on the frontline, working with the elderly who are vulnerable to serious illness, there is an added layer of stress, as we constantly worry about unintentionally bringing Covid into the workplace. On top of this, many of our clients have become withdrawn as a result of the isolation and fear they have experienced throughout the pandemic, which adds a further layer of challenges and mental load to our work. Where do we go from here? [13:49] More than four years on from the start of the pandemic, it is clear that Covid is not going away. So where do we go from here? Interestingly, many of the deeper issues we are dealing with in aged care – for example, loneliness, social disconnection and losses in late life – have always been there, but Covid has added another layer of complexity to the equation. There is no doubt it is challenging, for all those working on the frontline. Covid has had a serious impact on worker wellbeing, particularly for those within the aged care sector. In these times, it is so important to look after ourselves and strive for a healthy work-life balance. Not easy, I know, but so worth it. What is trending? [16:57] More than a movement, ‘Open the Doors 2030’ is fast becoming a catalyst for global change. Led by Nicole Smith, gerontologist, registered nurse and COO of Community House Australia, #OTD2030 aims to bring the best people together, from renowned experts to those supporting elders at a grassroots level, to create positive change in the way we talk about and care for those living with dementia. Currently in the early stages, #OTD2030 is gaining momentum worldwide. Follow Nicole on LinkedIn to keep up to date with news and events and stay tuned for the website (coming soon). You can also reach out via email: [email protected] CONNECT ● Email ● Instagram ● Facebook ● LinkedIn COMING SOON Resilient Worker – new workshop coming soon Our new workshop will cover the burning issues affecting aged care workers today. Head to our website to find out more – Resilient Worker

Podcast Show Notes – S2 Aged Care Ep 2

In episode 2 of her 6-part series for the So You Work in Aged Care podcast, Dr Julie continues to explore the news and trends affecting the aged care workforce in Australia.

One of the key topics discussed is something that affects far too many in the aged care industry – being overworked and overwhelmed. Dr Julie unpacks some of the key considerations when we are looking for strategies to reduce overwhelm, including self-awareness, identifying triggers, understanding when to escalate concerns and being aware of the supports available.

Lastly, in the ‘what is trending’ section, she shares findings from a longitudinal research study looking at the wellbeing of workers in the healthcare industry.

Self-awareness and triggers [5:40]

Regardless of where you are working day to day, whether you have your own business or are employed in a busy residential setting, it is important to do some sort of self-awareness check-in regularly.

This can be as simple as pausing to consider how you feel and reflect on what’s going on. Lots of people do things in response to stress – for example, stay up late, scrolling social media, then can’t get to sleep. Having a level of self-awareness can help us understand where we are at, so we can be our best and deliver the best service to our clients. Often just by being aware and tweaking our unhealthy lifestyle factors, we can significantly improve how we feel. Being able to identify our triggers can help us stay on track.

Escalating concerns [13:59]

When it comes to escalating concerns, we need to pick our battles. This means being clear on what we can do, what we can delegate and what needs to be escalated.

The tasks that fall within our scope and are part of our role need to be done, and they give us a sense of achievement when done. For those tasks outside of our expertise, understanding what is urgent/optional and learning to delegate is key.

Be transparent, identify where your areas of expertise lie, where you can get support, and be open to receiving support when you need it to avoid burnout.

Understanding supports [19:27]

Understanding what type of supports are available is important. Some workplaces have Employee Assistance Programs (EAP), or you may prefer to see a GP for a referral to a specialist. Other practical strategies involve talking to management, or if you work for yourself, seeking mentoring, or attending a mastermind. Either way, the first step is always to tease apart what is happening so you know what type of support to seek.

What is trending? [21:30]

A research study published by the Medical Journal of Australia in 2023 looked at the wellbeing healthcare workers before and after Covid. Participants of the longitudinal study were surveyed three times over the course of a year and the findings related to stress, PTSD, the impact of wearing masks, burnout and more on the levels of optimism and depression show the impact an outbreak can have on those working within the healthcare industry.  

You can read the full report here:

McGuinness SL, Eades O, Grantham KL, Zhong S, Johnson J, Cameron PA, Forbes AB, Fisher JR, Hodgson CL, Kasza J, Kelsall H, Kirkman M, Russell GM, Russo PL, Sim MR, Singh K, Skouteris H, Smith K, Stuart RL, Trauer JM, Udy A, Zoungas S, Leder K. Mental health and wellbeing of health and aged care workers in Australia, May 2021 - June 2022: a longitudinal cohort study. Med J Aust. 2023 May 1;218(8):361-367. doi: 10.5694/mja2.51918. Epub 2023 Apr 9. PMID: 37032118.

Resilient Worker – new workshop coming soon

Our new workshop will cover the burning issues affecting aged care workers today. Head to our website to find out more – Resilient Worker

Podcast Show Notes – S2 Aged Care Ep 1

In this episode, Dr Julie introduces her new podcast, So You Work in Aged Care, explaining the reasons for a shift in focus from the wellbeing of elders to the wellbeing of the aged care workforce, along with some insights on what to expect in future episodes.

She also touches on her passion for supporting wellbeing in the workplace, and her intention to address the wider issues impacting aged care workers rather than working with individuals as a psychologist.

Finally, Dr Julie shares some of the results from the recent survey she conducted with her network of subscribers who work within the aged care sector. The survey covered a broad range of themes, from how the industry has recovered since the onset of Covid, to the type of supports aged care employees would like to see in the workplace to reduce stress and improve wellbeing (and so much more).

Why the change? [3:56]

When The Voice of Aged Care podcast started, it was the first Australian podcast focused on issues within the aged care sector, giving a voice to those working in both residential and home care. After 5 years and almost 60 episodes, it feels like the right time to now switch the focus to the wellbeing of aged care workers.

While Employee Assistance Programs (EAP) are available in many workplaces to provide support to workers, the recent survey we conducted shows there is a gap and a need for resources and information to be more widely available to support aged care workers. In this new podcast, So You Work in Aged Care the intention is not to provide support as a psychologist, but rather, to tackle the bigger issues, to help employees process what happens at work and create a healthier work-life balance.

Wellbeing at work [8:53]

Working in aged care, both in home care settings and residential care comes with a unique set of challenges. If you are on the road, working solo, it can feel isolated with no-one to talk to. Residential care on the other hand is a busy environment, with lots of pressures and uncertainty, alongside of the ongoing need to process death and dying.

Support is available via the EAP, which is funded in many workplaces, or if preferred there is the option to see a private practitioner. As a starting point, it’s helpful to consider ways we can reduce stress in the workplace – for example, how we engage with others, learning to say no, learning to delegate, avoiding procrastination, and finding ways to disengage at end of day.

What is trending? [19:02]

In July 2024, we conducted a survey with our audience of aged care workers, to get a feel for what is going on within the industry, and what is impacting wellbeing. The response was overwhelming, covering a broad range of themes.

Some of the insights include that while most of the aged care workforce surveyed are satisfied at work (53%) almost all (93%) said they experience stress. When asked what type of additional supports aged care workers would like to see in their workplace, the common themes were more staff, training programs, psychological support, improved workplace policies and better equipment. Interestingly, only a small number of surveyed workers (30%) were aware of EAP, and even less had actually used it. This service is available not only when you have a problem, but also to discuss strategies, and debrief. Ask your workplace how to access it and share the information with your colleagues, so more of the workforce are aware of the service and can access it when needed.

Resilient Worker – new workshop coming soon

Our new workshop will cover the burning issues affecting aged care workers today. Head to our website to find out more – Resilient Worker

Show notes: Special edition

CASE STUDIES

Psychological input with treatment team in residential care

In this series of podcasts, we are exploring varies topics through case studies – and today we are looking at psychological inputs within the treatment team in aged care.

In this episode you will learn:

In this episode we’ll look at a case study of a client I supported who moved into an aged care facility after she had a fall and her mobility changed. She was still able to walk using a frame and she had no cognitive changes. There are a lot of myths around receiving psychological support, and especially with the older generation, there is so much stigma around if someone needs help. A telling sign when someone is in care and may need support is to look at the score on the Cornell Scale for depression, and for the lady in my case study, she scored quite high. She found it challenging managing her limited mobility and her transition into aged care was difficult for her.

I met her not long after she moved in, and she was sitting in her room, and she had her walker with her, and she displayed a mixture of relief that she could walk, but also disappointment that she needed it. From then on, I realised it wouldn’t be simple, and I needed to look at who else was there to support her. For residents in aged care, the treatment team or support team can include families, staff at the facility, support staff, and other allied health professionals. Connecting with the support team is so important, because in isolation, me talking to someone is not going to help them integrate into their environment. Support is needed to drive that behaviour in between session to promote those changes we are hoping to see.

‘Working alongside other health professionals, we will achieve better and more sustainable outcomes.’

Going back to my client, she would tell me how she saw her physiotherapist, and that her son was visiting, and I would think I need to speak to them to help us bring it all together. My first step was to make contact with her physiotherapist to find out what she could and couldn’t do and how we could avoid her sitting too long. He confirmed she could move around the facility with her walker, so we made a plan that got her moving a bit more to build her confidence in her mobility back up. What we did wasn’t rocket science, but we did it collaboratively.

I spoke to the nursing staff and attended her case conferencing to put all the pieces together. The risk with her was that she would become isolated in her room, and we know that if a person is not as active, their level of care needs can increase.

As psychologists, we really need to look at what we can do to support those in care to improve their quality of life, as so many people do experience depression. In the past the focus was just on giving them medication, but that’s not going to teach people skills in how to look at life differently, how to engage differently, how to feel differently, or to give them the option of being able to process what is going on for them.

There is certainly a lot of room to allow psychologist’s input into care plans, especially considering the high rate of depression in care residences, with 1 in 2 residents having symptoms of depression. This should not be surprising due to the many changes that are happening to their health and environment. There are many benefits to having a psychological assessment on admission conducted by a psychologist rather than a nurse, to help us gain a clearer picture of what is going on.

Working alongside other allied health professionals, psychologists will achieve better outcomes. We know that older people respond well to cognitive behaviour strategies, and that some elders won’t need too many sessions before they see some real benefits. Over the last 5 years there is much more awareness about the benefits of how psychologists can help elders in aged care settings and also around the importance of working together as a team.

Not everyone in aged care needs to see a psychologist, but there is an opportunity to look at non-pharmacological ways in how we help an older person in the later stages of their life to improve their engagement, improve their outlook and make those last years of their life in an aged care facility more enjoyable.

Resources:

Beyond the Reluctant Move, Dr Julie Bajic Smith

https://www.wisecare.com.au/book

Show notes: Special edition

CASE STUDIES

Intimacy and dementia

In this series of podcasts, we are exploring varies topics through case studies – and today we are looking at intimacy and dementia.

In this episode you will learn:

In this episode we’ll look at a case study of a couple and their need for intimacy in a residential care setting, with one of the parties experiencing dementia. Even today, this is not a subject that is discussed often, but it is an area we need to learn more about as there is an increased awareness about human rights of residential care residents despite changes in their health status.

Interestingly, when we talk about dementia and intimacy, it tends to focus on the inappropriate behaviours, and we can fail to acknowledge the actual need for intimacy and how to address that. In the last couple of years, the rights of those within aged care settings have significantly changed, so much so that a person from outside can come in and have intimate relations with a resident so long as there is consent, they know the person and the resident has the capacity to make that decision. I know that a number of aged care homes also allow sex workers to visit. We can’t say who can and cannot have intimate relations with another person, unless there is a lack of consent.

The story I am sharing centres around a couple I knew a few years ago, who have both since passed away. This beautiful couple moved into residential aged care after they had a car accident and the wife could no longer walk and was experiencing dementia. She needed residential care due to her support needs, while the husband moved to a nearby low-care facility as he was able to walk and he didn’t have memory changes. The wife was saying to me that she was missing the intimacy and felt her husband didn’t love her anymore as they were unable to be intimate. She had limited insight into where she lived, she knew who her husband was and presented well, but didn’t really understand why they couldn’t be living together in the same room.

‘When it comes to intimacy and dementia, you might notice changes in intimate and sexual expression. The person living with dementia may seem demanding or insensitive to others, feel more or less need for sexual expression and intimacy, and display sexual behaviours in inappropriate social context.’

For this lady, she was not expressing inappropriate behaviors but she did feel the need to be intimate with her husband. Just to add some context, for many elders living in residential care when they talk about making love they can mean just laying together and cuddling, so it is interesting to note what that terminology can mean in later life. But with this lady in the case study, she really wanted intimacy with her husband and was quite upset that she couldn’t due to her physical restrictions and the barriers she faced. When I think about some of the barriers in aged care settings, stereotypes and agism, staff attitudes, lack of privacy, family attitudes, lack of partner,  and the attitudes of other residents all come to mind.

For this couple, they were allowed to do what they wanted to do, because they were both adults, they were married, and there was no issues about the wife’s choice of partner. There was some elements about her consent and awareness, but she was quite clear about what she wanted. So there was no need to seek permission, they were just given the space. For her, cuddling with her husband was very reassuring, especially after the car accident which was quite frightening. Although they lived apart, he was able to visit, and while we won’t explore whether they did the deed, she became much calmer once she was told her room was her environment and she had the right to do what she wished in there.

When we talk about intimacy and dementia, topics around being aware and consenting are often raised. In the case of my lovely couple, it was something they both wanted to, so there really wasn’t any barriers other than her mobility.

For those without partners who wish to express their needs, they may wish to talk to families about the possibility of sex workers. Or if an elder meet someone within the aged care setting and both are consenting, they have the right to do what they wish in the privacy of their rooms.

There is a really good book and resource on the topic written by Gail Doll and it covers a lot about sexual behaviours of those with dementia. It also talks about environment, health and safety, staff and family attitudes, and lesbian, gay and transgender relations too. This is a good resource to explore, it is quite practical, giving examples on how you might address some of these things and divert inappropriate behavious if they happen.

When a person has more advanced changes in their brain in later life that might be masturbating in public, using sexualized language, undressing, might become aggressive or request excessive genital care. It’s important to know the policies and where you can escalate concerns.

I was referred once to an older man who was masturbating in his shared room, and it was suggested he needed psychological help and even medication. He didn’t need any of those things, just the space to do what he wanted to do in private. It’s important to look objectively at sexual behaviours in a residential care setting and be mindful whether they are hurting others, or if the elder involved is simply exercising a right.

Resources:

Sexuality and Long-Term Care, by Gail Appel Doll

Show notes: Special edition

CASE STUDIES

Supporting families of home care recipients

In this series of podcasts, we are exploring varies topics through case studies – and today we are looking at supporting families of home care recipients.

In this episode you will learn:

In this episode we’ll look at the role of families in terms of their acceptance of their loved one’s health in late life. We’ll also talk about families and the important role they play in noticing things or trends that are happening with their loved ones.

Today’s case study involves Rose, a lovely lady supported by her children to live in a retirement village. She has been diagnosed with dementia, and her husband who lived in a nursing home also had dementia. Rose is doing well in the retirement village, and there is no talk about the need to move her into residential care anytime soon. Although in her late 70s or early 80s, Rose remained very creative and young at heart.

Rose was well supported by the village she was living in. She had a limit on her licence which she adhered to and her dementia was quite mild. Her declarative memory was very good, but recalling the specific details was difficult and this was very frustrating for her.

I was seeing Rose as she had depression, and my role was to work through some cognitive behaviour therapy to help her within the home care setting. Rose was very good in her home environment, but once outside it was difficult for her to engage with others and that was causing her anxiety. We worked together on strategies to address her depression and anxiety. Between sessions she worked on goals we had set, and she made good progress.

Her two daughters were very caring and involved, and wanted to know what Rose and I discussed and what they could do. As a psychologist, we are bound by privacy and while there is a place for families to provide some background on their loved one, I needed to explain the boundaries concerning what I was able to disclose. I also highlighted to one of the daughters that she might need help herself, with some personal struggles she had outside of her carer responsibilities. She sought help and was grateful. Getting help herself also allowed her to more easily notice signs that showed that her mum’s anxiety and depressions was exacerbated.

‘Families provide a window of opportunity to elder background, and can also be the first to notice change in an elder and their wellbeing.’

Talking to families of home care recipients, you realise the struggles they have with the worry of not knowing if they are doing the right thing. For example, wondering if their loved one with dementia needs to move into care. This is not necessary for elders like Rose who have been diagnosed with dementia but are doing quite well; we don’t need to swiftly act because they are diagnosed. Instead, we can look for signs down the track that show that they might need to move into residential care, for example when the risks of harm increase.

In a different case, a client of mine lived alone on a busy road in a unit. She had no awareness of the traffic, and would wander out leaving the house open, or the stove on. She started burning her food, when once she was a wonderful cook. These are all clear signs that the impact of dementia is putting her at risk, and as a result, she needed to move into residential care. She presented really well, but when you spoke with her it became evident that there was a risk to her safety.

Burnout is common amongst carers, and when you consider they might have long hours of care, financial strain, isolation and stress, it’s easy to see why. There are different levels depending on where their loved one is currently at, and it is helpful to be aware of where you can direct families for support when they need it, so carers are looked after and can provide the best care. Coming to terms with the way our relationships change is also difficult, as we can transition from being the child to parenting our parent. Going back to Rose, she got better when her daughter addressed her own stressors in her own life as she was then able to provide better care to Rose, who was able to live happily in the village for years to come.

Carers forums are a safe space to connect with others in a similar situation, and Dementia Australia offers support to those with dementia to continue living at home, enjoying activities and learning about dementia. Often a diagnosis is met with fear, but there are strategies that can help those suffering to limit the impact. Find a Psychologist can also be very helpful. Or if delving into this seems all too much, simply recommending the family member has a chat with their GP is a great starting point.

Resources:

Carers Australia – SANE Forums: https://www.carersaustralia.com.au/support-for-carers/sane-forums/

Dementia Australia: https://www.dementia.org.au/  

Find a Psychologist: https://psychology.org.au/find-a-psychologist

Show notes: Special edition

CASE STUDIES

Routine management and activities of daily living for care recipients

In this series of podcasts we are exploring varies topics through case studies – and in this episode we look at routine management and activities of daily life for care recipients.

We will cover:

The case study we will share is the story of a lady called Carol. Carol has vision problems and mobility issues, and her routine is quite specific – she is very clear on when she wants her meds and help with her showers and so forth.

Routine management and activities of daily living (ADL) – we can’t talk about this topic without discussing the impact it has on workers. Time pressures are huge, regardless of what your role is, as there is so much to be done. We have had recent changes in Australia within the residential aged care sector in terms of how service delivery is measured. Every time there is a change it evokes stress, anxiety and fear from workers who wonder if they are going to keep up with the requirements of the new regulations.

So how can we best manage our time and get it all done, when we have so many things going on, and so many disruptions and unexpected things coming up?

Going back to the story of Carol, she had very high physical needs, and she would wake up in the morning and straight away request her medicine, and with an eye on the clock, would stress out if staff arrived late as she was very particular about the time she would have her tablets. So from the first moment she woke up, it was stressful for her, as she was totally focused on sticking to her routines.

‘Be adaptable and supportive, working with the changing needs of elders in your care and meet them at their level to best support their routine and ADLs. ‘

Carol was always someone who had high expectations of how she managed her time, and it caused her great distress when she was unable to maintain that independently. So to manage this, we reviewed her care plan together, looking at when things would happen, and really looking at each thing to see what she needed support with, and what she could do herself. It became clear that for her, the importance of the routine was really just about when she was taking her medicine and when she had her shower, the rest she was quite flexible with. So understanding that those were her non-negotiables helped staff to better manage her care.

What I ended up doing with Carol was sitting down with some paper with large font, and asking her about her routine. I explained that I had read in my psychology books that every day a person needs to do four different categories of activities to have a successful day, and I knew that having a successful day was important to her. So we talked about how every day she could do something from each of the four categories, that is, something cognitively stimulating, something that is enjoyable, something that keeps you active and something that is pleasurable. This idea really blew her mind, as she had been so focused on her routine and she was neglecting these areas, so we looked for activities that would suit her and could fit within these categories.

Routine management requires planning at different levels – at the care staff level, leisure and lifestyle and personal. Working together is key, as is looking at quality versus quantity of time.

For Carol, addressing her routine wasn’t an overly complicated task, she just needed help to set up what a successful day looks like for her.

As Paul J Meyer, a pioneer of the self-improvement industry once said, ‘productivity is never an accident – it is always the result of commitment to excellence, intelligent planning and focused effort’. Just because someone has moved into an aged care setting, doesn’t mean they don’t need to keep on planning, that they don’t need to keep on making an effort.

After Carol and I worked together, we put a calendar on the wall and she would spend time looking at the activities on offer and deciding what was of interest and suited her. So she went form someone rigidly focused on routine management, to someone who actually had a bit of a plan every day to attend to her health and happiness. As a result she was more fulfilled, as she improved her knowledge and was more able to participate in discussions.

While a successful day looks different for everyone, if we look at those four categories – being cognitively stimulated, experiencing pleasurable activities, being physically engaged and doing something enjoyable – then you are on the right track. It is really up to the elder (with our support) to find the activities that they like best that fits within these categories.

Today, Carol is doing well, is engaged in many activities and has become more flexible with herself and with others – which has vastly improved the situation for both herself and the workers who care for her.

In this episode you will learn:

Show notes: Special edition

CASE STUDIES

Episode #2 – Series #2   

Helpful sentence structure in dementia

In this series of podcasts we are exploring case studies – and in this episode we will look at dementia and sentence structure to improve engagement.

We will cover:

The case study we will focus on here involves a lady who we will call Ruth, and she wanted to go home. I will share her story and discuss strategies on how we can deal with an elder who repeatedly says they wants to go home.

Dementia, a very common neurological condition in late life, is not a normal part of aging and is used as an umbrella term for lots of different conditions and illnesses, including Alzheimer's disease. There are lots of different types and symptoms of dementia, it can be early onset, or late in life, and may or may not be formally diagnosed. Broadly, it is a term for loss of memory and other thinking abilities, which are severe enough to interfere with an individual’s daily life. We see lots of people in aged care and home care settings with dementia, and it can be hard to diagnose, especially when in their usual routines.

Ruth is living in an aged care setting, and continually says she wants to go home. For example, we might be offering to take her to an activity or outing, or be providing her usual daily care and she is repeatedly saying ‘I want to go home’. Do we tell her there is no home to go to? That she is here because she has dementia and needs care? Or try and change the subject by distracting her by looking out the window?

Sentence structure and practical strategies to address this repetitive behaviour is something I’ve been asked about many times over the years. Often we know it is dementia causing these behaviours, but we don’t want to spend our days having the same conversation over and over again. So what can we do instead?

My number one strategy is to check in with your client. Ask how are they going. How are they feeling? And exploring what is behind that sentence.

‘The sentence “I want to go home” is not uncommon, but exploring what stands behind that sentence is. Dig deeper – what is it that the person may be wanting to say but is not able to, due to neurological changes they may be experiencing?’

So for Ruth, she might be saying ‘I want to go home’ but could be meaning, ‘I’m feeling fearful’ or ‘I’m scared’. How would we then respond to someone who is feeling sacred or anxious?

Providing reassurance is a common response, perhaps letting them know they are safe, checking if they need to eat or go to the toilet. They may be bored and struggle to engage in activities. At these times the thought of being back at home is reassuring, and is the easiest way for them to articulate how they feel. A lot of people with dementia are in good physical health and have little insight into their challenges, as they see themselves as being well, so may find it hard to understand why they can’t be at home.

For Ruth, it turned out that she was really fearful of her environment, she found it really challenging to be around other people, particularly in the dining room, where she felt it was too noisy and overwhelming. The fear was around large group settings, and being at home was a safe environment for her. So we started looking at how we could get her to sit on the quieter side of the dining room, and she was able to form a friendship with another lady. Once she had this connection, she stopped requesting to go home as much, and started spending time with the other lady and attending to the gardens, where they had their routines of what they attended to. Gradually, Ruth began to engage in the care facility, and eventually, when she was on outings with her daughter, she would look forward to returning as she now recognised this as her home and her safe place.

An activity I often do with elders who may be having difficulties with sentence structure involves sharing the start of sentences and allowing them to fill in the gaps. You can access the sentence structure resource on my website https://www.wisecare.com.au/resources and can also source emotion cards which are similar from a variety of places including Officeworks. Start with cards and activities where there is only one missing word or idea, avoiding complex sentences with more than one idea. Be mindful of this, as we can often slip into complex sentences without realising it.

I used the flashcards with Ruth, and they helped her articulate how she was feeling and what she needed. We were able to help her make connections, and to articulate her desire to tend to the garden – and it had never looked as good as when Ruth was looking after it.

In this episode you will learn:

Resource: please reach out to [email protected] to access the flash cards resource 

Show notes: Special edition

CASE STUDIES

Supporting families in residential care

The focus this special six-episode series of the Voice of Aged Care podcast is case studies – real-life stories focused on the topics that impact those of us working within the aged care sector.

These topics have all been requested by listeners, and the first that we will discuss is supporting families whose loved ones are living in residential aged care.

In this episode we will cover:

The case study we will focus on here involves a family of three daughters and a mother who needed to move into residential care. Her husband had died some years before and she was living alone. She was experiencing memory changes and was suspected of having dementia but was refusing the thought of moving into care for additional support, as she had no concept that she needed help. Her daughters were taking turns assisting her at home and she also had some home care support visiting too. Her three daughters were working full time, and took turns in visiting their mum who spent time knitting and watching TV. It had gotten to a point where cooking meals was beyond her and her daughters were concerned (as was the home care provider) about falls and her safety.

When they came to the decision of residential care, it evoked a lot of emotions in the daughters as they came to terms with the reality of the situation. Changes in memory can happen fast or slow, and in this case it was slow, which made it hard for their mother to understand what was happening.

In Australia two thirds of people who access home care transition into residential care and over half are people living with dementia.

The journey towards acceptance for families can be quite different. Families have different challenges and pressures. Initially there can be a sense of relief, but guilt, stress and grief can follow. They may feel like they haven’t done enough.

So what can we do if the family is struggling? In this moment, we need to be able to respect their journey. It is not about us, or about the resident – it is about the family’s experience.

‘We need to be good at supporting families as they support the elders in our care. Supporting families does not mean handholding, counselling or doing tasks outside the scope of our roles. It may include listening, collaborating and working together towards shared goals.’

This really highlights that your role is not to fix everything – but to recognise and listen to what their concerns are, and notice when additional support is needed.

Flagging the need for additional support can be tricky. It can be difficult for families who feel like they are advocating for their loved one. The easiest way is to suggest they talk to their GP, to have a chat about how they are feeling about the family member’s move, as the GP may be better equipped to direct them to the right support.

In our case study, the mum didn’t want to move, and the three daughters all had different expectations. When their mum moved into residential care, they took turns staying overnight with her. They also told her she was staying in a hotel as they didn’t know how to say she was moving into aged care. This was really confusing for their mum. The daughters were basically doing what they had done in her home and were there the whole time, not allowing staff to care for her. They were visibly upset and this was also distressing for their mum who just wanted to go home.

What did help was when they started backing off, and their mum was able to start making connections with staff and other residents. Once they allowed her to start mixing with others, she started to adjust better. And that made them feel good too.

At about the two-month mark of admission, you could finally see they were all doing better. Over the course of the next 12 months, their mum started to flourish. She would be interacting with others, gardening, knitting, having really positive interactions with staff and residents.

This was so different to the beginning when she would actually lash out at staff. Once her daughters saw the change, they became more accepting of the situation themselves.

Everyone has different relationships with their loved one before they move into aged care. Everyone has different personalities and histories. So when it comes to families, I think it is just meeting them where they are in their journey and supporting them through that. We can’t have expectations as everyone’s experience is different. We need to meet them at the level where they are, listen without judgement, respect them and their journey and also notice when they might need additional help or support to assist them as they navigate their role as a caregiver of someone in a residential care setting. It’s not always easy.

For the family in the case study, we went from a complete mess in the beginning to seeing Mum flourish, and also the emotions of the daughters moving from stress, overwhelm and guilt, to relief and enjoyment. All it took was time, and skill from the workers, understanding where to meet the elder and the family where they were at.

In this episode you will learn:

Show notes:

Episode #52 – Special edition        

Coping strategies

In our 6-part special edition series of the Voice of Aged Care podcast, we are looking at factors associated with wellbeing for those within the aged care workforce – and in this, the sixth and final episode in the series, we discuss helpful versus unhelpful coping strategies for aged care workers.

In this episode, you will learn some new helpful coping strategies, discuss how to keep unhelpful strategies at bay, and also uncover how to identify when you need additional help and support.

So firstly, as a side note, it is worth mentioning the importance of maintaining an optimum level of stress, as it is in this state when we find our health and performance are at their peak. This is when we are feeling challenged and a little stretched, and not too comfortable, which is very positive for our resilience and wellbeing. So having a bit of stress is actually beneficial for us in this way, but not when it is all the time or ongoing. Just like we can’t run or exercise for 24 hours straight as we need to rest our bodies, we need to rest our brains in the same way too. For this reason, noticing where your stress levels sit and adjusting them to optimum levels is essential.

Back to coping strategies – what does a good one look like? Some positive coping mechanisms that you might already be aware of and be using include: connecting with others; communicating with others; talking about our feelings; practising feeling grounded; managing our stress or anger; getting to know ourselves and checking-in; expressing emotions; being open-minded; journalling; doodling; goal setting; cooking; baking; and delegating are all ones you might be familiar with.

Some other positive coping strategies that you may like to try include: meditation; reaching out for support or guidance; learning forgiveness; positive self-talk; getting out in nature; going on walks; and enjoying a new hobby, are all actions that will help to build your resilience and could be worthwhile to explore.

But what about negative coping mechanism that should be avoided? These include things that are not really good for you, or for others. This could be turning to drugs or alcohol, being passive, minimising things, repression, disassociating, controlling behaviours, becoming a workaholic to avoid feeling, and being overly helpful to others (rather than yourself).

It’s worth noting that when it comes to effective coping strategies, it involves ongoing work for each and every one of us. We must create a safe space for ourselves to be able to reflect and recognise what might be going on inside, and this can empower us to be better and stronger in supporting our clients as well.

So getting in touch with ourselves and recognising the importance of practising our helpful coping skills, knowing our strengths and identifying our support network, the people that we can turn to when we need. Also reflecting on what a successful day may look like for you, what gives you purpose and drive, finding opportunities to connect, and creating a space where you can safely laugh and cry, is highly beneficial for your wellbeing.

One final thought on helpful versus unhelpful coping strategies is, recognising when we need additional help and support. I’m very passionate about this and see a huge need to be more aware about recognising the warning signs that we might need for more help and support. Maybe it might be skipping meals or exercise or social interaction. Anything that takes us out of our routine can be a trigger point that we are not coping to well. If you’re in a large organisation, contacting the employee assistance program is an easy first step, otherwise visiting a GP for a referral can help. Other times talking to your manager and seeking practical support can be enough. Recognising there is support out there is beneficial – and also knowing that the sooner we get that help and support, the better we will feel.

In this episode you will learn:

Resources:

I will be running a workshop on resilience specific to aged care workforce. To register your interest sign up below. 

https://wisecare.com.au/resilience