Project Summary
Helping Hand Aged Care in partnership with the University of Notre Dame has been awarded an ARIIA grant for their ‘Retro-fitted dementia-friendly environments and staff education as determinants of positive outcomes for people living with dementia in aged care’ project.
This project examines the outcomes of dementia-friendly environment implementation, together with tailored training of staff in the context of human scale living for people with dementia. The Royal Commission supported small home living and recommended the Government guide the design of residential aged care accommodation with associated guidelines scheduled to come into effect by 2025.
However, with little evidence for benefits to residents of small home living, this project presents an opportunity to explore whether benefits of small scale correlate to the built environment itself, or to a combination of factors, such as providing a human scale environment and dementia education to ensure best practice dementia care is delivered to consumers. Pragmatically, it is unlikely that traditional homes with large resident numbers will be easily or quickly able to mobilise to change the built environment within the same footprint, or pivot to a radically different care model.
Thus, there is a clear need for providers to look at alternate and innovative ways to meet best practice within existing large homes into the future. This project aims to meets this need by examining the environment and care in three aged care facilities which are of differing ages and designs.
Project Outcomes
Background and Aims
Exploring how a combination of staff education and environmental design changes within residential aged care Memory Support Units (MSU) can lead to improved resident experience and increased resident quality of life.
What We Did
We involved teams across three Helping Hand care homes and provided comprehensive training to a range of staff; as well as selecting and funding environmental design changes based on creating dementia-friendly environments.
Outcomes
All staff were able to discuss person centred care at a basic level however some were able to describe this in a more sophisticated way including, enabling meaningful choices and tailoring wholistic care to residents’ individual preferences, cognitive abilities, history and the ways that residents wished to live. The environment was seen to impact residents holistically, with staff identifying how a dementia friendly environment supported resident’s independence and engagement. Staff described ways to maximise the benefits of the improved environment, balancing benefits with traditional views of risk and the need to maintain supportive aspects.
Training provided knowledge and enhanced staff confidence, as well as creating excitement and motivation needed to support change. Targeted training on dementia enabling environments and supporting responsive behaviours were considered most valuable. Staff recognised that knowledge takes time to acquire, and the training had not been sufficient for all people to develop knowledge and skills. Training refreshers, daily reminders, mentoring and buddy shifts in MSUs were considered helpful strategies to maintain a knowledgeable workforce. Staff recommended that training should be provided for all residential staff irrespective of role, area or site. Staff reported having improved skills in caring for residents and specifically, in their ability to adapt the environments within the MSUs to be more dementia friendly. Staff talked about developing skills that they could use to support residents, such as preventing and addressing changed behaviours. Improved skills in dementia care promoted staff engagement with residents and facilitated resident choice.
Following the training and environmental changes, staff had a better understanding of residents which led to improved connections between staff and residents and improved care. Staff were more confident in communicating their ideas about residents with clinical staff, and following care plans, which enhanced care. Staff observations of the positive impact of training and environmental changes on residents’ wellbeing and care gave them the motivation and confidence to challenge their concerns about potential risks. This was considered to support enablement of residents. Training supported the relationships between staff and residents. Training improved staff understanding and empathy and lead to greater emotional attachment towards residents. Environmental changes were seen to make the MSU’s more peaceful, welcoming and attractive. The modified environment was believed to increase resident choice, use and freedom as well as to invite engagement and interaction for both staff and residents. Changes to the environment allowed residents to better express their identities, with staff commenting that residents appeared happier and calmer. Staff reported that the adapted environment appeared to result in resident’s having more of a sense of purpose and connection to their previous identities.
Dementia friendly aspects of the environment were seen to support residents to utilise their cognitive abilities and provide an achievable level of challenge for activities. Residents became more purposeful and engaging in activities for longer periods of time. Residents were reported to appear more oriented to the unit and able to recognise and navigate to the spaces they wished to use. The environmental changes supported the provision of care. Staff were able to use the environment to support resident’s needs, reduce their distress, facilitate activities and encourage engagement. Residents were observed to be more willing to participate in their care and overall, experiencing less agitation. Overall, staff stated that alterations to the environment reduced triggers for distress and increased resident safety. Family responses to the survey and discussions in focus groups were mixed regarding their views of the environmental changes in the MSUs. Families understanding of the environmental changes were mostly related to ambience and safety. They did not comment on environmental changes impacting resident’s care or function.
Overall, there was variation in responses from families across the three sites, with findings suggesting that families’ perceptions and experiences of the environmental changes and impact on care were site dependant and likely to be influenced by broader contextual factors than those explored in this evaluation. Whilst most family members reported no change regarding the way staff supported residents to be active and no changes regarding environments impact on activity options and their ability to support resident in activity, positive responses were recorded regarding their own feelings of comfort and safety and observations that their family member was able to participate in tasks and activities.
Clinical Outcomes
Overall, there were increases in use of chemical restraints at Parafield Gardens and Lightsview after the dementia training and increases at Parafield Gardens after the environmental changes. Lightsview had a decrease in use of chemical restraints and responsive behaviours after environmental changes. Due to the lack of events (e.g., lack of physical and or chemical restraint, which was a positive outcome), the potential impact of the training and environmental changes was not able to be evaluated for these outcomes at Clare.
Impact on Aged Care and Workforce
This project provides evidence on the benefits for residents achieved through making environmental changes to MSUs, as well as benefits to the aged care workforce. This project demonstrates that increasing knowledge among the aged care workforce about the benefits of dementia-friendly environments can have a positive impact on the experience for residents and for staff.
Resources Developed
Resources that are influenced by this work will be available at Helping Hand’s website in future, such as the 2025+ Strategic Plan, which is due for release in June 2025.
Next Steps
The outcomes and learnings from this project will inform:
- Helping Hand’s 2025+ Strategic Plan.
- Helping Hand’s Dementia Model of Care.
- Future environmental changes at other Helping Hand care homes.
Key Contact for Further Information
Kerry Catt - kcatt@helpinghand.org.au
Chelsea Lewis - clewis@helpinghand.org.au