Final person centred approaches to best practice in dementia care 3
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Final Person Centred Approaches to Best Practice in Dementia Care 3
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Final person centred approaches to best practice in dementia care 3
- 1. Person Centred Approaches Best Practice in Dementia care Presented by Wendy Morey Executive Manager Workforce Development and Governance Resthaven Incorporated South Australia
- 2. Guiding Values: Person Centred Approaches Valuing People Autonomy Life Experience Understanding Relationships Environments
- 3. Person Centred Approaches Photo or rolling dvd
- 4. Thai Population 60 and older 2010 2015 2020 2026 2030 2035 2040 Number in 1000s 8408 10351 12622 15126 17579 19361 20519 Ratio to 2010 number 1.00 1.23 1.50 1.80 2.09 2.30 2.44
- 5. Person Centred Approaches People living with Dementia want to be as independent as possible and in control of their own lives Community and health care systems are important and impact quality of life Community and Government expectations are that support services meet diverse needs
- 6. What is a Person Centred Approach?
- 9. Guiding Values: Person Centred Approaches Valuing People Autonomy Life Experience Understanding Relationships Environments
- 10. Person Centred Approaches Valuing People •Respecting values and beliefs •Listening to each other
- 11. Person Centred Approaches Autonomy •Promoting independence •Balancing rights, risks and responsibilites
- 12. Person Centred Approaches Life Experience •Supporting the sense of self
- 13. Person Centred Approaches Understanding Relationships •A partnership approach •Community connections
- 14. Person Centred Approaches Environments •A supportive learning culture •Responsive support
- 15. Let’s get to work…
- 16. The journey towards Person Centred Approaches Valuing people Autonomy Life Experience Understanding Relationships Environments
- 17. Person Centred Approaches and Active Ageing
- 18. Using the Person Centred Approach values to support Active Ageing Valuing People Autonomy Life Experience Understanding Relationships Environments
- 19. WHO says… Active ageing • Optimizes opportunities for health, participation & security • Applies to individuals & population groups • Allows people to realize their potential for physical, social & mental well-being throughout life & to participate in society • Provides people with adequate protection, security & care when they need
- 20. WHO says… Active ageing • Optimizes opportunities for health, participation & security • Applies to individuals & population groups • Allows people to realize their potential for physical, social & mental well-being throughout life & to participate in society • Provides people with adequate protection, security & care when they need
- 21. WHO says… Active ageing • Optimizes opportunities for health, participation & security • Applies to individuals & population groups • Allows people to realize their potential for physical, social & mental well-being throughout life & to participate in society • Provides people with adequate protection, security & care when they need
- 22. WHO says… Active ageing • Optimizes opportunities for health, participation & security • Applies to individuals & population groups • Allows people to realize their potential for physical, social & mental well-being throughout life & to participate in society • Provides people with adequate protection, security & care when they need
- 23. WHO says…
- 24. Valuing People •Good footpaths •Easy crossing points on busy roads •Driver education and awareness •Warning signs in appropriate places •Easy access to community facilities •Inclusive community programs & activities •Program staff educated & aware of Dementia Using the values to support Active Ageing
- 25. Autonomy •Dementia friendly materials & information •Improve access to buildings •Staff and volunteers offer choices •Support organisations which give a voice to people with Dementia •Include people with Dementia when making decisions Using the values to support Active Ageing
- 26. Life Experience •Create new life experiences •Create enjoyment through community participation •Expose to IT and new technologies •Get to know the individual as a person •Explore their past and identify interests and experiences •Create connections to the past Using the values to support Active Ageing
- 27. Understanding Relationships •Connect/reconnect people > relationships •Staff build relationships •Connect with the community •Understand important relationships to the person with Dementia •Design programs to build relationships Using the values to support Active Ageing
- 28. Environments •Dementia friendly spaces •Spaces where people can be active and independent •Ensure spaces are safe and free of hazards •Cater for religious and cultural needs •Consider colours, sounds, temperature •Consider comfort •Design with needs of people with Dementia in mind Using the values to support Active Ageing
- 30. Living life
- 31. Thank you ขอบคุณ It has been an honour to be here today with such distinguished guests Resthaven greatly values its relationship with Baan Sudthavas
Hinweis der Redaktion
- 45 minutes 1030 - 1115 Thank you again for the opportunity to share some Australian experiences. I would like us to focus on Person Centred approaches to provide care and services to older people who have Dementia. Australia is trying to move forward with these approaches – in some areas we are doing well and in other areas we could do a lot better. But it is the small changes we make in many places – that transform our world and so we need to think long term to keep moving forward to the changes we want to see. In this first session we will talk about: Why person centred approaches are important What exactly person centred approaches are Then in the second part we will: Look at practical examples which illustrate these approaches and Ways to start to make changes to adopt these approaches Finally we will look at how person centred approaches support active ageing. (1145 > 1215)
- First I want to talk about a resource that I have used to prepare this part of the seminar. The ‘Valuing People’ resource is one that any organisation or professional person or carer can use to encourage and enable a person centred approach to Dementia care. It is freely available on the internet and was published by Alzheimer's Australia in 2014. It is a tool that organisations can use to increase their understanding of person centred approaches for people with Dementia and for those who want to be excellent in providing relevant services. It was developed based on a review of the published data, the experience of people living with dementia and the experience of Australian service providers. It provides a map for cultural change – so people and organisations can go on a journey to improve their understanding and use of person centred approaches. Australia has not arrived a the destination of this journey yet. We are still on the journey. My organisation is still on the journey – I suspect the journey never ends but it will never happen if it is not started! Hospitals can use this Community Services can implement Government departments can require this Universities can teach this to their undergraduates Carers of those with Dementia can use this If we are to get the person centered approach into action – we need to look at using the values in many areas of the community to build momentum for the change – so that there is cross function support.
- Why are these important for both Thailand and Australia? It is important to appreciate ‘why’ these values are important – so that when it comes to action – there is a clear link between the values and what we do Increasing numbers of older people and those who have chronic illness such as dementia will have a major impact on the health system and community care Australia has a rapid increase in numbers of older Australians. Population aged 65 years and over is expected to increase from 3.2 million in mid 2012 to about 5.8 million by 2031. As a result we have a rapid increase in those who have dementia. Currently 320,000 but projected to be 500,000 by 2050. (Australian Institute of health and welfare 2012 Dementia in Australia Cat No AGE 70 AIHW Canberra). Similarly, population ageing is well underway in Thailand. The number of older Thais has increased by 5 fold since 1960. There has also been a reduction in birth rates and increased survival into older ages with the older persons making up a % of the population growing from 5% to approximately 13%. According to UN estimates – for all ASEAN countries, only Singapore has a higher % of older persons in the population. Life expectancy has risen from 56.2 and 51.9 years for women and men respectively in the mid 1960s to around 75.7/69.9 years today (WHO, http://www.who.int/bulletin/volumes/90/2/12-020212/en/) Thailand has a rapid increase in numbers of older Thais. According to the 2014 publication: “Dementia in the Asia Pacific Region” published by Alzheimer’s Disease International the estimated number of Thais with dementia will rise from 600,000 in 2015 to 1,117,000 in 2030 and then to 2,077,000 in 2050. “In low- and middle-income countries specialist numbers are never going to be enough, and dementia care will need to involve community health workers, primary care doctors and nurses in a community-based programme,” says Dr Tarun Dua, a medical officer in WHO’s Evidence, Research and Action on Mental and Brain Disorders unit. http://www.who.int/bulletin/volumes/89/3/11-020311/en/ The Alzheimer’s disease and Related Disorders Association Thailand does a great job in in raising public awareness of dementia and the needs of those with this disease and their carers though: media engagement, publications, online engagements, events and stakeholder engagement (hotline and support group meetings).
- Source: Projections prepared the National Economic and Social Development Board for the 11th Socioeconomic Plan Currently the 13% is predicted to rise to about 33% by 2040. (% of older people in the entire population) The other important point is that the ratio of children 0 – 14 compared to the numbers of older people will continue to fall. This is a national treasure – to be valued and celebrated. Not feared or put down. Increasing numbers of older people is not actually a problem and should not be seen like this.
- Person centred care is a philosophical approach which adds value to service development and delivery and ultimately to older people who have Dementia. The Australian Govt is under constant pressure to do more with less – and encourage a move away from dependence upon govt funds and initiatives. Sandy to give out first cards ready for next slide.
- So if the person centred approach adds value – lets see what that value is. Make up flash cards with the 8 dot points on page 6. One table reads them out one by one and sticks up on the board. This board to say What's the value?
- So why would we want to consider person centred approaches to care and Servcies for older people with Dementia? What are the results we would be looking to see? Give out flash cards with the answers written on both sides in Thai and English. One table reads these out and sticks up on the board. This board to say: results The flash cards to say: Older people and their carers have greater control over their own lives Older people and their carers make choices about the types of care and Services they access Support staff value and seek to know the people they care for Support staff understand the experience of the person with dementia and support them to retain as much independence and dignity as possible Staff are happier and want to stay in your organisation because they see the difference you make Organisations provide culturally appropriate responses The reputation and standing of organisations is enhanced in the community So if we want these results - how do we do this? What are we doing already and what else do we need to do?
- We have talked about the growth in the expected numbers of Australian and Thai older people and the expected growth in those who have Dementia. We have talked about the value of person centred approaches to the older person, their carer and organisations and we have talked about the results that we expect to see if we use person centred approaches. We have seen that there is a model we can use called “Values” to guide us in our thinking about person centred approaches and in our planning to take some actions. Let’s now recap the model and then work together on some practical ways to use it to make changes.
- A reminder: it is a tool that organisations can use to increase their understanding of person centred approaches for people with Dementia and for those who want to be excellent in providing relevant services. Lets look at it in more detail
- A commitment to valuing people involves being aware of and supporting personal perspectives, values, beliefs and preferences incorporating a variety of characteristics that make individuals unique including race, ethnicity, gender, aged and physical abilities.
- Autonomy involves the provision of choice and respect for choices made; recognition of when a person requires support in decision-making; and optimising a person’s control through sharing of power, decision-making and responsibility.
- Life experience is the connection between a person’s past, their present day experience, and their hopes for the future.
- A commitment to developing collaborative relationships across the organisation including between the service provider and those receiving services and their carers and between all levels of staff. All parties work in partnership and understand the importance of community connections in designing and delivering services.
- Person-centred principles underpin the organisational values that describe what is important to an organisation and how people should approach their work. Person-centred organisations have a systematic approach to knowledge and skill development that is inclusive of the experiences of staff, consumers and the people who care for them.
- Lets do some brain storming together. The Manager in this cartoon obviously talked with the staff about person centred approaches but did not really explain the ‘how to do this’ of the approach. We will now work together to do this. We have many people in the room from different types of organisations. (state who they are). Turn to page …. In your booklets Work in tables – to create some simple ideas that we can take away from our time together to consider in our own work contexts. How does change happen? – one small step at a time. So if moving towards person centred approaches for people who have Dementia is something that people are willing to look at – this change can happen one small step at a time One value per table. Please open to page 20
- The journey has begun. I suspect the journey never ends but it will never happen if it is not started! In this exercise together – we have talked about how: Hospitals can use this Community Servcies can implement Government departments can think about this Universities can teach this to their students Carers of those with Dementia can use this Ask for one to two ideas: to read out one thing from the value that they thought about. Sandy to walk about with the relevant card. Recapping – we now have many different, practical ideas which can be used in the work environment. Each person can take away the framework and use it as a tool to create other ideas for moving towards a person centred approach for services and care for people with dementia and their carers. All the activities wont be the same – and that is good. If each person here made one change back in their workplace – and that change influenced 10 others – we would have X hundred people putting into practice person centred approaches. Thank you for working on this together. (Arnop can we collate all the ideas and share them via email?)
- 1145 – 1215 Lets make the link then between person centred approaches to care and services for people who have dementia and their carers – with active ageing. Lets all stand and stretch!
- Active ageing is being engaged in your life – making choices about what you do. It is about being physically active, mentally active, socially active and spiritually active – in ways that are healthy and which suit the person. Its about being in control. So if we use the person centred approach values to think about active ageing – what kinds of things can this expand to? WHO says that Active ageing is the ‘process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need. The word “active” refers to continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or to participate in the labour force. Older people who retire from work, ill or live with disabilities can remain active contributors to their families, peers, communities and nations. Active ageing aims to extend healthy life expectancy and quality of life for all people as they age. “Health” refers to physical, mental and social well being as expressed in the WHO definition of health. Maintaining autonomy and independence for the older people is a key goal in the policy framework for active ageing. Ageing takes place within the context of friends, work associates, neighbours and family members. This is why interdependence as well as intergenerational solidarity are important tenets of active ageing.
- WHO says that Active ageing is the ‘process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need.
- WHO says that Active ageing is the ‘process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need.
- WHO says that Active ageing is the ‘process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need.
- WHO says that Active ageing is the ‘process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need.
- The word “active” refers to continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or to participate in the labour force. Older people who retire from work, are ill or live with disabilities can remain active contributors to their families, peers, communities and nations. Active ageing aims to extend healthy life expectancy and quality of life for all people as they age. “Health” refers to physical, mental and social well being as expressed in the WHO definition of health. Maintaining autonomy and independence for the older people is a key goal in the policy framework for active ageing. Ageing takes place within the context of friends, work associates, neighbours and family members. This is why interdependence as well as intergenerational solidarity are important tenets of active ageing.
- So how can we use the person centered values to help us support active ageing? Dementia aware local government officials/departments can support dementia-friendly community activities if we share dementia knowledge with them. Balloon focuses on one dimension – road use. Another example might be in shopping centres – having signs with pictures (for example toilet or exit) – it might mean providing access to education for shop owners in basic understanding of dementia and how to assist someone with dementia buy things or do banking. What does this mean in practice to support active ageing for people with Dementia ? WHO: ‘The active ageing approach is based on the recognition of the human rights of older people and the United Nations Principles of independence, participation, dignity, care and self-fulfillment. It shifts strategic planning away from a “needs-based” approach (which assumes that older people are passive targets) to a “rights- based” approach that recognizes the rights of people to equality of opportunity and treatment in all aspects of life as they grow older. It supports their responsibility to exercise their participation in the political process and other aspects of community life. Here are two ideas to support active ageing for people with dementia - which demonstrate the valuing people person centred approach All of the ideas in the next 5 slides link to ‘The benefits of physical activity and exercise for people living with dementia’ November 2014 paper developed by the Policy, Research and Information Department, Alzheimer’s Australia NSW. Paper authored by Kylie Miskovski, Senior Research and Policy Officer, Alzheimer’s Australia NSW. Alzheimer’s Australia respectfully acknowledges the Traditional Owners of the land throughout Australia and their continuing connection to country. We pay respect to Elders both past and present and extend that respect to all Aboriginal and Torres Strait Islander people who have made a contribution to our organisation. © Copyright: Alzheimer’s Australia NSW, November 2014 Exercise, community and social groups can educate their staff/volunteers to facilitate inclusion of people with dementia and their carers into programs and activities.
- Dementia aware people address barriers to participation in active ageing for people with dementia. Active ageing programs should include people with dementia and use volunteer support for group activities such as walking groups, yoga, tai-chi and brain games. What does this mean in practice to support active ageing for people with Dementia ? Here are two ideas to support active ageing for people with dementia - which demonstrate the recognition of autonomy person centred approach What are the barriers? Transport Lack of confidence Lack of knowledge or information Wrong information and ignorance amongst people Using organisations such as ARDA-T to provide a voice for those who have dementia and their carers – can elders clubs work more closely with such organisations?
- Dementia aware people can actively encourage and create programs as a way to improve the physical, social and emotional wellbeing of people with dementia. Dementia aware people address barriers to participation in active ageing for people with dementia. What does this mean in practice to support active ageing for people with Dementia ? Here is one idea to support active ageing for people with dementia - which demonstrate the recognition of importance placed on the life experience in the person centred approach Can we use a range of communication methods to reach and teach people? How can this be promoted at the local level? How can health professionals in hospitals and health centres get involved? How can people with dementia be supported to continue to work as long as they can?
- Dementia aware people can design exercise programs and active ageing services to include carers of people with dementia What does this mean in practice to support active ageing for people with Dementia ? Here are two ideas to support active ageing for people with dementia - which demonstrate the recognition of importance in understanding relationships in a person centred approach How do we include carers? How do we find them? One of the suggestions from HelpAge in the 2013 publication (p89) is to expand IT access and familiarity for older people to encourage social inclusion, improve service delivery and help with maintaining family contacts. There are many apps available to assist with ‘brain training’ and IT platforms provide very suitable bridges between younger and older people.
- Dementia aware people can consider how environments (hospitals, residential aged care, dementia-specific homes, public spaces and retirement villages) enable mobility, freedom of movement and independence to be active Dementia aware people can consider social, emotional and spiritual environments from the perspective of those with dementia What does this mean in practice to support active ageing for people with Dementia ? Here are two ideas to support active ageing for people with dementia - which demonstrate the recognition of importance of environments to a person centred approach. Hospitals in particular and those who work in them have really big parts to play here. A life course perspective on ageing recognizes that older people are not one homogeneous group and that individual diversity tends to increase with age. Interventions that create supportive environments and foster healthy choices are important at all stages of life. As individuals age, noncommunicable diseases (NCDs) become the leading causes of morbidity, disability and mortality in all regions of the world, including in developing countries. NCDs, which are essentially diseases of later life, are costly to individuals, families and the public purse. But many NCDs are preventable or can be postponed. Failing to prevent or manage the growth of NCDs appropriately will result in enormous human and social costs that will absorb a disproportionate amount of resources, which could have been used to address the health problems of other age groups. ‘The benefits of physical activity and exercise for people living with dementia’ November 2014 This paper has been developed by the Policy, Research and Information Department, Alzheimer’s Australia NSW. Paper authored by Kylie Miskovski, Senior Research and Policy Officer, Alzheimer’s Australia NSW. Alzheimer’s Australia respectfully acknowledges the Traditional Owners of the land throughout Australia and their continuing connection to country. We pay respect to Elders both past and present and extend that respect to all Aboriginal and Torres Strait Islander people who have made a contribution to our organisation. © Copyright: Alzheimer’s Australia NSW, November 2014
- So we have seen that the concept of Active Ageing is consistent with the guiding values of the person centred approach to care and Servcies for people with dementia and their carers. The two can work hand in hand. The capacity to respond to both concepts is dependent upon many variables. Some of those variables are economic and out of our reach. But some capacity to respond is very much within our areas of influence. I am a firm believer in the fact that small acts change the world – and small acts can come from small shifts in understanding and belief about what is possible for the future. As we have seen, active ageing is not just about physical activity. It is about social, emotional, mental and spiritual health and activity as well.
- I will hand out a script now. This is the script of a video which I will show now. We will look at the video 2 times as once won’t be enough for you to fully appreciate the content in relation to all we have talked about today. This video is a great example of a service manager – who cares for people with dementia in a residential home – using the guiding values to shape his approach to care and services. His name is Colin and he understands the importance of autonomy, life experience, relationships, environments and it is very obvious that he values people.
- Questions and any final discussion.