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It’s time to rethink residential aged care within the framework of an ‘intentional community’. It is an ecosystem where everyday living and purposeful activity enables people to enjoy the later years of their life. Much like a shared house, an eco village or type of collective household, the residential aged care home is well placed to mirror the same sense of self-determination based on an egalitarian framework, where those who live in the community have a strong voice on how they are run and are active contributors in the design of their experience.

 

In general conversations many people describe residential care or the “old people’s home” as a place of last resort. It is no wonder that this view prevails, even to the point that older people have preferred to die in impoverished conditions or even suicide than to sign up for residential aged care. This is largely influenced by the reports of human rights violations in the media of a small number, yet profoundly obscene stories of abuse. Yet residential aged care offers opportunities for older people to live well, managing their activities of daily living with safety and comfort, in a community that can enable high levels of social connection.

 

No one ever wants to have their rights, their freedoms to choose, taken from them. Choice and control over our life and our need to feel safe arguably is taken for granted until the fear of it being threatened becomes a reality. It is not simply better marketing or pushing more positive stories out in the media that will change the pervasive social fear of residential aged care; something fundamentally must exist in the home’s governance structure that translates to the person’s experience of care and services as life enabling, where they are meaningfully participating in the homes’ culture. The lockdowns and restrictions of COVID illustrate the tension between the ‘common good’ at the sacrifice of the ‘individual right’ and living through a global pandemic has been a significant test of personal rights over a collective responsibility, between power and control and a sense of agency.

 

Three tips for aged care providers:

  1. Set the intention of the home, attract residents that subscribe to it and measure how this intention is being achieved
    • Set the mission and values of the home and how this applies from the resident’s experience
    • Establish impact measurement and a culture of transparency and accountability
    • Ensure that all feedback is constructively managed and be ready for those hard or difficult conversations where expectations are not aligned and provide a resolution pathway.

 

  1. Develop a deep understanding of the older person’s experience and establish processes for continuous improvement
    • Embed ways of enabling residents to inform management decisions across all areas of the ecosystem
    • Enable sensitive and effective communication pathways for all residents particularly appropriate for people living with dementia
    • Fundamentally understand who has capacity to make their own decisions and those who have the legal right to make decisions for those without capacity and understand the supported decision-making process.

 

  1. Hire and sustain a workforce that nurtures a relationship-based approach to care and service delivery
    • Design direct care and support that is enabling a relationship-based model (not a transactional one).
    • Leadership embraces the attitude that models a loving culture built on kindness, dignity and respect.
    • Foster curiosity and promote innovative problem-solving so that the operations of the home are always responsive to the individual lived experience of the older person foremost.

 

We can learn a great deal from models of intentional communities across the globe. Fundamentally the process of decision-making is what can significantly impact on the physical, social, emotional and spiritual wellbeing of those who reside in it.  The degree of self-determination and personal agency within a collective who share a common goal is key.

Dr Maggie Haertsch

Aged Services, Interim & Compliance Remediation Specialist

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