Partnering in Care – 8 Activation Tips
You may have heard the mantra “nothing about us without us”. It is commonly expressed in disability circles and a search will provide a reference as far back as 1505 being the name of Poland’s constitution. “Nothing about us without us” is a fundamental principle of human rights in democratic civil societies and an ethos vitally important in aged care services. It goes to the heart of the Quality Standards and is a legislative requirement under the Aged Care Act 1997, Standard 1 Consumer Dignity and Choice. This requirement is more than designing a person’s care plan with their involvement. This is not enough. Authentic engagement, partnering in care and support, is a whole-of-service system approach, a continuous process where the service users have their involvement, their views, and their recommendations incorporated into service operations and development. It is both at an individual level and group level that the active involvement of older people is not only expected, it is their right. Unless we really empower older people to engage in the services we will be continue to miss the richness, the inspiration and the opportunity that their voice brings to shaping the service’s culture.
The standard expects the services to “help consumers live their lives the way they choose”. Here are eight ideas of how your service could partner with older people:
Establish a community group of older people using your service
Invite all people in your service. It helps management if there are nominated chairs (preferably two) and a smaller steering group who are great connectors with other residents. Many older people have themselves been on boards, committees, or working parties so enlisting their help and provide administrative support for taking minutes and other needs like issuing letters of invitation will support the group to be successful. Management should only attend on invitation. Think of how to best facilitate this, the venue, the use of zoom, the ability for people to properly hear and participate in the group discussion and the role the staff play to ensure that participants arrive on time. Have a policy with terms of reference to formally recognise this group and its purpose for the service. This group would not replace the relatives and residents meetings as this is only for residents or services users not for relatives. Communication can never be underestimated, using letters in large font for meeting invitations, agendas and minutes is important. This is the first step where representatives of this group can be asked to participate in other initiatives. Management can ask for feedback on any initiatives they are thinking of introducing. This is an excellent forum to discuss changes to the service and seek input. You could also introduce new staff in this forum if the chairs agree. Consider training for older people who want to develop skills in group facilitation and the running of meetings. Consider how the older person’s engagement in the service is reflected on your organisational chart.
Participation in management team meetings
Having active participation in management led meetings by the nominated representatives of the community group puts the older person at the centre of decisions. There is nothing like having an older person in the room and being asked what they think. Elders with capacity to understand confidentiality and handling of sensitive information are more than able to comply with the privacy and confidentiality obligations. This level of participation can transform a service to being older person focused very quickly.
Recruitment of staff
All aged care services have older people with extensive life experience. They are highly capable to work in a group to determine who gets to work in your aged care home or home care service. For some providers there may be some resistance such as – ‘but they have dementia’ or ‘what about confidentiality’ or ‘they don’t really understand what we are looking for’. Participation can be a great experience even for the most frail in the service. Consider asking one meaningful question such as “why do you want to work in our home”. Some older people say that they only need to sit on a lounge and have a chat with the candidate to tell if they would be suitable in the service and be part of the culture. Importantly this process sends a clear message that older people come first, demonstrating ‘a service for us so we make decisions about us’. Don’t worry if practical issues like toilet stops or fatigue arise, plan to have a few older people available and structure your interview format at the best time to suit the older person’s energy levels.
Policies that have a direct impact on the older person’s lived experience, their risks and also how the service operates. The involvement of the older person in the review of policies is another positive way to engage discussion about what is important. Some of the obvious ones to start with are processes associated with the dining experience, how the processes for allied health and leisure and lifestyle are crafted, complaints management and maintenance requests. The resident community group will always benefit from receiving consultations or education about the organisation’s policies so that they are better informed about what is done to ensure they have a ‘well run’ service.
The roster and allocation of staff has the greatest impact to older people. The dynamics and interactions of staff with older people and also with other staff are a regular area of observation by them and their families. Older people will have positive insight about which staff are more aligned to values and their personal preferences and needs. The other insight older people are able to highlight are those staff who really embrace the organisation’s processes and commitment to positive communications. Having an older person give staff awards helps to reinforce what attributes and behaviours consumers have the greatest regard for and can be expressed at the award ceremonies. Use this opportunity for the older person to describe how that staff member’s behaviour has significantly affected the experience or quality of life of the people in the service.
Contribution to staff assigned training
The training on offer for staff is often of great interest to older people. What staff learn can have a significant impact to their lived experience reinforcing the capabilities necessary to really improve care and service. Consider inviting an older person to talk about their experience of the service. Some older people want to deliver training on their experience of manual handling and lifting particularly if they have had a difficult experience. They rely on the positive and safe approach to the way staff move them and their involvement can be very powerful for staff not only in developing skills and knowledge but changing attitudes and greater empathy.
Welcoming group / visiting group for older people in the service
Consider having a group of older people who would like to welcome new people to the service, show them around, introduce them to other people in the service and be there regularly as the older person adjusts to this new experience. No one knows the service better than the person already using the service. It can be surprising what staff don’t know. This welcoming group could also be available for showing around visitors and even meeting and greeting the Aged Care Quality and Safety Commission when they do site visits.
Review of menu plans and the meal service
The importance of food, meal choices, and the whole experience of dining can’t be emphasised enough. The constant review and seeking feedback is essential for a service particularly in residential services. Running focus groups with older people, asking them to make suggestions for the menu, consider ways in which food and drinks are available as self-service particularly outside of the meal time and consider the flexibility of dining options and locations including the involvement of family and friends. Meals are also a social experience and the dining room can be lonely and isolating for some older people. Consider how you can observe and encourage older people to give suggestions and try out new initiatives.
Other ideas can also include, older person led ‘guard of arms’ when a someone dies so they are actively acknowledging the life and its ending; engagement in the governance committee; and, active participation in the quality committee. Organisations that build a culture of true inclusion can then say that they are embracing the attitude of “nothing about us without us” for the older person.
Article written by:
Dr Maggie Haertsch
Aged Services, Interim and Compliance