AAA November-December 2018 Cover Story

NOV-DEC 18

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Real and lasting change Dementia Training Australia is making a difference AN ADVERTISING

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Real and lasting change Dementia Training Australia is helping aged care providers support older Australians to live meaningful lives through tailored education and change packages.

D

ementia Training Australia’s personalised education program combines environmental design and staff training to develop a package that provides lasting change within an aged care organisation.

DTA, which is a consortium of five universities from across Australia and consumers advocacy group Dementia Australia, has been funded by the Federal Government to provide dementia education and training across Australia since it was established in 2016.

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Features that spark familiarity among residents and encourage independence

It is striving for sustainable change in the sector by working with organisations to create Tailored Training Packages (TTPs), which aim to improve the care and wellbeing of people living with dementia and the staff who are supporting them.

The packages are made up of courses, services and resources and involve DTA getting alongside aged care organisations to really understand their needs and circumstances to deliver training to meet their goals.

Professor Richard Fleming, executive director at DTA, says the Tailored Training Packages assist organisations to bring about sustainable change through knowledge translation and capacity building.

“TTPs are provided to change-ready organisations that want a systematic approach to train their staff and to help them reach some clearly understood goals,” Fleming tells Australian Ageing Agenda.

Building a suitable TTP starts with undertaking a training needs analysis of the organisation and performing an environmental audit of the aged care facility to assess strengths and weaknesses of the built environment for people living with dementia, says Fleming.

“We’ve learnt through many decades of experience that it is a waste of time training people to deliver a model of care that an environment doesn’t support.”

Fleming says DTA works with providers to identify clearly defined goals and objectives that can be understood by all key stakeholders in the facility including managers, staff and consumers and their families.

A clearly defined goal, for example, is for residents to spend more time outside their room than they do now as opposed to wanting to

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Unpacking dementia A vision full of life: The Village by Scalabrini

improve their quality of life, which Fleming says is “far too difficult to measure.”

He says it’s important for the environmental design aspects of TTPs to go “hand in hand” with the staff training and engage all employees to address changes needed within the organisation’s environment.

“It’s a very good way of having a conversation with all members of staff from the executives to property people, managers, registered nurses and personal care workers about helping them identify what change is required and how they will play a part in bringing about change.”

DTA offers a face-to-face nationally accredited vocational training course to support staff in caring for those living with dementia.

Dementia Essentials, delivered by Dementia Australia, is a three-day course that guides aged care, health and community service staff on how to effectively communicate and engage, understand behaviours and create a supportive living environment.

A statement of attainment is awarded upon completion, which allows participants to claim credits if they undertake further qualifications related to the course.

Meaningful connection: Alana OKeefe and resident Elizabeth Walker

This process also allows staff to consider what different styles of care would look like and what other changes are required to bring the style into operation, says Fleming.

DTA offers a limited number of TTPs each year. TTPs are available to residential facilities, hospitals and community care. There are currently more than 300 facilities engaged in TTPs across Australia.

In New South Wales DTA is working with community owned aged care provider Warrigal on TTPs across all its sites. Warrigal was named Aged Care Provider of the Year at Aged and Community Services Australia’s national awards this year.

Mark Sewell, CEO of Warrigal, says working with DTA has enabled his staff to know how to better respond to residents who are living with dementia.

“Our staff are learning what to say, how to behave, which property and equipment recommendations to make and becoming agents of change for a dementia-friendly organisation,” Sewell tells AAA. The TTPs have brought about change in the organisation by empowering staff “to think about the why in how they interact,” he says. “This is a whole of organisation commitment where the changes brought about through the training and ongoing partnership with DTA will have an ongoing life and also influence how the lived experience for our customers living with dementia is shaped.”

DTA spent time getting to know Warrigal’s unique service profile across its 13 sites, and structured a series of training packages that work for Warrigal, Sewell says.

“They have enormous experience in understanding not just the needs of staff, but the needs of people living with dementia.”

Sewell encourages other providers to participate australianageingagenda.com.au

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in the program because DTA works to deliver the best possible package to suit an individual organisation. “It’s such a trap to use the latest training product, the most accessible or the cheapest one,” he says.

“Taking the time to have a tailored package that really works for your people in your settings and for your customers is going to be much better for you and deliver much stronger and lasting outcomes that won’t be eroded easily.

DTA is the nation’s expert in dementia training.

They do things properly.”

A different approach

DTA combines the expertise of its five academic member institutions, which include University of Wollongong, La Trobe University, Queensland University of Technology, University of Western Australia and the Wicking Dementia Research and Education Centre at University of Tasmania, to provide evidence-based training. Dementia Australia delivers DTA’s vocational training course Dementia Essentials.

DTA’s mission is to improve care and wellbeing of people living with dementia and the staff delivering their care. DTA is also committed to ongoing knowledge translation beyond training by helping organisations and individuals to put the best available evidence into practice.

The key element that makes DTA different to other dementia training providers is that it follows a salutogenic approach, which focuses on supporting health and wellbeing and is the opposite of a pathogenic approach targeting disease and illness, says Fleming.

“In dementia, the salutogenic approach focuses on providing a built, social and care environment that enables a person living with dementia to make the best of their abilities and live the fullest life they possibly can.”

A pathogenic approach by contrast would focus on developing a care environment in response to individual problems.

“We try very hard to provide resources that aren’t specifically focused on the solution of individual problems. We see our responsibility as helping organisations to see the person as a whole person and as a citizen in the context of society. Our job is to help organisations relate to people living with dementia as a whole person who has the right to a full life,” Fleming says.

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Alice Ward, a patient in one of the hospitals introducing The View From Here

“We see our responsibility as helping organisations to see the person as a whole person and as a citizen in the context of society.”

symptomless if you like, but that doesn’t mean they are leading a full life.”

DTA sees the salutogenic approach as part of a shift to a new paradigm where a sense of meaning and belonging among older Australians and those who care for them will be increasingly valued.

This transition is already illustrated in the new Aged Care Quality Standards, which replace the current four sets of standards for aged care accreditation from 1 July 2019.

The new standards highlight dignity, respect, choice, belonging, wellbeing, independence, and consumer partnerships and engagement as important factors in quality and accreditation.

Fleming says that the new quality standards and the Aged Care Workforce Taskforce Strategy both “have very salutogenic foundations to them.” While the standards, for example, use phrases like “emotional, spiritual and psychological wellbeing” rather than salutogenic, the meaning is the same and aligns with DTA’s approach to education.

“If you read the Aged Care Workforce Taskforce Strategy and the new Aged Care Quality Standards, it’s clear that there is a focus on seeing elderly people, particularly those with dementia, as having the rights of full citizens.

There is a very strong focus on autonomy and self-determination,” Fleming says.

Specialised services

Each consortium member of DTA has its own specialities and offers a different service as part of a Tailored Training Package. UOW offers the Designing for People with Dementia service, QUT provides the Responsive Behaviours Consultancy, UWA offers a Medication Management Consultancy and La Trobe runs Fellowships, which are coaching partnerships for leaders within organisations.

Queensland’s Responsive Behaviours Consultancy is prompting organisations to rethink traditional, and often outdated, approaches to responsive behaviours.

Online courses DTA offers a range of short, free and mobile-friendly online courses for people who work with people living with dementia: •C ommunity care and dementia: responsive behaviours provides strategies to prevent or reduce behaviours a person living with dementia can experience.

•C ommunity care and dementia: understanding the condition explains how dementia can affect a person’s ability to undertake daily living activities.

•B edtime to Breakfast: caring at night for people with dementia explores person-centred care at night for people living with dementia in residential care.

•P ainChek online course: a hands-on guide to intelligent pain assessment.

•T he Pain Puzzle: recognition, assessment and treatment of pain in people living with dementia in the residential care environment improves knowledge on pain assessment in the residential care environment.

•R ecognising, diagnosing and managing dementia in general practice provides advice on dementia care for general practitioners.

•M anagement of antipsychotic medications for responsive behaviour in residential aged care helps people create an evidence-based plan for using medications and explores drug-free alternatives.

•C aring for LGBTI people with dementia educates organisations on how to provide inclusive care for lesbian, gay, bisexual, transgender and intersex people with dementia.

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Dementia Training Australia executive team (from left) Richard Fleming, David Sykes (Dementia Australia), Elizabeth Beattie (QUT), Andrew Stafford (UWA), Margaret Winbolt (LaTrobe), Andrew Robinson (UTAS)

About DTA • Over 18,000 instances of continuing professional development (CPD) training • More than 12,900 learners engaged in vocational training • Over 9,000 online courses completed with an 85 per cent completion rate • More than 300 sites engaged in Tailored Training Packages

Bamara Health Service in South Australia, for example, is using a tool to lower the stress thresholds of people living with dementia, and exploring how changing background music can change behaviour. Bamara is also utilising DTA’s tools on pain recognition and management to increase staff knowledge of pain and its impact on behaviour.

Another offering from Queensland, the online course The View from Here has been introduced to hospitals as part of a TTP. The course encourages learners to understand the experience of a busy hospital from the perspective of a person living with dementia, and has resulted in greater understanding and a more empathetic, person-centred approach among hospital staff.

In Western Australia, residential aged care provider Baptistcare Dryandra has reduced the number of antipsychotic medications it uses following support from DTA’s Medication Management Consultancy service provided by UWA as part of a TTP. The consultancy service aims to help reduce the number of antipsychotic medications used to support people with responsive behaviours, ensuring that these medications are prescribed at the lowest possible dose for the shortest possible time, if they are used at all. It’s based on a growing body of research that antipsychotic medications have limited effect on alleviating responsive behaviours of people living with dementia.

Baptistcare Dryandra completed the medication management program in August and has achieved a sustained decrease in the amount of antipsychotic prescriptions. It has also achieved increases in staff knowledge on how to best support the people they care for.

Elsewhere as part of a DTA Fellowship, La Trobe University worked with Victorian provider Homestyle Aged Care to implement Fellowships with four managers at four of its sites.

At one facility, DTA fellow Julie Gray worked with lifestyle manager Alana OKeefe to lead a project that aimed to provide more meaningful connections for residents living with dementia in

its advanced stages and loved ones who live far away by facilitating Skype calls and video chat.

After the calls, staff would prompt residents to share information about themselves and their families, says Gray, and residents were enthusiastic about sharing parts of their life stories triggered by the calls. It also helped staff learn more about the residents, she says.

Back in New South Wales, DTA at the University of Wollongong worked with Scalabrini on its recently-opened community in Drummoyne in Sydney to implement a dementia-friendly environment that allowed residents to feel valued. The design embodies the salutogenic approach.

Fleming describes this community, known as The Village, and Scalabrini’s vision for people living with dementia as full of life. The building tells the people living in it that they are valued. It offers them activities to engage with and reminds them of the outside world, he says.

“People experience a meaningful life when they feel valued, when they look forward to getting up in the morning and getting on with things, and when they can put their lives into a broader context or see it as part of a bigger picture.” n

DTA apps available for iOS and Android devices: • Responsive Behaviours App, a quick guide for health professionals and care staff on common responsive behaviours of people living with dementia.

• Medication Management App, a guide for aged care staff on optimal use of antipsychotic medications.

• Built Environment Assessment Tool – Dementia (BEAT-D) App, a tool to assess the strengths and weaknesses of a building used to accommodate people with dementia.

For more information on Dementia Training Australia, including courses, events and resources for individual learners, go to dta.com.au or contact us by email dta@uow.edu.au or 02 4221 5555

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