Case Study 1:
Mrs O has been receiving home care services for several years. She has dementia and her needs have gradually increased, but she is capable of living semi-independently for now. Her two children live nearby and at least one of them visits daily. Mrs O gets on well with the care staff and makes it clear to them that she wants to keep doing as much of her own housework and personal care as she can.
However, her children express concern to the provider that she is no longer capable of making decisions that best meet her needs. They ask the provider to add laundry, ironing and bed-making to their duties, tasks that Mrs O has been doing herself until now without mishap. The care staff who look after her directly tell the service coordinator they think this change is unnecessary and risks making Mrs O unhappy and affecting her confidence. The provider has to balance the wishes of Mrs O’s family with Mrs O’s own preferences.
The main priorities are Mrs O’s safety, her well-being, and respecting her wish to keep doing her daily tasks. There are certainly safety and hygiene issues to consider. So far these have not arisen but may as Mrs O’s dementia progresses. A care coordinator with experience in dementia meets with Mrs O to talk about these issues. Mrs O understands the concerns being raised by her children and decides that the risks discussed with her are outweighed by the importance of the benefits she get from doing her own laundry and ironing. She agrees to a small increase in staff supervision for these activities. In explaining the plan to Mrs O’s children, the coordinator emphasises how important it is for their mother to maintain a sense of independence, self-worth and purpose. The coordinator also makes it clear that the provider has carefully discussed the health and safety risks with their mother and will continue to monitor them from day to day, and welcomes further input from the family about their observations of how she is coping.
Case Study 2:
Auntie V is an 87-year-old Aboriginal woman living with her extended family in a remote community and receiving home care services. Over the Christmas period many of her family go away on holiday. Auntie V usually remains at home and manages with a small amount of additional support from the aged care program. However, she has recently been diagnosed with early stage dementia and her family is concerned about her being at home alone. Her daughter suggests Auntie V could go to the National Aboriginal and Torres Strait Islander Flexible Aged Care Centre (the Centre) for a few weeks of rest over the holiday period. The Centre offers low care residential respite and is located in a nearby community. Auntie V and her daughter talk to the Manager of the Centre and are able to secure a four-week booking. They are invited to return one month before the booking to discuss Auntie V’s needs and preferences.
The Manager notices Auntie V has trouble understanding the options available to her and uses additional pictorial cues to help her make appropriate choices. Together they complete an intake assessment; this includes identifying any health issues that staff need to be aware of, including current medication, meal preferences, activities she enjoys, and personal care preferences. The Manager gives Auntie V and her daughter a tour of the Centre, answers their questions and provides them with a respite handbook to take away. The handbook provides plenty of colourful visual cues to assist Auntie V to understand what to bring with her and what to expect when she stays at the Centre.
On the first day of holidays, Auntie V is brought to the Centre by her family and they are invited to stay for a couple of hours to help her settle in. Auntie V’s room is light and bright, opening onto a secure garden area that includes many local native plants and a comfortable seating area. Once she has settled into her room and finished her lunch, Auntie V’s family leave and she takes a nap. When Auntie V wakes in the early afternoon she appears agitated. One of the care staff spends some time talking to her and walking with her around the garden and this appears to reassure her. During the intake interview, Auntie V mentioned she was a member of the local community choir and enjoys singing and listening to gospel music. Before they leave to assist someone else, the care worker puts on a CD of gospel music for Auntie V and they hear her singing softly to herself.
After the evening meal, consumers at the Centre can choose from a range of activities. Some enjoy sitting out on the covered verandah watching the community activity, others like to watch TV in the lounge area or in their bedrooms. Sitting around a fire pit and yarning is also a popular activity. After catching up with an old friend who now lives at the Centre, Auntie V decides to retire to her room for the night. During her intake interview, Auntie V stated she preferred to have a shower in the evening. In line with cultural protocols, a female care worker comes to assist Auntie V with her personal care tasks, however Auntie V feels too tired to shower. The care worker instead helps Auntie V prepare for bed, reassuring her that she can shower in the morning.
Auntie V soon settles into the daily routine at the Centre, enjoying the opportunity to catch up with old friends and the relaxing surroundings of the Centre. She enjoys the friendliness of the staff and the way they understand and meet her needs. When her family comes to pick her up, Auntie V asks the Manager if she can come back again next Christmas.
Case Study 3
Mr H migrated to Australia from Iraq as a refugee. After his wife died and his son returned to Iraq, he had difficulty looking after himself but did not want to live alone, so moved into a new residential aged care home on the outskirts of the city. He is a devout Muslim who prays five times a day. Praying times often coincide with meals and other services, which the staff find hard to understand and accommodate. Mr H feels belittled by their casual comments about his religious practice and distanced from the other consumers, none of whom share his faith. In his old neighbourhood Mr H had spiritual guidance from a local imam. Since being at the home, he has been out of touch with the imam and his community and this is causing him great distress. His religious faith and practice is an important part of his identity and culture and central to his wellbeing, but his care provider is not helping him to meet this need.
The doctor tells a senior manager that Mr H’s mental and physical health are likely to decline sharply if he remains unhappy and isolated. The manager acknowledges the home has excellent facilities but has been finding it difficult to recruit people who are culturally competent. After discussing the situation with the homes parent organisation and then with Mr H and (by email) his son, she gets him put on a high priority waiting list for a place in one of the organisation’s other homes. It is closer to Mr H’s old community and has more culturally skilled staff and diverse residents. In the meantime, she contacts Mr H’s former imam and arranges for Mr H to visit the mosque regularly and keep in touch with the imam by phone.
At the same time, the Human Resource team reviews the recruitment and training process. Cultural competence workshops are also arranged for all staff, including one focusing on Muslim cultural practices to reflect the community they are located within. Individual staff are also encouraged and supported to enrol in external training that will increase their understanding of diverse cultures and faiths.
In retrospect the home recognises that it should have been more transparent about how deficits in staff knowledge about the Muslim faith and the fact he would be the only individual of that faith in the home may impact his sense of belonging. Providing Mr H with this information at the start would have allowed him to make a more informed choice about which home would be able to meet all his needs, including his spiritual needs.
Case Study 4
Soon after moving into residential aged care, Mrs S has an assessment to identify ways to help her with adjusting to her new environment. During this assessment Mrs S tells the care manager that while she is ‘not spiritual’ and not sure what her religious beliefs are, when she lived by herself and was still able to drive she had gone to church most Sundays. The care manager asks Mrs B some open questions to find out what church meant to Mrs S personally, the and learns that the weekly services were an opportunity to connect with her community, see people she knew and identified with, and to help others by playing the church organ and visiting members of the congregation who were unwell.
Mrs S says she doesn’t mind missing the sermons but does miss the sense of inner peace and connection with ‘something out there’ she felt during silent prayer time. She adds that she regrets not being able to keep in touch with her church community or make the contributions that gave her a sense of purpose and value. After hearing this, the care manager asks if she can look into and help arrange some opportunities to help Mrs S stay connected with her old church. Mrs S is pleased about this and also interested in the suggestion that she consider volunteering her skills as a pianist to accompany the residents’ choir. After introducing Mrs S to the choir organisers, the care manager takes her to see the prayer and meditation room, gives her a program showing when the regular services and meditation groups are held and when the space is free for individual use.