When Rachel Argaman became Opal Healthcare’s CEO in 2018, she was committed to ushering in a new era of person-centred care.
Over the last four years, the aged care provider has been on a process of transformation, implementing person-centred care principles and initiating the process of deinstitutionalisation in its aged care and dementia-specific facilities across the country.
Roseanne Cartwright, Opal Healthcare’s director of communications and sustainability, tells Aged Care News that this process began with a refined mission statement that placed each resident’s individual needs front and centre.
“[Rachel’s] mission was to really turn it into a truly customer-centred organisation, where the resident really is at the heart of everything that we do,” Cartwright says.
“For us, it’s really about treating older people the way that you would like your loved ones to be treated — it’s really as simple as that.
“It’s giving them an experience to live out the rest of their days that is going to enable them to live with meaning and purpose and dignity and belonging and all those things that are so important to the human condition, and making them feel like they’re valuable people on this earth.”
Opal Healthcare’s new, person-centred care model comprises four key domains:
Language and culture
Language change, Cartwright says, was a vital means of improving their organisation’s culture at every level.
“We had a view that in order to develop culture in an organisation, there need to be some very deliberate markers that people can recognise as the way we do things here, and one of those was language.”
The “F Word” (facility) has been done away with, with all residential services now referred to as ‘Care Communities’.
[Renaming residential services as ‘Care Communities’] speaks to our purpose: to bring joy to those we care for… We want residents to feel at home, but, also, it’s important that people understand that we’re more than just a building: we’re actually a community of peopleOpal Healthcare’s director of communications and sustainability, Roseanne Cartwright.
“That name actually came from our team,” Cartwright says.
“It speaks to our purpose: to bring joy to those we care for… We want residents to feel at home, but, also, it’s important that people understand that we’re more than just a building: we’re actually a community of people.
“It’s a community for residents, their families and visitors, but also for our staff, local GPs, allied health professionals, volunteers, and more.”
Reforming attitudes toward staff, and creating a more horizontal organisational structure, has been another powerful means of deinstitutionalising the care environment.
“We always talk about our ‘team’… we don’t want that sort of hierarchical, more institutional, structure that you have in an acute, primary care setting like a hospital, where their procedures require that.
“For us, it’s much more about that whole person care, which encompasses clinical care, obviously, but also physical, spiritual, mental, emotional, social, all those different aspects.”
“It’s a very intimate service that we provide… every team member is as important as the other for us.”
As part of this culture, aged care workers are encouraged to provide person-centred care, as opposed to impersonal, task based operations.
For us, it’s much more about that whole person care, which encompasses clinical care, obviously, but also physical, spiritual, mental, emotional, social, all those different aspects. It’s a very intimate service that we provide… every team member is as important as the other for us.
“We really encourage all of our team to connect with residents, spend time with them,” Cartwright says.
“For example, when you go into a room, if you’ve got a cup of tea for Mabel, don’t just go in and dump the cup of tea on the side table, clean and have a chat with her, see how she’s doing and if she needs help.
“So we really encourage our team to take the initiative and to build those relationships.”
Valuing residents as contributors to the Care Communities’ shared culture is another vital part of Opal Healthcare’s philosophy, Cartwright adds.
“One of my favourite [opportunities for resident involvement] is recruitment committees,” she says.
“We have residents who sit in on recruitment interviews, so that they can be the voice of the resident and they can ask the potential new team member questions.
“They always ask some really cool questions like, ‘how are you going to respect me if you work here?’”
Working alongside the University of Stirling in Scotland, Opal Healthcare have been reforming their architecture to promote the best health and wellbeing outcomes.
One key principle, aligning with recommendations to deinstitutionalise care settings, has been to divide large cohorts into smaller, closer-knit living communities.
“We’ve moved to what we call ‘Hub Culture’ — a small household model — so whilst we might have a community of 100 people, it’s sectioned into smaller communities so that people feel like they’re in a smaller household space,” Cartwright says.
“The ‘H block’ of the old, institutionalised nursing home has been done away with for a long time, and while we still do have some older care communities that are built in that style, we’re constantly renovating and reimagining some of those spaces.”
Smaller living spaces are complemented with community facilities, to provide a town-like feel to the Care Community.
“There’s the hairdresser, the Wellness Centre and the cafe, some of those social areas so that people can come together,” Cartwright says.
“The community have their own resident kitchen with these beautiful open plan kitchens where residents can help themselves and families can come and sit around the kitchen bench and make a cup of tea and that sort of thing.”
Allowing residents the freedom to bring in some of their own furniture has been another successful means of making residents’ transition to aged care better.
“We focus a lot on that transition into care, and so that means enabling residents to bring some small furniture items from their own home and personalise their room a little bit.”
Variation in lighting between areas of the Care Communities has been utilised, Cartwright adds, to balance the needs of attending nurses with the social and psychological needs of residents.
“We create softer lighting in most public areas, so that it’s a bit more flattering for people, and then, in the bedrooms, we have a lighting that’s conducive for relaxation — not blue or fluorescent lighting.
“But in the bathrooms will have a brighter light, because that’s where often the carers need to be able to see if there’s a change in skin condition, or if there’s a bruise, or any other issues.”
Valuing dignity of risk
As older persons grow more vulnerable with age, there can be a tendency for their adult children or carers to engage in what is often dubbed ‘benevolent ageism’, which is discriminating against older persons, often through limiting their agency, to prevent them harm.
Conversely, dignity of risk refers to the rights of all adults, no matter their age or ability, to make choices according to their wishes, even where there is a risk to their health.
The fact that [some of our] residents can have a drink at happy hour, go for dinner, and then sit down for an hour or two and chat and have another glass of wine like anybody would at a dinner party on a Friday evening, is really lovely.Roseanne Cartwright
Opal Healthcare has been allowing residents, except where medical advice prevents them, to engage in fun pastimes such as enjoying alcoholic beverages as part of their Friday night tradition.
“The fact that these residents can have a drink at happy hour, go for dinner, and then sit down for an hour or two and chat and have another glass of wine like anybody would at a dinner party on a Friday evening, is really lovely,” Cartwright says.
“[The residents] have been doing it for years; it’s their Friday night thing, and they get huge enjoyment out of it.
“It creates a happy care community because there’s so much laughter and great friendships.”
Extra dementia-friendly considerations
Cartwright notes that Opal Healthcare have been implementing a variety of measures to make the environment as comfortable as possible for those living in their Memory Care Neighbourhoods.
“If it’s just a locked up part of the community, it’s not really supporting memory,” Cartwright says.
“They need to be secure, but we try and create a really thriving environment inside those areas.”
Potentially distressing elements of a high-care setting, such as locked front entries, have been decorated with artwork, to minimise instances of distress.
“If we create a mural or something that’s calming, they’ll just appreciate it for what it is and not think, ‘that’s a door: I need to get out’.”
Extra labels and signs are used when needed to help prompt residents’ to engage with facilities, such as reminding them what items are stored in particular cupboards and draws.
“Those signposts are often quite helpful to encourage those self-initiated activities,” Cartwright says.
Wayfinding is really important, particularly for people living with dementia, because one of the most confronting or anxiety inducing things for an older person is to feel like they don’t know where they are and how to find their way around their own living environment.Roseanne Cartwright
But Opal has tried to find other innovative ways to facilitate wayfinding, to reduce a clinical-looking environment.
“Wayfinding is really important, particularly for people living with dementia, because one of the most confronting or anxiety inducing things for an older person is to feel like they don’t know where they are and how to find their way around their own living environment,” Cartwright says.
“We look at things like the signs that we use, because we don’t want to make our communities look like hospitals because there’s signage everywhere, so we try and create signage that uses colour-coded symbols.
“It also helps people who are maybe not able to read as well as they used to, because of their eyesight or cognition.”
Living with dementia should not deny residents of their agency, Cartwright adds, and staff should do their best to accommodate individual needs, even when it means a resident is operating on a different routine to others.
“One resident, an Eastern European gentleman, would get up at three o’clock in the morning, and he would just pace up and down the corridor, because he didn’t want to go to bed,” Cartwright recalls.
“The team’s natural response was to try and say, ‘it’s OK, go back to bed’, but he’d never wanted to.
“The team ended up having to find things to keep them occupied, whilst they explored [the behaviour] more deeply, and … it turned out that he had been a baker his whole life, and he’d gotten up that early every day since he was about 16.
“Once the team understood that, they sat down and worked out that, since he’s going to get up at three o’clock in the morning, how do we provide a safe environment for him where he’s got something meaningful to do?
“So they set up a room that was not used after 7pm, one of the activity rooms, with a few things for him to do, and so he would get up at three in the morning and he’d go into the room and occupy himself, and then he was happy as Larry.”