Improving Quality of Life for People with Dementia: The Person-Centred Environment and Care Assessment Tool

1. Improving quality of life for people with dementia:The Person-Centred Environment and Care Assessment Tool Dr Chanel Burke RN, B.Soc.Sc., M. St (Psy)., M.Mgt, PhD

2. About dementia • World Health Organisation – Number of people living with dementia: • 2015 – 47.5 million • 2030 – 65.5 million • 2050 - 115.4 million • Currently the most common cause of severe disability in people admitted to residential aged care services in Australia. • Aged Care Act 1997 - Governing aged care standards in Australia

3. The reason for the PCECAT During my career I saw: • Inappropriate and disrespectful treatment, labels and medicating of people • Loss of dignity • Care provided was deficit focused rather than exploring how the existing skills of people with dementia could be maintained.

4. Person-centred care • Tom Kitwood – the pioneer of person-centred principles • The principles: • The person comes first - focus on person’s strengths, their remaining capabilities, individual needs • The person’s uniqueness is acknowledged – history • Staff seek to understand what the person is feeling - what staff need to do to assist the person maintain their skills • Staff’s personhood is maintained – staff needs (Kitwood 1997, Loveday & Kitwood 2000)

5. The person-centred approach Focus is on the person rather than on how dementia is affecting them D P

6. The benefits of the person-centred approach • Person-centred care has been shown to improve the well-being and quality of life of people with dementia in residential care. • Growing number of aged care services accepting person-centred approach. • Australian Government has endorsed the person-centredprinciples. BUT • No tools that link Australian Aged Care Residential Standards and Kitwood’s principles of person-centred care.

7. The development of the PCECAT • Mixed-methods approach used to develop, pilot and test the PCECAT • Delphi panel - international and national experts • Sequential data collection in 5 stages over 5 years

8. The PCECAT Person-Centred Environment and Care Assessment Tool (PCECAT) and Guidelines: • Link the Legislation and Accreditation Standards with the principles of person-centred care • Promote continuous improvement - core principle of the Accreditation Standards.

9. Aim of the PCECAT Determine: • If the home/care unit has the requisites to provide person-centred care • If services offered to people living with dementia in the home/care unit are person-centred • If the environment supports person-centred approach to care

10. PCECAT content PCECAT consists of three sections: Section A Characteristics of the home/care unit Section B Three Domains: 1. Organisational culture • Homes commitment to meeting needs of the person • Person’s awareness of home’s commitment • Consultation regarding individual needs • Staff awareness of home’s commitment • Staff efforts recognized and valued

11. PCECAT content 2. Care and activities, interpersonal relations and interactions • Care plans support unique needs • Life history • Respect for persons unique identity • Staff relationships 3. Physical layout and design of the home • Features to maintain person’s functioning • Domestic environment • Safety and security Section C Staff strategies to improve care practices and the environment

12. Assessment using PCECAT • Organisation’s documents, e.g. policies and handbook, are reviewed • Documents relating to each person, e.g. life histories and care plans are reviewed • Review Satisfaction Survey results • Interview staff • Observe interaction between staff and people living in the home • Review the design layout and physical characteristics of the home

13. At the conclusion of the assessment Managers provided with a report: • Identified strengths • Score for each domain • Opportunities for improvement

14. Anglicare – A PCECAT Case Study • 17 homes were assessed each year commencing in 2014 using the PCECAT • PCECAT results used to inform change strategies

15. Anglicare - Post-PCECAT actions 1. Implementation of Rhythm of life philosophy Everybody...... • Has a unique story • Deserves honour and respect • Will be supported in making decisions relating to their life • Will be encouraged to maintain and develop relationships that are meaningful • Will be provided with holistic care that meets their individual needs • Will be supported to feel safe, comfortable, welcome and ‘at home’ • Will have their needs and preferences acknowledged and valued • Will be shown the love of Jesus

16. Anglicare - Post-PCECAT actions (cont.) 2. Education on person-centred care 3. Dementia enabling environments 4. Agreed areas for improvement

17. Anglicare – PCECAT results

18. Comfort and choice

19. Assist wayfinding

20. Maintaining independence

21. Extended breakfast

22. Potting shed

23. Interesting gardens

24. Children’s playground

25. Conclusion Person Centred Environment and Care Assessment Tool: an effective tool to drive and assess change

26. Thank you