Podcast, Season 2 -

Activity Programs in Aged Care – A Panel Discussion

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The Aged Care Enrichment Podcast is proud to present our first panel episode. We’ve assembled our first panel with prominent guests from Australia, New Zealand and the United States to talk about activity programs and recreational therapy in aged care.

We were thrilled to have on the show:

Lee-Fay Low – Professor in Ageing and Health at the University of Sydney, and researcher in dementia care and quality of life.

Orquidea Tamayo Mortera – President of the New Zealand Society of Diversional and Recreational Therapists.

Maurie Voisey-Barlin: Creative Engagement Specialist and Practitioner, working predominantly one-one-one with aged care residents. And,

Sara Kyle and Kelly Stranburg – Principals at LE3 Solutions, consulting on the design and improvement of resident engagement programs, based in the USA.

This was a fantastic discussion with many diverse opinions, and it posed some interesting questions about activity programs in aged care. How do we build effective programs? How can we  increase engagement? What is the role of spontaneity?

It’s also interesting to hear that though the guests represent three different countries, the challenges and opportunities are very similar – and we might all find some value in looking overseas to enhance our activity program offerings.

If you enjoyed this panel episode, then great news it’s going to be a regular event! Once a month we’re bringing experts on a topic together to discuss their ideas and share them directly with you.

Transcript


Ash de Neef: Hello and welcome everybody to the aged care enrichment podcast. And welcome to our very special first panel episode. We’ve gathered a whole team and A-Team of experts on a specific topic so that we can present the ideas and discuss the, uh, the really important debates and present that directly to you.
So our crack squad for today, we’re going to go around the chat and introduce ourselves. Maurie, can we start with you?

Maurie Voisey-Barlin: Hi Ash. My name is Maurie Voicey-Barlin, and I am a creative engagement specialist. I deliver creative therapeutic weekly sessions to about 60 elders living in residential aged care. And these sessions are one-on-one. I would work with people with various stages of dementia and or people that are self isolating is primarily where I’m focused.
And of course people with distressed behaviors or reactive behaviors.

Ash de Neef: Perfect. Thanks Maurie. And Orquidea?

Orquidea Tamayo Mortera: Hello everyone. I am Orquidea and I am a registered diversional and recreational therapist in New Zealand. And my role is, as the president of the New Zealand society of DRT’s. So basically supporting around 2000 recreational therapists across the country. Yes. Thank you.

Ash de Neef: Fantastic, welcome. And Lee-Fay.

Lee-Fay Low: G’day. I’m Lee-Fay Low I’m a psychologist and professor in ageing and health at the University of Sydney. And I’m so excited to learn from everyone about how we can better engage our elders.

Ash de Neef: Fantastic. Thanks Lee-Fay and Kelly Stranburg and Sara Kyle.

Kelly Stranburg: Hello everyone. This is Kelly Stranburg, I’m principal at LE3 solutions, and we are part of a strategic consulting firm based out of Lake Mary Florida in the US.

Sara Kyle: That’s it. Sara from LE3 Solutions.

Ash de Neef: Perfect. Love it. Thanks so much everybody for joining us and let’s just jump right into it today. We’re talking about activities, engagement, leisure, and all sorts of different programming solutions for aged care of different types. And I wanted to pose a question first, maybe we’ll start with Kelly here.
This is a question about if we’re starting from scratch with an activities program in a residential care facility, or we’re looking to overhaul the existing offerings. What do you think is the very first step to consider?

Kelly Stranburg: The first step to consider is what is your community’s or your residential setting’s process to get to know the resident? And what is that process? What is the cadence that you connect with the resident? So is it day one when they move in? Those of us who worked in a community would probably tell you that’s not wise, they’re going through a lot as they transition? And then where does this information get housed. And how deep do we go?
And Sara and I continuously emphasize the need to go deeper beyond surface interests, hobbies that we need to start to get to know people on a much deeper level. But that is always where we want to start is how well do we know our residents? And what is that process?

Orquidea Tamayo Mortera: I think in my experience definitely a great point getting to know the process, the person’s life story, abilities, cognitive abilities, physical abilities, desires. I think due to the context of Aotearoa New Zealand culture definitely that’s something that it’s kind predominant in this country and the level of emotional need.
So that’s I think something that I will definitely focus on when I am looking at providing therapeutic recreation around a specific program, or just facilitating something that is meaningful for the person.

Ash de Neef: Fantastic. And if I can stay with you there Orquidea. Are we trying to present a selection of activities that will appeal to a wide number of people? Or are we trying to focus on a more specific group?

Orquidea Tamayo Mortera: I think it really depends in the place where you are facilitating. Because we have come a long way. And I believe that we’re changing the way in how we facilitate social engagement in order to enhance quality of life, which used to be just developing a timetable Monday to Friday nine to three.
That doesn’t work. Even for ourselves, that’s not the way that we work. When we go on holidays, we have choices. And it is important to actually, depending on the resources that you will have on site, to look at the numbers, to do a good assessment, to have conversations with the families.
Because at the end of the day, regardless of the program that you are going to be offering within a facility of a hundred people, you need to have the ability to provide something that is going to be meeting the needs of all those people, but at the same time, provide those one-on-one engagements.

Ash de Neef: And you mentioned there that one-on-one is going to play part of it, Maurie you’ve identified yourself as a one-on-one specialist practitioner. How do you reconcile this one-on-one versus group engagement?

Maurie Voisey-Barlin: Yeah there’s some really important points there that have raised, and particularly for Kelly who talked about surface interest and this is a really key thing. I do some very little group work and there’s reasons for that, which we can circle back to. But one-on-one is where I specialize to cater for those individual interests.
And often it’s exploratory to find out those, to get those deeper interests unearthed so that I can add to the process of how that information is collected and then how that is shared with the team, the multidisciplinary care team.
I run a review, of the program and engagement six monthly, and so this is where we bring everyone together to talk about those very things.
So my work being one-on-one is much more focused on having individual interactions for those that are self isolating, that aren’t participating in larger social group activities. And so I have to work very hard at finding time and finding the place where I can do that with individuals so that they’re not presented in a group because obviously someone that self isolates will withdraw in a group and the person that maybe is more dominant, more outgoing is likely to take over the interaction.
I do a lot of room visits and this requires some support from the team in them attending with me. So that in that way it can model to the team how I’m interacting and the way that I’m discovering the preferred interaction style of each individual. I call it the preferred interaction style, the way they like to be dealt with.

Lee-Fay Low: Listening to all the other really good ideas that people have talked about. I think we can also step back one more step further and think about how the activities program fits within the context of the life of the person. So we don’t want to think of the activities program as like a separate offering.
It should be part of clinical care. It’s part of lifestyle care. It’s part of meeting their needs. It’s not an additional extra that you check box. And how that program is embedded, in the care plans of the elders, in how staff treat them. Like not just during the activities, but afterwards and before and during other care processes, I think that’s really an important part of making a meaningful and useful activities program.
So it’s not just a calendar of events.

Ash de Neef: Great and Lee-Fay can you just double down there and explains it when you said that activities will be part of a care plan? My initial thought is, “oh is there mandatory singing at this time? Does this person need to have X, Y, and Z?” When you say careful and that’s what I think, but how do you integrate that in a more organic way?

Lee-Fay Low: If we know the person then we know how they like to interact and what their needs. And so someone might hate groups, have never wanted to be grouped, never been to a group. And would absolutely yell and kick and scream, or leave if you forced them to group singing.
And they might want someone like Marie or a friendly care worker to just chat with them or play cards with them, you know once a day, that might be what’s in their care plan.
Whereas if you have someone who’s very sociable, they might go to every single group that, that the facility offers, including groups outside the unit in which she works. And you might find her a special role as a volunteer to facilitate groups. So it’s really knowing the person. For every person, knowing that they’re getting the right types of activities and socialisation.
So not missing anyone, that’s why it should go in their care plan.

Maurie Voisey-Barlin: On that note of the care plan and going back to the preferred interaction style. If you can unlock how someone likes to interact, so I’m thinking of one particular resident that likes to create mutual mischief. And that’s, for him in his early stages of dementia, he’s quite concerned and depressed about his plight that he, as he calls it. So he likes to have a mischievous kind of interaction.
And what has happened at that service is that we’ve been playing around with that and writing letters to the manager for various things, which the manager plays along with and staff have begun to interact in that. And I’ve also been asking to read the letter. “What’s what have you written this week?”, so it becomes part of the staff initiative to join in on this interaction.
And a similar thing recently with someone that we discovered and really simply because I’m sitting there and I’m observing a lot. So I’ve got a lot of observational time, it was one of the my elders and I can use her name Laurel that’s quite okay to talk about Laurel. She’ll sit like this with her hands are tucked underneath.
But if her thumbs are out she’s cold. And she actually feels the cold more than most of us. She’s a reptile, she’s very, very cold. And we discovered this through observing her and she was being set at a really nice spot at the table, but right under the air conditioner.
So through observation and interacting with her and having her trust where I could that she was called. We’re able to say in our review, look, Laurel needs to be, have a jacket she’s colder than everybody else. And that if she does this with a thumbs, this means she’s cold. And these things come from observation as well.
And of course, this is where I think and Orquidea might have a view on this, that I think people, uh, staff care staff, and of course our activities team don’t always have the time to unlock some some of these conundrums that we get to observe.

Ash de Neef: Yeah. Fantastic. And I really liked this talk about activities that extend beyond specific timeframes. It’s not three to 3 – 3:30 is the time when we write letters, that the manager might be responding to a letter and send it back to this particular person. And it’s an ongoing sort of banter and environment that’s developing around the individual and their particular interests.
So Sara, you’ve been waiting very patiently and jumping over to – how do we use those kinds of activities? Do you have any experience in building programs that use activities that extend over a long period of time over days, weeks, anything like that?

Sara Kyle: Yeah. The one thing backing up, even a step. Lee you were talking about. Is it, there has to be the why. Why do we even have engagement and what are we trying to achieve? And so I think that becomes this first question we have to answer. But when we think about activities or opportunities, it’s about growth.
You don’t want to just do something once and then you’re done with it, but how do you start something that continues and burns on? And it draws you in, and there’s a mysteriousness to it. You don’t know exactly what’s going to happen and there’s a spontaneity.
And so when you think about activities and engagement, we stopped at this, “I tried it once, it didn’t work.” But you have to keep offering it and offering it in different ways, at different times, for different people, in a different group, one-on-one. And working through that, I think is where you learn the most. Especially through the observation, but always thinking about how do I expand upon this next time. If I’m going to offer music or art or creative curiosities of sorts, what are the next four to five after that, and what do they look like?
And when I introduce it the first time I talk about this progression. And I talk about this spontaneity or just interaction that could occur and draw you back over and over.

Ash de Neef: Fantastic. Lee-Fay, you’ve done quite a lot of research and advocacy for people living with dementia.
How do you think we can integrate activities for people living with dementia and people who aren’t living with dementia?

Lee-Fay Low: Having dementia, cognitive impairment is a continuum and definitely in residential settings and to me anyway, you need to cater for everyone. Acknowledging that most people will have some kind of cognitive disability.
I personally don’t like segregating people into with dementia and without dementia. They’re all people. And it’s our job to find, to unlock the thing that interests them. And often you’ll see beautiful friendships come out of activities because they have a shared interest.
So for example an art program, Sara was talking about you know, building that program over weeks. And we’ve seen some beautiful programs where they put on an exhibition and it doesn’t matter if you’ve got dementia or not dementia, they encourage each other, they praise each other, they laugh at what they’re doing. And art for example is also an activity that can extend beyond that block – “two to three we do art.”
Actually, if that person has access to art supplies and they love it, they can do art and drawing, through the day themselves. So we certainly do need to take into account the level of cognition that the person has, but it shouldn’t be a distinction within the group.
You’re trying to build relationship to those groups.

Ash de Neef: Fantastic. Kelly, would you like to add?

Kelly Stranburg: Yes. And I agree with you Lee-Fay, and I think when you are planning and programming that you can do programs and events where people of all abilities can attend. I think what might need to just be addressed is how do you approach people with those different abilities or cognitive impairments? When I still worked in a community that had multiple levels of care.
I think back to, I’m going to go back to singing. We would have a monthly singing group, all levels of care attended. But we just had, as the programming professionals, had to just plan accordingly. So we knew five of our residents who lived in memory care. We knew they loved music. They loved singing. We had to assign either someone from my team or somebody from nursing staff who would just go with them.
That was part of their responsibility that day, just to make sure, if they had any additional needs, they were fine, and sometimes I did that assignment. And what I found fascinating was when this group of individuals would arrive to the singing event every month, everybody else in the community was so excited and would welcome them with open arms and they would re-introduce themselves.
And, we had done a lot of work internally to coach our residents that yes, dementia or Alzheimer’s or cognitive impairment can be scary, but let’s try and educate you. So you know that you can still have these relationships with your previous friends and neighbors who maybe moved.
And so I think there’s a significant amount of opportunity when you take the time to flush all that out and educate and be proactive with your residents of all abilities. That then you can also start to stave off, maybe some misconceptions or stereotypes that go with ageing, but they’ll also go with cognitive impairment. Because it is scary, but that doesn’t mean that those individuals suffering, that aren’t still living a full, robust life and they’re happy. And so that’s what we want to also impart by bringing everybody together.

Orquidea Tamayo Mortera:
You know this is actually quite exciting being part of the conversation. Because at the end of the day we are all reflecting at our own future. It’s going to be us one day. And I think we are trying to pave ways, or to pave a good foundation for us to be able to enjoy life in the best possible way, regardless of my health or physical abilities or cognitive abilities.
But one of the things that I would like to add is that it’s not just about the programming. Yes. I do believe aas a therapeutic recreation person that there are certain ways or, probably programs that will wake up dormant abilities on people.
But at the same time, I believe that there is um, it is extremely important to have a spontaneity in aged care in these environments. I do believe that it’s important that we are all on the same page and that we all have the ability to have the permission to improvise. Which is something that when we are working with the care teams or we’re part of the multidisciplinary teams, there is this kind of barrier that that we don’t don’t feel like we have the permission, like our caregivers, to be silly. or our registered nurses, that they just have a task list that they need to complete.
But it’s not actually on the task. It’s about recognizing that engagement is actually a human right, that at the end of the day, we as humans do things for fun.
And that at the end of the day, If I am, when I hopefully touch wood, I am ninety. And I develop severe dementia and I go back to speaking in Spanish and I am going around the care home, hugging people. Someone is going to understand that’s part of my culture that hugging people, it’s actually a good thing and that is going to help me to settle down.
Instead of someone thinking, oh my goodness, she has dementia, she’s harassing people. We’re going to put a proper care plan, she’s going to be restrained, let’s give her medication.
So I think this conversation is extremely important, not just now, but it’s about how we can ensure that the knowledge that we have, what we’re sharing today, we can share with the teams in a practical way so that we can all be part of the solution.

Maurie Voisey-Barlin: That you, I love your work. I always have. And you know I’m a big fan. And I think what, what you’re talking about is incredible because we’re talking about legacy and we’re talking about our legacy because we know people say, why do I work in aged care? And basically, because I think I want it to be a bit better when I get in to be really super blunt.
And we talk about climate change and the coming, we might not see our kids might not see turtles. I kind of think that this is something that we need to fix because we are soon to go potentially into aged care and this directly will affect us. And are we happy to go into these environments that we all work in? So that’s my first point. Another point coming.
To what I think Sara talked about growth and spontaneity. Part of my work and what I try to do is to. I mean we have to remember that people are going into aged care and if we don’t have a sense of growth, then we are dying and people need to experience. We all need to experience growth.
So one of the things that I think that I like to try and bring and the team, there’s a team of us that do this work called The Outside In collective, to focus on the novel. So you have the familiar things that happened in a residential aged care service or a respite center. But then you try to create novel experiences. And these are spontaneous, you don’t know where they’re going to go.
And so my work is generative. It’s not a performance. So I use music quite a lot, but I use many other forms, particularly what I call ‘smart-assery’. Some people refer to as banter so that you create a situation, you throw a grenade into the mix with your elder and you don’t know what you’re going to get. And it provides great opportunity and no one knows what’s going to happen.
And it’s in that space of spontaneity that you talked about, Sara, where magic happens. And this is what I think can often be forgotten in a residential setting. I think we can forget that we need those spontaneous magical moments where we don’t know what’s happened.

Lee-Fay Low: One of the impediments to spontaneity is the culture in many facilities, of the checkbox or the list of things to do. And part of what we do is try and give staff permission to play, permission to connect. Work and play aren’t opposite. You can play at work. And letting staff be part of that engagement, bring their skills, their musicality, or their art, or their horse, or their child to work as part of the engagement.
That’s part of changing that culture from check boxing, to being relationships entered.

Sara Kyle: Yeah. I think that calendar approach Is so structured that it just does not leave space for organic moments when they happen. Because we have convinced ourselves that if we do things in a structured manner, that’s what people want. And there is some need for structure, but I think that is such a detriment and barrier to your point of what we’re doing and how to get better.
I think the hours, we talked about the hours all the time too. Like why do we staff it the same way we’d staff a business, why? And lastly, until we get past this notion that there’s one person or one department responsible for the idea of engagement – we have to think differently.
And someone asked the other day what does senior living look like in five or 10 years? And I said, I hope so much that there’s not an engagement department. There is not one person solely responsible for this interaction during the day, but it is just the culture and it’s a part of everyone’s job and people love doing it. It’s not a, “oh, I have to do this,” but, “I cannot wait to interact with the residents in this capacity to experience that playful, that joyfulness.”

Ash de Neef: Yeah, I got to say coming into some aged care facilities with SilVR Adventures and doing virtual reality with seniors as well, I’ve been struck when people are like, “oh the lifestyle staff aren’t here today. So we’ll do that later.” What what’s what’s that about, is sorry, the you know, the fun people aren’t here. So we’ve just got the people who are doing the clinical tasks at the moment.”
Orquidea you’re representing people who are lifestyle staff and engagement staff. How does, how do they see that kind of divide?

Orquidea Tamayo Mortera: The, you know, I think it’s something that it’s happening worldwide, so it’s not specific to New Zealand and there’s this new movement, which. It is not my intention, so I apologize in advance not being disrespectful. But we have these new movement. We’re trying to put, kind of dilute an essential role for everyone to do the same.
And look, I do strongly believe that engagement is everyone’s responsibility. But I also believe that if I am a caregiver and I am passionate actually about doing a really good job and I do relationships approach to my client. And through that, I am engaging someone that’s amazing. But if I am asking a caregiver to actually do the role of someone who absolutely is passionate about recreation, then that’s wrong, because we’re setting those people for failure. And that’s what happening now.
And you know, once again, it’s all connection, it’s about understanding, it’s about relationships. But in aged care it’s relationships before the task. If you don’t build that rapport and I’m not only talking about your work mates. But most importantly, the people that we care for or that we support, the families. How do we ensure that if I am a hundred, and I am at the end of my life, I still have a purpose.
How do I ensure that there is meaning for me? How do I ensure that people actually supporting me, regardless of your job title are helping me to feel that sense of belonging within this place, in this moment, in this time.
So to me, and look there’s plenty of research and we’re so lucky that Lee-Fay Low is here today. Plenty of research that shows that as humans, we are wired to be connected. That regardless of the stage of your life, even if it’s the last moment of your life, if you have someone holding your hand it’s going to be great, so that you can die peacefully. So I believe once again, that it is important for every single one of us today to advocate for this space in the best possible way. It is our legacy.
And most importantly, we definitely need to share this knowledge with everyone. Believe me, I am I am a pain, everywhere I go, regardless of who you are, you might be the CEO or the manager or an academic. I always make sure that I talk about engagement and I actually make them think about themselves.
What if it’s you, I don’t want you to think about the person that you are supporting. It’s you. You are a hundred, you’re at the end of your life. How would you like me to look after you? What are the things that you love doing? What did you want me to have ready for you? So just put it back to them and then you will see how the light bulb suddenly goes on.

Ash de Neef: Awesome. Hey, something that we’ve mentioned a couple of times here is this idea of having a regular daytime schedule, that activities end at three or five o’clock. And I can imagine that one barrier to this for anybody who’s programming is listening to that. They might think we don’t have the funding, or we don’t have the staffing to make that sort of thing possible.
Does anybody have any sort of solutions of how you can engage residents or care recipient at all hours of the day?

Sara Kyle: I think it goes back to recognizing that it’s not one department’s responsibility and that it is a team approach to this. And so there’s not money there. And more people are not the answer, right? You just put more people on the staff, that’s no the answer. But it’s this idea that people can recognize, I equate it to this.
If you walk into a community, you do not need to be a part of the housekeeping staff to know that there is something on the floor that needs to be picked up, right? If there is trash on the floor, you pick it up. If there’s food sitting somewhere, you pick it up. We have not gotten to that point yet that when people are just sitting idly, not engaged, staring at something that that is not necessarily the right approach. Just because they’re out of the room in common area does not constitute as engagement.
And so we have to teach people to look at what does engagement look like? Again what is the outcome of engagement? And when you start to recognize that, it’s no longer a task of, “I need you to come do this,” that’s not a part of your job because this person is also telling you please start this movie or pop the popcorn. It is, “the residents need me to facilitate something, so engagement happens.” Regardless if it’s in my exact job task or not.
And I would say that starts at management, right? If you’re a manager and you don’t come out of the office to engage residents and to show by example, this, then the staff aren’t going to do it either. It seems simple, but until we say it’s not more people it’s not expanding the department, it’s solely the responsibility of the current staff, and it can be done.

Lee-Fay Low: To riff off that, if we start to think of our activity staff as leaders, activity leaders, or clinical leaders in activity. Their jobs are to maybe to program as, figure out what things people engage with and maybe have the stuff there, the art equipment or the right music. Nut that all staff can put on the iPod or play the right song or have the right conversation with the person.
And if John gets up at nine o’clock at night and he’s going to play cards, then the deck of cards needs to be there. Not the activity staff, but that person who’s on night shift needs to know that John likes to play cards and have a hot milk at nine o’clock at night. So your activity staff, aren’t just doing the activities, but they’re the leaders and figuring out what happens and, making sure the right people know.
And there isn’t more money, but you can look at when you schedule your activity staff so that they’re on when people are wanting to be active. So many facilities have no one on the weekend, for example, or they’ll go home at three o’clock and people are really active, in the late, in late evenings. The roster can change.
And we have a lovely program where we have some of our health sciences students living and volunteering in a residential aged care facility. And they do lots of activities on the weekend. They’re not there to be clinicians, they’re there as volunteers, but they run lots of activities on the weekends and they bring the families in.
And it’s so fabulous because you’ve just got someone organizing and bringing energy to the place.

Maurie Voisey-Barlin: And it’s that energy too, that you’re talking about. I think we also think that an activity has to be led by someone up front, and then there’s a group of people that are passively consuming the activity. And I think also what we try to create often is that when I’m doing my stuff that these staff are involved in that.
And I think you talking about relationships earlier, and it’s like entertainment versus engagement. Like there’s this divide that leaders seem to lean and think you’re an entertainer. And there is a very important place for entertaining, don’t get me wrong, especially for you Ash because you’re a musician.
But, I’m looking at engagements. So when you have people playing and when I see some group activities and I know one person that does it so well is that there’s a real banter and a mix going on between the elders and the person leading activity, but also the staff coming in and joining in. And what the elders at this particular service are part of, is this playful environment that where people are actually interacting normally and playing with each other. Not walking past and having their head down and thinking, “I’m not part of that.”
So it’s the way I think the culture, the way people see their workspace and they interact, they feel like there is no license to play.
I also think that many people in my experience, don’t always know what questions to ask to get deeper than those surface interests that you talked about earlier. And I think that people also, in my experience, what I’ve seen is some people are not sure how to invite or entice people into an activity. They say, “do you want to feed the birds?” And a person itself isolates or is withdrawn or is sitting in depression is going to say, “no, I don’t want to do that.”
And it’s more like, “have you seen what’s out the window? Come look at this.” And it’s the way that you entice people into these engagements. And I think that’s a skill and not everyone has that skill. I think people, it can be modeled. And if you have the lifestyle leaders, like you talked about Lee-Fay people can model that. But it’s something that, that needs to be shared and learned.
And it’s a very difficult, it’s a very difficult skill. It comes from curiosity. I think curiosity, people talk about what’s important in this kind of work and empathy obviously is a no-brainer. But curiosity is the other thing, “what makes you tick?”
And when you try to uncover what it is that makes somebody tick, that curiosity leads, flows to authenticity. And that’s the other thing that people want. They want you to be authentically interested in who they are and genuinely interested to unlock that. And that requires you also to share some of yourself I think.

Kelly Stranburg: Maurie I’m so glad you said that about how do you effectively invite or entice people to want to be involved in different opportunities and events. But part of that, yes, I agree with you. It is a skill. It is a gift.
I had a former colleague, she was a rockstar at this. But when I think back to why she excelled at this so much and how we all tried to emulate her, she knew the residents so well. She knew what the trigger was for each and every person.
Like I remember when I started at this one community and I worked with this person, I would go up and down our assisted living hallway, knocking on doors, inviting people to come to my exercise class and I’d get a handful. Her name was Elizabeth, she would come up onto that floor and she’d be like, “oh, you should have 15 people out here. I’ll be right back.” And within minutes, I was like, “what did you say to them that I didn’t say?” And I learned from her.
And it always came back to she knew the residents so well. She knew exactly what made them tick. So she knew I could just tell this one, remind this one, ask this one, or even just say, “Hey, come on out, we’re having a bunch of people get together.” And then they come out and they’d be like, “oh, we’re exercising.” I’d be like, “sorry, you’re up, here we go.”
And that is all part of it, but that always goes back to what we’ve all been this evening the relationships. And it’s what is our process to get to know people and how deep can we go Maurie?
Sara and I always ask the question, what matters most to you today? I think sometimes in our world, people talk about, oh, the big, bucket list items. Do you want to jump out of a plane or go on this like insane trip? But we whittle it down to know what matters most today. I want to have lunch with friends. I want to go for a walk. I want to attend that painting class, whatever.
And it doesn’t need to be these big, bold things. It just means what’s going on today, that really is important to me, and I want to make sure I follow through.

Maurie Voisey-Barlin: And it’s, and the other thing too, Kelly, is that I love, I always ask, I always try to find out what drives you nuts? What is it that really annoys you because there’s a whole lot of fun in that, but there’s also, you can walk around that. You know like I hate people that honk their horns when you’re letting people in – that drives me nuts. My dad used to hate people that took up two car spaces. That was a personal thing.
What keeps you awake at night, but what’s puts you to sleep. And I think all of those things, those positive triggers that I call them, I think they are so important and all this does stem from relationship.
And that’s why I think, and I don’t mean anything against Tom Kitwood, but I think we need to move away from the idea of person centered care and come back to the term that I hear a lot more now is relationship-based care. It’s about relationship. Everything we do is built on relationship and how we relate to each other.
And again, I do think curiosity comes from that. But I mean, just to ask Kelly, like you said, that you learned from this worker, how she enticed people and invited people. How open do we think everyone is to having that modeled? And having what they do and they sit task challenged. You have to do that very delicately, right? You’re open-minded.

Kelly Stranburg: I agree. I remember when we would have interns or new employees, I would make it part of orientation, “you have to go spend two hours with Elizabeth to see how she engages and invites residents.” But again, I ended up making it a part of orientation, because it was so profound and significant.
And the people would be like, “I don’t know if I can do that. I’d be like with time, you’ll be able to, cause you’re going to get to know the residents well over time.”
You know Sara and I say this so often our work, how often do we just hit pause or stop? And ask ourselves, “what are we doing? How well do we know our folks?” And it all ties together with the schedule of the day and the calendar of offerings.
And do we need to be running around like crazy people? At one point I was even pushing for an organization, “don’t do any programs from 12:00 PM to 3:00 PM.” I know, like your face Maurie, you were like, “what?” And I was like let’s build some purposeful or intentional downtime into our day.
What do most programming people, commiserate about? I don’t have enough time to plan to do better with what I offer my residents. When is some downtime organically or naturally for residents, kind of that mid day post-lunch. So I’m like, so to me talking about how do we schedule hours that are more robust and active? I always think about mid-morning up to lunch and then late afternoon to post dinner, like into the evening.
I can’t remember who said something earlier and then I’ll stop. But I can’t recall the organization here in the United States to give them credit, but an organization came up with a night owl program and they took a full FTE or full-time employee, which is 40 hours. And they put that 40 hours into having somebody, I think, I want to say they came in around nine or 10 o’clock at night and worked until five, six o’clock in the morning to engage the people who are naturally night owls. And also engage people maybe in a memory care neighborhood or memory care community, people who get up in the middle of the night and maybe there’s wandering and different behaviors, they were addressing that.
And I found this fascinating. I would have to do some deep research to figure out who did this. But it went beautifully for this organization, and so I think the other thing is coming out of this COVID area, how can we, how can we pivot?
This is a wonderful time to look at everything we all focus on with resident engagement, in such a different fashion and come up with some new ways to approach it all.

Ash de Neef: I wanted to share something that might be interesting. My background is in music, as I’ve said a few times now, and I used to work on cruise ships and I would program the music on cruise ships.
So we would be looking at when, what times of the day people would want to hear music, what kinds of music they want to hear. And something that we experimented with in bringing in that spontaneous element was how can we surprise people throughout their night or their day on the ship? And you know, they would come out of dinner and there would be a band standing right at the door singing or something and just trying to throw new ideas at them. So this is very interesting for me to go, oh, actually, it’s quite similar in, how do you actually look at what people want and what would mimic the excitement of real life. And on that let’s take a very short break.

Welcome back everybody and we’ve been talking a lot about residential aged care at the moment. Can we can we talk about home care?

Lee-Fay Low: We started looking at this quite a few years ago when we had to change the assessment for home care, to put in a section on interests and activities. I think that’s improved now. And because home care is usually one-on-one and it’s usually the same person, each week or the same few people every week, it’s actually easier to build that relationship.
You’re in the person’s home. You can see what, what makes up their life. And as part of personal care, shopping, recreation, you can really enhance. I think it’s easier to enhance the person’s engagement when you’re one-on-one in a person’s home or in the community.
Part of it again is giving permission to the care staff, to have a laugh and have a cup of tea because their sheet says they’re here to clean the house. It doesn’t say, and you should stop and have a chat with Janine while you’re here because you’re the only person she’s seeing today. So having that permission to clean the house, but also stop for five minute cup of tea, cause it makes a big difference to the Janine. I think that’s where it’s going.
There’s not going to be much more time. So having engagement as part of the other duties is the first thing. In Australia we have consumer directed care and part of it is also educating both the care coordinators, the case managers and the elders and families., that it’s worthwhile investing in your social health.
So people will spend their money on getting the house clean. They’ll spend the money on shopping, but they seem to not want to spend their money to have someone take them out for an ice cream. Or to take them, drive them to see their friend they haven’t seen for a long time. And because that’s seen as frivolous or not essential to care.
So part of it is also I think, educating the planners and elders, that this is a really good option to improve their quality of life and they should invest their funds in that.

Sara Kyle: It’s a total well being and you can’t separate human components health versus social well being and everything else. So you can have great clinical care, but you can be lonely and devastated. You can have bad clinical care, but you can have amazing connections and relationships that can be equally important. And so it keeps going, it’s all about relationships.
But helping people to understand that your role is not just, I don’t know why we do this in aged care, but we’re so siloed and how we interact and treat or connect with people and helping. You would never do that with a child or with a middle-aged person, and so why do we separate all of that as we age?
And I think that’s a basic caregiving lesson that we, if you look at any type of education in caregiving, it’s just not there. And that play right? You lose that importance of play because it does seem juvenile or is it childlike? Is it a waste of my time?
And I think the one thing that is also missing in that home care is that same discovery Kelly and I have had the opportunity to talk with some home care agencies, providers, and that same resident discovery patient discovery is missing. And it goes straight to a list of diagnoses and conditions that I’m treating.
And so again, it has to be that foundational approach of, “who are you as a person? Clinical chart aside, who are you?”

Maurie Voisey-Barlin: What’s the social prescription, really? What needs to be socially prescribed?

Lee-Fay Low: It’s so easy. Not, not always easy, but it’s much easier in someone’s house to to get to know who they are. There’s pictures on the walls, there’s memorabilia. It’s easier to learn who they are.
And in some residential aged care facilities, so in some nursing homes, the innovative ones are starting to try and do a home visit before they admit a person to the nursing home, because that’s when you really figure out who they are before that big shock of the change.
And so I’m starting to see that not many places for they’re starting to do those visits, which is really exciting.

Maurie Voisey-Barlin: Do you think that’s the point where, so with home care, that’s the point where this, this information can be garnered and drawn in? So that it’s present when people do, if they do come into residential aged care.
Because it seems to me that, as we know, people are coming into aged care further down their journey of dementia and then their care needs. And often that’s when it’s hardest to bond and form bonds. Not only with people like myself, but with the staff and with each other.
So it seems that’s the primary time to really get your handle around the profile of who is this person? Who are they?

Lee-Fay Low: That’s the ideal Maurie, but even within the one organization, the home care team don’t really talk to the residential care team. So I haven’t seen an example, I can’t see why it couldn’t happen. That when someone moves from home care to residential care that their care worker helps them transition.
So, talks to the residential care team of what they’re interested in and what they like and might come and visit them or work on that unit for a bit, to really help them, but we don’t see any examples of that. I don’t even know if they have the same, they can share records, they can share the past care plan.
So until there’s better integration of home care and residential care so that we have what we call a warm referral, so that the staff in the one team talk to the staff and the other team with the person and their family there so that It’s a more seamless transition. You know, all that knowledge that the home care worker has just sits with them and never moves on to residential.

Maurie Voisey-Barlin: And this, I experienced this in residential as well, but of course, you know what you’re talking about, we’re talking about. This is a great area Ash, for another panel podcast. You know how to integrate.
I love the term warm referrals too, but this sharing of knowledge just is incredible. And part of, quickly part of the review that I run does try to bring all those in. Because people like the cleaners know stuff, because they’re there at different hours and they know things about people that nobody else knows. But I do get alarmed Lee-Fay, when you say that we don’t know if they talk to each other, because that seems to be a major gap.

Lee-Fay Low: Well, they don’t talk to each other within the organization often because if we try and talk to the two managers, they hardly talk to each other. So I haven’t heard of this happening. We see some of these warm handovers from hospital to nursing, home teams who know each other very well. And if they’re trying to discharge someone from hospital who perhaps has behaviors or, who needs has special needs. You’ll see the hospital team work with the nursing home team and do this warm handover. Whereas I haven’t seen any other examples of that really, and that’s unusual, but that’s happen.

Ash de Neef: I guess just to jump in now. Sorry Orquidea, just cause we’re getting close to the end of time and not the end of all time, but the end of our time today. And I just wanted to – I just wanted to open it up to you all, if you have any questions for each other? Because we have people here from Australia, New Zealand, America with various experiences and backgrounds.
Does anybody have anything they want to know about, or questions they want answered?

Sara Kyle: I wanted to ask Orquidea from your point of view, is it predominant that you have a degree professional or a rec therapist that is overseeing programming in your organizations?

Orquidea Tamayo Mortera: So we have been working on that. Things have changed in the last five years, people were not required to have a qualification, now they do. Particularly because under the ministry of health, you need to have a qualified – in New Zealand they are called diversional therapist. But it’s recreational therapy in a place where people with dementia and basically 90% of every care home will have people living with cognitive impairment or someone living with dementia.
But not only that, auditors have been working hard on trying when they go in to audit certification audits, they will ask if the recreational therapist is actually registered. So that means that is someone who is meeting national competencies, follows a code of ethics, standards of practice.
So we are trying in the country and we’re just on the baby steps to make sure that we have consistency under delivery of care. That activities is not just something to kill the time to keep people occupied, to entertain, but it’s actually a proper profession that should be valued. That’s where we are at the moment.
Something that I wanted to just quickly make a comment on regarding home care in New Zealand, there is only one place that I am aware of what they do hire recreational therapists to do education for the caregivers. Because they value the importance of training the caregivers on how, “okay you’re going to be doing tasks, but how do you do it so that you can actually facilitate and foster social engagement?” So they’re working really hard on that, and I have actually done quite a few training for the teams.
And from the New Zealand perspective, and I don’t know how much people are aware of, so we follow the Treaty of Waitangi principles and that’s embedded as part of the delivery of care that we do. So people’s culture in trying to close the gap in inequality, it’s quite strong in our country. It’s something that you just can’t get away from it. It’s about Maori people, but at the same time, people from all cultures.
So the Maori point of view, it’s about people of all cultures and how we support everyone, not just one specific ethnicity. So yeah, it’s kind of a unique place to be honest and to facilitate engagement, but we still have a lot of room for improvement. But we have a strong advocates and touching on the right, touching the right doors to the right people, it works.

Maurie Voisey-Barlin: I didn’t have anything to add on that. I was curious about what happened to divisional therapists, they seem to be disappearing from residential aged care? I recall there was more. And I feel, I want to be careful how I say this, but I felt that field that there’s a certain rigour to studying intensely, diversion.
And when I say that I mean methodologies and modalities of engagement. But I do wonder, you what’s happened to our DT’s. They don’t seem to be as prevalent in the service anymore. I don’t know if I’m right or wrong there.

Lee-Fay Low: I would agree Mauri, that we there’s certainly no requirement that we have in Australia that we have in a credited DT. DTs generally are less valued than the other at health, I think that would be reasonable. And it’s very unusual to find one, a qualified DT in a nursing home.

Maurie Voisey-Barlin: I worry about that. I think I’d mentioned that to you too before.
I just wondered if I could briefly ask about families and because anyone listening to this that is a family member, and I wondered what the others thought. Because I think families sit on this goldmine of information about their loved one, their mom, their dad, their auntie. And more often than not what I see is that this is massive, Aad I know from personal experience with my mum, that there’s this massive forms that you have to fill out to get mum and dad into the service. And then the last one at the bottom that is not required to be filled out at any point in time and often gets left is tell us about your mum or your dad.
And I know that it’s a source of frustration for a lot of activities teams, but there’s also something else that I see with families that when I asked about, “what did your dad do? What did he like?” “Oh he doesn’t like anything. He’s got dementia.” There’s a resignation to this and it’s really hard and it’s a stumbling block for the teams.
But I think, again, it comes back to asking questions because I was doing some research a while ago for a company and I started to ask what, “okay that’s cool. I understand that, but before you go, can I ask what did dad do when he came home from work?”
And it would be like, “oh, he he get into his gumboots, take his business shirt off and he get in the garden.” “Oh, what did he do?” “Oh, we had a Fern house.” “Oh we had a Fern house? “Oh ferns, orchids, he loved them.” And there it is. There’s the thing that you’re looking for.
But I think families don’t realize the goldmine of information they sit on, which can help us to understand all the things that Sara and Kelly and Orquidea and Lee-Fay have talked about is to know who this person is. And when someone is progressively along their journey of dementia, and if there may be not communicating in a way that we can understand, it’s often – if the family members don’t give you the information it’s lost, it’s not known.
And I think there’s a really big gap here too, that we could fill and finding ways of engaging families to give us those stories.

Sara Kyle: I totally agree that family is a wealth of knowledge. I think the hardest part is when you get that written content or when you get that information, where does it go? Because we can’t just keep living in notebooks. So what is the repository, exactly Kelly said at the beginning, that we can pull this information up and it’s pushed to us, to the care team rather than going to search for it in a binder.

Ash de Neef: Guys, we’ve covered so much today. This has been really fascinating, very interesting for me and great to have a new group of people together in a room, a virtual room together to talk about these ideas. Thank you so much for your time. Sara, Maurie, Kelly, Orquidea and Lee-Fay. We really appreciate it and we’ll see you soon.

Orquidea Tamayo Mortera: Thank you so much.

Sara Kyle: Thank you.

Kelly Stranburg: Thanks.

Maurie Voisey-Barlin: Thanks Ash, thanks everybody.

Lee-Fay Low: Bye!

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