11
Flying Solo:Flying Solo:
Living at home alone Living at home alone
with dignitywith dignity
Perth Home Care Services
Wendy Francis
22
ContentsContents
Overview of ProgramOverview of Program
Comparison of OutcomesComparison of Outcomes
Case StudiesCase Studies
Success Factors and ChallengesSuccess Factors and Challenges
FutureFuture
33
HistoryHistory
Dementia specific CACPDementia specific CACP’’s s
People living alone with memory lossPeople living alone with memory loss
No voice and highly vulnerableNo voice and highly vulnerable
Programs operating in NSWPrograms operating in NSW
Application HACC Social Support 2005Application HACC Social Support 2005
Extension to other areas 2006Extension to other areas 2006
44
Client GroupClient Group
Person having difficulty remembering, Person having difficulty remembering,
making decisions, thinking through making decisions, thinking through
complex ideas, carrying out practical tasks, complex ideas, carrying out practical tasks,
retaining information and acquiring new retaining information and acquiring new
skillsskills
Diagnosis of dementia not necessaryDiagnosis of dementia not necessary
Living alone or with person who lacks Living alone or with person who lacks
capacity to care; e.g. also has dementiacapacity to care; e.g. also has dementia
55
Key Aspects of ProgramKey Aspects of Program
1. Relationship and Community1. Relationship and Community
2. Monitoring2. Monitoring
3. Support Workers3. Support Workers
66
Relationship and Relationship and
CommunityCommunity
Person Centred Care, social history, interests, Person Centred Care, social history, interests,
roles, strengths and capacitiesroles, strengths and capacities
Trust and rapport, clientTrust and rapport, client’’s ease determines s ease determines
the progress and direction of the servicethe progress and direction of the service
Link to meaningful activities; e.g. art classes, Link to meaningful activities; e.g. art classes,
library, swimming, previous networkslibrary, swimming, previous networks
Support and educate familiesSupport and educate families
77
MonitoringMonitoring
Nutrition: meal preparation, MOWNutrition: meal preparation, MOW’’ss
Medication: management, Webster packsMedication: management, Webster packs
Personal Care: presentation, hygiene, Personal Care: presentation, hygiene,
continencecontinence
Bill paying, shoppingBill paying, shopping
Appointments: i.e. GP, eyes, hearing, clinicsAppointments: i.e. GP, eyes, hearing, clinics
Household management Household management
OSHOSH
88
Hours of ServiceHours of Service
Range: 10 minutes to 5 hoursRange: 10 minutes to 5 hours
Average 3 hours per weekAverage 3 hours per week
Services coalesce around specific events; i.e. Services coalesce around specific events; i.e.
GP, hospital, dental, appointments, home GP, hospital, dental, appointments, home
maintenance, ill health, transitions to other maintenance, ill health, transitions to other
services, linkage to new activitiesservices, linkage to new activities
99
AssessmentAssessment
Formal assessment with family or referral Formal assessment with family or referral
sourcesource
Informal meeting with client via positive Informal meeting with client via positive
personperson
Coordinator or family introduce support Coordinator or family introduce support
workerworker
1010
ExitExit
When direct sustained assistance required When direct sustained assistance required
for:for:
�� ShoweringShowering
�� Medication promptsMedication prompts
�� Meal preparation Meal preparation
Refer to ACAT for CACPRefer to ACAT for CACP
1111
Support WorkersSupport Workers
CharacteristicsCharacteristics –– empathic, non judgemental, empathic, non judgemental, flexible, problem solversflexible, problem solvers
AutonomyAutonomy -- to determine day, time and duration to determine day, time and duration of visit according to client needs and approx 7 of visit according to client needs and approx 7 clients eachclients each
LiaisonLiaison -- directly with family, role model for directly with family, role model for person enhancing communication, education, person enhancing communication, education, informationinformation
1212
StaffingStaffing
Recruitment ForumRecruitment Forum
Attitudes and values, not qualificationsAttitudes and values, not qualifications
70 Applicants: 3 successful 200570 Applicants: 3 successful 2005
2006 same process: 9 successful2006 same process: 9 successful
Attrition of 5 staff: 3 other opportunities Attrition of 5 staff: 3 other opportunities
and 2 unsuitableand 2 unsuitable
1 replaced now 8 ongoing staff1 replaced now 8 ongoing staff
1313
TrainingTraining
Training Alzheimer's Australia Effective Training Alzheimer's Australia Effective
Dementia CareDementia Care
Ongoing training, support, monthly team Ongoing training, support, monthly team
meetings, educationmeetings, education
Attendance at conferences, seminarsAttendance at conferences, seminars
1414
OutcomesOutcomes
Feb Feb ‘‘05 to Feb 05 to Feb ‘‘0606
North Metro onlyNorth Metro only
Mar Mar ‘‘06 to Mar 06 to Mar ‘‘0707
North MetroNorth Metro
East MetroEast Metro
South East MetroSouth East Metro
South West MetroSouth West Metro
1515
DemographicsDemographicsFeb Feb ‘‘0505-- Mar Mar ’’0606--
Feb Feb ‘‘0606 Mar Mar ‘‘0707
Total Total 3030 6464
YoungestYoungest 5656 6262
OldestOldest 100100 101101
Average Age Average Age 8282 7979
Males Males 55 1212
Females Females 2525 4444
With diagnosis With diagnosis 1010 3737
Without diagnosis Without diagnosis 2020 2727
Living alone Living alone 3030 6060
1616
Referral SourcesReferral SourcesFeb Feb ’’0505-- Mar Mar ’’0606--
Feb Feb ‘‘0606 Mar Mar ‘‘0707
ACATACAT 1919 5151
Psycho Geriatric Unit Psycho Geriatric Unit 33 55
HospitalHospital 22 33
Family Family 22 22
Commonwealth Carelink Commonwealth Carelink 11 00
Alzheimers WAAlzheimers WA 11 00
Other Service ProviderOther Service Provider 11 11
Existing client Existing client 11 22
1717
Time on ProgramTime on Program
2005 to 20062005 to 2006
10 Clients exited; 20 Clients ongoing10 Clients exited; 20 Clients ongoing
2006 to 20072006 to 2007
24 Clients exited; 40 Clients ongoing24 Clients exited; 40 Clients ongoing
1818
Client ExitsClient Exits
20062006 20072007
Safety issues res care Safety issues res care 22 1010
Higher level of community service Higher level of community service 3 3 1313
Falls and admission to Hospital Falls and admission to Hospital 44 00
Psycho Geriatric Unit Psycho Geriatric Unit 11 00
Family support Family support 00 11
Total 10 24
1919
Case StudyCase Study
2020
Success FactorsSuccess Factors
Client ease determines pace of relationship, Client ease determines pace of relationship,
frequency, duration of servicefrequency, duration of service
Coordinator and Support Workers person centred Coordinator and Support Workers person centred
approach, strengths, capacities, interestsapproach, strengths, capacities, interests
Establishing or improving community supports, Establishing or improving community supports,
links or networkslinks or networks
Collaboration with family, education, information, Collaboration with family, education, information,
feedbackfeedback
Tolerance around OSHTolerance around OSH
Links with referral sourcesLinks with referral sources
2121
Case StudyCase Study
2222
Challenges Challenges Physical Environment, OSHPhysical Environment, OSH
Absence of family supportAbsence of family support
Timely assessments: memory, competency, driving, ACATTimely assessments: memory, competency, driving, ACAT
Guardianship, AdministrationGuardianship, Administration
Links between GP, ACAT, Hospitals, State Administrative Links between GP, ACAT, Hospitals, State Administrative
Tribunal and Service ProvidersTribunal and Service Providers
Links with referral sourcesLinks with referral sources
CALD ATSI clientsCALD ATSI clients
Extension across agencyExtension across agency
Reaching those people without diagnosis; program application Reaching those people without diagnosis; program application
unsuccessfulunsuccessful
2323
• CommunityWest Inc overseeing Evaluation
Objectives•Evaluate the effectiveness of the DMP
•Identify key success factors and areas for improvement of the program
•Provide feedback and recommendations to the key funding body
•Identify if the program fits within the HACC framework
•Determine if DMP is a best practise model that can be adapted by other HACC funded service providers
EvaluationEvaluation
2424
Agency direction to improve knowledge and skills in Agency direction to improve knowledge and skills in linkagelinkage
Citizenship and self advocacy; learn from disability Citizenship and self advocacy; learn from disability sectorsector
Ways to reach people in early stages without Ways to reach people in early stages without diagnosisdiagnosis
Future
2525
Contact:Contact:
Wendy FrancisWendy Francis
Perth Home Care ServicesPerth Home Care Services
[email protected]@phcs.org.au