A new model of care being piloted here aims to make residential centres for the elderly more like their own homes, writes MICHELLE MCDONAGH.
THE MAJORITY of older people, if given the option, would choose to stay in their own homes for as long as possible rather than go into long-term residential care. However, illness, increasing frailty and difficulty in maintaining their home can mean that long-term residential or nursing home care is the only option for some.
In a report on The Housing Needs of Older Peoplecommissioned by Age Action, Dr David Stratton noted that the loss of independence of going into a nursing home was a major factor for older people who had been used to their independence.
“One of the criticisms about such facilities is that they are not ‘home’,” he commented.
Now, a new model of care being piloted in Ireland aims to make long-term residential centres for the elderly more like their own homes – not only in terms of layout, decor and furnishings, but in allowing patients more independence and control over their own lives.
Carol McCann, director of nursing at Clonakilty Community Hospital, explains that the ‘Teaglach’ or ‘Household’ model of care, which originated in the United States, focuses totally on the patients and their needs and looks at how care can be delivered in a hospital setting reflecting, in as much as is possible, the environment of the patient’s own home.
The new approach, which is the first of its kind to be introduced in Ireland, promotes the principles of privacy, autonomy and self-determination for the older person, she says.
“To implement this model of care, a change in the physical environment is required to make the hospital more homelike. For instance, the kitchen/dining room will become the central focus of the household and every effort will be made to include the residents in the rituals of preparing and eating meals.
“For some, this may include in assisting in the preparation [maintaining domestic skills] but, for many, it may just be about the sensory and social experience that is a part of everyday family meal times. Other examples include residents having an active role in their daily routines and the reconfiguration of wards into more of a household- style unit.”
Clonakilty Community Hospital and St Oliver Plunkett’s Hospital in Dundalk have been selected as pilot sites for the Teaglach model, with funding provided under the HSE’s Innovation Fund 2008.
Long-term patients in Clonakilty Community Hospital currently spend most of their time, including meal times, either in or sitting beside their beds in cramped wards with space for only a chair and a bedside locker. Under the Teaglach model, these wards will be totally reconfigured, giving each patient extra living space as well as a separate kitchen and living room, similar to their own homes.
“The environment will mirror that of a true home and be supported by staff who will embrace the initiative of resident- directed care. This in itself is a challenge, but the funding will also include money for appropriate training for staff to be able to support this initiative. This type of care has shown to increase the quality of life for the resident and a sense of fulfilment and satisfaction for staff,” says McCann.
The household model principle has already been successfully used in the new dementia unit at the Clonakilty hospital. The unit has been carefully designed and furnished so that patients suffering from dementia feel comfortable, safe and at home there.
The unit looks and feels more like somebody’s home from 50 or 60 years ago than a residential care home for older people. In the kitchen, a group of patients sit at a table drinking cups of tea poured from a squat teapot. Chairs are set around a cosy range and old-fashioned delph lines a traditional style dresser.
Next door in the sitting room, patients can sit in front of the fire with their visitors and feel right at home with the obligatory framed photograph of Pope John Paul beaming down from above the fireplace. For often confused dementia patients, such familiar objects and furnishings can create a feeling of security.
Old-style shopfronts line the hallway, the aim being, McCann explains, to reduce the size of the corridors and to encourage reminiscence among the patients who are brought back to times past by the sight of such familiar staples as boxes of Saxa salt, a bag of Siúcra sugar, Bisto gravy and Houlihan’s sliced pan, an old Cork favourite.
The objective now is to expand this household model from the dementia unit into the general hospital population, starting with 24 patients.
“We have seen the value this model has had for our patients in the dementia unit, now we want to do it for our general patients.
“Instead of having all their meals beside their beds as they do now, the patients in the wards will be able to eat in the dining room or make a cup of tea in the kitchen if they want to,” explains McCann.
Patients will also be encouraged to bring their own belongings such as lamps, armchairs and other furnishings from their own homes to help them feel more at home in the hospital setting.
McCann says: “The idea is to have a group of people living together as part of a household and let them create the household in the way they want. They might want to decide what time they get up or go to bed, what time they have their meals or want to have input into the decor of the new unit.
“Normally, the way we work is that the power is with the staff and nurses who tell the patients what to do, so there will be a huge culture change required for the staff.”
While staff will still be looking after the clinical care of the unit’s residents, they will also be encouraged to look at each person as a whole and to take into account their life story and past experiences, not just their current illness or infirmity. Men who may have farmed all their lives will be able to do some work in the new garden space if they so wish, while women can help to bake in the kitchen.
McCann is hopeful that building work on the new unit will be completed by next April and the all-important furnishing – with the input of residents and occupational therapists – can then begin. If the pilot model is successful, she would hope to obtain funding to expand the concept to a further 24 patients and to see the model replicated nationwide.
Area co-ordinator of older person’s services in Co Louth, Brighide Lynch, explains that she shares the same vision as Carol McCann for St Oliver Plunkett’s Hospital in Dundalk, the location for the second pilot Teaglach unit.
“We feel this model will improve the quality of life as opposed to the quality of care of older persons and ensure they are able to make meaningful choices and direct their own care,” she explains.
Bessie O’Neill from Clonakilty, a resident of Clonakilty Community Hospital for the past 18 months, thinks the Teaglach model seems like a nice idea. She spends her days sitting beside her bed in the cramped ward where there is not even space for chairs for visitors.
Her daughter Elizabeth Cormican agrees enthusiastically: “I think it sounds like a very good idea. They really do need more space. There’s no privacy for patients and relatives. Sometimes it can be hard to hear each other speak with all the racket and I have to bring my mother outside to talk in private.”
Margaret O’Driscoll, also from Clonakilty, also welcomes the idea of the new unit and the badly needed increase in living space. She especially likes the idea of being able to go into the kitchen and sit at the table with a cup of tea – a simple routine she used to enjoyed in her own home.
The chief executive of Age Action, Robin Webster, says the Teaglach concept is one of many attempts – along with sheltered housing and retirement villages – to create a home environment within an institution and to reduce the distinction between being in a person’s own home and a care setting.
He notes: “This is critically important for people who are very ill going from a home they lived in for maybe 80 years, a move that can be devastating and certainly disorientating. By providing a home away from home, the move is made as smooth as possible and older people may settle in faster.”
Webster points to a move in the US towards redesigning traditional nursing homes on a group living basis which, even with additional staff, he says, need not cost any more to run than the traditional institutions.
“I think this is an encouraging move and reflects the trend towards being much more person-centred in care and sensitive to the needs of patients. The old system was to treat people in long-stay care homes as a homologous group but here, the design of the unit emphasises each person’s individuality.”