Is this the future shape of aged and dementia care?

Natasha Chadwick is on a mission to reshape how older Australians are cared for.

Is this the future shape of aged and dementia care?

Edited by Janelle Ward

The founder and chief executive of NewDirection Care, Natasha Chadwick, is the 2019 Telstra Australian Business Woman of the Year. She is on a mission to reshape the way older Australians and those living with dementia are cared for when they need to move into residential accommodation.

In her acceptance speech, Ms Chadwick said: “The questions that the Australian community need to ask itself are: do we still think its okay to segregate someone who is living with dementia from other people in a secure environment – to criminalise someone who is living with a brain injury or brain disease? If you had a loved one in this situation, it’s not what you would want for them. Winning this award will shine a spotlight on my mission at NewDirection Care for radical change across all aged care.”

In this edited Q&A she did with Inside Ageing, Ms Chadwick explains her vision, the result and the hurdles she had to overcome.

Q. What does winning this award mean for you?
A.
The win means a lot as it recognises what we have done to improve the lives of the people who live in our inclusive micro-town. It also demonstrates that change and innovation, while not easy, is achievable even in the current environment.

This award also provides me with an additional platform to promote the good work we do in aged care and bring light to the fact that we still have some way to go. As a society, we need to rethink the way that both aged and dementia care is delivered, so that older Australians and people living with dementia can continue to live meaningful lives beyond their diagnosis or move to residential aged care.

What has been your motivation?
It was simply from the desire to change the way we care for elderly members of society and those living with dementia. I had been growing increasingly frustrated with the traditional institutional model of care, which is segregated and task driven and doesn’t treat residents as individuals.

They have little or no independence and are forced into regimented schedules of waking, dressing, eating and sleeping. This is simply not the way to live.

There hadn’t been significant innovations in the industry for decades. No other industry would tolerate such inertia, yet aged care is much more important because we are dealing with people’s lives.

My desire to do something radically different was reinforced by research coming out of universities and Alzheimer’s organisations around the world that revealed that the traditional way of doing things is, frankly, not helpful and that people living with Alzheimer’s can thrive when given their freedom and independence.

They do well when they have some control over their lives, are part of a community and live in familiar, home-like surroundings. Understanding this, channelled my thoughts into the best ways of making all of this happen.

Do you think the current aged care funding model supports innovation and opportunity for fresh thinking?
I think we are getting there. Certainly, within the last couple of years, there have been some encouraging signs coming from the Federal Government.  For example, in 2017 it was announced that $34 million in funding grants was to be made available to start-ups and organisations working on innovative services within the aged care space, especially those with dementia care as a key focus.

The grants were awarded to 42 projects and will cover them until June 2019.  Now, what I don’t know at the present time is whether there will be a new round of funding in the pipeline to further support innovative programs.

Australian Government expenditure on aged care was $18.1 billion in 2017–18 and is expected to increase to $22.2 billion by 2021–22, according to the Royal Commission into Aged Care Quality and Safety. The funding is made up of operational funding to support day-to-day services and capital financing to support the construction of new residential aged care facilities and the refurbishment of existing facilities. However, what I would like to see is ring-fenced funding for innovation across the entire aged care sector.

How is your facility different?
It is worlds apart from traditional aged care with its one-size-fits-all approach. Our residents are treated as individuals, not one of a crowd. There are no regimented eating times, shower times, visiting times or other fixed points in the day or week that can threaten a person’s autonomy.  

We respect the right of individuals to make their own decisions. Within each home [which accommodates seven people], residents can even choose to help with the preparation of meals, all of which are enjoyed family-style …

In traditional institutions, life seems to stop for residents once they enter the facilities … Among the other key differences are the ‘house companions’, who wear everyday clothes, not uniforms, and who provide assistance and support, operating around residents not dictating to them.

What have been the biggest hurdles in launching this concept?
There are a couple that spring to mind. The first is that there really hasn’t been a lot of support from within the industry. There are some people who have been and remain incredibly supportive of everything we are trying to do and are interested in our model of care. But then there are others who want us to fail, because success is proof that the industry itself has to change and not operate the way it has always done. 

I suppose this shouldn’t come as a surprise. There are always going to be people who are resistant to change, no matter what industry you work in, because it is too much effort for them to break the status quo.

The other hurdle I want to mention is that to make our small-scale living concept work, we needed to radically rethink and reinvent the staff model, which is very task-focused. We had to break away from it completely, which we did by inventing the multi-skilled role of the ‘house companion’. 

Our ‘house companions’ support residents as part of the family unit of each home and help with daily activities as needed. This was also a challenge initially because staff applying for positions had no reference points as the role hadn’t previously existed. However, we have devised a demanding assessment process and a five-week induction program to train them.

Do you think female leaders in aged care face unique challenges?
Yes, I do, but in my opinion they are not specific to this industry. They are exactly the same challenges that female business leaders experience in many work environments. Among the biggest challenges are the difficulty in finding enough time to build a business because of family commitments and problems sourcing financing because women are sometimes not taken seriously. The misconception persists that only males can make effective business leaders. I often hear stories of women attending trade shows and being overlooked by potential business partners or clients who assumed that a man standing at the booth was the person in charge. And, even though we live in a so-called enlightened age, earning respect in male-dominated industries can still be a struggle.

Other challenges exist because women can be their own worst enemies. This is due to several factors, from a lack of confidence and not speaking up to a fear of failure and downplaying accomplishments because of concerns of being seen as boastful. There is also the problem of imposter syndrome, that no matter how great their achievements, some women feel they don’t deserve them.

Do you think Natasha Chadwick’s aged care and dementia care model is the way of the future? Do you think sufficient funds are set aside for research into the best care models?

• YourLifeChoices has no association with any aged-care organisation but believes it is important to report on developments – or lack of them – in the sector.

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    COMMENTS

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    lynndi
    9th Jun 2019
    9:53am
    Such a hot topic. So many different types of dementia. Several friends are going through at the moment. 1st major problem is married couples and when one gets dementia and the other can't fully look after them even with help at home. There should be more couples rooms where they can stay together. For a few not all, yes this plan would work. But for someone who has seen it first hand, they like routine but need to be treated like humans. I think in large age facilities this could work as a wing but I doubt it would work for the more serious cases.
    MICK
    9th Jun 2019
    10:26am
    More feel good talk from the next champion of the aged.
    The reality is care facilities are businesses and businesses which make the most money gobble up smaller players no matter what the business. Aged care is no different, which is why the industry is a battery hen business.
    I was lucky enough to find a great care facility for my mother but I also was there every day. The staff all knew me and mum got TLC as I was on to them if anything was not right. Whilst these facilities are essentially places to go and die they can and should be required to actually 'care' for their patients. Its not as though they don't get a huge financial return for doing so. The industry should be regulated including the fees they can charge and that includes the so called fees for 'extras' which you have to agree to before you get into some places.
    Ted Wards
    10th Jun 2019
    9:05am
    HI Mick

    I'm going through this at the moment. My Dad has now ended up in hospital twice because of the neglect of the staff and they have admitted it. The trouble is they don't actually engage with the residents they placate them, entertainment them and do their job.

    The secure facilities are important for the security of the residents when they wander. Most aged care residential facilities are open and you can come and go as you please. As you can see this would present a safety issue for people with dementia who can wander.

    Yes they do rely on the families a lot and there's nothing wrong with that.
    Cheezil61
    15th Jun 2019
    11:46pm
    Well said Mick!
    Scott
    9th Jun 2019
    10:04am
    More objective information about the actual operation of this ‘aged care and dementia care model’ is warranted.
    Pity that the editor did not see fit to indicate who wrote the promo and who composed the Dorothy Dixers.
    Sundays
    9th Jun 2019
    11:59am
    How negative you people are. Natasha Chadwick should be applauded for wanting to implement different models an treat people with dementia with care and respect.
    Tom Tank
    9th Jun 2019
    12:05pm
    Very true but the standard model is aged care facilities run for profit so quality care is, in so many instances, based on maximising profit. This is achieved by minimising staffing and running costs.
    Tom Tank
    9th Jun 2019
    12:05pm
    Very true but the standard model is aged care facilities run for profit so quality care is, in so many instances, based on maximising profit. This is achieved by minimising staffing and running costs.
    MJM
    10th Jun 2019
    6:46am
    Many facilities are not for profit but this is a crock also I tried to advocate for residents making changes to diet and other things unfortunately there is such a wide gap between care and money... the bigwigs don’t care once your in they have got you.
    Sangara 45
    9th Jun 2019
    12:34pm
    It is so inspiring to hear of Natasha Chadwick’s ambition to bring this new model of care to the Aged and Dementia sufferers. Well done! I totally agree that by the time we get to our “sell by date” figuratively speaking, we should not be pidgeon holed and forgotten as individuals.
    Attitudes got to change. Change comes from the Community and from the Community it kick starts those in government and other Professional governing bodies to respond and action the changes
    Buggsie
    9th Jun 2019
    5:19pm
    Its not only dementia patients who suffer in aged care facilities. My wife went in recently for 2 weeks respite care and suffered some neglect, including isolation in her room and lack of essential toileting. As soon as I got home from hospital I visited my wife every day and the standard of care improved, particularly after a few complaints from me. Aged care facilities should be better than this, but while ever the government condones the profit motive nothing will change. As for the dementia patients in this facility, I never saw any as they were locked away out of sight. Perhaps the quality of their conditions are reflected in the time that staff spend caring for them - staff seem to be rotated in and out quite regularly presumably to minimise their own stress levels from isolation and misery.
    Circum
    9th Jun 2019
    8:10pm
    Sadly Aged care facilities are places people go to die and it is more cost effective to run the place like a zoo by reducing client options to make a difficult caring job more manageable.The usual privitisation issues arise in that the government will not provide additional funding to rectify the issue and the private owners are more likely to apply any additional funding towards profit claiming higher operating costs.So no one wins.Yes it can be very depressing visiting people in aged care and seing the dehuminising nature people are treated.Staff try their best but can only do what the system tells them to do.
    Circum
    9th Jun 2019
    8:10pm
    Sadly Aged care facilities are places people go to die and it is more cost effective to run the place like a zoo by reducing client options to make a difficult caring job more manageable.The usual privitisation issues arise in that the government will not provide additional funding to rectify the issue and the private owners are more likely to apply any additional funding towards profit claiming higher operating costs.So no one wins.Yes it can be very depressing visiting people in aged care and seing the dehuminising nature people are treated.Staff try their best but can only do what the system tells them to do.
    BillF2
    10th Jun 2019
    12:53am
    While Natasha Chadwick is undoubtedly concerned for dementia sufferers, the model she promotes appears to be only good for those who are in the early stages and aware of their surroundings. Those who are immobile or who have no recognition of family or friends are a completely different category, for whom Natasha's model would not work. Autonomy is not possible in those cases. I don't know the answer to that one, except to treat them as lovingly as possible.
    However, the one question that was not addressed, and never seems to be asked, is why there is so much dementia, and why it appears to be increasing. Is there any research into curing the condition, or at least stopping it? Treating the symptoms humanely may be a necessity, but how about some more effort into understanding why it occurs.
    MJM
    10th Jun 2019
    6:37am
    Worked in residential. And life with or without dementia stops for them. There is no independent living no choices on waking times to eat, shower etc. my children know that if they try to place me in one I will be donating to the RSPCA. I cared for a lady who after death discovered she had 11 children!!!! Only one was every present. Imagine if those 11 took a month each then foe a month placed her in respite. I was disgusted. Elderly resign themselves to going into care because the don’t want to be a burden... well I say to you be a “ burden” you deserve your family to rally around you watch your grandchildren grow up eat decent food and be cared for by people you raised. How hard is it really we sit sleep eat very little and if we have specific needs we hire nurses to assist. Dementia becomes worse once you take everything they are holding onto away.i understand we are all busy but it’s a crappy excuse.
    Cheezil61
    16th Jun 2019
    12:01am
    Yes, you are possibly right with some cases, but have you tried caring for someone like my dad who had used chainsaws & sawmills & all sorts of dangerous machinery all his life & could not understand why we were restricting him from using it & forbidding him to drive his truck or a car because he'd lost his license? Perhaps we should've let him keep using them & have my mother discover him chopped in half or receive news that he'd ran over or into someone whilst driving without the license ? He was not a happy man (& neither were we) while we were going thru this for 2 or 3 years plus before finally giving in & putting him in full time care (no nurse would've been able to manage him at home, but my 80yo mum, with our help did an amazing job of it for as long as possible). He absconded from the locked nursing home (dementia section with locked/coded doors, etc) around 10 times in the last 2 years he's been a resi there. He has been severely medicated for the last 12 months or so & the absconding has eased but he is not a very broken & sad man who rarely talks to us & can barely walk or eat, etc & it is heart-wrenching to see someone you love so dearly end their life in this way! If you have answers to how we could've done better I'm all ears (although it is too late for that now I would think). Placing him in care has been the hardest thing we have ever had to do (& we beat ourselves up over it every single day) but realistically was there a choice in this case or others like him (who could end up hurting their partners/family/carers or themselves or others)?
    Cheezil61
    15th Jun 2019
    11:45pm
    The idea is good, but the reality is that it's not always possible in practice, unfortunately. My dad became very aggressive when we had to stop him from using chainsaws, sawmill etc (advice from a nurse) & driving (mainly his truck) after losing his license (extremely difficult to do & very stressful for all involved). I'm not sure how we were going to keep him at home but we would've loved to but it would've put my mum in an early grave (& myself & siblings) with all the stress of watching him 24/7 to ensure he was safe (as well as my mum) & we had to call police help a couple of times when he took off in a rage (& got lost-he was very fit/active, physically anyway) because we restricted his use of these tools, etc (which he could've killed himself or others with if he wasn't in a good frame of mind using them). He broke out of nursing home around 10 times & was severely medicated (not sure which is worse-over medication or seeing the aggression/agitation,behaviours etc & nursing staff could not & should not have to endure the risk of harm to themselves - so what is the answer in cases like this Ms Chadwick? I wonder if you have experienced this kind of dementia & it's behaviours, etc first hand because it is definitely not all shiny & sparkly as you seem to think it is!