Residential Care
Level of Care and Services A handbook for residents outlining important information about the scope of care and services provided in our residential care centres
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Contents Introduction
3
Welcome to ECH Residential Care
4
1.
4
Care and service concepts
1.1 Concept of care
4
1.2 Choice and decision-making
4
1.3 Aged care not hospital care
5
2.
6
Administrative information
2.1
Resident Care Service Agreement
6
2.2
Information on admission
6
2.3
One contact person
7
2.4 Accounts
7
3.
Aspects of service provision
7
3.1
Activities of daily living
7
3.2
Use of the bathroom
8
3.3
‘Let Them Sleep’ Program
8
3.4
Monitoring of residents
9
3.5
Staff response
10
3.6
Staffing
11
3.7
Funding
11
3.8
Respect for others
12
4.
Personal items
12
4.1
Clothing
12
4.2
Hearing aids, spectacles and dentures
13
4.3
Insurance
13
4.4
Valuables
14
5.
Daily and social activities
14
5.1
Lifestyle activities
14
5.2
Meals
15
5.3
Providing extra food items
16
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Hairdresser
16
5.5
Church services
17
5.6
Volunteers
17
5.7
Mail and newspapers
17
5.8
Private telephone
17
5.9
Alcohol
18
5.10 Smoking
18
5.11
18
Intimacy
5.12 Pets
19
5.13 Holidays
19
6.
Health and wellbeing
19
6.1
Visits to specialists or health professionals
19
6.2
Doctor
19
6.3
Pharmacy services
20
6.4
Physiotherapy and other therapy services
20
6.5
Health and care updates
20
6.6
Infection control practices
20
7.
Safety and security
23
7.1
Bedroom furniture
23
7.2
Electric blankets, knee rugs and cushions
23
7.3
Falls and restraint
23
7.4
Fire safety
24
7.5
Placement in the Memory Support Unit
24
7.6
Room changes within the care centre
25
7.7
Use of gophers and motorised wheelchairs
25
7.8
Visitor access
25
7.9
Use of personal fridges
25
8.
Feedback and disputes
26
8.1
Raising concerns
26
8.2
Giving compliments
26
8.3
Resident forums
27
Contact information
28
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 3
Introduction This booklet provides an explanation of the level of care provided in ECH residential care centres and covers the scope of service for some of the issues that may arise during the course of a resident’s stay.
Acceptance of a placement in an ECH residential care centre implies that the resident and/or their representative have read, understood and accepted the information in this document as the scope of care and services that will be provided. However, it is acknowledged that information about every aspect of care and service is not included in this booklet. The intention is to provide sufficient information to enable a prospective resident and/or their representative to gain an understanding of the scope of service offered by ECH so they
can make an informed decision whether to accept an offer of a placement. This booklet also provides useful information for residents once they have entered an ECH residential care centre. Residential care centres accepting Commonwealth funding for the care of a resident must comply with various government acts and associated regulations which prescribe the level of care and service to be provided. The list of care and services documented in the Commonwealth Aged Care Principles is included in the Resident Care Service Agreement which a resident and/ or their representative signs upon placement in an ECH residential care centre. This list can be accessed on the Department of Health and Ageing website: www.health.gov.au. Please note: throughout this booklet there are instances where responsibility for certain items or processes etc rests with the resident. If a resident is not capable of making these decisions or completing these processes, responsibility rests with the resident’s representative and/or family.
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Welcome to ECH Residential Care We hope you will enjoy your time with us. We realise that, upon entering residential care, the first few weeks can be daunting. We also understand that each resident will cope with this in different ways. You may feel emotional or even bewildered as you adjust to life in the care centre. These feelings are normal and justifiable. Please talk with us about how you are feeling. Our team of caring professionals is here to support you through this process. Judi Coombe General Manager, Residential Care
1. Care and service concepts 1.1 Concept of care At ECH we have a Lifestyle Model of Care. This model seeks to enable each resident to maintain their optimal level of independence. If a resident is able to perform some aspects of their care themselves our staff will continue to facilitate this with them. It is not our intention to take over and make residents dependent on our staff.
An example of this is making a cup of tea or coffee. We offer all residents a cup of tea or coffee at meal times as well as at morning and afternoon tea times. However, if a resident wants a warm drink at another time and they are capable of doing this themselves, without being at any greater risk than could be expected of an older person undertaking this task, then we would encourage them to make their own. The level of care and service offered is based on a resident’s assessed needs and we provide assistance with tasks that are outside their capabilities. We provide care at a level that is reasonable and equitable, having consideration for the needs of the resident and the community of residents on an individual and collective basis. Our Lifestyle Model of Care is addressed further throughout this booklet in relation to how it applies to the various care and service aspects provided in our care centres. 1.2 Choice and decision-making Before coming into residential care, a resident could choose what information they gave to their loved ones.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 5 For example, if they experienced a fall, they could choose whether or not to tell their family. Once an older person enters residential care, some relatives or representatives consider that they should be told of every issue. However, while residents have the ability to make informed decisions they have a right to continue doing so. They will be supported to make decisions about what they want to do and what information they wish to share. Therefore, we adopt the following principles and guidelines to enable choice and decision-making while protecting a resident’s right to privacy: • Residents will be supported to make decisions and will be given the appropriate amount of time and information to do so. • The choices made by residents will be respected and adhered to. • It is acknowledged that residents have the right to make choices that may result in them sustaining harm. • For residents who are able to make an informed decision, staff will not automatically inform their family members or
representatives of information or issues regarding that resident. • Residents will be given the choice as to whether we inform their relatives or whether they wish to do it themselves, or even whether or not they share the information at all. This decision will rest with the resident. Relatives or representatives may want to be given the information, but the resident’s right to choose what is disclosed will be respected and supported. 1.3 Aged care not hospital care Residential care is provided on the basis that residents need assistance to undertake self care, not on the basis that they are sick. While we have registered and enrolled nurses in our care centres we are not a substitute for a public hospital. Nurses provide assessment and care interventions with and for residents, accessing allied health care services and providing care for daily living just as each resident would have done for themselves while living in the community.
6 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE We cannot prevent or even anticipate every illness, fall or issue that will affect the wellbeing of a resident. While we try to monitor each resident’s health issues and provide care in a manner that promotes safety and wellbeing, the process of ageing will continue. Residents have the right to move freely around the care centre if they are able and as a result of this freedom a resident may have a fall which we are not able to prevent. Coming into residential care changes the place the resident lives, not their need to keep living and enjoying life in a way that they choose in accordance with their ability. Risk taking is a part of every person’s life in the community and this right continues in residential care.
2. Administrative information 2.1 Resident Care Service Agreement On entry to an ECH residential care centre we provide residents with a Resident Care Service Agreement detailing the level of care and services they are entitled to receive. In circumstances where residents are unable to make an informed decision, their authorised
representative will be required to enter into the agreement on their behalf. Residents and/or their representatives should take full advantage of the time provided to read the agreement. If required, we recommend you seek independent advice to help understand the document’s content. Within seven days of entering the care centre an appointment will be made for the resident and/or their representative to go through and sign the agreement. Please feel free to ask questions or seek clarity about any concerns regarding this agreement. Residents and/or their representatives are required to sign this document. Signing indicates that the resident or their representative understands and will abide by the content of the agreement. 2.2 Information on admission During the admission process, residents and/or their representatives will give and receive a lot of information during what can be a very stressful time. We know from experience that it is hard for residents and/or their representatives to remember everything we have talked about during this time. Please do not
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 7 hesitate to speak to the Residential Site Manager, Care Services Manager or Business Services Manager about any concerns or queries regarding the care and services we provide. We are more than happy to discuss any issues. 2.3 One contact person We are aware that residents can have several relatives or representatives who wish to be informed about incidents or changes in their health status. On admission, the resident will be asked, if they are able to make this decision, who they wish to nominate as their contact person. In the event an issue arises that might be appropriate to communicate to a relative or other nominated person, ECH will only inform the nominated contact person. If other family members need or wish to be informed of the issue, it is the responsibility of the nominated contact person to inform them. In the event the resident is not able to nominate a contact person, the issue will be determined by legal authority (such as a Guardianship Order) or by the family. 2.4 Accounts ECH invoices on a monthly basis for the care and services provided
to residents. Each account is for services provided in the previous month. Invoices are issued on or about the fourth day of the month. Payment can be made via an automatic debit from a resident’s bank account. Please note that pharmacy and hairdressing costs are included in the monthly account at some ECH residential care centres. If the care centre does not include these invoices with the monthly account, a separate invoice will be supplied for these costs.
3. Aspects of service provision 3.1 Activities of daily living Residents will continue to undertake tasks of which they are capable and staff will assist residents with tasks they are unable to complete themselves. Personal assistance with bathing, showering, personal hygiene, continence and grooming is provided in accordance with assessed need. Staff will try to schedule showering and activities of daily living at a resident’s preferred time. Each resident is asked what time they would like to get out of bed in the morning, when they would
8 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE like to go to bed in the evening and what their lifestyle preferences are between those times. There may then be some negotiation required as our staff cannot attend to every resident first or at the same time. We try to offer assistance as close to the preferred time as possible but on occasions this will mean that a resident has to wait a little while. Our staff do try to rotate the order of attendance so everyone is assisted at their preferred time as often as possible. There will be times when a resident has a mishap and requires immediate attention and this can further disrupt the flow of care to other residents. We try to avoid having a strict routine and prefer to have a pattern to the workflow so that every day is not the same and allowances are made for the unexpected to occur. 3.2 Use of the bathroom We know that older people often have a short space of time between realising they want to use the bathroom and no longer being able to ‘hold on’. This can cause some distress if staff are not able to respond in the exact timeframe the resident would like. Staff will respond to a call for assistance as quickly as they can safely do so. Staff will not leave a
resident in an unsafe position to attend to another resident requiring assistance. Our funding and hence our staffing levels do not allow us to have a staff member waiting for a resident to express such a need and being able to respond in the same instant. We are constantly assessing the needs of residents and scheduling care to enable the best response for the individual while also being mindful of other residents’ needs. However, there will be times when a number of residents want to use the bathroom at the same time and staff need to prioritise attending to them. 3.3 ‘Let Them Sleep’ Program We have a program in place across our residential care centres to reduce sleep disturbance. Research has shown that regular turns throughout the night have a disturbing effect on the sleeping patterns of older people. This can occur because a resident may be just getting back into a deep sleep when the next turn is scheduled. In order to promote effective sleeping patterns and reduce tiredness and lethargy often experienced as a result of frequent sleep disturbance, our staff will monitor residents but try not to wake them through the night.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 9 Continence pad changes and toileting will only occur when residents wake. If a full pad does not cause the resident to wake then they will be left asleep and allowed to wake naturally. Continence assessment will be undertaken if residents regularly have a full pad on waking. With the exception of the very frail or residents assessed as being at high risk of pressure areas, staff will only change the position of residents rather than full side to side turns. Position changes will be done in a manner that causes the minimum level of disturbance possible to the resident. The position change can be as simple as placing a pillow behind the resident so they are supported on their side and later removing the pillow to lower them gently onto their back. Maintaining skin integrity is assisted by mattress technology which has made significant advances in reducing the possibility of a resident sustaining a pressure area. The special mattresses we use for very frail residents distribute pressure evenly rather than having it concentrated in one or two areas.
This program to encourage better sleep has more aspects than have been explained here. It also includes a continence management program, scheduling of activities throughout the day to promote cognitive stimulation, and the way in which night staff go about their work. Please speak with the Residential Site Manager or Care Services Manager for further information. 3.4 Monitoring of residents In general we find that residents have lived alone for many years before entering our care centres and may have only had a visitor a couple of times per week. It would have been unusual for them to be involved in a special activity every morning and afternoon, and more than likely they would have spent time watching television, looking out the window, doing a craft such as knitting or appearing to do nothing. Similarly they will have periods when they are sitting quietly on the fringes of activities within the care centre. It is not realistic to expect a resident to be involved in an activity morning and afternoon each day. We offer a range of activities, some of which will appeal to certain residents and some
10 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE of which will not. Residents can choose what they want to participate in and we will seek their input into the range of activities offered. Most residents would be exhausted if they participated in everything that was offered. Residents need time to sit quietly and reflect on times past or to observe what is going on around them. Our staff do not offer a visitor service. While they enjoy interacting with the residents, this is generally done while attending to their care needs. While relatives may not be able to visit as often as they would like, the frequency of visits is usually no different from when the resident was living in the community. We encourage residents to participate in activities but we also allow them time to be alone or apart from other residents whether in their room or in a communal area. Residents are monitored but it is not possible to have a staff member in every area for every minute that a resident may be there. Seeing a resident sitting on their own does not mean they are being neglected. Staff move through areas constantly and are always mindful of what
is happening with residents to ensure their safety and wellbeing. We are able to discreetly observe residents without them feeling like we are watching their every move. This is a community living environment where residents can choose who they associate with, what they do (or don’t do) and how they want to spend their day. Our monitoring should not be intrusive or overbearing because the residents are essentially well and still able to make decisions for themselves, even if being able to verbalise their wants is not possible. 3.5 Staff response Call bells are provided in all bedrooms, bathrooms and communal living areas. Residents may sometimes have a short wait for staff to attend to their needs. Staff are not always free to respond to a call bell immediately. It can be similar to going into a shop and waiting for the person in front of you to be served before you can be attended to. Our staff may be attending to another resident and it might not be safe to leave that resident to answer a call bell.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 11 3.6 Staffing Commonwealth funding is allocated in accordance with the assessed needs of residents. The needs of residents are assessed using a process which is regulated by the Federal Government. ECH allocates as much of the funding as possible to staffing. Agency staff are used when ECH staff are not available. If you do not readily see staff when you enter an ECH care centre it is because they are busy ensuring each resident gets the attention they require with consideration for their safety, wellbeing, privacy and care needs. Each care centre has registered nurses to perform specialised nursing duties as well as enrolled nurses and carers to perform other tasks. Housekeeping and hospitality staff provide food, cleaning and laundry services. A government specified staffing requirement does not exist. It is the responsibility of each organisation to provide a mix of staff that best meets the collective needs of their residents. 3.7 Funding Each resident is assessed under three categories: • activities of daily living covering
care needs such as showering, dressing and eating • behaviour management which covers the need for emotional support and issues such as wandering and verbal or physical aggression • complex health care for those technical aspects of care including (but not limited to) pain management, wound care and administration of medications The combined weighted score for the three categories of care attract a capped funding level. Each resident is assessed by Centrelink and their contribution to their care and accommodation costs is determined. The Federal Government provides the remaining part of the fee that is not paid for by the resident. The Centrelink assessment may also require some residents to pay an accommodation bond or accommodation charges. This is means tested. The funds retained by ECH from the accommodation bond or charge are invested and can only be used for future capital works programs such as the refurbishment or rebuilding of a care centre.
12 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE This money is not available for the day to day care of residents or operation of the care centre. 3.8 Respect for others Our staff will treat residents, and their representatives and visitors, in a respectful and kind manner. We ask that residents and their visitors also respect our staff as we expect staff to respect them. They provide exceptional care often under difficult circumstances where everyone has different needs and different expectations. In our care centres we sometimes have residents who have no understanding that they are intruding into another person’s space. At times they will enter another resident’s room and find treasures which they take back to their room, not realising they should not be doing this. This can be one of the ways that resident’s belongings go missing. We need to treat all residents with compassion and understanding. If a resident is suspected to be intruding into another person’s room, please tell staff and they will try to ensure that the resident is guided away from the room. The core values at ECH are empathy, respect and integrity, and we hope these are values that are important to residents
and their representatives as well. It is by working together that we can achieve the best outcomes. Ensuring we each feel valued for the contribution we make to the care of residents is an important factor. We understand the expectations of residents and/or their representatives will not always be met and their needs will not always be responded to in the time desired but we need residents to be mindful that we are trying to attend to everyone in the best possible way.
4. Personal items 4.1 Clothing Supply and labelling of clothing is the responsibility of the resident. ECH offers a labelling service, with costs charged to the resident, and it is recommended that residents take up this option. This is not a guarantee that clothing will not go missing or will not find its way into another resident’s wardrobe but it does reduce the incidence of this. Labels not sourced through the care centre should include the resident’s surname, initial and the name of the care centre. ECH offers a laundering service for the washing of residents’ clothes in our commercial washing
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 13 machines. We do not offer a dry cleaning service or a hand washing service. While we take care not to damage or lose clothing, it remains one of the issues that residents may encounter at some time during their stay. Clothing can become damaged due to frequent washing as we adhere to strict guidelines for laundry services. ECH does not reimburse for any damage to or loss of clothing. We recommend that residents do not bring items of clothing for everyday use that need special laundering processes. If a resident is going on an outing and they wish to wear a special or treasured item of clothing, we suggest that this be brought into the care centre on the day of or the day prior to the outing and staff will assist with dressing if required. In the event this item of clothing finds its way into our laundry and is damaged in the laundering process, we do not provide reimbursement for the damaged item. All care is taken to return clothing to the correct owner but there may be a time when an item is put in the wrong wardrobe. Our staff take care to ensure they are dressing the resident in their own clothes but there may be times when a resident is found to be wearing someone else’s clothes. Please
report this immediately to staff and we will rectify the issue as soon as possible. 4.2 Hearing aids, spectacles and dentures The purchase of hearing aids, batteries, spectacles and dentures is the responsibility of the resident. Staff will assist with changing hearing aid batteries and with putting aids in place for residents when needed. A labelling service is also offered at a cost. Some residents have a tendency to remove their hearing aids, spectacles and dentures and leave them in unknown places. They can be picked up by another resident and taken to their room which can make locating missing items very difficult for staff. Our staff will make every effort to find the missing items but there are times when we just cannot locate them. It is the responsibility of the resident to replace these items if they cannot be found. 4.3 Insurance ECH does not reimburse for damaged or missing items. We recommend that these items be included in a resident’s insurance policy if they are considering taking out personal insurance cover. Replacement of lost or damaged
14 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE personal items, including but not limited to clothing, hearing aids, spectacles and dentures, is the responsibility of the resident. 4.4 Valuables A residential care centre is a shared home environment. Visitors also come and go throughout the day. We recommend that residents keep valuables safe. Residents are provided with a lockable drawer. We request that residents use their drawer to secure their valuables (including purses and wallets). Residents can request a key for their locked drawer. For security reasons, these keys must not be copied or given to another person. Keys remain the property of ECH. If a resident plans to be absent from the care centre or is unfortunate enough to be admitted to hospital, they are required to leave their key with the Business Services Manager. The key will be securely stored during their absence. Office staff can arrange safekeeping for small amounts of cash. Please enquire about this service at reception during normal business hours. As ECH does not accept responsibility for the loss of personal items, we recommend
residents take out insurance that covers personal items.
5. Daily and social activities 5.1 Lifestyle activities A range of activities is offered in our care centres. Residents’ interests and preferences are taken into consideration and their input shapes the schedule of activities. However, we cannot offer an activity every morning and afternoon that will meet the interests of every resident. Fewer activities are offered during the weekend because residents tend to have more visitors at this time. The care centre does not receive specific funding to provide activities. Whilst under the Aged Care Accreditation Standards we are required to have activities available for residents, the legislation does not prescribe the level or type of activities. Activities come at a cost and we are mindful that these are provided from funds paid to provide for each resident’s care needs rather than social or recreational needs. Fundraising is conducted to support the activities program and we appreciate the assistance families provide with this.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 15 Some activities offered will incur a cost that is charged to a resident’s monthly account. The resident and/or their representative will be consulted about attendance at activities that incur a charge. Prior to entering residential care, very few residents will have participated in activities every morning and afternoon. Reading, listening to the radio, watching television or watching people walking past in the street may have been common pastimes. In residential care, it is not any different. Residents require quiet time and do not necessarily want to have their entire day filled with interaction and activity. Care centre staff will discuss with residents what sort of activities they wish to participate in and a program will be developed to meet their preferences. Sometimes this may mean seeking input from an external agency if we cannot meet a resident’s needs. The cost for external activities will be the responsibility of the resident. Some group activities will appeal to some residents, but it is very much a case of not being able to please everyone all of the time. 5.2 Meals Residents are provided with a
nutritionally balanced diet. Our menu is assessed by a dietitian to ensure it meets the healthy eating recommendations for older people. Meals are prepared in ECH’s own industrial kitchens by qualified chefs. We find that when a resident first moves in they will enjoy the food. However, they may reach a point where they will want to have a meal cooked the way they used to cook it. The enjoyment of not having to cook and then do the dishes eventually wears off. It is like being on holiday, after a while we tire of restaurant meals and just want what we are used to having at home. It is this sense of loss of an activity that has been a big part of a resident’s previous life that they can find hard to overcome. Meal choices are made ahead of time by residents so we can prepare the right amount of each food thereby avoiding unnecessary wastage. Menu options vary from summer to winter and residents can change their menu choice up to five days prior to the meal. We try to accommodate the needs of all residents but there will be times when there is something on the menu that is not to the taste of every resident.
16 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE The main meal of the day is served at midday and the evening meal is a light meal. Each winter or summer menu has a choice of one of two options per meal plus dessert. Residents are consulted twice a year regarding changes and improvements to menus. Preferred food brands (such as a particular brand of bread or mayonnaise) are the responsibility of the resident. Special food requirements for health reasons will be assessed and provided for by the care centre. ECH will liaise with the resident and/or their representative for culturally specific food items. 5.3 Providing extra food items While relatives and friends are able to bring in food items for a resident, it is essential that certain standards are followed. It is known that as we age our immune system gets weaker and this makes older people more susceptible to food poisoning. Additionally, the effects of food poisoning are likely to be more severe and longer lasting in older people. As the care centre has an obligation to supply food that has been prepared to strict standards, our staff are not permitted to participate in the preparation or serving of food that has not
been provided by our approved suppliers. A representative or visitor is not deemed to be an approved supplier. Therefore staff will not prepare or serve a resident any food that has not been supplied by the care centre. Food will be discarded by staff if it is considered to be a risk to the resident. The safety of food brought into a care centre for a resident is the responsibility of the person supplying the food, not the care centre staff. A ‘Guideline for the Supply of Food to Residents’ is available to guide visitors in the preparation, handling, transport and storage of food items intended for a resident. Please ask the Care Services Manager for a copy of this guideline. If a resident has any special or cultural dietary needs, these should be discussed with the Care Services Manager. It is only in extenuating circumstances that we can allow staff to participate in the preparation or serving of food that has not been provided by the care centre’s approved suppliers. 5.4 Hairdresser Each ECH care centre has provision for a hairdresser to provide services to residents.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 17 The hairdresser is an independent contractor and is responsible for operating their business within the care centre. Staff will wash a resident’s hair as necessary, but the cost of hairdressing services is the responsibility of the resident. While all care is taken to ensure staff do not wash a resident’s hair after they have been to the hairdresser, there are occasions when this may occur. If this does happen please report it to the Care Services Manager as soon as possible so we can address the issue with the staff member immediately. 5.5 Church services Times and dates of church services are displayed on notice boards around the care centre. Services are generally held in the activity room. In some of our residential care centres there is a chapel available. Please discuss individual spiritual or religious requirements with the Lifestyle Coordinator. We will work with residents so they can continue to observe their faith or attend their place of worship. 5.6 Volunteers Besides paid employees we have a team of volunteers who make a significant contribution toward the day to day social environment of
our residential care centres. They assist with a range of activities such as social events and kiosk or café management as well as providing support for outings. Our volunteers are dedicated to enriching the lives of residents. They are an incredibly important part of our team and we hope residents enjoy the special support that volunteers bring to our care centres. 5.7 Mail and newspapers Mail is delivered to residents’ rooms on weekdays. We can also post letters on residents’ behalf if required. Please speak with the receptionist about this service. Residents are required to cover the cost of stamps. To arrange delivery of newspapers, please enquire at reception. 5.8 Private telephone Every room is wired to enable each resident to have a private telephone. It is the responsibility of the resident to arrange connection of a telephone should they wish to have this service. All charges, including but not limited to connection, supply of a telephone, line rental, call costs and disconnection fees, are the responsibility of the resident.
18 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE Some residents can benefit from telephones with large numbers and buttons. These can be purchased from most telecommunication outlets and some major electrical retailers. 5.9 Alcohol There are no restrictions on the consumption of alcohol. However, any health issues affected by alcohol will be discussed with the resident so they can make an informed decision about having a drink. Residents are responsible for the cost of purchasing their own alcoholic beverages. 5.10 Smoking These days smoking is not considered to be as socially acceptable as it once was. In residential care, residents who still enjoy a cigarette often require supervision while smoking and this puts staff in a position of passive smoking which may be against their personal health choice. Therefore smoking is only permitted in the designated outdoor area. Each resident who would like to smoke will be assessed to ensure that they can safely smoke independently. If a resident is assessed as unable to safely
smoke on their own, then their representative will be informed of this assessment and it will be the responsibility of the resident’s representative to be with them and assist them if they still want to smoke. Residents assessed as not being able to smoke safely on their own will not be permitted to smoke without their representative’s supervision. Our staff may assist the resident to the designated smoking area but they are unable to stay with them while they smoke. 5.11 Intimacy Intimacy is an essential part of life for everyone including people living in residential care. The type of intimacy can take many forms, from a sense of companionship, touching and kissing, through to more intimate contact. At ECH we respect each resident’s right to associate with whomever they please and this includes their right to intimacy based on consent. For residents with dementia, our role is simply to ensure that both residents are consenting to the intimacy and this can be very evident, even for a resident with a severe level of dementia.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 19 We acknowledge that family members can struggle with their elderly relative or parent wanting a level of intimacy, particularly if this involves forming a new relationship with a fellow resident. However, the resident has a right to dignity and privacy, and therefore we will not discuss or inform the family of the resident’s intimacy activities unless there are very exceptional circumstances. 5.12 Pets Residents are not permitted to keep pets at the care centre (with the exception of approved visual assistance dogs). Pets may visit at any time provided they are restrained either by leash or in a cage, and are under control. Most of our care centres have regular visits from volunteers who bring in their pets. 5.13 Holidays Residents are entitled to 52 days social (overnight) leave each year. During these periods residents are still required to pay their accommodation and care fee charges. We ask that residents discuss their holiday plans with us. We can then assist the resident to ensure they have appropriate medications and equipment to make their holiday successful.
6. Health and wellbeing 6.1 Visits to specialists or health professionals Care centre staff will liaise with health professionals to gain access to specialist medical or health related services for residents. Occasionally, a resident may be referred to a health professional who does not visit the care centre. If this occurs, it is the responsibility of the resident to arrange transport as well as an escort to safely attend the appointment. If a resident’s representative is unable to escort them to an appointment a care centre staff member may be able to assist. This will be at the discretion of the Residential Site Manager and must be requested at least one week prior to the appointment with the time and transport costs charged to the resident. 6.2 Doctor A resident’s usual doctor may agree to visit them in the residential care centre. However, if this is not an option we can provide a list of doctors who will provide home visits. Please ask the Care Services Manager for assistance with this on entry to the care centre if required.
20 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE 6.3 Pharmacy services Staff order, store and administer prescribed and some non prescribed medications on behalf of residents. In addition to those prescribed by a resident’s doctor, we ask that residents please advise staff if they are self administering or taking any complementary or ‘over the counter’ medications. ‘Over the counter’ preparations have the potential to interact with prescribed medications. Some interactions can result in sickness or cause other medications to be less effective. Therefore, please let staff know of any other medications being taken in addition to what we are providing. 6.4 Physiotherapy and other therapy services We provide therapy services which focus on maintaining the best level of movement and function a resident is able to attain. We have access to allied health services such as dietetics, speech pathology, podiatry and occupational therapy, and these will be accessed as required. Residents receiving high level care who have been assessed by a health professional as requiring slow stream allied health services will not be required to pay for their
prescribed services. Residents receiving low level care are required to pay for allied health services. Transition Care Program clients, in accordance with the contractual requirement for this level of care, will have access to higher level therapy services than are available to permanent residential care residents. 6.5 Health and care updates ECH’s priority is the health, safety and welfare of every resident and every member of staff. We want residents to be fully informed of ECH’s control practices on numerous health matters. These include influenza, gastroenteritis and Legionella. As well as the information in this handbook, we will send health and care updates and information to you and your representatives throughout the year as part of our regular mail outs. 6.6 Infection control practices Gastroenteritis Gastroenteritis is a common infection of the stomach and intestines that results in vomiting and diarrhoea. It can be caused by a number of different viruses, such as rotavirus and norovirus, but can also be caused by bacteria, toxins,
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 21 parasites and some non-infectious diseases. Viral gastroenteritis is highly infectious and is spread by the vomit or faeces of an infected person through: • person-to-person contact, for example shaking hands with someone who has been sick and has the virus on their hands or through inhalation of aerosolised particles that occur when someone vomits • contaminated objects • contaminated food or drink Influenza Winter usually heralds the start of the flu season when residents are more susceptible to colds and other infectious respiratory illnesses. Those most at risk include, but are not limited to, people with cardiac disease, chronic respiratory illnesses, renal failure, impaired immune function and older people. Each year, around March and April, ECH care centres facilitate a ‘Fluvax’ program for residents and staff. We encourage residents and relatives to discuss the option of having an influenza vaccine injection to help protect themselves against contracting the flu.
Spread of infections In most cases, influenza and gastroenteritis are spread by a person who has symptoms. However, some people can pass on these infections even if they don’t have any apparent symptoms, particularly in the first 48 hours after recovery. We ask that visitors who have experienced an infectious illness such as influenza or gastroenteritis do not visit the facility until they have been free of symptoms for more than 48 hours. Control of infectious illnesses ECH staff practice good hand hygiene at all times and we encourage residents and visitors to use the non-water hand cleaners located throughout our care centres. Our food safety and housekeeping practices also seek to limit the spread of any virus or bacteria through effective food handling, cleaning and other hygiene methods. We also take other precautions such as ceasing group activities at a site and asking residents to remain in their rooms during an infectious outbreak. This is done to reduce the possibility of the virus spreading through resident to resident contact.
22 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE When possible, our staff will provide social interaction during this time and we will keep residents informed and post notices at the entrance to the facility asking for the co-operation of visitors. Potential restriction of visitors during an infectious outbreak As the most common method of spreading influenza and gastroenteritis is by direct contact from one person to another, from time to time we will find it necessary to limit visitors to a site if we experience an infectious outbreak. We are aware of the immense comfort that residents gain from visits from family and friends and we would not make the decision to restrict visits for a period of time unless absolutely necessary. In the event we need to restrict visitors, it is not possible to alert every family member in advance. You may arrive at the care centre to find entry is limited to visitors of terminally ill residents only. We recognise the distress and inconvenience of restricting visits and we trust that you will understand that our first obligation at all times is to ensure the health and wellbeing of our residents.
Legionella As a matter of good health practice, all ECH aged care facilities use warm water systems to prevent hot water scalding. Legionella is often found in warm water systems. The water systems of at least 70 per cent of large institutions and public buildings are colonised by Legionella. That is why ECH takes every precaution to manage any risk and continues to effectively implement Legionella control practices. Legionella is a pathogenic group of bacteria that includes the species Legionella pneumophila, which causes Legionnaire’s Disease, a serious form of pneumonia. Disease caused by this bacterium is called Legionellosis. The bacterium is common in soil, potting mix and aquatic systems including warm water systems, cooling towers, domestic cold water systems, spas, large central air conditioning systems and fountains. Legionella is rarely a threat to healthy people and tends to harm only those with a compromised immune system. This can include smokers, people with chronic lung disease, cancer, kidney failure, diabetes or AIDS and the elderly.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 23 Legionella infection can be contracted by waterborne vapour known as aerosol, which means that the aerosols must be inhaled for infection to occur. Unlike influenza and gastroenteritis, Legionella infection cannot be transmitted from one person to another. ECH maintains and regularly tests each warm water system. If Legionella is detected, warm water system experts are notified and they immediately disinfect the system. There will be notices placed near taps, showers and outlets to advise that water is temporarily unavailable. Unlike Queensland and the Northern Territory, South Australia has very comprehensive guidelines for the control of Legionella in hospitals, aged care facilities and commercial buildings. ECH follows these guidelines to control Legionella in all its residential care centres in South Australia and its Tiwi facility in the Northern Territory. ECH’s testing regime and control procedures have been assessed by a leading authority on warm water systems and meet all the requirements of South Australian legislation.
7. Safety and security 7.1 Bedroom furniture Residents can personalise their room with their own furniture. Our staff will monitor each resident’s room to ensure the furniture type and placement maintains a safe environment for both the resident and staff. It is important that furniture is able to be easily moved for cleaning purposes and by staff to enable sufficient space for a resident’s care needs. If furniture is not able to be moved or is hampering safe movement and care delivery, we will ask for the item to be removed. 7.2 Electric blankets, knee rugs and cushions Each resident has the ability to control the temperature of their room and therefore there is no need for electrically heated under blankets, knee rugs and cushions. We have found residents sometimes turn blankets on during the day and place items on the bed, creating a fire risk. 7.3 Falls and restraint It is well known that as we age we are at more risk of falls. However, contrary to popular belief, research
24 | LEVEL OF CARE AND SERVICES | RESIDENTIAL CARE has shown that using restraining devices such as bed rails and seat belts does not prevent falls and can even add to the risk of harm. Therefore, restraint is only used as a last resort when other non-restraint alternatives have been tried to no avail. Other alternatives can include devices such as alarm mats, targeted activities, low beds, concave mattresses and other resident specific strategies. The decision to use a restraining device can only be made by a registered nurse or medical officer based on a range of clinical and ethical considerations. The resident and/or their representative will also be consulted as part of the decision-making process. It should be noted that a family member or legal representative does not have the legal power to require that a resident be restrained. 7.4 Fire safety ECH residential care centres are fitted with smoke detectors, fire alarms with sprinkler systems and fire fighting equipment. Our staff test alarm systems on a regular basis. A specialist external organisation regularly checks other
fire prevention equipment and systems. We provide our staff with regular training so they can respond correctly if there is a fire. In the event the fire alarm sounds, residents must remain in their rooms or in their closest communal area and staff will come to assist with evacuation as necessary. Residents will receive regular updates at resident forums about what to do in the event of a fire. 7.5 Placement in the Memory Support Unit If required, a resident will be offered placement in the Memory Support Unit of the care centre. The Residential Site Manager will discuss the criteria in the event a resident is being offered a place in the secure area. If, after accepting a placement in the unit, the resident ceases to meet these criteria, they will be moved to a room in the open area. The resident’s representative will be consulted regarding their placement in another area of the care centre. The decision regarding whether a resident meets the criteria to remain in the Memory Support Unit is a clinical issue. Therefore, it is the role of a registered nurse to make this decision which
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 25 will be based on a range of considerations. 7.6 Room changes within the care centre Occasionally, we may consult with a resident regarding a room change. This is usually done in response to the changing needs of a resident. For example, they may require closer monitoring in a room nearer to the nurse’s station. Room changes are suggested in consideration of the needs of the wider resident community to achieve the greatest benefit for all residents. 7.7 Use of gophers and motorised wheelchairs While ECH supports the use of aids such as motorised wheelchairs and gophers to maintain a resident’s independence, we must ensure the safety of all residents in the care centre. There are many obstacles that need to be considered. For example, our more frail residents cannot get out of the way quickly to avoid a collision. The driver’s coordination, strength, vision, physical balance, rate of reaction, level of skill and cognitive and physical ability to drive safely are all important factors. Therefore, we reserve the right to prevent
residents from using these aids if, after a physiotherapist and risk assessment, it is determined that a resident does not have the essential skills and abilities required to operate a motorised mobility aid safely. 7.8 Visitor access The safety and security of our residents and staff is very important to us. Visitors must enter the care centre using the main entrance. Access is usually freely available from 8.30am to 5pm on weekdays. After hours we usually require visitors to ring the door bell (located at the main entrance) and a staff member will open the door. 7.9 Use of personal fridges The care centre provides all meals required by residents. We do not support the use of personal fridges as this poses risks for a resident if they inadvertently eat food that is out of date. Staff will not provide any foodstuffs out of a personal fridge to a resident or be responsible in any way for the cleaning, defrosting or maintenance of a personal fridge. Fridges are not to be brought into the care centre without permission from the Residential Site Manager.
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8. Feedback and disputes 8.1 Raising concerns At ECH we are very keen to develop good relationships with our residents and their representatives, and having an open dialogue about concerns by either party is an important part of this. A concern may be able to be resolved by care or ancillary staff but there will be times when the issue needs the input of a senior staff member. If this is the case, please do not assume that by telling care staff the concern will be relayed to a senior staff member. We advise that the concern should be taken directly to the Care Services Manager if about clinical issues or the Business Services Manager if about non-clinical issues. If necessary, the Residential Site Manager will become involved. Senior staff at the care centre will consult with the resident and/or their representative to achieve the best outcome for both the resident and the care centre. We will attempt to resolve the concern within three weeks or, if this is not possible, provide feedback to the complainant regarding progress toward
resolving the issue at three weeks and fortnightly thereafter. If the concern is not addressed in a timely or appropriate manner, please contact the Residential Site Manager or send a feedback form to ECH’s Corporate Office in Parkside. Forms entitled “Feedback Please” are available throughout the care centre. Most concerns are able to be resolved to the satisfaction of all parties by using our internal complaints resolution process. We are committed to achieving the best outcomes for residents and use of the internal resolution process assists in better understanding the needs of residents so services can be continually improved. 8.2 Giving compliments We are also keen to hear about things we do well. The same “Feedback Please” form can be used for providing compliments. We recognise how hard our staff work, so it is always nice to provide positive feedback to them about their contribution. Our staff are always looking for ways to make a positive difference in the lives of residents.
RESIDENTIAL CARE | LEVEL OF CARE AND SERVICES | 27 8.3 Resident forums ECH residential care centres hold regular resident forums. We encourage involvement and input from residents and/or their representatives. Our forums provide opportunities for residents to speak openly about issues concerning them or to make suggestions that improve care and services. During the forums, there will also be sharing of up to date information about general activities and events within the care centre. From time to time staff are invited to attend to provide or receive information about activities. If you decide to attend these meetings, please feel free to speak up. We welcome feedback both positive and negative. Resident feedback provides important information to enable us to improve the way we deliver care and services at ECH.
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Contact information If you require more information, please contact ECH’s Corporate Office or one of our residential care centres. ECH Corporate Office 174 Greenhill Road Parkside SA 5063 Telephone: 8407 5151
Ridgehaven Residential Care Centre Gate 3, Hazel Grove Ridgehaven SA 5097 Telephone: 8397 0100
Carinya Residential Care Centre 39 Fisher Street Myrtle Bank SA 5064 Telephone: 8130 6444
Ross Robertson Memorial Care Centre 19 Cornhill Road Victor Harbor SA 5211 Telephone: 8551 0600
Charles Young Residential Care Centre 53 Austral Terrace Morphettville SA 5043 Telephone: 8350 3600
Smithfield Residential Care Centre 1 Warooka Drive Smithfield SA 5114 Telephone: 8254 4700
Hillside Residential Care Centre 177 Longwood Road Heathfield SA 5153 Telephone: 8230 5500
Somerton Residential Care Centre Grainger Road Somerton Park SA 5044 Telephone: 8375 1500
Holly Residential Care Centre 16-24 Penneys Hill Road Hackham SA 5163 Telephone: 8392 6700
Tiwi Residential Care Centre 11 Creswell Street Tiwi NT 0810 Telephone: 8922 6600
Marten Residential Care Centre 110 Strathfield Terrace Largs North SA 5016 Telephone: 8248 9555
Walkerville Residential Care Centre 160 Walkerville Terrace Walkerville SA 5081 Telephone: 8342 8300
Our Purpose To provide quality affordable homes and support to enrich the lives of older people.
ECH Inc 174 Greenhill Road Parkside SA 5063 Telephone: 8407 5151 Country Callers: 1800 629 889 Facsimile: 8407 5130 Email: admin@ech.asn.au Web: www.ech.asn.au