Perspectives of the community-based dementia care workforce: "occupational communion" a key finding from the Work 4 Dementia Project

Implementing Arts on Prescription at Home for People Living With Dementia: A Hybrid-Effectiveness Feasibility Study

Arts on prescription at home (AoP@Home) is a participatory art-based approach involving a professional artist engaging a person with dementia (and their family carer) in art-making in their own home. This study evaluated the implementation of AoP@Home within a real-world community aged care context. A hybrid effectiveness-implementation design was used to simultaneously test both the AoP@Home intervention and the implementation process. AoP@Home program outcomes included person with dementia and family carer (dyad) health and wellbeing, and personal goal attainment. Implementation outcomes were evaluated according to feasibility, fidelity, acceptability, uptake, and costs via routinely collected data, artist notes, and interviews with program managers, artists, and participant dyads. Four dyads completed an AoP@Home program during the study period. All participants with dementia reported improvements in their overall health and wellbeing, and wellbeing scores improved for all carers from baseline to post-program. Implementation was feasible using existing government funding mechanisms, and programs were acceptable to all stakeholders. It is possible to deliver participatory arts programs for community-dwelling people with dementia and their family, in their home, using sustainable and available funding models. Programs such as AoP@Home should be made more accessible alongside broader allied health and care services.

Implementation of an Arts at Home program for people living with dementia: Learnings from key stakeholders

ISSUE ADDRESSED

This study explores experiences of people with dementia and family carers who participated in an Arts on Prescription at Home (AoP@Home) program, artists who delivered the AoP@Home program and the managers who coordinated the AoP@Home programs.

METHODS

Semi structured interviews were conducted with the three stakeholder groups to explore experiences around implementation of AoP@Home. Interview questions were specific to each stakeholder group, and designed to capture the varied experiences around coordinating, delivering and participating in AoP@Home programs when delivered as a standard service offering. Qualitative content analysis was applied to evaluate the transcripts.

RESULTS

A total of 13 stakeholders participated in interviews: four people living with dementia and four family carers, three artists and two AoP program managers. Three overarching themes emerged across the stakeholder groups: 'what worked well', 'challenges' and 'moving forward'.

CONCLUSIONS

AoP@Home has potential as an important offering for community-dwelling people with dementia who may no longer be able to access group-based community programs. As AoP@Home is expanded, ongoing implementation monitoring and quality improvement will be essential to ensure maximal applicability of the program across the community aged care sector. SO WHAT?: The implementation of a new AoP@home service has been examined, and finds consumer satisfaction (person with dementia and their carer), and support from staff (artists and program managers). The novel nature of the service, however, requires considerable work to educate service referrers about the service and its benefits.

You clapped, you cheered, but did anybody hear? A mixed-methods systematic review of dementia homecare workers' training and psychosocial needs

The homecare sector's high turnover rate is linked to poor working conditions and a lack of person-centered practice. Limited research exists on the training and psychosocial needs of homecare workers caring for people living with dementia (PLWD). This systematic review explored these needs and identified 285 studies, of which seven studies met the inclusion criteria. A narrative synthesis identified four themes: "training and education challenges and facilitators;" "social isolation and the importance of peer support;" "emotional attachments and distress experienced by homecare workers;" and "working with families and its emotional impact on homecare workers." This review highlights the unmet educational and psychosocial needs of homecare workers and the negative impacts these unmet needs have. To improve person-centered practice in homecare, workers require dementia-specific training, and concurrent emotional and peer support, alongside support managing relationships with clients' families. Future research is required to implement an intervention to meet these needs.

The precarious resilience of aged care employees enrolled in an Australian online dementia course: A cross-sectional study of occupational health and well-being

OBJECTIVE

Australian aged care workforce surveys offer limited information about those who engage in online dementia education regarding their occupational health and well-being. A salutogenic approach was applied to an aged care context to quantitatively assess both positive and negative aspects of health at work to inform the development of workplace interventions tailored to those interested in self-development.

METHODS

Physical, psychological and occupational health were measured in an online cross-sectional survey of general health, chronic conditions, psychological distress, positive and negative affect, job satisfaction, access to workplace amenities and turnover intentions of aged care workers undertaking an online dementia course in October 2014.

RESULTS

Participants (N = 662) rated their general physical health as good and a minority experienced chronic conditions such as obesity. Overall, workers had average levels of positive and negative affect and low distress. However, 25% were likely to have a mental health condition. While most were employed on a permanent basis (80%) and reported moderate job satisfaction, 18% were likely to leave their job. There were some gaps in workplace amenities to support health and well-being: for example, 13% reported no access to lunch break areas.

CONCLUSIONS

Results suggest precarious resilience in aged care workers enrolled in an Australian online dementia course. Workplace interventions that focus on preventative health strategies are required to address the health risks associated with higher than national averages of obesity and mental health, and reduce exposure of workers to physical and psychological harms.

Mind the gap: Comparing perspectives of service providers to the needs of people with dementia living in the community

INTRODUCTION

Research with West Australian people with dementia and their carers living in the community identified that they have a diverse range of needs. However, little is known about the needs of people with dementia and their carers from the perspectives of service providers who provide formal support. This study aimed to investigate the needs of people with dementia and their carers living in the community from the perspectives of service providers, and compare this to service recipients.

METHOD

This interpretive descriptive study used focus groups to collect qualitative data from service providers (N = 10). Data were analysed using a hybrid inductive-deductive approach to compare the needs identified by service providers to those identified by people with dementia and their carers.

RESULTS

Three major themes were identified: (i) services and supports required by people with dementia and their carers should be flexible, tailored, and equitable; (ii) building capacity to support carers and people with dementia; and (iii) systems designed to care were fragmented and difficult to navigate. Service providers prioritise needs that are limited to their current capacity to provide in contrast to the holistic needs of people with dementia and their carers.

CONCLUSION

There was poor alignment between the perceived needs of people with dementia and their carers and the needs prioritised by service providers in the West Australian community. This gap may reduce the ability of services to effectively support people with dementia to remain living in the community.

Who Knows, who Cares? Dementia Knowledge among Nurses, Care Workers, and Family members of People Living with Dementia

The number of people with dementia is increasing rapidly worldwide. Commensurate with population ageing, the use of nursing homes in Australia (known as residential aged care facilities) for individuals with dementia is growing. As a terminal condition, dementia is best managed by instituting a palliative approach to care. A good knowledge of dementia, including its progression and management, among staff and families of people living with dementia is essential for clear decision making and the provision of appropriate care. Yet there is limited information regarding relative levels of dementia knowledge. This paper reports the results of a study that assessed dementia knowledge among these two cohorts using the Dementia Knowledge Assessment Tool; the study surveyed 279 staff members and 164 family members of residents with dementia. Dementia knowledge deficits were evident in both cohorts across a range of areas. It is critical that dementia knowledge deficits are identified and addressed in order to support evidence-based dementia care.

Le nombre de personnes atteintes de démence augmente rapidement à travers le monde. Ainsi on remarque en Australie une augmentation du nombre de ces malades admis dans les institutions de soins de longue durée. La démence étant une maladie terminale il appert que l'approche palliative est la meilleure forme de soins. Cependant, il est essentiel que le personnel soignant autant que les familles aient une bonne connaissance de la maladie, de ses symptomes, de la façon de traiter les maladies, et des décisions à prendre. Or, on en sait très peu quant au niveau de connaissances de ces deux groupes de personnes sur le sujet. Cet article porte sur les résultats d'une étude qui tentait d'évaluer le niveau de connaissances de 279 membres du personnel et de 164 membres des familles à l'aide de l'Έchelle d'évaluation des connaissances sur la démence. Le peu de connaissances était évident chez les deux cohortes et ce, sur un bon nombre de points. Il est donc de la plus haute importance que l'on identifie spécifiquement ces points et qu'on améliore la qualité des soins chez les personnes démentes en se basant sur des données probantes.

We are not all coping: a cross-sectional investigation of resilience in the dementia care workforce

Background

Research on workforce development for high‐quality dementia care more often focuses on enhancing employee knowledge and skill and less on managing employee stress and coping at work.

Objective

To review employee stress and coping in response to high job demands in community‐based dementia care organizations in Tasmania, Australia.

Methods

Stress and coping in response to job roles of 25 community‐based dementia care workers were reviewed using self‐report questionnaire data. Data were analysed for descriptive results and at an individual case level. Individual participant scores were reviewed for clinically significant stress and coping factors to create worker profiles of adjustment.

Results

Two adjustment profiles were found. The ‘global resilience’ profile, where workers showed positive adjustment and resilience indicating they found their jobs highly rewarding, were very confident in their abilities at work and had a strong match between their personal and organizational values. The second ‘isolated distress’ profile was only found in a minority and included poor opportunities for job advancement, a missmatch in personal and work values or clinically high levels of psychological distress.

Conclusion

Aged care workplaces that advocate employee well‐being and support employees to cope with their work roles may be more likely to retain motivated and committed staff. Future research should consider employee stress and coping at the workforce level, and how this can influence high‐quality care delivery by applying the measures identified for this study. Comparative research across different care settings using meta‐analytic studies may then be possible.