A care model that's less institutional and more homely

“Come in, have a biscuit.”

Without context, these five words may not seem particularly special, but for Sandeep Kandel, General Manager of Calvary’s aged care homes in the Hunter Region, hearing these words at work was a profound moment.

On a quest to make aged care less institutional, Kandel and colleagues at Calvary recently implemented a ‘Small Home’ initiative — a model of care designed to make aged care environments more homely.

Starting with the physical design and layout, the initiative first set out to better liken the facilities to a series of private dwellings. Second, to limit the number of residents in each household, so that the homes don’t get too big. Next, to abolish the ‘hierarchy’ — and associated rules — letting residents carry out their daily routines as desired.

Eleven months into piloting the project at the Cessnock facility, Kandel knew it was already a success when he was invited in for a biscuit by one of the residents.

“I had never experienced something like this from a resident, prior to the project. She invited me in as if it were her own home and offered me a cookie that she and her fellow residents had baked that day. She treated me as if I were a guest,” Kandel said.

“It was so lovely to see. It showed me that not only did she feel more at home there, but that she was seeing me for the first time as an equal, not as a manager.”

Previously — and as is commonplace in aged care throughout Australia — the facilities at Calvary had a hierarchical system. Additionally, there were a number of ‘rules’ in place, for practical reasons. Residents had to be up at a certain time for breakfast and work around the rosters of staff for various activities.

Things have changed with the Small Home initiative. Managers, staff and residents are treated as equals and residents have more say on how they live.

Adopting a ‘nothing about us without us approach’, the opinions of all residents are sought when designing new initiatives. When holding meetings, staff and residents sit in a ‘learning circle’ to reinforce the notion that everyone is equal, with each person given their turn to speak. Family members can also participate.

While some investment was required for the initial refurbishment — for things like converting larger spaces into cosier rooms — the learning circles and various other measures associated with the initiative are free, Kandel said.

“We did have some upfront construction costs, and a few ongoing training expenses, but besides that the initiative has cost very little to implement. Much of it is based on small cultural changes that make a big difference to how people feel — residents and staff alike. Even telling new people when they come in, ‘This is your home, there are no rules here!’ has had a meaningful impact,” he said.

Calvary homes are also big on seemingly small gestures. To help one resident celebrate his 60th wedding anniversary, the organisation laid on a special lunch and bought flowers for him to give his wife.

It also created an opportunity for one resident — a former World War II fighter pilot — to sit in the cockpit of a beloved Spitfire; and encouraged a couple of ‘old rockers’ to put on shows to keep their fellow residents entertained and smiling during the pandemic.

Meanwhile, to ensure visits from family and loved ones could continue safely during lockdowns, the organisation created a PPE training video.

In response to these measures, Kandel said Calvary residents in the Hunter region have reported better feelings of wellbeing, and waiting lists are now in place for many of the homes.

This comes at a time when institutions across the country are experiencing a decline in occupancy rates and, therefore, profits. As of May 2022, more than 60% of aged care homes in Australia were operating at a loss, with an average deficit of $11.34 per resident, per day. Dwindling occupancy rates have been cited as one of the main factors behind this decline.

While it is important to maintain profitability in light of the sector’s budgetary challenges, it is the social return on investment that matters most to Calvary — a charitable, not-for-profit, Catholic health care organisation, Kandel said.

“It has been so heartwarming to see residents relaxing more and behaving differently in their new home environment. We have seen vegetable gardens being planted, cookies being baked and a lot more smiling than we ever saw with the traditional set-up.

“At a time when the sector is facing so many challenges, this is certainly something to celebrate. I look forward to seeing what other measures we can introduce to keep our staff and residents happy,” Kandel concluded.

Images supplied.