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Multipurpose Service Collaborative
ACS Northern Regions Conference 10 March 2017
Jenny Zirkler
Executive Care Manager, Nambucca Valley Care
Rural Health Executive Committee Member
Rural Health Network
Principles of Care for Living Well in Multipurpose Services
60 MPS
Background
In 2014 gaps were identified by the Australian
Commission on Safety and Quality in Healthcare
Consultancy between the National Safety and Quality
Healthcare Standards (NSQHS) and the Aged Care
Standards:
Homelike Environment
Role of the person in their own care
(person-centred)
Cognitive Impairment
Hydration and Nutrition
Leisure activities and Lifestyle
Objectives of MPS Collaborative
To enhance quality of life , lifestyle and wellbeing for
people living in Multipurpose Services through the
development and implementation of :
Principles of Care for Living Well in MPSs:
To support staff capability in providing individualised
care and a person-centred culture for residents
underpinned by person-centred care dimensions;
including staff experience, and
in alignment with Aged Care Standards Framework:
Standard 2 (Health and Personal Care)
Standard 3 (Lifestyle and Leisure)
MPS sites visitedLocal Health
DistrictMPS Build Status
Inpatient
Beds
Aged
Care
Total
BedsCo-Located
Services
Mid North
Coast LHD Dorrigo Operational 1998 – Rebuild
6 21 H/L 30 Government
Access
Southern NSW Braidwood Operational 1993- Refurb
5 27 H/L 32
Murrumbidgee Gundagai Operational 2012- Rebuild
12 18 H/L 30 MOU manage
private RAC
Western NSW Warren Operational 2000- Rebuild
12 30H/L 42 GP
Western NSW Grenfell Operational 2001- Refurb
7 28 35
Northern NSW Nimbin Operational 2004- Rebuild
7 11 18 GP
Far West NSW Balranald Operational 2010- Rebuild
8 15 23 GP
Murrumbidgee Berrigan Operational 2008- Rebuild
4 10 14 Private RAC
HNE LHD Manilla Operational 2011- Rebuild
12 40 H/L 52 GP/Health
One
HNE LHD Tingha Operational 2008- Rebuild
0 8 8 No Acute
Diagnostic Feedback
Baseline Data – Survey Results
More people are being admitted into high care due to the increase in
community support strategies.
Almost 25% MPS Residents have dementia
76% MPS have either a Diversional Therapist or Activities Officer (from
8 – 30 hrs per week)
66% have external Medication Review Process
Majority of MPS had Allied Health up to 8 hrs per week, but none had
designated hours for the Residential Aged Care Section.
30% of the MPS had an Aboriginal resident (1 or 2 residents)
0% of MPS had a structured Aged Care Specific Education calendar
Workforce – Nurses find it difficult moving between acute and RACF
(focus of care on clinical need).
1. Person Centred Care
Care Delivery
Family Involvement, independence, access to medical care,
staff respect, Resident meetings, links to community
Access to Outdoor space
Care Planning
Different documentation sets at each site - a need for standardised
aged care assessment and care plan
LHD forms and care plans are acute - not appropriate for aged care
Social Profile and Advance Care Directives
Pre-admission information; Resident Handbook, Welcome Pack
Outdoor environment
2. Leisure and Recreation
Diversional Therapist/Activities Officer hours are limited
Recurrent theme of general ‘boredom’
Lack of transport availability/access for outings
There is difficulty recruiting volunteers due to LHD policy and
aging population
There are limited or no activities offered on the weekends
3. Food and Nutrition
Pre-packaged food has a low level of satisfaction
Only 3 of the 10 MPS cooked meals on site!
Residents, carers and staff report ‘home cooked meals’ are best
Flavours, aromas, textures and choice perceived as lacking with
pre-packaged and pre-cooked
Often excessive waste reported with pre-packaged meals
Restrictions on outside food being brought in for residents
No BBQs
Menus have little variation and rotate on a fortnightly basis –
“same old every week”
3. Food and Nutrition
Pre Packaged Foods
Jams and Sauces
4. Access to Multidisciplinary Services
1. Staff resources
Limited allied health services
Physiotherapy – mobility assessments, exercise groups
Dietitian – Dietetic review for Residents
Social Work – Bereavement support
Pharmacist – Medication Review
2. Model of Care
Staff have difficulty changing from acute ‘clinical ‘ care to a
‘well’ aged care focus when working across the MPS
4. Workforce
3. Aged Care Expertise
Limited or no Aged Care specific Education
There is general anxiety around dementia care for
residents (risk)
4. Networking between MPS sites
Benchmarking and sharing of resources
Professional Development (case studies, grand
rounds, journal clubs)
A Private RACF: Reflections
All staff are required to undertake a minimum Certificate III in Aged
Care
A strong family-like environment, pet friendly, care plans reviewed
every 3 months
Emphasis on Diversional Therapy and bus outings
High level of satisfaction with meals (cooked on-site)
Similar Issues to MPS’s:
Workplace Health and Safety Policy: Food Safety
Meal time routine too restrictive:
“breakfast too late at 8am / dinner too early at 5pm”
Respect as an Individual
The resident is respected as an individual with
emphasis on rights,
quality of life and wellbeing
Informed & Involved
The resident and carer receive timely and
appropriate information
Comprehensive Assessment & Care
Planning
The resident participates in Comprehensive
Assessment and Care Planning
Homelike Environment
The resident lives in an environment which
involves freedom and choice
Recreational & Leisure Activities
The resident has access to activities that are
meaningful and maintain links to the community
Positive Dining Experience
The resident’s meals are varied, nutritious and
appetising
Multidisciplinary Services
The resident has access
to individualised care
Expertise in Aged Care
MPS leadership enables staff to develop expertise in aged care and the delivery of
resident-centred care
Principles of Care
The Resident is respected for rights as an individual
The Resident is informed and involved.
Regular Case Conferences and family involvement
Consistent rostering – build 1 on 1 relationships
Cultural shift away from acute ‘clinical’ care to individualised ‘wellness’ care
Marketing and Promotion / LHD MPS Websites
Develop generic Welcome Pack on admission / Resident Handbook pre-
admission
Resident’s meetings
Principles of Care
The Resident participates in Assessment and Care Planning
The Resident lives in a homelike environment.
‘Living’ Care Plan – Activities of daily living
Introduce top 5 / Story Boards
Develop common data set (aged care assessment, Social Profile, Advance
Care Plans)
Ready access to outdoor spaces
De-institutionalise environment (daily routines): language of ‘home’
Address physical layout of facilities to create a welcoming atmosphere
Streamline Volunteer recruitment process
Principles of Care
The Resident can access meaningful recreational and
leisure activities.
The Resident has a positive dining experience
Share activities calendars (between MPS or with private RACFs)
Maintain links to community and community transport
Certificate IV in Leisure and Health (AIN or AHA)
Meal Presentation – tablecloths, condiments on the table, smaller tables
Flexible meal times – choice and control (kitchenettes, snack cart)
Bring back the BBQ!
Principles of Care
The Resident has access to multidisciplinary services
MPS Leadership enables expertise in Aged Care
Access MBS Item Nos
Access Private Providers (Priv. Health Insurance)
Increase uptake of Telehealth (Referral and Peer support)
Quarantine Allied Health hours for RAC
Strengthen the profile of Aged Care as a Speciality - Build capability:
Minimum Cert 111 in Individualised Support
MPS Network streams – Aged Care leadership and staff education
Build relationships with private RACFs
Resources developed include:
Toolkit
MPS Principles of Care
Resource Guide
Self-Assessment Tool
Evaluation / Measurement Package
Implementation - Clinical Innovation Program $$
- Collaborative EOI September
Timeline
2016 2017
Sept
Oc
t Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
EOI Process
Pre-work with
sites
Learning Set 1 X
Action Period
1
Learning Set 2X
Action Period
2
Learning Set 3 X
Action Period
3
Closing Event X
Write up
learnings
Role and Expectations
MPS Collaborative Advisory Team
Provide subject matter expertise
Offer coaching to Collaborative teams
Be available for Collaborative teams if needed
Attend Community of Practice teleconference if needed
Assist with communique to keep Collaborative teams
connected to LHD
Review monthly reports
