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A handbook for community care services Empowering people, enhancing independence, enriching lives

Acknowledgements

This handbook has been developed by Ageing, Disability and Home Care (ADHC) using material prepared for ADHC by Alt Beatty Consulting. It is the end product of the mapping innovation and better practices initiative undertaken by ADHC as part of The Better Practice Project for Home and Community Care (HACC) in NSW.

The handbook has been made possible by the enthusiastic cooperation of HACC service providers and the many people who shared their experiences and stories. All the HACC service providers whose practice ideas and personal stories are featured have given their permission to be included, and many have provided photographs which have the permission of those pictured. The names of people who are receiving community care support are fictitious.

Every care has been taken in the preparation of this publication and the information it contains is believed to be accurate. However, ADHC does not accept any responsibility for errors, omissions, or inaccuracies.The views and information presented in this handbook are not intended as a statement of ADHC policy and do not necessarily, or at all, reflect the views or information held by ADHC, the NSW Government or the Minister for Ageing, Minister for Disability Services.

Contents

1. About this resource 2

1.1 What is the purpose of this handbook? 2

1.2 What does the handbook cover? 2

1.3 How is the handbook structured? 3

2. About an enabling approach 5

3. Key lessons 7

4. Practice ideas and personal stories 10

4.1 Achieving people’s goals 11

4.2 Building on strengths and interests 17

4.3 Connecting people with social networks 22

4.4 Restoring capacity with shortterm support 36

4.5 Improving capability with exercise, assistive 41

technology and education

5. Managing change 57

6. Demonstration Projects in NSW 65

7. Attachments 69

Attachment A Active ageing 69

Attachment B The Better Practice Project overview 70

Attachment C Fact sheets 71

Attachment D Resources from practice ideas 109

Attachment E Other resources for an 111

enabling approach

Attachment F References 115

Attachment G Organisations in this document 117

A handbook for community care services 1

About this handbook 1 1.1 What is the purpose of this handbook?

This handbook has been developed to support NSW Home and Community Care (HACC) service providers. It may be of use if you are either:

n reviewing your community care service delivery

n wanting to continually improve your support

n implementing an enabling approach, or

n wanting to keep up to date and to use evidencebased practice.

There is something here for everyone. Whether your organisation is a large, citybased multiservice provider or a small single service regional provider there is material here which can help in your goal of better serving people who require support to live at home in their community.

This handbook presents relevant practice ideas and people’s stories relating to an enabling approach. It is designed as a working handbook, for you to dip into when you need ideas, resources or contacts to help implement an enabling approach. Evidence from community care programs, both interstate and overseas, has shown that an enabling approach can help people enhance their physical functioning, their social connections, and lead to improvement in their overall personal wellbeing.

All the practice ideas have been implemented within existing funding levels. In a few cases, this has been supplemented by other resources. Where funding has been supplemented, this is indicated in the text.

The handbook focuses on enabling approaches to support older people. While an enabling approach has the potential to enhance outcomes for people of all ages who require support to live at home in their community, approximately 80 per cent of HACC clients in NSW are 65 years or over, or 50 years and over for Indigenous Australians. Additionally, a large proportion of the evidencebase supporting an enabling approach focuses on results with frail older people.

1.2 What does the handbook cover?

Practice ideas and personal stories

The handbook reviews better practice ideas, looks at managing change and includes personal stories from 50 services, showing how elements of an enabling approach are already being successfully implemented in NSW HACC services. The practice ideas represent each of ADHC’s regions in NSW, with almost half of the ideas from services based in metropolitan regions (24) and just over half from regional and rural areas (26). The selection includes both small and large services, with different supporting organisations.

2 A handbook for community care services

1 The handbook includes:

n four practice ideas from Aboriginal organisations

n six practice ideas from services supporting people from CALD (culturally and linguistically diverse) backgrounds

n 14 practice ideas about supporting people with dementia.

Fact sheets

Each of the practice ideas and personal stories in Chapter 4 has a related fact sheet (see Attachment C).

The fact sheet gives contact details for the service providing the practice idea, and provides information about the aim of the service, the target group and the auspice body.

Resources

Attachment D lists resources which these organisations have found useful. This covers links to websites, conference presentations and tools such as exercise programs and staff manuals.

Attachment E lists other resources to help in implementing an enabling approach. It includes:

n links to websites for interstate and overseas approaches

n tools such as trainthetrainer

n community education program for bilingual community educators to inform people from a culturally and linguistically diverse background about the Australian aged care system

n other websites with useful materials.

1.3 How is the handbook structured?

There are seven major sections:

1. About this handbook

2. About an enabling approach

3. Key lessons – for adopting enabling practices as shared by services in consultations for this project.

4. Practice ideas and personal stories – illustrating elements of an enabling approach

5. Managing change – strategies for moving towards an enabling approach from three NSW providers, Victoria and Western Australia.


6. Demonstration Projects in NSW – what they aim to achieve and results so far.

7. Attachments

A. Active ageing

B. The Better Practice Project overview

C. Fact sheets

D. Resources from practice ideas

E. Other resources for an enabling approach

F. References

G. Organisations in this document described, by service type, region and particular target group.


2About an enabling approach An enabling approach is a new way of supporting frail older people and people with a disability to live at home in their community. It is based on the following principles:

1. Frail older people and people living with a disability have the capacity to make gains in their physical, social, and emotional wellbeing.

2. The best outcomes for clients accessing community care occur when services are responsive to individual needs rather than being implemented on the basis of the types of services that are available.

3. An individual’s needs are best met when there are collaborative working relationships between the person, their carers and family, social networks, support workers and between service providers.

An enabling approach focuses on what the person can do and wants to be able to do, not just what they are unable to do at present. It offers people the opportunity to be actively involved in identifying goals that are important and meaningful to them and to participate alongside their support worker to achieve their goals.

Evidence from around the world shows that when well targeted and implemented, an enabling approach in community care can benefit people by building their confidence and self esteem, empowering them by their active involvement in their care needs, enhancing their autonomy and independence, enriching their lives and improving their personal wellbeing and quality of life.

Successful enabling programs may include a shortterm restorative component. This is suitable for people who have recently entered the community care system, existing clients who have experienced a recent change in functioning or existing clients who identify goals around improving their functioning and independence. An enabling approach focuses on ‘doing An enabling approach is personcentred with’ and supports the person ‘to do’ and uses a number of evidencebased rather than ‘doing for’ or ‘doing to’ the better practices to achieve agreed goals person. and outcomes. These include practices around wellness, active ageing, early intervention and prevention, social inclusion, and shortterm restorative care (also known as reablement).

To access a paper entitled Towards an enabling approach in community care, visit www.adhc.nsw.gov.au > Doing business with us > Home and COmmunity Care Program.


www.adhc.nsw.gov.au

An enabling approach is consistent with the aims of the HACC program. These aims are to:

n provide a comprehensive, coordinated and integrated range of basic maintenance and support services for frail aged people, people with a disability and their carers

n support these people to be more independent at home and in the community, thereby enhancing their quality of life and/or preventing their inappropriate admission to residential care

n provide flexible, timely services that respond to the needs of consumers.

This approach is consistent with the NSW State Plan, which commits government agencies to embedding early intervention and prevention into service delivery and to reducing unnecessary hospital admissions. An enabling approach is also consistent with Towards 2030: Planning for our changing population, a wholeofgovernment strategy to actively plan for the ageing population in NSW.


3Key lessons Many community care providers in NSW are already applying an enabling approach. They may not be calling it ‘enabling’ or ‘wellness’ or ‘restorative’ and they may not be applying it to all aspects of their service delivery.

The providers who are represented in this handbook have agreed to share with others their own experiences of introducing enabling practices. The key lessons drawn from their experiences can be summarised in the following key points:

Focus on achieving the goals of each person. This will promote their engagement and the likelihood of success.

Build on the interests, skills, history and culture of each person.

Integrate support into everyday home and community activities.

Recognise that such a focus may require a shift from the way your organisation operates and what it offers.

“The manager and team work differently, not harder...” (UnitingCare Ageing NSW and ACT)

There are people to help within the HACC community. This includes allied health staff, dieticians, HACC development officers and Multicultural Access Project (MAPS) workers.

Don’t reinvent the wheel. Find out how others have dealt with the same issues you are facing. Community care and related providers involved in this project were happy to share the other resources and tools they had developed or information about where they received help.

Useful resources are available in the broader community. An enabling approach recognises the breadth of people’s interests and the benefits of getting out and about. Services and people beyond community care are essential ingredients. Consider local libraries, service clubs or sporting clubs. Healthy older people may be prepared to be involved as volunteers in a shortterm capacity or simply to join in exercise sessions, space permitting.

“Activity based groups are more likely to engage people and offer a community safety net.” (UnitingCare Ageing NSW and ACT discussion)

A champion is needed. Whether an enabling approach is being introduced in a large organisation or in a small one providing a single service type, the approach needs to be championed. Management support is essential.

Staff and volunteers can be inspired by the results an enabling approach achieves with individuals.


“Staff need to feel empowered by the enabling approach. I say to them ‘Don’t tell me why we can’t. Tell me why we can.’” (Senior Case Manager, Newcastle Lake Macquarie Case Management Services)

Training of staff and volunteers is vital. Awareness and training, especially of frontline staff, is a key part of implementation.

“… training and development options to facilitate a paradigm shift for HACC services including allied health, community care staff and volunteers across the full range of service providers. There is a particular need to focus on shifting perceptions about older adults. These include attitudes known to be quite common among aged care staff, such as the idea that it is necessary to limit risks more for older people than younger people (Dickson, 1993, as cited in Townsend, 2002, p 2).” (Australian Institute of Primary Care, 2008:14)

‘Doing with’ rather than ‘doing for’. Enabling practices may initially require more direct support time. However this may be outweighed by the benefits for the older person in restored independence, for the support worker in witnessing the older person’s improved quality of life and for the system in delaying or avoiding hospital and residential care admissions.

Cultural competence is important. Recognising the cultural and linguistic diversity of the person is fundamental to enabling approaches. People from diverse backgrounds will not gain confidence in or use available services without such recognition. Bilingual, culturally competent workers are needed to support people to engage in culturally


3 appropriate activities at valued and culturally safe venues and to connect with their community. Workers need training and support to understand how a key part of a person’s identity is their culture and language and their engagement with their community.

Older people may think their physical or social capability is limited. Consistent with experience elsewhere, older people may need information and education to understand that their current situation may improve.

“Often the older people we support think they are too old to plan, to dream and to set goals. We show they are not. The 76yearold man is back on his bike – albeit a tandem – after a stroke and the 93yearold with dementia dresses up every Wednesday night for dinner with friends.” (General Manager, Health and Community Services, ACH Group, South Australia)

Partnerships with other HACC service providers and with other parts of the broader health and community care sectors are needed. Providing support which is personcentred and enabling will often require working beyond a single service type and involve collaboration with other HACC providers and tapping into skills held by other agencies.

More focus may need to be invested on assessment and the development of individual, goal based, timelimited plans. Initial assessment of a person may take longer. More regular reviews are an intrinsic part of an enabling approach.

Initiatives should be informed by evidence. For example, research findings are clear about the benefits of a minimum of 30 minutes of appropriate, daily exercise. There are many clinically tested exercise programs relevant to the older population.

Staff need to check service progress and results, and if necessary refine the approach. Mechanisms need to be put in place to check changes with the person receiving support, their carers and families, workers and other stakeholders. HACC service providers can learn from what does not seem to work, while celebrating successes.


Practice ideas and personal stories 4 The practice ideas and personal stories presented in this chapter illustrate elements of an enabling approach. The stories have been collated into five major themes:

4.1 Achieving people’s goals

4.2 Building on individual strengths and interests

4.3 Connecting people with social networks

4.4 Restoring capacity with short term support

4.5 Improving capability with exercise and assistive technology.

Each practice idea is told with a focus on one of these themes. However, many of the ideas also illustrate other themes. So at the end of each practice idea, “tags”, like the one following, highlight any additional themes:

n Building on strengths and interests

A list of the services described is provided at the beginning of each theme. Full lists of all services in this document, by service type, region and particular target group, are provided at Attachment G.

10 A handbook for community care services

4 4.1 Achieving people’s goals

This section illustrates how four services are designing their support around the individual goals of older people. Older people, and their carers, are encouraged to identify what they most need to ensure the older person’s wellbeing and to enable her or him to continue to live in their own home and community as independently as possible.

Such an approach looks beyond the provision of a set suite of maintenance services to a broader range of possibilities aimed at improving each older person’s life and functioning. Providers work with each person to identify what they want to achieve and how they will be supported to get there. As the following stories show, older people’s goals may be related to regaining lost confidence in getting out and about in the community or in tasks such as driving, to building friendships, meeting new partners, learning new skills, regaining strength and mobility.

The stories show how the four different services plan their support around the goals and interests of each person. Clear timeframes and processes for monitoring, reviewing, replanning and ending support are also agreed.

Above all, their approach is based on strong evidence that positive change, however large or small, is possible for every older person. Each older person, sometimes with their carers, pictures what a ‘good life’ might be for them (Kendrick, 2009:4) and is supported to work towards this.

The first three stories also show how the design of group programs can be built up from individual goals.

Services in this section

Centre based day care

1. Acacia Living Life, UnitingCare Ageing NSW and ACT, Brooklyn Metro North

2. Ourcare, Singleton Hunter

3. Healthy Living for Seniors Centres, UnitingCare Ageing, Central Coast and Lake Macquarie Hunter

Case management

4. Northern Community Care, Glen Innes Northern



Practice idea 1

Acacia Living Life, Brooklyn, UnitingCare Ageing NSW and ACT What people want is a social life

It’s Monday morning in Brooklyn on the Hawkesbury River. A dozen people, the eldest of whom is 87, are meeting for their regular Healthy Heart Moves class. Under the guidance of the group’s exercise instructor, each person participates according to their ability. At the same time, they are noting further ways to build their strength and mobility. They do this with knowledge of the gains they have already made:

“When I first came down, I was struggling to do 10–15 minutes of the exercises. After a couple of months, I was doing 30 minutes and after a couple more months, I was doing the whole class. I get a lot of benefit. So does my wife. She was having to do everything for me before. Now I do it all myself: my shower, getting dressed, everything.” (Brooklyn day program participant)

“Before Healthy Heart Moves I’d try to cut the grass. I’d only do half of it at best and I’d be exhausted and couldn’t go on. Now I can cut it all and do the weeding as well as meeting and getting to know people I didn’t know before.” (Another participant)

The group is also given advice as to how to continue their exercises away from class.

“A lot of the exercises you can do at home. I feel a lot more able to do other things at home than before. Also I can do all the shopping now.” (Another participant)

After the class, morning tea and a chat, some people leave.

“What I hadn’t expected when I went to Healthy Heart Moves was how great it was seeing people there.” (Another participant)

Others are off with a worker to go bushwalking. A few women have gone to catch the ferry to do craft together, having met for the first time at Healthy Heart Moves. A man sits with a worker for onetoone computer tuition. He wants to be able to email his children who live overseas. After the lesson they leave for lunch together at the pub.

The day program runs two days a week. Participants usually attend at least one activity at the centre each week and another outing of their choice. These other activities and their locations are matched to the interests, goals and convenience of participants. Current options include:

n a weekly Stepping On falls prevention group

n a men’s group which fishes, holds barbecues, meets at the local club and/or makes special trips such as to the RAAF base

n a mixed gender Thursday group which meets at cafés and restaurants or also goes on trips, including to a Flora Festival and an airport tarmac backstage tour

n a monthly Indoor Carpet Bowls group at the local RSL, with some members progressing to a monthly Outdoor Bowls Group


4 n the Scrabble Ladies, who met each other at the centre and who now meet in one of the women’s homes.

The centre is the base from which activities are organised, rather than the location of all activities. UnitingCare Ageing describes the day centre as an “activity hub”. What is clear is how much each person values the friendships and community connections they have made. These friendships and connections extend beyond activities organised by the group.

What is not immediately obvious is that the group’s activities and the dynamic and trust between the group members and workers have been built up from a foundation of careful discussion and planning. Each person has an individual plan designed to achieve his or her individual goals. Group or individual activities are then organised, depending upon the extent of shared goals and interests.

Participants say not only are they maintaining their health so that they can stay at home as long as possible, but that their new social connections encourage them to keep well and active, both in mind and body, and “to continue to grow and reconnect”.

“Traditional day centres are the welfare version of a social life. What people want is a social life” (Project Manager, UnitingCare Ageing NSW and ACT)

This practice idea links with fact sheet 1

Themes in this practice idea:


n Connecting people

n Improving capability


Practice idea 2

Ourcare, Singleton

Ourcare organises day programs for frail elderly people and for people living with dementia in Singleton. Both programs are built up from a focus on the individual goals and plans of participants and from a review of all activities with participants and workers.

Daily activities now incorporate:

n gentle falls prevention exercises, designed by the service’s occupational therapist. Centre workers coordinate the exercises, after training by the therapist

n a hot lunch, which has been found to be very useful in generating discussion between participants, workers and volunteers

n a community activity each day, such as lunch or morning tea away from the centre, shopping, ten pin bowling, or going for a walk.

Before the exercise program began in March 2010, each participant’s fitness and falls risk was assessed and will be regularly reassessed to check change.

Rose dances

Rose attends Singleton’s Ourcare day care group for people living with dementia. She rarely participated in any physical activities. However discussions, to prepare her individual care plan, revealed she had once been a very keen dancer. Now Rose, prompted by certain types of music, enjoys dancing at the centre.


4 This practice idea links with fact sheet 2



n Connecting people


Practice idea 3

Healthy Living For Seniors Centres, UnitingCare Ageing NSW and ACT

Healthy Living For Seniors (HLFS) centres are operated by UnitingCare Ageing on the Central Coast and in the Lake Macquarie area.

Centre activities are organised around the achievement of the individual goals and plans of day centre participants and their families. Goals are written within the SMART structure: Specific, Measurable, Attainable, Realistic and Timely. At least every three months, goals and plans are reviewed and reassessments conducted.

To help realise participants’ community participation goals, a community development framework is used to strengthen social bonds, build social bridges and develop linkages between community care services, community groups and individuals.

“We get people back in touch with each other. They are reconnecting with old friends, as well as making new friends.” (Service Coordinator, HLFS)

Centre activities incorporate targeted physical and mental exercises; education and guest speakers; and social outings. Pastoral care, information and support is given to help participants achieve goals and to engage in activities beyond the centre.

“I was very pleased to see the improvement in Mr Jones and I think this relates to his engagement with the cognitive training and exercise program that UnitingCare is providing for him at Garden Suburbs. He also has the regular outing with his mates and these things are absolutely critical in terms of keeping his mental agility and flexibility as good as we can maintain it.” (Letter from local neurologist to HLFS)


Some HLFS stories

George is from a nonEnglish speaking background. He was very socially isolated and depressed. His major goal was to be once again linked into the community. He thrived on the connections he made at Healthy Living, particularly the conversation. Workers helped him to find other ways to get back involved in the community. He now goes to a local gym and works as a volunteer at the public library.

Bob’s goal was to find a life partner. He wanted to look beyond the centre so started to go to Heart Moves and to a community kitchen and became a volunteer at the community radio, where he was successful in his goal.

Elva, after an illness, wanted to regain her confidence firstly to drive to Healthy Living and then with more confidence, to drive to Sydney to visit her children. She and another lady decided to take it in turns to drive together to the centre. With this experience and the encouragement of workers, other participants and her fellow driver, she has now driven to visit her family.




n Connecting people


Case management

Practice idea 4

Older people scoring how well their goals have been achieved: Northern Community Care

Northern Community Care (NCC) is a case management service supporting older people living in areas around Glen Innes. It works under the banner You choose, we assist. Like other case management services, it aims to empower individuals to maintain and enhance their independence.

People supported by NCC are encouraged to nominate their goals, on which their individual plan is focussed. In their planning, case managers help each person to identify realistic actions to achieve their goals, and if necessary to avoid disappointment, to identify goals which cannot be realistically achieved. An exit strategy from NCC support is discussed at the outset as “independence is treasured”. Each person is “encouraged and supported to be as independent as possible”.

At agreed intervals, each person supported by NCC scores how well they believe their goals have been achieved, using the following scoring system:

+2: Achieved goal with additional positive outcomes being achieved as a result.

+1: Achieved goal with better than anticipated outcomes or within a reduced timeframe.


4 0: Goal achieved within set timeframe.

1: Goal not yet achieved, but will be achieved within an extended timeframe.

2: Not satisfied with outcomes.

These goal evaluation scores are then linked to case managers’ performance indicators. Case managers are expected to achieve at least 70% of their consumers’ planned goals. Quarterly results are then used to inform skills development plans for each case manager.




4.2 Building on strengths and interests

Older people, like everyone, want to participate in activities that interest them and which recognise their life, experience, culture, language and strengths. Recognition of past or new achievements, sharing knowledge and cultural practices, and building or rebuilding skills, resonate with everyone. Indeed without such ingredients few people are likely to engage in proffered support or activities.

The following practice ideas show how five services recognise and value older people’s culture and lifelong interests. All of these providers focus on working with either people from CALD (culturally and linguistically diverse) backgrounds or with people living with dementia.



5. Multicultural Communities Council, Wollongong Southern

6. Magnolia Cottage, Nowra Southern

7. Hills CALD Social Day Programs, Baulkham Hills Metro North

Social support

8. The Ella Centre, Haberfield Metro South

9. Dementia Advisory Service, South East Sydney, Miranda Metro South



Practice idea 5

Multicultural Communities Council, Wollongong Respecting Ramadan: Middle Eastern and Turkish Centre Based Day Care

Muslim women attending day care at Cringila in Wollongong suggested that a different program was needed during Ramadan. The coordinator was concerned that many did not attend at that time. So together they developed a new activity for their day program.

“During the religious celebration of Ramadan a strict fasting practice often deters clients from attending normal activities outside their home during the day. Clients now look forward to Ramadan knowing they can still attend day care and retain their independence to cook their own meals.” (Day Care Supervisor, Multicultural Communities Council of Illawarra)

Food is prepared by the clients then carefully packaged and taken home to be eaten after dusk in accordance with Ramadan rules. The new program has included cultural cooking classes and education in new food safety practices and kitchen hygiene which people can apply at home.

“Food Safety was initially an issue but after consultation with Food Safety Authorities, and careful selection of ‘low risk’ foods to be prepared, the activity was approved. All relevant information was recorded to meet food safety requirements. The agency’s policy and procedures manual was updated and now covers these practices.” (Day Care Supervisor, Multicultural Communities Council of Illawarra)

The responsiveness of the centre seems to be appreciated the Arabic and Turkish day care group has grown considerably since the culturally appropriate program for Ramadan was introduced.



n Connecting people


4 Practice idea 6

Magnolia Cottage, Nowra Day programs for people living with dementia

Playing the drums in the big band, bushwalking on a clear day, spending time at the local library, doing an exercise session, restoring items salvaged from the tip to use as raised beds in their own garden or knitting squares for Ethiopia are just some of the activities that people with dementia share at Magnolia Cottage at North Nowra.

“Our goal is to make sure clients succeed in whatever it is they want to do.” (Manager, Magnolia Cottage)

Understanding the areas of interest for new clients starts during assessment at the Cottage. Each future participant, carer and other family members are invited for morning tea to meet existing clients and experience the Cottage’s ambience. By hearing the person’s history, including through a separate chat with the carer, the manager can develop a picture of the kinds of activities a person might enjoy.

Men’s different interests are recognised. For example, a new client who had been a mechanic “was a man who used his hands, enjoyed getting them dirty and liked the smell of garages”. Individual activities to promote this person’s self worth and usefulness were developed through the Cottage’s Hands on Workshop for Men. In this program, skills of a lifetime are the basis for tailoring individual activities within tasks such as restoring old items by sanding, assembling, painting, drilling and tinkering. All activities are modified to accommodate a person’s cognitive ability to ensure they succeed. Some of this activity occurs indoors and some outside in the garden. Indoors, a room set up like a ‘trophy room’ with sporting and car photos and pub memorabilia, is a favourite gathering place for the men. The range of activities available will be extended when a shed is built alongside the cottage.

“You don’t do it properly.” As dementia progresses, family members’ anxiety is often expressed to the person in these terms. At Magnolia Cottage the focus is on enabling the person. For example, clients with an interest in domestic tasks are encouraged by the Cottage’s housekeeping coordinator to set and clear tables, assist with the baking for morning tea and perform other kitchen duties.

“You are there to fit into their routine. Not vice versa,” the Centre Manager explains to staff.

“A useful tool for all day programs is Beyond Crowd Control”.



n Connecting people



Practice idea 7

Hills CALD Social Day Progams, Baulkham Hills Activities rich in cultural relevance

Improved health and renewed connection with their community, increased physical activity and greater confidence in cooking for themselves are some of the results reported by people who attend the Hills Community Care Chinese Social Day Program.

“We have three Tai Chi Masters, all aged over 80, who lead our Tai Chi sessions.” (Bilingual Worker, Chinese Day Program, Hills Community Care)

In addition to Tai Chi, the activities program includes Chinese cooking classes, guest speakers discussing topics like the importance of good nutrition, a falls prevention program and other information sessions, mahjong, karaoke, art and craft, indoor sports and a range of outings. The program is developed by bilingual workers in consultation with the older Chinese participants of the group.

The Chinese program is one of three CALD social day programs operated by Hills Community Care, a service of Hills Shire Council. The other two services support people of Maltese and Korean backgrounds. Brochures and flyers about the programs are in the three community languages. Aspects common to the three programs include:

n specific cultural programs, both centre based and out in the community

n bilingual workers and volunteers

n developing the activities program with clients

n giving clients the opportunity to lead activities they are proficient in, for example, art, lace making, history, Tai Chi

n encouraging clients to lead the group in discussions and to contribute actively such as by presenting a poem they have written or playing a musical instrument

n celebrating cultural and national events relating to the group’s culture

n actively participating in the local community by celebrating events such as Australia Day, local government and Seniors Week

n keeping clients well informed about their cultural community, both local and overseas, by including documentaries, photo displays, books, using the internet and reading newspapers in their program

n providing clients with a culturally specific meal, recognising choice and particular dietary needs.

“Undertaking community surveys on needs and setting up a steering committee with community members from each cultural group were important steps in developing the programs.” (Social Day Programs/CALD Coordinator, Hills Community Care)



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4 Social support

Practice idea 8

The Ella Centre, Haberfield Younger Onset Dementia Social Support and Respite Program

Mainstream dementia services may not suit a younger person with dementia as the support model often presumes a high level of frailty. Also people with younger onset dementia have particular issues often not faced by older people with dementia. These issues may include a dependent family and financial and legal issues due to forced early retirement. The Ella Centre in Sydney’s inner west is one of several HACC providers which has established a program to cater especially for people under 65 diagnosed with dementia.

“The program has provided normal, community based, age appropriate activities that my husband can participate in and enjoy. These are all the activities that he used to love.” (Carer)

The program is designed to meet the needs of both people with younger onset dementia and their carers. Carers are provided with a break and people who access the program are provided with social and recreational opportunities in the community in a small group setting. Activities include visiting local nature parks and reserves, visits to local cafés, playing ten pin bowling and playing golf at a local driving range.

“Our carers tell me of their great relief and the improvement in wellbeing of their family member since coming to the program.”

“The range of carers that the program is supporting has been changing over time. When we started the service it was to support the husbands of a group of predominately working wives who were desperate for meaningful social activities for their husbands. Two years later we now have several younger carers, caring for a parent, with a range of additional problems to face (for example, maintaining relationships, juggling the desire for a social life with caring responsibilities.)” (Executive Officer, The Ella Centre)



n Connecting people


Practice idea 9

Dementia Advisory Service South East Sydney, Miranda Local government support for younger onset dementia

Sutherland Shire Council has acknowledged the growing need for services for people diagnosed with younger onset dementia in its area. The Council has provided a oneoff grant for 12 months to the local HACC funded

dementia advisory service to conduct a pilot community access (social support) project for these people. The project, which commenced in February 2010, has two arms: a younger onset community access program and a dementia café (see Practice Idea 18, for an established dementia café).

Community access activities to date include lunches at a local restaurant, visiting the Art Gallery, going fishing, bush walking and visiting the Maritime Museum.

“People know what they like doing and you need to let them choose what they would like to do,” said the Coordinator. “The focus of our program is on people doing activities they enjoy and connecting with other people. They are very supportive of each other and they laugh at each other’s lack of memory.”



n Connecting people

4.3 Connecting people with social networks

This section presents some of the creative ways in which 12 community care providers are facilitating social participation and connectedness for older people. Their work builds on evidence that wellbeing is strongly linked with family, social and community relationships.

Their practice begins by recognising that older people are citizens with community connections, who have individual social goals and interests. Some, such as the Multicultural Respite Network, Dungog Neighbourcare, Parramatta Book Club and the Manly Warringah Pittwater Social Inclusion group, work to support individuals to tap into available social networks that exist beyond community care.

The examples all show how older people are being supported to connect with old friends or to make new ones. They show older people renewing old interests, using longheld skills or learning new skills. They illustrate how activity and engagement can enhance older people’s wellbeing, their ability to remain independent and their relationships with carers and families.


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10. Multicultural Respite Network / Inner South West Sydney Home Care Branch, Bankstown Metro South

11. The Men’s Shed, Wollongong Southern

12. Dungog and District Neighbourcare Inc Hunter

13. Gnarra Aboriginal HACC Project, Jannali Metro South

14. Ageless Angels, Catholic Community Services, Waitara Metro North

15. Waitara Wellness Day Therapy Centre, Catholic Community Services, Waitara Metro North

Transport

16. Port Stephens Mystery Tours, Nelsons Bay Hunter

Social support

17. Berridale Community Kitchen, Berridale Southern

18. Connections Coffee Club, Blacktown Metro North

19. Gumbaynggirr Elders Choir, Bowraville Northern

20. Parramatta Book Club, Parramatta Metro North

21. Manly Warringah Pittwater Social Isolation Working Party Metro North



Practice idea 10

Multicultural Respite Network/Inner South West Sydney Home Care Branch, Bankstown Using cultural networks and venues

Mr Wang was born in China. He is now 80 and cares for his wife who has dementia. He plays the Chinese flute to entertain others at the Christmas party which is attended by all the people supported by the Multicultural Respite Network. Mr Wang and his wife attend a Mandarin day group organised by the Network. Other groups are for people from Russian, Cambodian and Indian backgrounds and one is for Arabic women. All run at centres operated, or used, by each culturally and linguistically diverse (CALD) community. For instance, the Cambodian group operates in association with the Cambodian Welfare Association; and the Indian Group with Sri Om.

Each of the groups has been set up by a partnership between local community groups and the Multicultural Respite Network (MRN) under the management of Inner South West Sydney Home Care. MRN is funded to provide “a planned program of centre based, inhome respite and transport, carer support and advocacy that is culturally appropriate and tailored to the needs of frail aged people, people with disabilities and their carers” from CALD backgrounds.

The model recognises that:

n people from newer CALD populations in Inner South West Sydney were not necessarily seeking HACC support through mainstream intake channels

n local mainstream services working alone may not have the staff or experience to offer culturally tailored support to the small numbers of people from these cultural groups in their catchment

n relevant cultural associations may be too small or not have the capacity to operate HACC services for their eligible members.

MRN’s bilingual workers link with existing CALD and other community organisations to identify the communities most needing support and their key players, resources and capacities. Then, the Network in partnership with each community’s leaders and representatives, plans the provision of support which complements what the community can offer and which celebrates and reinforces the community’s culture and cultural ties. Compared to past issues with promotion and referrals:

“We have never had to search for people after we have found the right cultural partner.” (Home Care Manager)

Twice a year the groups come together for a special celebration where they all perform something from their own culture.

“Last year we went on a harbour cruise for our Christmas party… For a lot of people, it was the first time they had ever been out of Cabramatta.” (Manager)


4 This practice idea links with fact sheet 10



Practice idea 11

The Men’s Shed, Wollongong “Somewhere we can just be blokes”

Men’s Sheds are spreading across Australia as local communities recognise the need for a broader range of activities for retired men. Wollongong City Council auspices six day care centres. The annual planning day for the services, which involves clients, carers, volunteers and staff, highlighted the fact that male clients would like something different. When asked how current services met their needs, the common answer from men was: “They don’t”.

The Men’s Shed was the response. It began by forming a new partnership with the Home Maintenance and Modification service – sharing their shed and drawing on their carpenters. The demand for the service and space is strong and the shed is relocating. Fifteen men attend the shed which is held one day per week. Lunch is ordered from a take away food shop around the corner.

The men have much more choice and control over what they are doing and how the shed runs than is typical of traditional day care. They sit down and discuss what they are going to do. Varying abilities are accommodated through each individual indicating what they would like to do. Projects have included building storage boxes for equipment at a local school, possum boxes for use by WIRES and wooden toys for children supported by charities. Partnerships with each of these organisations have been a key element of this initiative.

“I come to the shed to have a laugh while I’m doing something that is purposeful and helps someone else.” (A participant)

No women are allowed at the shed, except for the current coordinator. Male volunteers are welcome and have been recruited by targeting retired TAFE teachers, carpenters and other tradespeople. Health promotion and chronic disease awareness is covered by visiting speakers on men’s health.


Health and safety issues needed to be addressed in the set up of the shed. Council undertook a risk assessment and both clients and volunteers have agreements which cover these areas.


Brian’s story

Brian, who had been a builder in his working life, had a stroke. He lost all confidence and didn’t want to do anything but stay at home. He was encouraged to attend the Men’s Shed. Since becoming a regular, Brian’s confidence has been restored and he has even returned to his local club. Reports are that he is now more outgoing than he used to be – initiating conversations and engaged in what is happening in the area.

Practice idea 12

Dungog and District Neighbourcare Inc Expanding recreational options in the community

Dungog and District Neighbourcare Inc receives HACC funding for a range of services including transport, delivered meals, centre based day care and social support.

To complement its directly delivered services, the organisation has been actively supporting the formation of new recreational groups which offer activities for the wider community and in which older people want to participate.

It helped set up a men’s shed: the Dungog Menshed. The shed now operates as a separately incorporated body, with Neighbourcare continuing to provide support and advice as necessary.

Neighbourcare also helped establish Dungog Croquet Inc.

Older people benefit considerably from the wider array of social and physical options now available in the village.




Practice idea 13

Gnarra Aboriginal HACC Project, Jannali Enhancing wellbeing and making community

The wellbeing of Elders is the focus of Gnarra Aboriginal HACC Project’s case management, social support, day centre and transport services.

“Although we want to focus on enhancing the wellbeing of our Elders, we have to recognise that for a lot of our people, this means focussing on the basics, such as helping out if they haven’t got a roof over their head... While we tend to move from crisis


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to crisis, for some we can move into enabling options.” (Coordinator, Gnarra Aboriginal HACC Project)

Gnarra is based with the Kurranulla Aboriginal Corporation which offers a culturally appropriate and safe drop in and resource centre for Aboriginal people of the St George and Sutherland areas.

Each Friday, 20–25 Elders meet for activities such as art and craft, indoor bowling, a walking group, and gentle exercises. Each year, the group exhibits its art and craft work at a local gallery, library or shop. Special events are also arranged – most recently to the opening night of “The Sapphires”. Other activities are offered to meet individual goals:

“We started some gentle hydrotherapy exercises. A number of people started, but one person, in particular, loved it. While the others did not continue, we kept the activity going for this person and her health improved threefold. I think that the 1:1 support meant that the lady achieved things she wouldn’t have in a group setting..”.

“One man wants to get his driver’s licence. He has never driven. So I sat with him to talk about how he could achieve this. There are some things he has to do … and ways we can support him. For example, he can practise his test here. I’ve told him that together we can get there.” (Coordinator)

The day has become important to the whole community:

“It has become a real community day. The young ones drop in as they know the Elders will be here…. It’s about making community… We are not like other Aboriginal areas.


We don’t have an established Aboriginal community. Only a few of our Elders knew each other before they started coming here. …. And some were Stolen Generation.” (Coordinator)

The centre had had mixed success in attracting men until they started a men’s group, every Thursday. About eight men now regularly meet to go fishing or play golf or have a barbecue.

“When we started the numbers were really small. But we started off letting them bring a buddy for a barbecue and a yarn... We try to mix the activities up. Last weekend we took them to the football…. For a couple of men, this is the only time they leave their house.” (Coordinator)

Gnarra also supports Elders to get appropriate health care. Over the last couple of months, groups of Elders have been taken to an outreach GP clinic, although talks are now underway for a monthly clinic to be held at Kurranulla. Women have been taken by bus for mammograms, Hearing Australia hearing checks, diabetes and eye health clinics. Exercise and nutrition workshops have also been offered at the centre.


Practice idea 14

Ageless Angels, Catholic Community Services, Waitara Reinvigorating memories for people living with dementia

Early memories are lost last by people living with dementia. Two initiatives of Catholic Community Services show how skills thought to have been lost and the early memories of people living with dementia have been used to build a choir and a garden. Other stories in the literature similarly describe how comedy (eg Stevens 2009), art and music (eg JonasSimpson 2005) can bring pride and joy to people living with dementia and to those around them. They all show that memories, skills, enthusiasm and indeed anticipation can be reinvigorated.

The Ageless Angels:

Most men in the choir have some form of dementia. One woman comes to choir with her husband and brotherinlaw, both of whom have dementia and for whom she cares:

“She has told us that with the choir the men get to know faces. She hopes that it will help with being able to get support services into their home, as in the past her husband had not been willing to accept help… We have found that some people are very happy to be in the choir, but have previously refused other support.” (Coordinator)

A woman with dementia comes with her daughter. A range of musical skills are shared among the group: one person was a music teacher, another a singing teacher and yet another played trombone in a brass band. Others participate, including younger people with disabilities, staff and volunteers.

“We sing old songs and some songs have been banned! They have also shown they can learn new songs. We are currently singing one song in four parts with different A handbook for community care services 28

4 words. Everyone gets involved in deciding what we will sing…. Some want us to meet every week and not just fortnightly…. They love the camaraderie and the social parts – the afternoon tea… We know that everyone enjoys it as they are getting here earlier and going home later.” (Coordinator)

The choir was started after everyone enjoyed singing at a Christmas concert in 2008. A Choir Committee decides how the choir is run, fundraising activities, what events to participate in and the choir’s musical direction, name and signature tune. Decisions made by choir members themselves include outfits, song choices, musical styles and the afternoon tea roster.

Choir members enjoy the banter between the men’s and ladies’ chorus and “the delight at finishing a song together and managing a song sung in parts”. Some members are now attending without their carers. They are making friends and take photos home to show their family and friends. Carers are talking with each other for support. The choir has already performed twice publicly and hopes to produce a CD to bolster their fundraising.




Practice idea 15

Waitara Wellness Day Therapy Centre, Catholic CommunityServices, Waitara “We tapped into their love of gardening.” (Coordinator)

Kelvin, John and Cecil proudly show the vegetables they have grown and explain how they are best cooked. It is now autumn, so they debate what they may plant in spring and which plants produced the best results last summer. Kelvin is a passionate advocate of organic gardening. They all have ideas about pest control. They take their produce home for family meals and sell spare produce. Funds raised purchase material for future crops. They proudly show their garden to colleagues, family members and visitors. As they would like to expand the garden, they have helped write funding proposals for an additional raised garden bed and for a microwave to cook their produce. Kelvin ran a cooking day to show how the bok choy they grew could be used in a recipe from his country of birth.

The garden is located at the Waitara Wellness Day Therapy Centre. The three men are part of the Centre’s men’s group. The three, who all have some form of dementia or brain impairment, decided they wanted a garden, what they wanted to plant and how the garden was to be managed. They are responsible for the maintenance of the garden. They do as much as they can, with staff assisting the men to problem solve, tailoring any support to each man’s abilities, providing assistive technology and/or referring the men for other support as necessary.

The men’s achievement is recognised by others attending the centre, with workers reporting that this has helped the introduction of the men into the centre and its activities.





Transport

Practice idea 16

Port Stephens Mystery Tours, Nelson Bay The mystery provides a bit of oomph: Port Stephens Community Transport

Every four to five months, Port Stephens Community Transport now offers people it supports extended social trips of two to three days to unknown destinations. All accommodation and activities are prebooked. The service provides drivers and a hostess to provide any necessary support. Destinations have included Eco Point (Myall Lakes), Mudgee, Blue Mountains and Forster. Trips are now being planned to Dubbo and to Canberra. The Canberra trip includes for the first time an evening rendezvous with a South West (Sydney) Community Transport tour group.

“We wanted to offer new options to motivate older people to maintain existing, and make new, social connections... The mystery provides a bit of oomph… Not knowing the destination adds to the total excitement of the trip. It provides a start to help them revitalise their life…

“We wanted to get out of the box and move away from offering the same old, same old …. We would rather take people to places they have never been to before, than to spend our available resources on taking them to places they have been to many times…

“We took them on the Zig Zag railway, and one 92 year old lady loved it and said this was the first time she had been on it since she was 14!” (Manager, Port Stephens Community Transport)

“I was feeling very down in the dumps before I started going on social outings and trips with you. Now I have more confidence and am meeting more people.” (Mrs S F, Mystery Tour Traveller)

“A trip to an unknown destination encourages independence, self determination, confidence and enhances social networks. The mystery part of the tour seems to motivate and animate clients, promoting their participation, interaction and enjoyment. They also have to buddy up and share rooms and this has helped participants to form ongoing friendships. It has also allowed husbands and wives who haven’t been able to afford holidays together for quite a while to travel together… Clients form good friendships and support each other. They buddy up on tours and are known to stay in communication afterwards.” (Manager)

Travellers are encouraged to alter the itinerary as they travel in order to stop at additional places or have more time at stops of particular interest. They are also encouraged to suggest destinations for future trips. It is hoped in the future that a small group of


4 travellers

“When we had our planning day, they could not really suggest new ideas. However, when we said “what about this” or “what about that” they were keen… We are hoping that through their experiences they will start coming to us with ideas. If they suggest it, we will try and take them there….” (Manager)




will assist the service with pretrip planning.

Social support

Practice idea 17

Berridale Community Kitchen, Snowy River Home Living Support Service, Berridale

Bill is slicing chicken, Dave is chopping carrots, May is hulling strawber

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