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Keeping residents and families connected – Supporting Self Determination

How do we support older persons communicate their wishes and needs, so that staff know exactly what they are and families remain connected? How do we operationalise self-determination through the use of technology? How do we support staff, who mostly want older people to live their best lives, easily and quickly access data, enter data, record outcomes and communicate next steps at shift handover?

The technology tools resident’s and different staff audiences need are different. Resident’s have to be able to easily communicate to staff and their family/friends, their needs, preferences and care planning goals. They want to send photos, receive newsletters, know what’s on the calendar today for them, and receive staff feedback. Managers need to be able to provide feedback to the resident and/or their family re key information and receive critical information, photos and confirmations of  consultations and care planned. A carer needs to record care, access care details, act on key tasks (e.g. obtain an MSU, record pain management actions, food/fluid outcomes) and in real time, on the ground, report issues as found. A nurse, nurse manager or operations’ manager needs technology to provide overviews, analyses, ensure governance reports and critical outcomes are acted on and recorded, analysed, closed off. All from a single source of truth.

The technology audiences’ ability to achieve their goal is a function of their education, understanding, empathy, wisdom but most importantly, their position in the management hierarchy. Management decide what tools resident’s, families and staff have available to them. But if the tools don’t ensure the information can support self-determining care, communicate next steps effectively or sufficiently analyse what will work and what won’t, or if staff aren’t shown how to use the tools to achieve the required outcomes, those tools don’t work.

Aged care, regardless of the country, include care standards, funding validations or as in Australia, requirements dictated from the Royal and Quality Commissions. Working out how best to support residents, families and friends who have not chosen to live together, but due to fate, a health accident or growing dependency they must, has always taken skill and wisdom. Each audience needs to navigate a regulated building, staff and government funding and regulatory systems. Residents removed from their home, family, friends, things, daily community access and life choices live every day, dependent on who is supporting them that day, and on how good the system management has setup to empower them is. So how do we ensure ‘control of life’ or ‘simple decisions’ are honoured to achieve as much of the ‘old life’, that families remain connected and can also contribute?

An App for resident’s (or their loved ones if needed) to enter care preferences and read what staff have written, that populates directly into their care plan, demonstrating feedback and care plan consultation, which staff then access using their App to provide and record care, achieves part of the self-determination loop. Staff have to observe, listen, ask, experience and do the work to know what resident needs and preferences are. But sometimes a body just doesn’t do or respond as predicted, residents change their mind, want or decide to do something different, or want some routines strictly performed the same each day. Residents need to be able to send that information directly to staff’s device/program/alert and families need to be able to login and be reassured or contribute using their login, as per resident wishes.

Stakeholders have to have the information made available to them, in an easy to obtain manner, presented in a summary and detailed format, presented with predictive, informative and quality data. Aged Care will always need to qualify and validate using public funds, and be responsible for providing considered and appropriate care as professional healthcare providers, but we need to ensure staff can focus their attention and efforts on what a resident actually wants and needs, and ensure families are assured that this is the outcome.

Apps, which staff and resident’s and or their families use, that are linked to programs which Care Managers, nurses or operation’s personnel use, achieve the communication loop outcome using the same source of truth.

Working out the best procedure to achieve self-determination is dependent on the skill and wisdom of those who manage and control the ‘everyday’, their sincerity, their knowledge, their recognition of paternalistic and infantilisation practices. But also their skill in managing a community where all stakeholders are heard and accommodated. Each person has their own, different routines ie. Breakfast, shower, meals, mobility, pain, continence, community access, settling and waking routines. But assessing needs uses the same skill, forms and procedure which technology can support. Technology can record what is needed, remind what was needed, and communicate to others what outcome was achieved or remaining tasks.

Apps that residents or their loved ones can use to tell staff what is wanted regarding everything, linked to the carer and nurse / management tool is critical in this day and age. Aged Care requires a trusted source of truth and automation to ensure everyone is informed.

Self-determination is about decision-making in everyday life, using the views of all involved health professionals’, but being able to control your legal/ethical rights in health and lifestyle decisions. If you have the capacity to state care goals, your aged care provider needs to empower you to do so. Families accessing the same App and contributing where relevant, adding in their own photos so their loved ones can see them instantly or viewing newsletters, calendar and linked ‘App’ information from a full clinical and lifestyle system, also ensures everyone is singing from the same hymn sheet and the source of truth is coming from those who need staff to know it.

Caring requires us to be vigilant – to know every wish and need, watch out for cues for change, and to know what we need to know. But obtaining the information directly from the person the care impacts, using technology, a system linked App, ensures our care is not only about the Standards, or public demands, or legal responsibilities but is real and can be followed through onto the ground where it is needed most.

Author Dr Caroline Lee

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