Emmaus Community Embraces a New Model of Care

The Emmaus Community is a 115 bed aged care facility located in Port Macquarie on the Mid North Coast of NSW and is operated by Catholic Care of the Aged (Lismore Diocese). It is a new facility that completed its commissioning process in mid 2011.

"In order to achieve big improvement there are times when you have to be brave and step outside of current thinking and be prepared to take a risk or two". This thought echoed through the minds of Joy Walsh (Community Leader) and Sue McCann (Director of Care) when they started the planning process for the Emmaus Community Facility to replace the ageing Lourdes Nursing Homes facility in Port Macquarie, located on the Mid North Coast of NSW.

Joy and Sue think deeply about care for the aged, and discussion with either of them will convince you of that. Three years ago when QPS conducted a major review of its resident satisfaction surveys with A/Professor Rod O'Connor it was Sue McCann who raised the importance of adding questions about meeting the spiritual needs of the residents. The term spiritual was not meant in a specific religious sense but instead attempted to address whether or not an aged care facility made it possible for a resident to find peace, contentment or that feeling that their soul was in a soothing or happy place. It is this sort of deep thinking that no doubt contributed to the development of a new and exciting model of aged care for Emmaus Community.

In preparation for the planning process Sue and Joy did not want the facility to be home like but instead the facility must be a home, a place where the spiritual or soul needs of the residents could be met and where sensible risks could and should be taken. To cut a very long story short the pair were impressed by a model described in the American book "In Pursuit of the Sunbeam" by Steve Shields and LaVerne Norton (2006), and in particular the household framework developed by Linda Bump. In essence, this framework is characterised by:

• A sense of home, a sense of belonging, enabling, engaging with life where the boundaries of the person and his/her home are clear and respected as a matter of course.
• Grace. A shared sense of what is sacred about the house and its people, is deeply valued, consciously created and preserved. Ritual, spontaneity, friendship, spirituality, celebration, recreation, choice, interdependence, art and humour are all manifestations of a culture of grace.
• Resident directed care is about changing life for our residents rather than making it easier for us (the staff).
• The people who live here are loved and served by a responsive, highly valued, decentralised, self led service team.
• Blended roles, meaning everyone helps with whatever needs to be done.
• Risks are managed, not always eliminated.
• Building community with one another, our family, our neighbours, and our town.
• Change is everyone's job. Staff members in all households are responsible for finding how best to foster the freedom of home with each resident.

When making decisions Bump's Law will be applied:

• What does the resident want?
• How did the resident do this at his or her previous home?
• How do you do it at home?
• How should be do it here?

These words are emblazoned on the front of every job description for Emmaus Community.

To create the new model, the new facility was designed to create eight houses of 12-18 beds each. House type models have existed before but the number of bedrooms in each unit were increased to create a home that could be supported by individual teams.

One of the problems noted in facilities that had pods of 4-6 beds was that staffing had to cross over between the pods. To further develop the home concept there is an appointed team leader for each house. The team leader can come from any professional background and there is currently 1 RN, 3 EN's and the rest come from a care staff background. One team leader was originally a cleaner. It has been observed by the management that this mix of team leaders seems to keep the thoughts of leaders fresh, innovative and not constrained by professional boundaries.

Prior to the actual commissioning of the new building the new team concepts were being deployed via a big effort in the area of staff consultation and feedback. It was critical that staff both understood and were prepared to make work the new house team concept.

The outcomes in terms of staffing are interesting. As Joy Walsh says, "this is not necessarily a more dollar efficient way of doing business but we do employ less registered nurse hours than before because they have been excused of the burden of the general running of the facility and this allows them to focus more effectively on the roles of assessment and treatment. We have noted that the registered nurses now appear to have more time to do 'the clinical work'".

As part of the shift in the staffing model Certificate 4 nurses were trained up and internally credentialed to do the routine medications and the RN now focuses on PRNs and pain management....and the medication error rates have dropped. Joy Walsh explains that this model does lose some inevitable economies of scale but a model based solely on economies of scale would not necessarily fit Bump's Law, and this is a somewhat refreshing thought for those of us pre-occupied with bean counting.

Staff formerly employed as cleaners or food service staff have been deployed to the houses and they have got on with the business of multi-skilling and applying that part of new model framework that talks about the importance of blended roles and getting on with whatever needs to be done.

Lifestyle services have been restructured. The number of dedicated lifestyle staff has been reduced in favour of these duties being shared among the house staff. The dedicated lifestyle staff members are now charged with a role for increased coordination and innovation. With this change it is also noted that more residents are now playing larger roles in helping to facilitate activities.

Staff members are not rotating throughout the facility (as before) and this is helping to build a team that is entirely focused on the residents. As the amount of contact has increased so too has the level of friendship between the residents and staff. In one charming anecdote a relative reported to the manager "in all the time mum has been here this is the first time that he has witnessed his mum calling the staff by their names". If there is one factor that defines the difference between a home and institutional care, maybe this is it. An accreditation auditor also reported another wonderful story. He asked a male resident for his views on staff. The reply: "Michael, he's not staff he's my mate" (Michael was a CSE working that shift).

The level of complaints has dropped but significantly the nature of complaints has shifted dramatically as the number of complaints about staff members has evaporated. This is further reinforced by a framework that makes it clear to new staff that continued employment is subject to resident and other staff satisfaction with their work attitude and performance. Some new staff fit into one team but not another, and in the same way as any home, some personalities are compatible and others not. Symbolism is also important, and one house has all the photos of residents and staff members together on the one wall. This reinforces the view that it takes both residents and staff members to make the home.

During the planning phase, residents were given their own choice of rooms and whilst precise location was not that important almost every resident stipulated that they wanted a view of the outside and access to the gardens. This was easily and spectacularly achieved and the gardens are a credit to the landscape designers.

Emmaus has also strived to achieve a sense of community. The houses are named after the local catholic schools and a relationship between each house and its namesake school is being nurtured. A program of skill sharing has been introduced where students will teach residents about how to use a computer and residents will help students with skills such as sewing. The students of one school have painted a wonderful mural for their house and music sessions for the residents are becoming a regular feature.

Is there evidence coming from the benchmarking KPI's to suggest that improvement has been achieved? The answer is yes. Resident and relative satisfaction are Emmaus sits well above the industry average.

A breakdown of the scorecard data shows that improvement has been achieved in every section of the resident satisfaction survey when the combined data for the old Emmaus and Lourdes facilities is compared to new Emmaus facility with the biggest gains in the areas of services received from care staff, the home's accommodation and living area, environmental services and maintaining community contact.

It has been a long journey for the team at the new Emmaus but the step of moving away from a traditional model of care appears to have been one very much appreciated by both residents and staff.