Meaningful engagement key to avoiding poor dementia care practices

Addressing challenges to help care staff be present with residents living with dementia is “the key to help avoiding poor care practices and resident outcomes”. This is according to a new survey involving three residential aged care homes (RACHs) in New South Wales.

HammondCare researchers John Swinton, Srivalli Nagarajan Vilapakkam, Mustafa Atee, Tom Morris and Chris Poulos interviewed staff on their experiences of being present — defined as meaningful engagement and person-centred care along with other attributes such as attentiveness and living in the moment; connecting with the person and meeting them where they are.

The study found that workers want to be more meaningfully engaged — or present — with residents living with dementia in their care, yet face challenges like staff shortages, competing workplace demands and time constraints.

“Practising presence and spending focused time with residents helped care workers to see different aspects in residents who were regarded as difficult to care for,” the researchers wrote.

There were two key findings from the study published in The Gerontologist. Firstly, meaningful engagement needs a connection of trust, which is then maintained through reliable relationships over time with residents. This is difficult to achieve with a transient workforce, staff attrition and changes to restrictions on foreign workers during COVID-19.

Secondly, care worker presence requires appropriate organisational structure, supporting resources and adequate staffing levels to ensure that care workers were able to pay attention to the individual resident.

Participants in the survey consistently cited being present with those they care for the most enjoyable and rewarding aspects of what is a demanding role. One study participant described the noticeable improvement in resident engagement when she was an additional staff member on a two-person shift due to being on reduced duties following an injury.

Other participants said they had similar experiences, including a reduction in behaviours associated with dementia when there was extra staff help available.

The surveys showed that attempts by staff to connect with the residents with dementia can be complicated by the condition itself. A common theme in responses from the participating staff was that residents were often disorientated by their condition with a sense of loss of their previous lives, leading to them withdrawing from connection.

To improve the capacity of staff to be present, the researchers wrote that adequate staff-to-resident ratios, through increased government funding, would seem to be an obvious response, but the researchers note the presence issue is more complex.

A combination of education, training and coaching strategies for care staff may also be required, along with regular reminders about practising presence during routine workplace activities such as shift handovers.

The researchers concluded that the challenges for enabling care worker presence should not be left to aged care providers alone to resolve.

“Regulatory bodies, governments, community groups and residential aged care homes need to collaborate to ensure appropriate funding and resources are available to enable care workers in residential aged care homes to be more present and provide person-centred care,” the researchers noted.

Image caption: Aged care worker Suzi Gibson with a resident. Image courtesy of HammondCare.