Out of Home Respite Centres – Their Importance & Do They Need a Redesign?
As our aged care services industry is overwhelmed with demand, the peripheral services can have a large impact on helping those in need and reducing pressure on the industry. One of these is out of home respite care, however when these services and facilities are poorly designed they do not meet user needs and due to this, end up being underutilised.
Out of Home Respite Centres are a service offered by aged care providers that provide temporary short term care to help support carers and those being cared for. They can be day respite centres or overnight facilities, and often provide a combination of both options.
Respite centres are recognised as an important service to the community, and the federal government has a programme, the Commonwealth Home Support Programme (CHSP) that helps older Australians access services to support them as they age, including respite care. To access respite care you must be assessed for your needs and eligibility, with a maximum of 63 days that can be subsidised per financial year, with respite residents paying only the basic daily fee at the minimum rate and paying no bond or accommodation charges. One of the reasons that respite centres are so vital to the community is that they provide a mechanism to reduce carer stress. It has long been recognised that caring for an elderly person can be demanding and can easily result in mental and emotional fatigue. Without any assistance, this leads to high levels of carer stress, which can negatively impact the lives of both the elderly person and the carer. Carer stress has been recognised by WA Parliament’s Select Committee into Elder Abuse as a risk factor for elder abuse, thus measures to reduce carer stress are vital to protect our older Australians. This extra support service for carers and elderly Australians can extend the time they remain at home and delay admission to full-time residential care. Remaining at home for as long as possible is generally the preferred option for ageing Australians thus this can contribute positively to their mental health, in addition to easing the burden off the limited number of aged care places.
However, despite the benefits, a recent study revealed that only just over a quarter (27%) of those who were approved for respite care used it within 12 months. There has been a reported hesitancy from carers to use respite care. In consultation studies with carers, they found general concerns existed regarding the usefulness, quality, convenience, cost, flexibility, and responsiveness of respite care. Carers for those with dementia also reported concerns about triggering increased levels of confusion, disorientation, and deterioration of cognitive function and behaviour, in addition to lack of confidence that care will sufficiently address the complex needs of their care recipients. It is clear that the hesitancy for the carers to take up respite care stems from a fear that those they care for will not have their needs met, that they will not receive the customised best care possible, and will suffer as a result. Perhaps this fear has resulted negative public perception or from poor past experiences. It is common to see respite centres developed as an ad hoc extension of larger aged care facilities. However, converted buildings that are not custom built for purpose in addition to the more common care approach of providing collective passive entertainment for a large group of people is not conducive to each individuals’ unique physical, emotional, social, and psychological needs being addressed.
Everyone is an individual and only flourishes according to their unique needs, interests, and desires being met. Those that care for the elderly must recognise that they now have a significant amount of influence over that person’s life and they can help or hinder them in meeting their own unique needs. The best outcomes for those in care are realised when their day-to-day life is structured to meet those needs. In respite care, this means that the environment must be flexible enough to allow each person’s needs to be met in a different way rather than a uniform approach enforced on them by staff.
Respite care must provide an individualised, well designed physical and social environment. It is important that respite care centres are specially designed buildings and not existing buildings converted to a respite centre. These facilities must become homes, places of comfort and support and freedom with the right atmosphere or they will not be used. They need to be designed to encourage flexibility and independence, a place the attendees feel that they have some ownership in. This needs to be done in collaboration with the provider’s operating model – where attendees can help maintain the gardens, make decisions around the home, can engage in food preparation, or help others in the kitchen when they feel like it. This is important so that attendees are engaged, feel useful, are involved in decisions as much as possible, can plan what they want to do, have both the opportunity to give and receive care and help. This all contributes to the feeling of a home, and connection amongst attendees, and staff who act more as a friendly support role rather than the enforcer of decisions and rules.
Respite Homes that have adopted this approach have received hugely positive feedback from carers and those being cared for alike. These experiences can have positive health outcomes, both mentally and physically. This is reassuring for their carers, and provides them with much needed rest and rejuvenation so that when their caring continues it is not impacted by physical, emotional, or mental fatigue. It is vital that respite centres transform their approach to respite care, only when they do this will we see hugely improved outcomes for both carers and care recipients alike.