Jenny worked as a generalist community nurse and sole practitioner from the Dorrigo Multipurpose Service in NSW, servicing a farming community for 15 years. This experience provided the platform for a passionate interest in rural health and the unique challenges associated with equity and access to health services for rural communities.
After working with the Health Education and Training Institute Rural for six years, Jenny joined the Agency for Clinical Innovation in 2013 to establish the Rural Health Network. The primary focus of the Network is to identify and showcase platforms for sharing rural innovation and to progress ground up priorities as identified by the rural Local Health Districts. The development and implementation of the Living Well in Multipurpose Services Principles of Care to transform residential aged care in NSW was identified as the priority for 2016 / 2017.
Residents Living Well in NSW Multipurpose Services: not a hospital, but home
There are 65 Multipurpose Services (MPS) in small rural communities across NSW, Australia that provide a combination of hospital and health services for their communities; including emergency, acute, community and residential aged care. This presentation will describe how eight Principles of Care for Living Well in an MPS were developed and implemented to improve the quality of life, lifestyle and homelike environment for aged residents who live in NSW MPS; not as inpatients in hospital, but as people living in their home.
Using a Toolkit developed by the NSW Agency for Clinical Innovation (ACI), 25 MPS teams implemented small scale changes throughout 2017 using the Boston Institute of Healthcare Improvement (IHI) Collaborative methodology. The toolkit includes a Self-Assessment Checklist, a Resource Guide of evidence based strategies and the Principles of Care:
- Respect for Rights as an Individual
- Comprehensive assessment and care planning
- Homelike Environment
- Informed and Involved
- Access to Recreation and Leisure activities
- Positive dining experience
- Multidisciplinary services
- Expertise in aged care
Over 460 small scale improvements were completed over the year using rapid Plan-Do-Study-Act (PDSA) change cycles and sharing results via an on-line portal to enable faster collective improvement state-wide. Outcomes against the Principles of Care were measured bi-monthly using resident and staff reported quality of life indicators showing significant outcomes across all domains:
- Relationships between residents and staff
- Overall Mood
- Usual level of physical wellbeing
- Quality of everyday life
- Amount of independence
Some of the highlights include harnessing local community and volunteer networks available in small country towns to increase connectivity with resident’s lifestyle factors; integrating community and residential living to strengthen relationships, inclusion, control and a sense of belonging and self-worth for residents. Examples include: Men’s Sheds restoring outdoor furniture, building vegetable gardens and chicken coups, Hospital Auxiliaries donating BBQs and furniture, volunteer outings and activity calendars, intergenerational activities such as school visits, pets and care planning based on lifestyle, individual preferences and routines.
The culture of care has shifted from one based on clinical need as inpatients, to one based on quality of life and enablement as residents. Living well in MPS is now business as usual, having generated a wellness philosophy influencing all MPS and improving the quality of life and homelike environment for their residents who call MPS their home.
“The Living Well in MPS Collaborative has transformed the NSW approach to providing residential aged care in MPS.” Murrumbidgee Local Health District (LHD) Board