the dilemmas of dementia

Transcription

1 In case of emergency break glass: fire safety, environmental design and the dilemmas of dementia care Ashley Carr Simon Biggs School of Social And Political Sciences, Melbourne University.

2 Outline Overview of research Phase 3: Vertical slice Fire safety regulations in aged care The special case of dementia Embedding regulation and dementia in design Working with the regulators Adaptations Regulation = variation within limits (Gray and Silbey 2014)

3 Our research About the project This project is Activity 7 of the Cognitive Decline Partnership Centre (CDPC), a national initiative funded jointly by the National Health and Medical Research Centre (NHMRC), Alzheimer s Australia, which supports the Consumer Dementia Research Network (CDRN), and three aged care industry partners Brightwater Care Group, Hammond Care and Helping Hand Aged Care. Simon Biggs is Professor of Gerontology and Social Policy in the School of Social & Political Sciences, University of Melbourne and Brotherhood of St Laurence (BSL), Research and Policy Centre (RPC). Ashley Carr is a Research Fellow in the School of Social & Political Sciences, University of Melbourne and a Research Officer at the BSL, RPC. Further details Research Insights are published by the Brotherhood of St Laurence as a contribution to the CDPC. For more information: Simon Biggs SBiggs@bsl.org.au Ashley Carr acarr@bsl.org.au Or visit: pc/

4 Research design Phase 1 Phase 2 Phase 3 Phase 4 Reviewing Making connections to key themes in previous research Interviewing Gaining perspectives from stakeholder knowledge Visiting Examining practice with providers on site Advising Providing recommendations to policy-makers and partners Mapping Understanding the regulatory environments and pathways Analysing Identifying recurring issues and cross-group differences Surveying Developing a vertical slice perspective on key issues Networking Circulating research findings and influencing future agendas Designing Using learning to plan and guide data collection Refining Using findings to shape focus and move research forward Interpreting Using findings to frame patterns, discourses and needs Concluding Completing the project, summarising and looking ahead Jan Dec 2014 Jan Mar 2015 Apr Dec 2015 Jan Dec 2016 Identifying architecture for a complex system Understanding the state of regulatory play Examining practice in action Recommending effective systems change

5 Phase 3: Vertical slice Layer Respondent Principal focus Respondents (no. ) Organisation Senior Manager Strategic capture 17 Facility Facility Manager Operational capture 13 Direct care Personal Care Workers Interactional capture 24 Providers exist in the middle-ground between regulators and care recipients Different understandings and experiences of regulation depending on the organisational level or layer Regulation has moved closer to the action (Huising and Silbey 2011)

6 Regulating fire safety in aged care Response to fire and disaster Kew Residential Services fire (Vic. 1996) Quakers Hill fire (NSW. 2011) Coronial Recommendations Increased regulations Regulatory hot-spots (Braithwaite 2012) Overlap and duplication Australian Building Code (Class 9c) Standards Australia Accreditation standards

7 A case of too many regulations? aged care and childcare are two of the most regulated areas of expertise in the world and in Australia [W]e have all the clinical outcomes that need regulatory requirements like palliative care, behaviour management, so it s all regulated. We then have to stick to management regulations, there s regulations for fire safety, regulations for workplace health and safety, regulations for archiving or materials and how long we keep them, so it is very regulated. (Senior Manager 10).

8 or too many regulators?...fire is very important as you can well appreciate in this industry... [A]s part of the accreditation they look at the building, the fire safety and the building code... On top of that we have the local metropolitan fire service who also come through every three years. They look at it more of an operational type thing just to make sure that everything is being maintained, access is still okay, communication, staff training is still happening and then in date. Then on top of that we ve now got the local council coming through...we have potentially three or four different bodies of groups coming through looking at...the same thing, the fire safety and compliance of that building. But...they ve all got a different spin on it all. (Senior Manager 11).

9 or irrelevant? There might be other examples of where there is a particular regulation or piece of legislation but we cannot follow it because it s just not relevant to the context and it s just a bit of a symptom of the lack in the legislation becoming relevant, rather than us not wanting to do something. (Senior Manager 9) We will look at legislation and go, well how does that impact on a person with dementia? And if we think that the legislation is, the building codes are detrimental to that then we will make an argument and a case on that, to improve the design for our people. (Senior Manager 13)

10 The special nature of dementia care if we have residents that like to wander and continuously wander through the cottage, if there was fire testing or something where doors had to be shut that could actually be quite distressing to them because if they wanted to get through a particular door and they couldn t they d have to be redirected away. That may cause them to be quite agitated and that agitation could actually go on for some time if we can t deescalate that. So that would be a real negative impact. (Facility Manager 13)

11 when the alarms go off if someone burns the toast or if we do have a false alarm or an activation of detection all the audio alarms goes off. It can distress especially people in the secure unit, it can distress them somewhat. (Senior Manager 11) Calm and calming environments (over-) Stimulation Minimising distress Homelike and familiar The diversity of dementia

12 the building code is very prescriptive to, I guess, with building, they don t always consider what those codes mean for people living in them. So, I think that when they put the codes and standards and regulations together I think they re not necessarily people that have worked within the industry and have worked with people with dementia. They re looking at it from a, with a level of respect, they re looking at it from a safety point of view. They re looking at it from the environmental point of view. (Senior Manager 15)

13 Homelike or work-like Yes I understand that we need big exit signs and yes I understand that we need push handles on fire doors, but from our resident cohort you and I don't have that in our home environment so it s kind of indicating that you re really staying somewhere else. We can t reflect 100 percent home or domiciliary model because of the building regulations that we come under. (Facility Manager 2) Finding a balance between Fire Safety, Regulation and Homeliness

14 Solution 1: Dementia care by design Dementia care is usually part of the facility so I look at the building in total. There is some little bits and pieces which I need to be aware of with dementia [W]e try and keep the regulations very much behind the scenes I can t really think of anything which we can t do due to regulations. (Senior Manager 11)

15 Solution 2: Working with the regulators The other one in the fire space is the break glass emergency fire boxes, the ones where you break the glass and press the button. We've changed all those to not say break glass and worked with the regulators, because when they used to say break glass, a person would walk past, read it says break glass and break the glass, yeah. (Senior Manager 13) I encourage others within the industry to use, and that is work with a fire engineer, fire consultants to come up with alternative solutions to what you re doing to satisfy provisions [of the Building Code Australia]. In most cases fire consultants will find an alternative solution I don t know why other providers don t use those options (Senior Manager 15)

16 Solution 3: Adaptations But there s a whole heap of alternative ways of getting things that we do explore. So, for example, an obvious one is fire evacuation signage, just as an example. So we choose to put evacuation signage back of house, out [of] resident areas. We know you re required to have evacuation procedures But the reality is with people with dementia, they don t understand what the fire evacuation sign is. And nor would they necessarily use them even in a fire. So, we work with fire engineers and fire consultants to not only deliver the locations and baselines but we will say we ve ensured that our staff training identifies where they are located and that staff can demonstrate that they are trained in the fire evacuation drills. (Senior Manager 15)

17 Implications for other areas Building design Food safety Care standards Mobility Restraint and freedom of movement

18 Conclusions Specific needs of people living with dementia in residential care Regulation as variation within limits Flexibility and degrees of freedom Organisational strategies Developing expertise Applies to other areas: Food safety, Restraint, Care Standards Regulation as a collaborative enterprise ashley.carr@unimelb.edu.au