Coming to the realisation that a loved one needs to move into residential aged care (RAC) can be stressful for everyone involved.
Difficult circumstances, including grief and family conflict, are combined with adjusting to an unfamiliar situation, making the potential for a communication breakdown high. The situation is often made more complex as RAC staff manage the flow of information between several family members; on average staff collaborate with 4 family members for every one resident (according to Violet's 2020 research).
Here’s some practical advice for establishing positive communication with RAC staff right from the start, so you can both do the best job of supporting your loved one through to end-of-life care.
Build positive relationships for lifelong care
Rose Dillon, an experienced Violet guide who supported her mother through RAC and end of life care, says good relationships are key to smoothing the transition into a facility. “You need to look beyond the glossy brochures that tell you about the swimming pool and hairdresser,” she says. “It’s all about the staff and those relationships. The care, kindness, compassion and honesty surpass all those physical attributes.”
“Bond building happens quickly when I know something about you.”
Rose’s mum built relationships by learning all the staff’s names and more about their backgrounds. However, this may not be possible if your loved one has a cognitive impairment, and caregivers may need to do more.
Megan Luhr, a RAC support manager with significant palliative care experience, recommends relatives write a resident biography, describing things like their background, work history, likes, dislikes and hobbies. “The more I can read about that person, especially when they have a diagnosis of dementia, the more I get to know people. That bond-building happens quickly when I know something about you.”
She also advises finding a staff member you connect with - a buddy. “It could be the resident nurse, assistant in nursing or the admin lady,” she says, “as long as you gel with them.” Having one person you can openly talk to helps ensure your messages filter through to the right people.
And don’t be afraid to ask questions, she adds. “I say, keep coming, keep talking. I don't care how many questions you ask me. I will not have all the answers, but I can go away and find them for you.”
Support staff to support your loved one
When it comes to talking to RAC staff, Megan advises being honest, calm and respectful. She points out that staff are sometimes abused by relatives and get represented badly in the media. Relationships can disintegrate when caregivers approach them in an aggressive manner.
When it comes to talking to RAC staff, Megan advises being honest, calm and respectful. She points out that staff are sometimes in very confronting conversations with disappointed relatives, and can be poorly represented in the media, which can effect the relationship building between the facility and the community
“In one RAC shift, the nurses could be supporting someone with dementia one minute, then managing a cardiac issue or wound care the next.”
She adds that RAC nursing staff are highly trained and have a broad skill set. “Working in RAC is not like working in a hospital renal or orthopaedic ward where you’re dealing with one field,” she says. “In one RAC shift, the nurses could be supporting someone with dementia one minute, then managing a cardiac issue or wound care the next.”Rose notes that RAC staff “are usually very fond of older people and they try their best, often under adverse conditions like incredibly high workloads and poor pay.”When problems arise, focus on finding a solution rather than laying blame as this is often the key to resolving issues quickly.
Keep your loved one's needs at the centre
It helps to remember RAC staff and caregivers want the same thing – the best care for each resident. As Rose says, “The resident is the most important person. We're all trying to support them to have the best life they can. You need to put aside your own stuff and focus on what they want.”
Remember RAC is your loved one's new home
It’s also crucial to realise that RAC is not a hospital, and adjust your expectations accordingly, Megan says. She explains that people go to the hospital to get treatment and come out again, whereas RAC becomes the person’s home. “It will never be perfect. Your life at home wasn’t always perfect, either.”
Megan adds that hospitals and RACs are funded and staffed very differently. “I'm not going to see them every 10 minutes and I don't have all the equipment of a hospital,” she says. “A lot of dysfunctional communication can be avoided by understanding the difference.”
Accepting the reality of what's available in RAC will help you to make the most of the experience and know where you can best add the important, personal touches that mean most to your loved one.
Begin with the end in mind
“You need to find the courage to have the really difficult conversations.”
As Rose points out, most people leave RAC when they die, so it helps to consider end-of-life plans from the beginning. “It's about digging deep and finding the courage to have those tough conversations and thinking about what matters most to people at that stage of their life.” That means broaching sensitive and complex decisions with your loved one as early as possible to better understand how they want to spend their remaining time and what they want and don’t want to happen if their health declines.
Once you better understand the needs and desires of your family member you can discuss these with staff. Rose advises asking questions like:
- Can the facility look after someone at the end of life? What care can they provide?
- Can they do advance care planning?
- How do they understand what a person wants at the end of life (e.g. whether they want to go to the hospital)?
- Will those wishes be respected?
Importantly, Rose notes that people living in RAC can still have new and positive experiences. Her mum was in RAC for two years and, after some initial hurdles, she was happy and peaceful when she died, surrounded by people who loved her and knew how to care for her. The legacy of her interest in carer’s lives was a facility-wide Spanish language learning group started after a chance conversation with a staff member from South America. Many staff attended her funeral.
As Rose says, “It's never going to be the same as home, but it's the place where people will hopefully care about you and respect you. There is light at the end of the tunnel.”
Violet is a national not-for-profit organisation, providing information and support to help everyone in Australia navigate the last stages of life, and the grief and loss that accompanies it. We focus on the needs of family members, caregivers and friends, so that they can be better prepared and supported to help those they love to die well.