Cooinda Village Shows us the Benefits of being Restraint-Free

Cooinda Village Shows us the Benefits of being Restraint-Free

Cooinda Village is a not for profit community organisation for older people located in North East Victoria. They provide high and low residential aged care including palliative care, independent living and respite care to the local community. Cooinda Village has been with QPS Benchmarking since the 09/07/2008 and have utilised the benchmarking process to identify opportunities to provide a better resident lifestyle. In the last reporting period, QPS noted that Cooinda Village does not use physical restraints on their residents. As an alternative to restraints, there are a number of plans put in place to eliminate the need for restraints. QPS spoke to Jenny Bickerdike, the Clinical Care Manager to find out more.

On admission to Cooinda Village it is explained to residents and families that it is a no restraint facility, so that they are aware that residents will be allowed to live as independently as possible. This ensures that residents and family members are aware of the implications around risk, and have the opportunity to discuss this further with the Clinical Care Manager.

A no restraint facility means that all residents including residents with dementia are free to wander within the facility at all times. As residents health deteriorates Jenny is often asked by families regarding the use of bedrails, and it is explained to them that bedrails and restraints of any sort can cause increased agitation, because residents are confined to a certain space. Bed rails are also a major risk factor with residents trying to climb over the sides of them which may result in a major injury. Jenny goes on to explain that residents will be seated in open communal areas. The restraint free care of residents requires that staff are vigilant and observe residents closely, to eliminate the possibility of falls. Gerontic beds and alarm mats are utilised while residents are in bed so that there is a reduced risk of residents falling from a bed, and early intervention should a person get up unaided. Call bells and, in some instances, personal alarms are situated by the resident at all times, so that if able they can alert staff that they wish to get out of bed.

Dementia residents love to potter around the unit and interact with staff and other residents and the joy on their faces is very rewarding. The reasoning behind not using restraints is varied, from respect to safety. Cooinda Village focuses their energy on a person centred model of care, with all staff being trained to provide individualised care. What this means for the residents is a more home like environment, with recreational activities being centred on enhancing their movement, rather than confining their movement. All of the residents are encouraged to participate in these programs, which include regular exercise, dance therapy and Tai Chi. The use of Tai Chi and dance therapy as physical therapy improves residents muscle strength, balance, psychological health and general well-being. Staff note that following these sessions there is a marked decrease in agitation and increased interaction by residents with staff. The relaxed demeanour of the residents following such sessions makes it extremely rewarding. Residents with severe dementia often display their enjoyment through smiles, tapping of feet and hands or participation by movement of the hands, which is not often displayed at other times.

Cooinda Village also utilises the Smile or
"Play up" program to manage resident's agitation. A performer visits the facility on a weekly basis and shares fun times with the residents. The reactions from the residents to Mark, the performer are priceless. The joy and happiness exhibited by the residents, through beaming smiles and interactions that he is able to draw from the residents during their participation in the activities, is a pleasure to view. Comments from residents include "I have seen him in the recreation room and really enjoy what he does; I would like him to come visit me. He makes people forget about all the things that are worrying them" and "He makes a good effort to make people happy, I think he is fantastic. I enjoy being in the recreation room for the group sessions, everyone is happy" and "His sense of humour, I love people with a sense of humour, he is good fun".

Since the introduction of the Play up and Person Centred Care model Cooinda Village aggression statistics have decreased from 156 in 2010 to 22 in 2013. This in itself speaks for how just two variations in the way in which care is delivered can decrease the need for restraints.

Dementia Mapping sessions were introduced following the Person Centred Care education and from these sessions each individual resident has a plan of care put in place with activities that are known to decrease agitation. Restraint, is therefore not necessary, as the residents are happy and settled if staff provide them with a series of activities that are known to settle them. Mapping also informs staff of early signs of agitation, which, if responded to, can eliminate risk of a person standing unaided.

Jenny, the Clinical Care Manager analyses falls statistics each quarter to note any trends and new strategies are put in place to try to decrease or eliminate falls. It was noted recently that falls were occurring during the afternoon change over period, so staff handover was changed so that a staff member remained on the floor with the residents at this time. Also, falls were occurring just prior to dinner time as staff were often busy with residents in their rooms, so now a member of the Leisure and Lifestyle staff remains with the residents to monitor them during this time. This has seen a decrease in falls during these times as staff are around to distract and monitor residents more closely. It was also found that falls are occurring mostly in the residents' bedroom when they are attempting to mobilise alone. Staff encourage residents to sit in the communal areas where they can be monitored closely. If the residents wish to remain in their rooms resting on their bed then, alarm mats are placed in strategic places to alert staff when residents are moving around. Cooinda Village staff are also investigating the use of chair alarms for resident's rooms as an alternative method of closely monitoring residents who are not in sight. Cooinda Village has found that dementia residents are more settled when in the communal setting as they feel safer when they can visualise the care staff and other residents.

Individualised care of residents and the introduction of alternative programs have enabled Cooinda Village to remain restraint free. This has seen the decrease in the number of aggressive episodes and an increase in the psychological and physical well-being of our residents.