Exploring the concepts of consumer feedback systems for occupational therapy student learning during practice placements: A scoping review.

INTRODUCTION: Consumer contribution to occupational therapy student learning is mandated for Australian educational programs. However, there is limited research about how consumers contribute to student learning during practice placements. A scoping review was completed to explore the concepts of existing feedback systems for consumers to authentically contribute to student learning during practice placements. METHODS: Five databases were searched for all articles up to and including July 2023. All publications were included if they described and investigated authentic contribution to student learning during a practice placement experience. Data from the results and discussion sections of the papers were transformed into qualitative data and thematically analysed to develop a conceptual understanding of consumer feedback systems. RESULTS: Forty-six papers met the eligibility criteria. Most articles originated from Medicine (30%) and Nursing (45%) education. Feedback systems were primarily designed to critique student communication and professional behaviours using a variety of standardised and non-standardised methods. Five interconnected themes were created that addressed the concepts of consumer feedback systems. The themes were (1) creating value specific for each stakeholder is essential, (2) preparation is required and nuanced; (3) consumers do engage and provide critical feedback when the system is supportive of all stakeholders; (4) gathering approaches need to be responsive to the diversity of practice and learning; (5) processing feedback with a trusted mentor is critical for learning. CONCLUSIONS: Consumers, academics, practice educators, and students recognised that consumers have an important role in contributing to student learning during practice placements. Future consumer feedback systems need to be co-produced to create an optimal mode for consumers to authentically contribute to student learning constructively and safely. CONSUMER AND COMMUNITY INVOLVEMENT: A consumer consultant was a member of the advisory panel for the larger research project that this review is part of and provided advice to the research team at all stages of the project. PLAIN LANGUAGE SUMMARY: In Australia, occupational therapy training programs require input from consumers to help students learn. However, there is not much research on how consumers help occupational therapy students during their practical training. We did a review to see how existing feedback systems let consumers genuinely help students during their training. We searched five databases for research up to July 2023. We included research that talked about how consumers help all health students learn during practical training. We found 46 articles, mostly from Medicine and Nursing education. We analysed them to understand how consumer feedback systems work and found five main themes: (1) making sure everyone involved gets value out of it, (2) being prepared is important, (3) consumers give useful feedback when the system supports everyone involved, (4) different approaches are needed because practices and learning vary, and (5) discussing feedback with other people helps students learn. Current feedback systems mostly focused on how students communicate and behave professionally. Consumers, educators, and students all agree that consumers play a vital role in helping students learn during practical training. In the future, we need to work together to make feedback systems that let consumers help students in the best way possible, making sure it is constructive and safe for everyone.

Comparing the effectiveness of active and reactive mattresses in pressure injury healing: a pilot study.

OBJECTIVE: A feasibility study to test the proposed methodology for a larger randomised control trial was conducted, investigating the comparative effectiveness of the two types of pressure management support surfaces with regards to healing pressure injuries (PI). A secondary objective was to provide insights into the user acceptability of the two types of pressure management support surfaces. METHOD: A randomised control feasibility study was conducted in a community health setting in Canberra, Australia. Patients aged ≥65 years with an existing Stage 2 PI who slept in a bed were eligible. Participants were randomised to either the active mattress group or the reactive mattress group for use on their bed. All participants received standard wound care by community nursing staff and were provided an air-flotation cushion for use when not in bed. Photographs were taken and used for blind assessment of wound healing. Secondary information was gathered through a survey regarding user acceptability of the support surfaces and changes in habits regarding PI prevention strategies. RESULTS: In total, five patients were recruited, with one passing away prior to mattress allocation. Results were inconclusive with regards to comparative effectiveness and user acceptability due to the small sample size; however, secondary data indicated an increasing implementation of PI prevention strategies. CONCLUSION: This study confirmed the need for further high quality research comparing reactive and active pressure mattresses. Trends indicate the importance of including education on PI prevention strategies to promote changes in behaviour. Changes to the proposed methodology will be made to increase recruitment in the primary study.

Virtual reality after stroke: Identifying important characteristics when designing experiences to improve engagement in upper limb rehabilitation.

Objective: Virtual reality (VR) has been used to improve upper limb function after stroke but there is little to guide product developers in building experiences that engage users in the sustained, repetitive training required. This research sought to understand the characteristics of VR scenarios best suited to engaging someone with a stroke during recovery to achieve therapeutic outcomes. Methods: Five creative immersive VR scenarios were designed by an experienced VR content creator containing unique combinations of VR characteristics. The usefulness of the scenarios was reviewed by expert clinicians experienced in stroke rehabilitation. Following this review, seven stroke survivors participated in each experience and reported on their engagement and motivation. Outcome measures were the User Satisfaction Evaluation Questionnaire and the modified Intrinsic Motivation Inventory. Semi-structured interviews were conducted with five participants following their immersive VR experience and analysed thematically. Results: Expert clinicians reported potential therapeutic value in the immersive VR scenarios by providing opportunities for repeated and graded practice of upper limb movements. Stroke survivors reported varied levels of enjoyment and engagement for each scenario. They recommended changes to the experiences, primarily relating to the tailoring of the scenarios to match varied upper limb capacities. Conclusion: This study highlights the characteristics of immersive VR scenarios that are important in sustaining motivation and providing high-repetition task-specific movement experiences. Differences in the experience and preferences of stroke participants regarding the characteristics of immersive VR experiences indicate that a variety of experiences are necessary to engage and sustain participation in an immersive VR-related therapy programme.

Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.

INTRODUCTION: Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. METHODS: Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. RESULTS: The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6 minutes per person per day in the first quarter, reported allied health minutes fell to 4.6 minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3 minutes per person per day. This is just over half the Australian average of 8 minutes reported to the RCACQS in 2019. CONCLUSION: Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.

Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design.

INTRODUCTION: Occupation-based interventions use engagement in a person's daily activities to achieve change. There is growing research into the use of occupation-based group interventions in the inpatient rehabilitation setting. It remains unclear whether occupation-based groups offer comparable outcomes to occupation-based interventions delivered individually; this research will precede a clinical trial aimed at comparing these two approaches for improving occupational performance outcomes. This study details the process of co-designing the intervention. Partnering with clinicians and patients in the design of healthcare interventions can promote patient-centred care, enhance uptake, and improve applicability and sustainability of the intervention to that setting. METHODS: A modified nominal group technique (NGT) design was applied to facilitate two meetings and an electronic survey with an expert panel of clinicians and patients. Twelve participants (n = 4 occupational therapists, n = 1 registered nurse, n = 1 physiotherapist, n = 1 occupational therapy assistant, n = 1 occupational therapy manager, and n = 4 patients) were purposively recruited. A modified approach to the technique's four stages was used: silent generation, round robin, clarification, and voting. Consensus was set at >50%. Qualitative data from group discussions were analysed thematically. FINDINGS: All participants agreed the intervention should include patient-centred, goal-directed, practice of daily activities, including breakfast and lunch preparation, domestic tasks, and laundry. Other components that were agreed included where the groups could run, group size, eligibility criteria, and frequency. Key themes from clinicians included needing a goal-directed intervention, focused on progressing towards hospital discharge; time and resource requirements were also discussed. Patients emphasised the importance of building social connections, opportunity to engage in meaningful activity, and the importance of linking participation to patient goals. CONCLUSION: Through collaboration with clinicians and patients, an occupation-based group intervention considering the available evidence, alongside clinical, experiential, and contextual sources of knowledge was developed; this resulted in an evidence-based, patient-centred, and contextually relevant intervention.

Immersive virtual reality in the promotion of health and well-being for people in residential aged care without cognitive impairment: A scoping review.

Objective: Sustaining the health and well-being of older people living in residential aged care (RAC) requires new means of providing safe and stimulating recreational and therapeutic programs such as using virtual reality (VR). The aim of the scoping review was to investigate the utility of immersive VR interventions using head-mounted display technology to promote the health and well-being of people without cognitive impairment living in RAC. Method: The following databases were searched from inception until January 2024: PubMed, PsycINFO, Scopus, Cochrane and CINAHL. The eligibility criteria were quantitative, qualitative or mixed methods studies published in English, conducted in RAC, using VR with head-mounted display with people without cognitive impairment. Results: Of the 274 articles identified, 9 articles with a total of 310 residents and 50 staff met the inclusion criteria. Seven factors to either impede or enable the use of VR with head-mounted displays in RAC were: residents' agency; the nature of the VR experience; the content of the experience; the ease of use and comfort of the technology; the role of RAC staff; and the role of residents' family members. Conclusion: Immersive VR has potential as a tool to promote the health and well-being of people without cognitive impairment living in RAC. Small sample sizes, variations in study design, and selection bias mean that generalisability of the results is limited. Further research is recommended to inform the design and implementation of immersive VR programs tailored specifically for this population.

The use of practice evidence by Australian occupational therapists: Perspectives and actions.

INTRODUCTION: Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. METHODS: A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. RESULTS: Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. CONCLUSION: Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

Risk of Social Isolation as a Contributing Factor to Diet Quality in Community-Dwelling Older Persons Living in the Australian Capital Territory-A Pilot Study.

OBJECTIVES: Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons. METHODS: This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII. RESULTS: Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was -1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = -0.041 (-0.066, -0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001). CONCLUSION: Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community.

A pilot study of an intergenerational program for people in residential aged care with cognitive impairment and children from a co-located early learning centre during COVID-19.

Intergenerational programs in residential aged care may improve well-being and combat loneliness and social isolation in older people with cognitive impairment. This pilot study investigated the effects of a semi-structured intergenerational group, including children from a co-located early learning centre and people living in residential aged care with cognitive impairment. This 9-week study used a mixed methods pre- and post-program design. Sessions were designed and delivered once per week by Occupational Therapists and took into account residents' interests and children's developmental needs and interests, identified in pre-program interviews. Nine older people with cognitive impairment and 13 children participated. The program was well attended despite disruptions and complications caused by COVID-19 and weather conditions. Older people valued the opportunity to engage with the children. Children were observed to gain confidence in communicating and forming friendships with older people with different levels of ability. There did not appear to be any change in loneliness or neuropsychiatric symptoms. The intergenerational program benefited participants and received strong support from family members and staff of the early learning centre and aged care home.

Occupation-Based Interventions to Improve Occupational Performance Among Older Adults Living in Long-Term Care: A Systematic Review.

IMPORTANCE: Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care. OBJECTIVE: To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal-database inception to February 2023. STUDY SELECTION AND DATA COLLECTION: This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance. FINDINGS: Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents' goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported. CONCLUSIONS AND RELEVANCE: Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited. Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.

NHCs silver complexes as potential antimicrobial agents.

NHCs (N-heterocyclic carbenes) are generally used as organic ligands that can coordinate with metal ions like silver to form stable complexes. These complexes have shown enhanced antimicrobial properties compared to silver alone. This document provides an overview of the reported NHC-based silver derivatives (acetates, chlorides, bromides, and iodides) who possess antimicrobial activity. This review covers articles published between the first report (2006) and 2023.

Regiodivergent sulfonylation of terminal olefins via dearomative rearrangement.

Sulfones are fascinating and highly used functional groups, but current syntheses still have limitations. Here, a regiodivergent transition metal-free approach towards sulfones [(E)-allylic sulfones and α-sulfonyl-methyl styrenes] is reported. The method employs commercially available olefins, bases, additives, solvents, and sodium sulfinates (RSO2Na) and produces adducts in good yields. Considering that up to 4 reactions (bromination, dearomative rearrangement, E2, and SN2) are happening, this approach is very efficient. The structures of key adducts were confirmed by X-ray crystallography.

Synthesis of a New α-Azidomethyl Styrene from Safrole via a Dearomative Rearrangement.

There is a growing interest in developing more efficient synthetic alternatives for the synthesis of nitrogen-containing allylic compounds. This article presents a straightforward two-step protocol to produce 5-(3-azidoprop-1-en-2-yl)benzo[d][1,3]dioxole 4 from the natural product safrole. The method yielded the expected α-azidomethyl styrene 4, in good yield, via a dearomative rearrangement.

Quantum Chemical Insight into 1,2-Shift Rearrangement in Bromination of Allylaryls.

In this work, we have provided mechanistic insight into the addition of bromine to an allylic double bond of allylaryl derivatives using experimental and DFT-based electronic structure methods. The experimental yields indicate the influence of the functional group on the aryl ring on the ratio of 1,2-dibromo and 1,3-dibromo adducts formed in the reaction. The optimized geometry and the electron density maps of the allylaryls and their cationic intermediates from DFT simulations revealed that electron-rich aryl rings promoted formation of cationic spiro[2.5] intermediate II, whereas electron-poor aryl rings resulted in formation of bromonium intermediate I. It was observed that electron-rich allylaryls promoted the 1,2-shift of the aryl ring that resulted in bond formation between the carbon atom (C1) on the aryl ring and the central carbon atom (C3) in the allylic double bond and formed spiro[2.5] intermediate II, a trend which was confirmed by harmonic oscillator model of aromaticity index. Also, Wiberg bond order analysis is in good agreement with the experimental work. Thermochemical analysis indicates that smaller C1···C3 distance resulted in favorable values for the difference in free energy change (ΔΔG). The favorable ΔΔG values are a result of higher electron density on the aryl ring, making it more nucleophilic toward C3 carbon and promoting 1,2-shift that led to formation of the spiro[2.5] intermediate. Thus, the underlying mechanism indicates that the electron-rich allylaryls promote the formation of 1,3-dibromo compounds through formation and stabilization of the spiro[2.5] intermediate II.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review.

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Designing an Alternative, Community Integrated Model of Residential Aged Care for People Living with Dementia: Nominal Group Technique and Thematic Analysis.

BACKGROUND: Small-scale models of dementia care are a potential solution to deinstitutionalize residential aged care and have been associated with improved resident outcomes, including quality of life and reduced hospitalizations for people living with dementia. OBJECTIVE: This study aimed to generate strategies and ideas on how homes for people living with dementia in a village setting within a suburban community, could be designed and function without external boundaries. In particular, how could residents of the village and members of the surrounding community access and engage safely and equitably so that interpersonal connections might be fostered? METHODS: Twenty-one participants provided an idea for discussion at three Nominal Group Technique workshops, including people living with dementia, carers or former carers, academics, researchers, and clinicians. Discussion and ranking of ideas were facilitated in each workshop, and qualitative data were analyzed thematically. RESULTS: All three workshops highlighted the importance of a surrounding community invested in the village; education and dementia awareness training for staff, families, services, and the community; and the necessity for adequately and appropriately trained staff. An appropriate mission, vision, and values of the organization providing care were deemed essential to facilitate an inclusive culture that promotes dignity of risk and meaningful activities. CONCLUSION: These principles can be used to develop an improved model of residential aged care for people living with dementia. In particular, inclusivity, enablement, and dignity of risk are essential principles for residents to live meaningful lives free from stigma in a village without external boundaries.

An Exploratory Study of Nutrition Knowledge and Challenges Faced by Informal Carers of Community-Dwelling People with Dementia: Online Survey and Thematic Analysis.

Nutrition knowledge is a primary factor influencing food choices and the ability to identify nutritional risk for carers of people with dementia. Acquiring nutrition knowledge helps carers monitor changes in food intake and micronutrient intake, and whether a healthy and balanced diet is being consumed. This study aimed to assess the nutrition knowledge of carers in the Australian community and their experiences with nutrition education. Using a mixed-methods approach, the nutrition knowledge of informal carers was assessed using the revised General Nutrition Knowledge Questionnaire (AUS-R-NKQ), and interviews of informal carers were used to explore the perspectives in a sub-sample. A total of 57 carers (44 females; mean age of 63.0 ± 13.1) completed the survey, and 11 carers participated in follow-up interviews. The total sample scored 22.9 (±4.57) out of 38 on the AUS-R-NKQ, suggesting basic nutrition knowledge. The interviewed carers acknowledged the importance of healthy nutrition but viewed the provision of a healthy diet for a person with dementia as challenging. In both the survey and interviews, carers reported limited use and availability of dementia-specific nutrition resources. Carers were unsatisfied with the advice and number of referrals provided to improve the nutrition of the person with dementia and desired less confusing nutrition education materials adapted to their level of knowledge. The present study highlights the need for informal carers to be supported to acquire adequate nutrition knowledge.

Occupation-based interventions to improve occupational performance and participation in the hospital setting: a systematic review.

PURPOSE: To critically review the evidence for occupation-based interventions in improving occupational performance and participation outcomes in the hospital setting. METHODS: Five databases were searched from 2000-2022. Peer-reviewed studies of any design investigating the impact of occupation-based interventions in the hospital setting were included. Methodological quality was assessed using the appropriate tool for each study design. Following data extraction, a narrative synthesis was conducted. RESULTS: Thirty-three studies comprising of 26 experimental, five non-experimental, and two mixed methods studies were included (n = 1646 participants). Results indicate good evidence to support occupation-based interventions to improve occupational performance and participation outcomes in inpatient rehabilitation; it is unclear whether they are more effective than any control/alternative intervention. Research in the acute and mental health hospital settings were scarcer. Understanding the benefits of occupation-based interventions was enhanced through qualitative results including improving independence and confidence to discharge home, increasing motivation for therapy, connecting with others, and peer-based learning. CONCLUSIONS: Heterogeneity and methodological weaknesses across existing studies limits the conclusions that can be drawn on the impact of occupation-based interventions in the hospital setting. More rigorous research should be conducted with better reporting of intervention design and the use of robust measures of occupational performance.Implications For RehabilitationThe use of occupation-based interventions should be considered to improve occupational performance and participation outcomes in the hospital setting.There is good evidence to support the impact of occupation-based interventions on improving occupational performance and participation outcomes in the inpatient rehabilitation setting; evidence in the acute and mental health settings is scarcer.Occupation-based interventions are valued by both patients and clinicians for their impact on patient outcomes and the patient experience.

'It's like home' - A small-scale dementia care home and the use of technology: A qualitative study.

AIM: To explore the experiences of residents, families and staff in the establishment of a new small-scale home model of care for people living with dementia. BACKGROUND: New and innovative small-scale models of care have the potential to improve outcomes for older people, especially those with dementia, who experience high rates of cognitive impairment in traditional residential aged care homes in Australia. DESIGN: A qualitative descriptive study. METHODS: Semi-structured interviews with 14 guests, family and staff of a new small-scale dementia home named 'Kambera House' in the Australian Capital Territory were conducted between July 2021 when the home opened and August 2022. Data were analysed using reflexive thematic analysis and reported according to the COREQ guidelines. RESULTS: Two guests with mild-to-moderate dementia, five family and seven staff members participated in the study. The data revealed high satisfaction with Kambera House, generating five themes. Falls detection technology in the home provided a sense of safety, enabling more time for person-centred care. Free, everyday technology connected the home with families as part of an overall community of care where staff were empowered to maximize choice and dignity of risk of guests living in the home. This contributed to the sense of community, rather than an institution, where the conditions of work supported the conditions of care, and were embedded in a culture of responsiveness, change and flexibility. CONCLUSION: Kambera House represents a successful example of a new small-scale dementia home. Technology played an important background role in improving overall safety and flexibility as part of a model of care which demonstrated positive experiences for guests and families by being responsive to their individual needs. IMPACTS: Small-scale homes for people with dementia offer an alternative model that may provide more individualized, person-centred care compared with the traditional institutionalized care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.