JAVA Memory Care program: Facilitating social and occupational engagement for older adults living with advanced dementia.

BACKGROUND AND OBJECTIVES: Residents in aged care homes often report lack of life purpose and meaning and limited opportunities to contribute to their community. The JAVA Memory Care program is designed to facilitate engagement for older adults with advanced dementia. This study explored whether JAVA Memory Care engaged such adults meaningfully, on social and occupational levels, within one Australian residential care home. METHODS: A mixed method design guided this exploration. Trained staff facilitated six JAVA groups over 2 months. Three sources of data were utilised. Observational data (qualitative and quantitative) were obtained using a narratively enhanced Assessment Tool for Social and Occupational Engagement (ATOSE). The other two data sources were qualitative and analysed thematically: reflections by the lead JAVA facilitator and data generated by a research discussion group. RESULTS: The quantitative data comprised 564 ATOSE behaviour markers. Participants were categorised as being engaged in 93% of these markers. Two of the three qualitative themes focused on the collective and self-expressive nature of participant engagement. The third theme focused on practicalities such as time pressures, facilitator training, resident selection, and resource preparation. For residents, the groups provided a context for relating meaningfully to others. CONCLUSION: The JAVA program achieved a high level of engagement. However, it was a time intensive intervention and required a person-centred philosophy, appropriate staff training, organisational support, and a suitable quiet space. The program had positive benefits, but practical issues identified needed to be considered before implementation.

The residential environment impact scale: Benefits and barriers to implementation in the Australian residential aged care facility context.

The organisational, physical and social environment within residential aged care settings greatly influence its residents' sense of autonomy, choice and control and their ability to engage in meaningful occupations. Identifying to what extent these environmental contexts are supportive and well-coordinated could assist with promoting meaningful engagement of residents. The Residential Environment Impact Scale (REIS) was developed to measure the impact of the physical and social environment on residents. This study examined the benefits and barriers to implementing the REIS in four Australian Residential Aged Care Facilities (RACFs) and factors to consider during implementation. METHOD: A multisite sequential mixed-methods study was conducted. Research participants included occupational therapists conducting the REIS and leadership staff examining the REIS reports in four facilities. Data consisted of formal observations of the REIS assessment process, an online survey of all participants and two research consensus groups. Qualitative findings were generated from field notes, open-ended survey questions and group discussions. Close-ended survey questions provided quantitative data. FINDINGS: The REIS was considered a useful audit tool, generating a holistic overview of the RACF. It highlighted the quality of person-centred care and the potential role of occupational therapists to promote opportunities for meaningful occupational engagement. Barriers included administration time, personal characteristics of residents and limited resources to action recommendations. CONCLUSION: The REIS has potential to be an audit tool for a whole-environment approach to facility assessment of residents' sense of autonomy, occupational choice and meaningful engagement. As such, it provides occupational therapists with scope to support RACFs meeting national quality standards.

Peer-enabled staff training in residential care settings as means for promoting person-centred dementia care.

Background: Person-centred care (PCC) is regarded as best practice within dementia care, however there is a gap between the understanding and the implementation of this type of care practice. The Peer Enablement Program (PEP) incorporates a group problem solving model for promoting PCC of residents with moderate to advanced dementia living in care facilities.Objective: Trained PEP facilitators introduced the program to selected staff from an organisation with 99 facilities across Australia. The objective of this study was to identify what particular aspects of the PEP these facilitators valued for advancing PCC and care culture change.Method: An embedded mixed methods study design guided this investigation. The qualitative component of the study focussed on the insights of the nine PEP facilitators who presented the workshops. This information was supported and contrasted with descriptive data generated from 322 workshop feedback forms by attendees over the course of the three workshops presented nationally.Results: Facilitators identified peer support as the most valued aspect of the PEP. It promoted collaboration among attendees; supported development of their occupational identities as transformational leaders; and created communities of practice with potential to sustain advances in PCC.Conclusions: The PEP has the potential to advance PCC. Further research is needed to evaluate the long-term sustainability of these advances and to determine if this program can be utilised more widely, both in a national and international context.