Background and Aims
People living with advanced dementia suffer serious symptoms as they approach end of life including immobility, incontinence, pain from underlying painful conditions, such as arthritis, difficulty eating and swallowing, sleeping problems, and psychological problems. Additionally, they have lost the ability to communicate in words and are often socially isolated. Many people in the advanced stage of the disease are admitted to residential aged care facilities where they are dependent on care staff to attend to their needs. Care tends to focus on physical or health-related needs and staff do not have the time to attend to the holistic - psychological, emotional, social or spiritual - needs of the person. For people living with advanced dementia, communication challenges limit their participation in usual activities or memory care programs offered within a care facility. Programs aimed at improving quality of life for people living with advanced dementia are not widely available. A program called Namaste Care TM was developed specifically for people living in the advanced stages of the disease. The Namaste Care group program takes place in an environment as free from distractions as possible. Activities of daily living are offered using a slow, unhurried ‘loving touch’ approach. The program includes staff, volunteers, and family carers.
Namaste Care stimulates a person’s senses to promote comfort and pleasure. Faces are gently washed and moisturized. Hair is gently combed or brushed. Hands and arms are moisturised. These activities are provided by the Namaste Carers to each person in the program.
The Namaste Care room is prepared in advance and attention is paid to creating a calm, relaxing and welcoming environment. Gentle and relaxing sounds or music are used to create an atmosphere rather than provide entertainment. Natural aromas or aromatherapy diffusers create pleasing smells, visual images including photos or pictures are used for reminiscence. Residents are offered drinks and nutritious tasty snacks that help stimulate appetite and increase food intake and hydration.
This structured program adopts palliative care principles aimed at enhancing comfort and quality of life and offers personalised care and sensory engagement in a calm, dedicated environment. Namaste Care is the only program to our knowledge that can be offered until the end of a person’s life. Despite the uptake of the program internationally in care homes, hospices, acute settings and in the community, there has been limited evidence of the program’s uptake in Australia and little evaluation on the benefits for residents’ quality of life, staff satisfaction or family care partners’ experiences of a Namaste Care program.
Therefore, this project aimed to implement the Namaste Care ProgramTM in three RACFs within one organisation in Tasmania and to evaluate its impact on (i): the quality of life of residents with advanced dementia (ii) staff and volunteers’ experience of providing the Namaste Care ProgramTM and, (iii) family caregivers’ satisfaction with care and experience of Namaste Care.
Our project also aimed to provide further evidence of the feasibility and acceptability of the Namaste Care group program for residents living with advanced dementia, family carers, staff and volunteers within the participating RACFs to support a wider roll-out of the program as a new model of care.
What We Did
All stages of the research were completed as follows:
Outcomes
The project had four stages and each stage was completed.
In the first stage, we conducted eight information sessions across three facilities to raise awareness among staff. Following these sessions, we offered three four-hour education workshops at each site.
In the second stage, we conducted co-design meetings at each site involving staff, volunteers, and family caregivers who became the Namaste Community of Care (COC). The goal was to create site-specific implementation plans. As a result, a once-daily program was agreed upon for each implementation plan.
During the third stage, residents were screened and recruited to the Namaste Care intervention using eligibility criteria and identification by COC members.
- The target Sample was thirty residents (10 from each of the three sites). A Resident Screening Log captured eligible residents (total of 30).
- Ten residents were recruited, and two sites proceeded with the intervention.
Program Implementation: At the two sites, the Namaste Care intervention commenced for approximately 2.5 hours each day in the afternoons.
In the fourth stage, we focused on maintaining the Namaste Care intervention and conducting evaluations. We conducted focus groups and interviews with members of the COC. We evaluated our data and found that the interventions showed positive improvements in residents’ quality of life and behaviours as measured by two instruments. These were statistically significant and highlight that even a short time participating in the Namaste Care intervention had positive results in quality of life and behavioural indicators in the sample of residents. This finding is especially relevant for residents in advanced stages of dementia who are nearing the end of life.
We also found positive associations with staff experiences that were mapped qualitative data to “The Senses Framework,” aiming to improve care for older people through a relationship-centered approach. Staff expressed positive feelings toward the program and thought it was a good idea for their residents in the advanced stages of dementia.
Did you encounter any unexpected results during evaluation?
The departure of the executive level leadership was unexpected and had a significant impact on the project outcomes. Direct care workforce shortages (around 80% agency staff reported) also posed difficulties. However, other non-clinical staff played crucial roles: the Head Chef at one service proactively responded to catering requirements ensuring these were served to engage the senses; the maintenance man recognised staff time constraints and supported the room set-up, the administration staff remained engaged and supported communication, and the rostering staff expressed interest in joining project meetings.
Impact on Aged Care and Workforce
The project was seen as a positive by participating staff who expressed a sense of appreciation about what the project intervention had taught them about their residents. Staff seemed to enjoy providing the kind of care they don’t normally get to provide e.g. a more person-centred and relational approach to care versus task-focused care. Given adequate education and training, consistent leadership support and resourcing, staff are well prepared to deliver the Namaste Care intervention and provide more holistic care to residents with high care needs. The support of leisure and lifestyle team members, volunteers and family members would also further enable implementation of the program.
Resources Developed
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An updated Train the Trainer Education Workshop Manual for the Knowledge & Implementation Hub (date tbc)
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A proposed Enhanced Sensory Care Network for RACF staff involved in the project and other stakeholders involved in enhanced sensory care programs in Australia (commencement date tbc).
Next Steps
Several papers and presentations are planned to disseminate the outcomes of this project. A proposed Enhanced Sensory Care Network, when operationalised, will support staff involved in multisensory programs, such as Namaste Care. Further work will be undertaken to seek engagement of external stakeholders including health care professionals and scoping of the potential for social prescribing of psychosocial interventions for people living with dementia in residential aged care facilities.
For further information contact: Dr Sara Karacsony, School of Nursing, University of Tasmania sara.karacsony@utas.edu.au
