FRAIL - Part two - video transcript

Margaret 00:19
Do you like living here?

Billie 00:21
Would I like to have a sleep? A cup of tea?

Margaret 00:29
Do you like living here?

Billie 00:32
Oh, yes, it's lovely thanks.

00:38
You know, people when they come here for the tour, and they have a guilt kind of guilty, you know, in their mind, they are putting their loved one in an aged care facility, but we are just here to change that perception, you know, in some ways not gonna be hospital setting, it's gonna be their home, and they can set the room as per their wishes, you know, they can decorate their room accordingly. They can change their curtains, you know, whatever makes our resident comfortable and their family comfortable. It's just depend upon individuals. So when they come into our care, we assess their individual needs. And then we sit together the clinical nurse, myself, GPs, family members, and also the resident to talk about their history, you know, what they've been doing and how they grew up and what their career was, you know, and, and what's their medical care needs. So we just work accordingly and create a care plan for the resident and the care plan get changed as the needs get changed. Normally, we review the care plan every three months, but we involve the families and the staff and the resident and GP, to review their care plan. I always encourage my staff don't get task oriented, it's residents home and always ask the way they wanted to do things here. We always enforce like, have you asked the resident, you know, it's just a mantra kind of thing, you know, so you can't put whatever you wanted them to do. We always, you know, enforce, we are working in their home, they are not living at our workplace. We respect all their wishes here. It's just like a second home to me, you know, and every staff, they are working here for a long term, it's not only me, we have a staff member working from almost 21 years. So it's just like, I didn't think to go anywhere else because I love coming here.

Rhonda Purtill 02:50
Hi, I'm Rhonda, Rhonda Purtill, and I'm a nurse to the role that I'm presently in. It's driven by passion. There are people in society that very elderly and frail, who cannot no longer live at home, and they would love to and we often hear the story. I want to stay here and die with my boots on until I you know, come. But sadly, that doesn't happen this through some traumatic episode, whether they break their hip and end up in hospital. And sadly, they can't return home. So I fell in love with listening to their stories. I love their stories. I'm, I'm captivated by their stories. I was working in the emergency department some years ago at the Royal Brisbane looking after people vulnerable, who lived in community and couldn't help but be astounded by the amount of people coming in from residential aged care facilities, for very, very simple procedural problems, and there was absolutely no one that they could call upon. So I used to, I guess, twitter on and witter on about, look, I think if we had some really, really senior nurses, we could go out and change that catheter or do this or do that dressing or talk to the family about their angst. We actually made a significant statistical difference. Whereas once in a week, there might be 12 presentations from our ACS with catheters needs that were down to about two. And they were tricky, and they needed to come in because they needed a urologist with the ability to take some hospital personnel, medical nursing, even allied health sometimes depending on what the what it is. We can go out, Undertaker pretty good assessments still run some bloods. imaging is done now we've got an aged care imaging, radiology service radiography service I can do plain films for us plain chests to see if there's a pneumonia, obvious pneumonia, we can order some antibiotics. We can actually provide an acute service within the residential aged care facility. That has to be negotiated with, of course, their families and the GP and any body significant others. And once that's negotiated and the families are reassured that their loved one is being given exactly this and in a in a quite timely manner, and they don't have to undergo that awful awful journey and wait that awful time and they can still remain in their environment in their home.

Billie 05:38
Do I sleep well at night? Yes. And by myself too.

FRAIL - Part three - video transcript

Scott 00:17
About three years ago, Harold died. And Billie was by herself. And it wasn't easy for her, she was probably starting to show some signs of dementia before Herald eyes. But she was still fairly self sufficient until about a year ago when she started to get some infections. And it was clear that she couldn't live by herself. And we were we were faced with that awful decision of having to have to move, move Billie to a aged care facility. And we're very fortunate really, because, you know, we saw a number of places that we probably, wouldn't have suited Billie we didn't think would have suited Billie. And really, you know, we found hilltop and yeah, the whole experience there getting her moved in was very, very quick and very, very easy.

Margaret 01:02
Right? It was. We were fortunate that we were very lucky that there was such a nice room available when we needed it so badly.

Scott 01:11
So the staff were great getting her in and getting a settlement. Oh, yes, it did with her dementia. It took her a long time to settle because she always thought that she was going to go home. It probably has taken her the better part of a year to get used to the idea that this is her new home. But yeah, really been anxious. And the staff have really been very good through all of that. She has had medical conditions. And I have to say that the standard of the both the medical nursing care and the doctors who are looking after her we've been very happy with.

Margaret 01:45
Yes, yes.

Scott 01:51
Billie's made a decision that she doesn't want to have medical intervention and in these latest stages of her life, and the staff are aware of that. And so, yeah, they've really managed sort of her condition. Well, she doesn't need to go to hospital. Yeah. If she needs to, I'm sure that that will be. That may be an event but but certainly we're looking to sort of spend as much of the later stages of her life here as is possible.

Margaret 02:19
I think the longer she's here, the more it's going to feel like her sort of home. I think she's becoming more and more accustomed to feeling as though it's home, rather than sort of feeling strange in a strange area. Yes, so that's good as well.

Dr John Twomey 02:37
Hi, Billie. I'm gonna check your blood pressure. How are you feeling? I've been a country GP. So I've been used to managing a lot of conditions myself in a one doctor hospital. So I'm more than happy to manage stuff here in house with the assistance of the RADAR unit with Dr. Bill Lukin, and Denise Hobson, I often will call him for advice. And we can we can manage things here without having to send people off. It's much more convenient for the for the resident. And it's convenient for the Royal Brisbane hospital as well. But we're not necessarily to transfer people unnecessarily. But I'm more than happy to manage quite a lot of conditions here with their assistance.

Dr Bill Lukin 03:27
Bill Lukin's, my name and I'm the consultant in charge of the RADAR service at Royal Brisbane Hospital. I'm an emergency physician originally by training and I've done a second fellowship in the last few years in palliative care, which led me to develop this service with my nursing colleagues around supporting residential aged care patients who interact with the hospital. We started out looking after the residential aged care patients who came to emergency and that's in some ways what brought me into the palliative care space, these really vulnerable group do come to emergency and it's very difficult to get their needs right. And often the risk of them coming to the hospital is quite high. And the ability of the hospital to help them can be limited because of a whole lot of other medical conditions that go along with being frail and elderly. And just trying to get clinicians to understand the special needs of the residential aged care patients both in emergency, up in the wards and also we will outreach to the facilities to bring care to those people if leaving the facility is not in their best interests. Oh, hang on a second. That's John actually. He wants me to see a patient today out at hilltop. That should be fine. So John was one of the I like to call him one of the early adopters of the service. We were able, when we developed the RADAR service to have a model that we think is quite different in that we didn't want to provide care directly to patients. We thought that the teams providing the care were doing a brilliant job already. And they just needed some support. So early on in the service, we discovered that the GPs wanted to know what was happening to their patients, and they loved taking calls from the consultants. So an early rule was, if the patient comes from residential aged care, and they're in the emergency department, the GP will be rung with the decisions that are made and make sure that they are okay. And in keeping with what their understanding of the patient is. It's developed into a really great relationship in that John can ring me or can send me a message about a patient, we can visit or he'll ring and we can decide the patient does need to come to the hospital. And we've also got a sense of trust so that if John thinks the patient needs to come to the hospital, they'll need to come to the hospital, and we can back that up. But John also trusts us about making decisions and sharing that care forward into the future.

Dr John Twomey 05:46
It's important to the residents, it's also important to their families, that they're managed by staff they're familiar with, they have access to visitors coming and going, and that they're in their own home. And I feel much more comfortable about that.

Dr Bill Lukin 06:01
The families are ecstatic. One of the reasons why I think the RADAR service evolved successfully is that often these patients actually don't want what we think they want. When we sit down and ask them properly and ask their families properly. What do they want, they are incredibly grateful for being asked even, and they really respond to the idea that we're trying to hear the voice of that older person who may not be able to speak for themselves, and give the family that privileged role to be able to speak and speak honestly about what their older relative wanted. We think that it's better care. That's the first thing. So you'll never be able to come into HHS, all the doctors and nurses in the HHS that we should do this because it saves money. There's less beds involved. So primarily, it has to be about better care.

Dr John Twomey 06:52
And good to see you again and I'll see you again next week or two.

Billie 06:55
Ahh, who are you?

Dr John Twomey 07:00
I'm your doctor.

Billie 07:01
Oh, thank you.