In recent years, the principles behind person centered practice has slowly become synonymous with the delivery of aged care services. This is partly due to Government policy, Living Longer Living Better, which in turn has been driven by a broader incorporation of human rights into the governance of aged care.
Traditionally associated with early childhood development, Montessori is a philosophy developed to enable individuals to be as independent as possible, to have a meaningful place in community, to make choices and meaningful contributions to their community that provides purpose and maintains their self-esteem.
In further exploring the outcomes gleaned from Montessori, the idea this approach would enhance working with adults with memory loss including dementia, has resulted in some organisations adopting the practice in different environments.
VMCH CEO Sonya Smart has a long history with Montessori, leading implementation as CEO of Perth based Catholic Homes. Travelling east to Melbourne to take up her role as CEO, Sonya saw a great opportunity to roll out the practice in Melbourne.
“We call it “Care with Purpose” in WA. It’s about making aged care as home like as possible. There’s no dignity in plastic plates and cups using clothe protectors in dining rooms. It’s the little things that make a difference to how people feel about moving to a phase in their life where they may feel they are relinquishing power.”
Montessori founder Dr Maria Montessori developed the practice for early education, but also originally saw the benefits when working with people with disability. By putting many different activities and other materials into the children’s environment, a teacher could quickly identify the things that kept the child engaged. What she came to realise was that children who were placed in an environment where activities were designed to support their natural development had the power to educate themselves.
Adapting the same rationale to people with dementia, requires an environment working to support an individual’s memory through repetition and visual aids, encouraging increased participation and sense of wellbeing.
Anne Kelly works closely with Villa Maria Catholic Homes in implementing Montessori practice. Her experience in witnessing the changes in people through adapting living environments and providing visual aids, is remarkable.
“Montessori as it relates to older people, is about true person centred care where we look at enabling people to be independent, make true choices, have high self-esteem and to be able to make meaningful contributions to their community. ”
There is no shortage of appropriate research to support the headway Montessori has made, particularly in relation to people with Dementia.
Professor Michelle Bourgeois from the University of South Florida presents a compelling case for the Montessori approach in Ageing and Dementia and its impact on clients and care culture.
Anne has seen firsthand the affect Montessori has had on the lives of people experiencing memory loss.
“When we’re working with adults, we’re working with people who have a lifetime of experience, their bucket of knowledge and experience is full and we’re also working with people who, many of them, have cognitive impairment so it’s completely different to working with children.”
“What we have found are people are more alert, more awake,they are smiling and happier.”
There are several organisations participating in research. The Australian Dementia Journal recently published the results of a study that was done over in Perth. It showed an improvement in satisfaction from staff and families, a reduction in medication, residents sleeping better and a reduction in falls.
Unlike conventional Aged Care environments, a Montessori environment would be distinguished by people doing and participating. Instead of getting someone dressed a staff member would encourage the person to do the parts they can themselves before they would step in. For example, if someone can put their shoes on but they can’t do up their shoe laces, a staff member would do up their shoe laces.
You would see buffet style food service, where a person would serve themselves and also be able to wake up later, instead of having to adhere to a strict and regimented timetable. The self-serve buffets are designed for purpose and support mobility and dexterity from the height of the buffets to the size of the handles on jugs.
“We talk about a prepared environment that supports the person, supports their memory loss through the environment.”
Regardless, we all need a reason to get out of bed every day. Everybody needs to feel valued, everybody needs to feel that they’ve got a place and everybody needs the opportunity to make true choices in their lives and to be as independent as possible.
The success of the model is in leadership and mentoring within organisations themselves. Staff need to be able to leave training and apply the principles back in the work place. Experience comes with practice and so mentoring staff on the floor is essential.
VMCH’s latest residence, Star of the Sea in Torquay, has the advantage of being built to already accommodate a Montessori environment.
VMCH CEO Sonya Smart acknowledges the commitment required by an organisation to properly implement Montessori including ensuring governance, quality and assurance practices are reviewed to support Montessori.
However, Sonya believes an industry vision to revolutionise the way services are delivered is called for to raise expectations when it comes to delivering aged care services.
“We need to raise the bar, to expect more for people who live in Residential Aged Care and do the best we possibly can to ensure quality of life.”