Getting actual change is putting residents in the driver’s seat – Sally Hopkins of Eden in Oz and NZ knows disruption for good brings sector-wide results

Sally Hopkins will always ask one particular question to the people she works with. Over sixteen years at Eden in Oz and NZ she’s asked it of everyone, from CEOs, to nurses and the newest care worker hires. It’s a big one.

“If you needed care tomorrow, would you be prepared to live where you currently work?”

Above all the noise of debate, around all the opinions on how to fix a broken aged care system, this question has the power to cut through. Hopkins believes this underpins the work that Eden in Oz and NZ is all about, “thinking about what we want the care system to look like, it must be what we want. It does require a shift in our culture. The new Aged Care Act and the strengthened standards are aiming to fix the system and to provide a better answer.”

Hopkins is a straight talker, and clear in the goal of what Eden in Oz and NZ does, “if it’s not good enough for us, it’s not good enough for the people in care now.” She shares the time for actual, meaningful change is here, “the shift must be now, to do what we can right here, right now.”

No more band aid

Hopkins is alongside executives and front-line staff stressed about compliance. “Everyone’s focused on compliance, and you do need to do that but what makes it stick?” Essentially, she asks, what is actually going to make “person-centred” care a reality for residents, and make it humanly possible for front-line staff to support and enact?

“The current system is broken, for organisations and people”, Hopkins voices, “operating in institutional structures, and government is saying, we want you to be person-centred. It’s been a band-aid up until now, and unless we shift our thinking and our practice we won’t be providing the care that we want, let alone what older people want now.”

“We’ve got people at the centre of what we’re doing but for so many staff the task list still dominates.” Hopkins sees current practice as, “‘I’m here to do ‘you’ instead of what can ‘we’ achieve together?” This is a big shift.

She calls a spade a spade, for so many front-line staff and residents, the current rigid institutional way of doing aged care is, “lip-service to supporting relationships between front-line staff and residents.” She has had the privilege of educating and supporting leadership and front line teams alike in the Eden Alternative, and she’s paid attention. She says with conviction, “most people don’t work in aged care for the money, they really don’t, they do it because they love their jobs and working with older people.”

Core to Eden in Oz and NZ is supporting aged care organisations to change their culture, policies and practices to support front-line staff to have the time, energy and support to build incredible relationships with residents, and in supporting this, putting residents where they need to be, in the driver’s seat of their care.

Supporting relationships

Hopkins says what she sees, “we’re asking front-line staff to be person-centred but the organisation needs to support that with their policies and procedures. They need to embrace person centred care in its entirety.”

She says of organisations, “if the policies aren’t in place, to support the practice of person-centred care, we’re not going to get any change.”

“The Eden Alternative focuses upon a person directed approach, putting the person in the driver’s seat. We’re empowering staff to be able to let go, to continue to do their jobs, but be able to listen, and to put into place what the senior wants to have happen on their time-table.”

Eden in Oz and NZ works to an ambitious goal, “the rhythm of daily life should be determined by the seniors living in the home and their interests, and what they want to do today, with guidance of course. Residents should be the main conductor of how they want things done, in partnership with the care partner (worker), then they can achieve more together.”

Hopkins notes this means embracing the powerful but subtle reality of meaningful relationships by providers and staff. In her experience and relationship with executive staff she has seen this, “they have to embrace the intentionality of meaningful relationships between people, to see this as valuable and not a waste of time or money.”

Front-line staff need to be supported to build relationships. That means policies that encourage the establishment of permanently assigned teams, and the development of genuine teams, ensuring staff are protected from burnout. Practices that put an end to staff walking through the door and shouldering pre-emptive tension at possible understaffing, weighed down by worries of the next error, this is depth of leadership translating to routine safeguards.

Acknowledging the cost

Hopkins has seen this process for many providers, “it takes time, money and resources to make these changes.” However, she attests, “you only have to do this change once if you’re consistent with your messaging and practice. The return on investment for homes implementing the Eden Alternative, includes lower staff turnover, because the hugely important ingredient of culture is already in place.”

“Working in a great culture is what people want.”

“Workforce attraction is a challenge globally.” Hopkins names a pain-point of many an aged care CEO, “’how do I keep my staff? How do I get the right people to work at this organisation?’ It’s about the culture that you offer.”

For providers, investing in their culture, shaping it and taking the time to create a vibrant, supportive and resilient culture takes a sizable amount of time but yields substantial returns. Supporting providers in this growth through the Eden Alternative Framework, across the whole organisation, Hopkins has seen sustained change in practice.

“Front-line staff and residents want an alignment of values, they align consciously or subconsciously.” Or they can be repelled by an organisation’s culture, and quit or leave the residence. Getting it wrong can have costly impacts.

Residents are a resource

Hopkins and team teaches organisations, and all levels of personnel, how to start the conversation of deep cultural change, to navigate it for residents and staff, by residents and staff.

An example is that Eden in Oz and NZ always recommends to any organisation to put the end user, the resident, as part of any recruitment panel. “It needs to be intentional and continuous, and for every position in the organisation including the CEO.”

Hopkins shares, “when residents are part of the selection process, they are looking for a different set of skills. They are looking for, ‘are you going to be nice to me? Are you someone I can rely on? Can I trust you?’”

“All that stuff. It’s the emotional stuff they are responding to.”

From her nearly two decades of experience she shares, “at the end of the day, the residents want to know the hire is going to be the right fit for them, this home and the organisation, based on what they know, as a person living here.”

“CEO’s have told me, every time they ignore the residents’ comments or selections, ‘I like A over B’, every time they ignore the advice on who to hire, because they like B’s skill-set they bring, invariably, they get it wrong.”

Hopkins has had frank conversations with executives, “turnover costs are big, you could save a lot of money every time you recruit someone because you’ve made the right decision in the first place.”

“Residents also have a vested interest in new hires succeeding, they will be your champions to check in and support new staff.” Hopkins shares that she has seen when this culture of resident inclusion is supported and maintained, it has built up a rock-solid support network for staff at all levels.

“[Residents] They are a resource that is really untapped.”

RAC must have purpose for residents

“When my aunt moved into aged care she thought her life was over.” It turned out not to be the case. Hopkins is about fighting this perception with profound stories of vibrancy and real person-centred care practice.

“The general perception when walking in the door is, ‘I lose autonomy, that I can’t do, that I’m not allowed to do’, this is the institutional approach, all about risk and control.” Yet Hopkins has seen a shift from many provider leaders, where there is an appetite to change approach and secure strategic growth as a result. Happier residents who feel empowered and in control of their care can be significant resources to build up, contribute and support the quality of providers. 

“With an organisation pursuing policy and practice supported person-centred care, this is asking, ‘how can we shift the control of direct care back to the end user, the resident?’”

“People need purpose. In every home or community centre, we have lawyers, nurses, engineers, doctors, teachers with a host of skills, they just need support to do some things they can no longer do easily, but for so many their brain is sharp, they are interested in their world and they want to and can contribute.”

“In a home in NZ, a resident who was an engineer and had worked for the water board was able to contribute to a review of the master plan for a new building. One day the CEO put up master plans for building works not thinking anything of it, but the resident engineer quietly looked at the plans. It was complicated egress of water plans. He spent time with them and then went straight to the CEO and said to her, ‘if you do this it’s not going to work’, and not only that, for free he told them how to fix it. It gets better, he told them not only how to fix it but how to save money in the process, ‘I suggest you do it this way’ he said, ‘you will have it work and save yourself 250,000.’”

“He saved them $250,000.”

Policy and practice

Eden in Oz and NZ works with all stakeholders to make meaningful sustained change happen. That means tackling the reality. No ifs or buts about it.

“The organisation needs to set up their culture of person-centred care, that supports the routines and daily approach of person-centred practice. Organisations must ask ‘what does that mean for staff?’ ‘How do we, in practice and policy, embed and support this?’”

“Encouraging meaningful and purposeful relationships for staff and people they are supporting”, is the baseline start for Hopkins and training in the Eden Alternative.

Staff must be supported to “identify common interests” with residents, they must be able to “take time to spend with residents, have morning tea with them, and be able to have ways to do genuine connection.  There is no “I” in team.”

Hopkins has seen this many times, “residents may not have a lot of friends and care staff, who also may be from overseas may not either. By enabling them both to find friendship and connection, (just through that small change in practice) can support a depth of relationship that changes the reality of the home for people in profoundly beneficial ways.”

“And in supporting this for all staff, and residents, change is magnified. That leads to a whole lot of subtle shifts.”

Hopkins is proud of and has experienced the Eden Alternative approach, “addressing loneliness, helplessness and boredom” in the day-to-day. Through the model of care taught, she has seen this to be true for residents and staff. With everyone lifted, all can feel the benefits.

“Loneliness’s antidote is companionship. Helplessness, the giving and receiving of care. If residents are able to share information about themselves with you, the care partner; they can care for you as well. Companionship and giving care are steeped in reciprocity.  It’s not a one way street.”

Hopkins has seen providers turn around operations with small changes in policy, and simply making time to listen and know residents, “there’s a gift in purpose and community. Spontaneous tea breaks and conversations can alleviate boredom, particularly if they’re not programmed into a schedule.” 

“Time together could even be at lunch time. Supporting staff to be able to sit down with residents, have a meal with them can have profound impacts on a home’s culture and operation. We are social animals, and thrive when supported to have genuine relationships.”

Front-line staff empowered in work

A front-line staff member shared her experience in completing a post Eden training project at a recent  Eden Alternative presentation. ‘I thought this was going to be hard but it was so much easier because we just talked to the residents’”.

In workshops, Hopkins has worked through subtle shifts in thinking and practice, that front-line staff can do to put residents back in the driver’s seat, from asking what side of the bed they sleep on, to what sock goes on first, to would they like to lead bingo sessions, setting tables, being a volunteer and more. There are biases that people can bring into care which are acted upon without thinking.

“We apply our background/approaches to people we’re supporting, which could be wrong, and they wonder why people get cranky.”

“The new strengthened Aged Care standards demand we are caring for people with dignity and respect. We are not ‘othering’ them.” Hopkins notes, “in practice it’s, we hear you, we work together to put into place….whatever you might want or need!”

Disrupting for good

When it comes to residents with cognitive challenges, Hopkins says she and the team continue to push for freedom to be a human and meeting that person where they are at. She shares that when we see them as a person first (and not their diagnosis), and we enable them to do as much for themselves as possible, and to continue to contribute, we are creating inclusive, supportive communities.  

With a person first approach, organisations and front-line staff are able to see substantial results.  Hopkins explains that in using developed supports of connection, like the Eden Domains of Wellbeing, provider leadership and all roles of staff are supported in getting to know the residents better than the current care plan.  And in the process, themselves.

“We need to encourage people, regardless of cognition, to do things for themselves around the home, that is serving everyone.”

Hopkins assesses, “the dominant risk profile in the institutional setting needs to be broken down, we need to not keep everyone wrapped in cotton wool, and stop people from engaging in meaningful activities because they ‘might’ hurt themselves.” She says, “a person-directed approach needs to be embraced, and that means taking risks and braving some disruption”.

She advocates for some pluck for provider leadership, “supporting risk and disruption from the norm”, is a viable and worthwhile strategy.

“There needs to be a transformational lens. We’re the Eden Alternative, and we’re called that for a reason. It’s the alternative to what is in place, disruptive and transformative and life changing. It’s not driven by compliance.”

She is frank, “it’s more than a marketing exercise. You can’t be an Eden Alternative home, centre or organisation without Eden training and validation through the Eden Registry process. It’s more than paying lip-service, you must show the changes that you’ve made.”

Hopkins says, “the Eden Alternative sells hope and possibility, and teaches it into practice: it is not imposing it, but being a part of a solution, particularly including seniors, front-line staff and families. Inviting and hearing everyone’s voice is essential.”

Walking the talk

Within the Eden Alternative approach, no one is above learning. “Education is ongoing. We train absolutely everyone, board members, executives and leadership teams, care partners, staff, residents, and volunteers.”

“‘What does it mean for me as a community member? How do I make it happen? How do we move it to the we? How do we as a collective get this to happen?’”

At the end of the day, she is emphatic on listening to the seniors at the midst of it all, “when you talk to the end users, you are always going to get further.”

Always a straight-talker, Hopkins says in the aged care industry there’s been, “too much talking not much walking in the shoes of the end users, seniors.”

“All the marketing blurb can say whatever glossy things they want, but are they walking the talk?”

Cards on the table

Hopkins sees the new Act as an opportunity to build on the ‘good stuff’ the industry has been doing but to also have honest conversations about what hasn’t been working. “We need to be quite honest, to put all the cards on the table, do some soul searching, we can’t keep continuing to do exactly what we’ve been doing and expect something different.” Hopkins assesses, if anyone answered no to her original, big question, it shows something needs to be addressed.

She encourages providers looking at the budgets ahead to be, “prepared for the longevity of change, you might know you need a culture shift, so let’s start the conversation, ‘who do we talk to? Where do we start?’ Planning is a big part that must be honoured”.

The Eden Alternative approach is an alternative, it’s right there in the name and it’s here to disrupt for good. At its heart? Resident-directed care, and workplaces that front-line staff never want to leave. This is good for residents, good for staff and good for business.

“We want every service provider to say, from the most veteran board member and CEO, to the newest member of the care staff, ‘I would live here, I would use our services’. Genuinely.” That’s when Hopkins knows we’ve got it right.