Wintringham is a specialised welfare company working with the elderly homeless in Melbourne Australia. Established in 1989 as a response to the inability of aged homeless people to gain access to mainstream aged care services, Wintringham today provides a wide range of services to some 800 clients per night by some 300 staff. Services include housing, low and high care residential aged care, community based services and outreach and advocacy.
The first Facility was opened in 1993. This was Mclean Lodge in Flemington, and our most recent project a 60 bed facility: Eunice Seddon due to open March 2009. Wintringham provides a full range of non clinical and non institutional style of services. We have developed specialized care strategies such as visually stimulating home environments, intensive and individualized recreational support and individually tailored behavioral modification responses and financial management programs. Our services are inventive, flexible open minded and importantly non punitive. Eg : residential care facility clients drinking and smoking programs established, clients who continue to drink and smoke controlled. Since inception Wintringham has developed a range of new and innovative housing and resi services and we have done so whilst maintaining financial viability.
Built from the need for specialised services to support the residential care needs of older homeless people who were displaced through the closing down of night shelters in Melbourne in the 1980s. The organisation has successfully fought for special consideration from the government to recognise the high incidence of premature aging among our client population; thereby allowing us to offer all our aged care services to people aged 50 years and older as compared with the standard of 65 years.
Some improvement may be expected when a person stops using alcohol.
The potential for recovery or stabilisation of cell damage is dependent on:
The severity of ARBI progression;
The person’s age, diet and health;
Their ability to achieve and maintain sobriety;
Other Social, Physical and Psychological determinants eg. support, money, mental health, housing stability
Younger sufferers have a better chance of recovery; however, this may come at the cost of loss in potential capacity due to slowed brain development as well as the development of a psychological dependence on alcohol
Chronic alcohol misuse in older people increases the:
Risk of chronic heart disease, hypertension & stroke;
Incidence of malabsorption, pancreatitis & liver damage;
Risk of falls and accidents;
Likelihood of incontinence and gastrointestinal problems;
Prevalence of memory loss and the development of dementia, psychiatric problems & Parkinson’s disease;
Effects of self-neglect, such as poor nutrition and hygiene;
A person’s behaviour can be labelled as challenging as a result of reduced physical, cognitive ability, intense emotions about the situation they are in, or as a result of them denying their physical and cognitive limitations.
It is important to keep in mind that people do not generally set out to intentionally disrupt or challenge others. The behaviours that we see as challenging is their way of endeavouring to meet their perceived needs.
Often referred to as:
“ Behaviours of Unmet Need”
A key question is therefore “How else can the person’s need be met ?”
A = Antecedents or Causes – What were the background factors leading up to an incident?
B = Behaviour – Precisely what happened? How did the behaviour play out?
C = Consequences – What happened after the behaviour occurred? Short-term & Longer term .
D = Discuss and Debrief – Brain storm all aspects of the incident and consider future actions to avoid or minimise the impact of this behaviour in the future .
Behaviour Monitoring TIME/DATE SITUATION/ TRIGGER (what triggered the behaviour or what occurred just before the incident) A WHAT HAPPENED? (describe the incident/behaviour) B WHAT DID YOU DO? (What was done) C WHAT WAS THEIR RESPONSE? C 17.00 22/1/10 Mary demanded a cigarette from another client but when this was refused she persisted and was eventually told to “Piss Off”. Physical aggression: Mary pushed the client against the wall swearing repeatedly and waving her fist in the threatening manner. The client yelled at Mary to “stop” and reception staff informed Mary that they had called the police. Mary quickly released the client and ran out of the building
The ‘person’ living with an ARBI is not the ‘problem’.
The behaviour occurs as a result of changes to brain functioning and is an expression of unmet need.
The behaviour is directed ‘at you’ not ‘to you’ personally.
It is important to remember that there is a person (possibly a very distressed person) behind the behaviour that we find disturbing.
By focusing on the objective of maximising each client’s potential it becomes clear that it is us who need to change – our care practices, our understanding, the social and physical environment etc.
The Downward Spiral 1. The PERSON with ARBI is “difficult,” “hard to manage,” or even “aggressive” 2. Caregivers attempt to change the PERSON’s behaviour 3. If they aren't successful, the PERSON may be labeled: “Problem person” -“Impossible” - “Mean” -“Unappreciative” - “Manipulative” - “a Pain” 4. No new interventions are tried because THE PERSON IS the "PROBLEM" 5. Caregivers “cope” by ignoring or avoiding the PERSON 6. The PERSON is NOT comforted or assisted and behaviours become more intense 7. Caregivers feel even more distressed and frustrated by the behaviours 8. Caregivers avoid, ignore, or even "fight back" 9.The PERSON’s behaviour continues, and often becomes even more intense
Not about WHO THEY ARE (i.e. does not define the person)
It’s about WHAT THEY DO and WHY?
Remember these Do’s in supporting someone living with an ARBI.
Avoid overloading the person
Break down information and present one idea at a time
Discuss one point at a time
Tackle one problem at a time, one step at a time
Allow sufficient time for the person to work at their own pace
Minimise distractions and stressors in the environment
Allow frequent breaks or rest periods
Remember these Don’ts to reduce challenging behaviours from arising.
Use judgemental language - avoid the use of labels, such as difficult , aggressive, agitated, nasty etc . Replace them with a comprehensive description of what actually happened before, during and after an incident.
Labelling – When referring to an individual or their behaviour, s eparate out your opinion and subjective feelings and establish objective facts. This can change your point of reference in interactions with the person.
Labels create generalisations and can foster negativity which is transferred between staff and will invariably be directed toward the individual.
Remember these Do’s to reduce challenging behaviours from arising.
Encourage the cooperation and involvement of the person living with ARBI in the process of behaviour modification but this may not always be possible (poor insight, denial, unwillingness to change)
Listen to what someone is saying by watching the whole person and not just their words. This helps us to understand their wants, fears, hopes, values and beliefs.
Respond to each client with empathy and respect at all times.
Break down tasks into simple achievable steps – encourage and reward small achievements. Keep focus on the positive steps that are achieved. Plan in advance to ensure small successes
WINTRINGHAM Dignified services to elderly homeless men and women
Wintringham is driven by a simple and overwhelming conviction: we believe in social justice
The Wicking Project In October 2006 Wintringham was awarded a $900,000 J.O and J.R Wicking Trust Research grant administered by ANZ Trustees to develop and trial a specialised model of care to support older people living with an acquired brain injury (ABI), in particular older homeless people with challenging behaviour as a result of an alcohol related brain injury (ARBI). This grant was the largest ever awarded by The Wicking Trust and regarded as a flagship project. Older People with Acquired Brain Injury and Associated Complex Behaviours: A Psychosocial Model of Care
Involves the provision of alcohol and cigarettes in accordance with a prescribed administration regimen
Due to the client’s inability to self regulate their consumption – Inability to Rehabilitate
Requires 100 % consistency Inconsistent implementation by staff may avoid immediate challenges but will eventually lead to an escalation in the frequency and severity of behaviours. Cantrell H, (2008) & Bobova L, (2009)
Policy Recognition, Support & Funding Education & Training Research Prevention Service Improvement Cultural Establish Specialised Care Services Coordinated Service Delivery Prevention New Vs Long -Term Homeless Older Person Living with an ARBI