A community health dietetic service for group homes: Review and reflections
Ju-Lin Lee (APD)
Michelle Livy (APD)
DAA Conference 17 May 2018
HEALTH ~~?u£
Acknowledgements
Michelle Livy, HACC Dietitian
Dietetics Unit, Your Community Health
Group Home residents and managers Ellen Harris and Rhiannan Cheng
DAA Disability IG Committee Members
Your Community Health, Victoria
(previously Darebin Community Health)
Government funded medical, dental, allied health & public health programs Social model of health
I_ jRapidly changing landscape of ·, -,-J --,~ ,- \ ., funding from HACC to ,·d~<~-" ' ' .................., , j ........... NDIS/CHSP ...-,s-7-.Jj ........... ' -
' •People with mental or physical - ;.t -- --· .·-
disability are a priority population
- ••
CHSP: Commonwealth Home Support Program
Group Homes
Residential facilities for people with developmental disability Considered a home - healthcare is provided in the community Now operated by Vic DHHS or not-for-profit organisations Under Disability Act 2006:
“Ensure there is a balance between the rights of a person and the safety of all people living in the residential service”
Dietetics service –
Development and Implementation
Transfer of HACC funding 3.
Community
Service development in line with social model of health 2. Group home
-
Individual dietetics advice (home staff/carers visit) – varying clinical complexity
-
Nutrition education to staff
-
Health promotion activities to 1. Resident engage residents – based on learning needs
Review of Service
Aim: Review the implementation of Your Community Health dietetic services to group homes
Objectives:
a) What is the scope of the dietetic service we can offer? b) What are the facilitators and underlying barriers to evidence-based practice?
c) Is there a suitable model of care to address gaps whilst considering funding changes? And if so, what?
Methods
- Review of Literature
- Workload review
- Survey and interviews to group home staff
- Expert opinion
- Benchmarking with other community health settings
Results
Benchmarking
with neighbouring Community Health organisations Over a 12 month period: (Number of Group Home clients)
CH-C, unknownIncreasing number of new referrals; long episode of care
CH-B, 10Requests beyond service capacity – E.g. menu planning, care coordination
Your CommunityAddressing implementation in the whole Health,
41 CH-A, 23 home rather than focus of client in the
absence of policy Time and complexity – disability specialist
Facilitators
Relationship with staff was crucial for implementation
83% staff “Really good education for staff - helps to inform well-balanced reported menu plans for residents” increased nutrition knowledge due “Having the dietitian as part of the staff and available to to current continue the conversation and support is essential. It has kept us dietetics services all on track and helped all involved to be invested in what it takes to promote healthy eating”
Barriers
Your Community Health Group homes: Menu planning is currently No nutrition policy- Staff training out of scope of practice inconsistent across homes Variation in food and cooking knowledge/skills “What I think is beneficial for the residents; or the next person High staff turnover thinks is beneficial [differs]… I Multiple staff/agencies involved think that’s where we really need Hungry for support some training”
Limitations of this review
Convenience sampling - surveys limited to groups homes known to service only Small sample size and limited quantitative analysis Challenge to seek direct feedback from residents and using carers as a proxy
Reflections and Conclusions
“People living in Community level evidence of significant residential care service and funding gap Health or Disability? have the same – Goes beyond individual NDIS service agreements right to good Vulnerable population group that need a nutrition as the specialist service rest of the – What does this look like in a community health setting? population” Call to action as a profession