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_ j\u2013Rapidly changing landscape of
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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\nThe safety of all people living in the residential service”

Dietetics Service – Development and Implementation

Transfer of HACC funding

Community

Service development in line with social model of health

Group

Home

Individual dietetics advice (home visit) – varying clinical complexity
Nutrition education to staff
Health promotion activities to engage residents – based on learning needs

Resident

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

1. Review of Literature

2. Workload review

3. Survey and interviews to group home staff

4. Expert opinion

5. Benchmarking with other community health settings

Results

Benchmarking with neighbouring Community Health organisations

Over a 12 month period: (Number of Group Home clients)



Benchmarking
with neighbouring Community Health organisations

Increasing number of new referrals; long episode of care
Requests beyond service capacity
Addressing implementation in the whole 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 continue the conversation and support is essential. It has kept us 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 out of scope of practice
No nutrition policy - Staff training inconsistent across homes
Variation in food and cooking knowledge/skills “What I think is beneficial for the residents; or the next person thinks is beneficial [differs]… I think that’s where we really need some training”
High staff turnover
Multiple staff/agencies involved
Hungry for support

Limitations of this review
Convenience sampling - surveys limited to group 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

Ju-Lin Lee Clinical Leader – Dietetics/Diabetes Education and Child Youth & Family Dietitian
Michelle Livy Dietitian – Older Adults Program