#55: Routine Management and ADLs

Show notes: Special edition

CASE STUDIES

Routine management and activities of daily living for care recipients

In this series of podcasts we are exploring varies topics through case studies – and in this episode we look at routine management and activities of daily life for care recipients.

We will cover:

• Common time pressures when supporting the elderly
• Managing the pressures in meeting standards of care
• The importance of setting up an elder for a successful day

The case study we will share is the story of a lady called Carol. Carol has vision problems and mobility issues, and her routine is quite specific – she is very clear on when she wants her meds and help with her showers and so forth.

Routine management and activities of daily living (ADL) – we can’t talk about this topic without discussing the impact it has on workers. Time pressures are huge, regardless of what your role is, as there is so much to be done. We have had recent changes in Australia within the residential aged care sector in terms of how service delivery is measured. Every time there is a change it evokes stress, anxiety and fear from workers who wonder if they are going to keep up with the requirements of the new regulations.

So how can we best manage our time and get it all done, when we have so many things going on, and so many disruptions and unexpected things coming up?

Going back to the story of Carol, she had very high physical needs, and she would wake up in the morning and straight away request her medicine, and with an eye on the clock, would stress out if staff arrived late as she was very particular about the time she would have her tablets. So from the first moment she woke up, it was stressful for her, as she was totally focused on sticking to her routines.

‘Be adaptable and supportive, working with the changing needs of elders in your care and meet them at their level to best support their routine and ADLs. ‘

Carol was always someone who had high expectations of how she managed her time, and it caused her great distress when she was unable to maintain that independently. So to manage this, we reviewed her care plan together, looking at when things would happen, and really looking at each thing to see what she needed support with, and what she could do herself. It became clear that for her, the importance of the routine was really just about when she was taking her medicine and when she had her shower, the rest she was quite flexible with. So understanding that those were her non-negotiables helped staff to better manage her care.

What I ended up doing with Carol was sitting down with some paper with large font, and asking her about her routine. I explained that I had read in my psychology books that every day a person needs to do four different categories of activities to have a successful day, and I knew that having a successful day was important to her. So we talked about how every day she could do something from each of the four categories, that is, something cognitively stimulating, something that is enjoyable, something that keeps you active and something that is pleasurable. This idea really blew her mind, as she had been so focused on her routine and she was neglecting these areas, so we looked for activities that would suit her and could fit within these categories.

Routine management requires planning at different levels – at the care staff level, leisure and lifestyle and personal. Working together is key, as is looking at quality versus quantity of time.

For Carol, addressing her routine wasn’t an overly complicated task, she just needed help to set up what a successful day looks like for her.

As Paul J Meyer, a pioneer of the self-improvement industry once said, ‘productivity is never an accident – it is always the result of commitment to excellence, intelligent planning and focused effort’. Just because someone has moved into an aged care setting, doesn’t mean they don’t need to keep on planning, that they don’t need to keep on making an effort.

After Carol and I worked together, we put a calendar on the wall and she would spend time looking at the activities on offer and deciding what was of interest and suited her. So she went form someone rigidly focused on routine management, to someone who actually had a bit of a plan every day to attend to her health and happiness. As a result she was more fulfilled, as she improved her knowledge and was more able to participate in discussions.

While a successful day looks different for everyone, if we look at those four categories – being cognitively stimulated, experiencing pleasurable activities, being physically engaged and doing something enjoyable – then you are on the right track. It is really up to the elder (with our support) to find the activities that they like best that fits within these categories.

Today, Carol is doing well, is engaged in many activities and has become more flexible with herself and with others – which has vastly improved the situation for both herself and the workers who care for her.

In this episode you will learn:

• Simple strategies to reduce overwhelm when supporting an elder in their day-to-day life
• The four pillars of a successful day and how to help elders include these in their routines
• Practical ideas to help to support elders in planning their own successful day.