Schmieder_Feldkircher_CARE

C A R E OA S I S
Switzerland´s Evidence-based
Contribution for a Dementia Care Unit
29th AHCA Seminar
Michael Schmieder and Christian Feldkircher
Orlando, October 7th 2013
OUTLINE
• DEFINITION
• SOFT FACTORS
• OPERATION
• TIME
• CARE GIVER
• RELATIVES
• HARD FACTORS
• CASE STUDIES
• Q & As
STUTTGART
MUNICH
LAKE
CONSTANCE
60 MIN
ZÜRICH
SONNWEID
150 MIN
MILAN
GENEVA
120 MIN
VIENNA
SONNWEID CENTER FOR DEMENTIA CARE
location
owner
WETZIKON, Switzerland (near Zürich)
for profit
year
employees
since 1986 dementia care
280 total
residents
units
155 beds total
9 care groups (110 beds), long-term care
4 family groups (30 beds), more independent
1 oasis (6 beds)
1 oasis under construction (2014)
THEORETICAL BACKGROUND
CARE OASIS
• 6-8 persons
• one room with clear center
• outside garden
DEFINITION
“A Care Oasis is a care and housing concept for
persons with severe need of care.”
“ The basic concept of a care oasis is to
allow the resident to participate in the community,
hence to antagonize isolation.”
(Michael Schmieder 2013)
care oasis 3 - opening 2014
PHYSICAL ENVIRONMENT
OPERATION
softfactors ELEMENT 1 of 4
large space (min. 100 m 2 / 1100 sft)
6-8 residents
secure private area
center (living area with kitchen)
separate room for agitated residents
bathroom / 2 toilets
large balcony / garden
OASIS 3
2013 (under construction)
OASIS 3
2013 (under construction)
TO FEEL SOCIAL RELATIONS
A care oasis is not a cost effective multibed nursing room.
It is not a place to die. But it is a place to live before you die.
TO FEEL SECURE
“Not feeeling anxious at the end of one’s life, is probably the highest profit a human can reach.”
(Schmieder 1998)
EXPERIENCE COMMUNITY
TIME
softfactors ELEMENT 2 of 4
Oasis 2 since 2001
TIME
softfactors ELEMENT 2 of 4
TIME
softfactors ELEMENT 2 of 4
create memory and atmosphere
conventional care group
care oasis
CARE GIVER
softfactors ELEMENT 3 of 4
CARE GIVER
softfactors ELEMENT 3 of 4
“Good nursing care involves trying to create a good life for patients
where they can experience acceptance, communication, familiarity,
a place where they can feel home.” (Zingmark 1993)
RELATIVES
softfactors ELEMENT 4 of 4
RELATIVES
softfactors ELEMENT 4 of 4
CONTEXT
international dimension
OUTLINE 2 part
nd
• FUTURE OF CARE
• HARD FACTORS
• CASE STUDIES
• Q & As
CONTEXT
history of nursing homes
CASE STUDY 1
city of WIL - INTENSIFY AMBULANT / HOME CARE
HOME
HOME
SENIORAPARMENTS
HOME
NEIGHBORHOOD
CENTER
PUPLIC &
SOCIAL
SERVICES
CASE STUDY 1
STRATEGY - future of nursing homes
CARE
PUBLIC
SERVICES
SENIOR
APARTMENTS
AMBULANT CARE - HOME CARE
STATIONARY CARE
SENIOR CENTERS
HOME
DAYCARE
SENIORAPARTMENTS
REHAB
TEMPORARY
CARE
DEMENTIA
CARE
CENTER
A C C E P T A N C E
PRIVATE
HOMES
CARE
OASIS
HOME
CASE STUDY 1
STRATEGY - future of nursing homes
CARE
OASIS
CASE STUDY 2
CARE CENTER APPENZELL - LONG TERM CARE FACILITY WITH FOCUS ON DEMENTIA CARE
APPENZELL CULTURE
t
CARE CENTER APPENZELL
LONG-TERM CARE WITH FOCUS ON DEMENTIA CARE
village
Appenzell, Schweiz
owner
Bau- und Umweltdepartement Appenzell
government of canton, non-profit
Architekten
Bob Gysin + Partners bpg
Zürich
construction
2013-2015
bedstotal: 63 (incl. 6 beds for oasis)
Wohngruppen
2 units for people with dementia
4 units for long term care
1 unit as a care oasis
floor space 8’344 m2 / 90’000 sft
building volume
28’608 m3
total costs
24.8 Mio Fr. / 27.2 Mio $
- without land
- incl. 8% taxes
- incl. furniture
N
EXTERIOR
southeast corner / dementia garden / concrete frames - framing a resident room / wooden fillings
2nd floor
2 units for dementia care / dementia garden / therapy
4th floor
2 units for long term care + care oasis
CATALOG OF CRITERIAS for a CARE OASIS
ONE ROOM turned into SYSTEM OF CARE
INCREASED SIZE
LIGHT
CENTER
ACOUSTICS
ACCESS to NATURE
MATRIX of FEATURES and OUTCOMES
Accessible roof garden
Clear / Symmetrical floor plan
Acoustic Environment
DESIGN INNOVATIONS
Artwork ( only in private area)
Reduced Design Elements on
walls and ceiling
Care giver Workstation at Main
Table
Main Table in Center of Room
Visible Kitchen element in Center
of Room
partition wall with private area /
objects
private room / relatives
light from 3 orientations with
reduced direct sunlight
large windows along one side
lighting (circadian)
Improve nurse
satisfaction
Improve patient /
visitor satisfaction
Improve
communication of
resident
Improve Nutrition
Improve resident
Activities
Reduce drug usage
Reduce nurse stress
Reduce resident /
visitor stress
Reduce Patient Falls
OUTCOMES
N
SYSTEM OF CARE
INCREASED SIZE
CENTER
ACOUSTICS
ACCESS to NATURE
LIGHT
TOTAL 1´750 sft
MAIN ROOM 1´250 sft
SERVICE 250 sft
TERRACE
250 sft
CURRENT LITERATURE
PUBLICATIONS
2012
TITLE: Pflegeoasen in Deutschland: Forschungs- und handlungsrelevante
Perspektiven zu einem Wohn- und Pflegekonzept für Menschen mit schwerer Demenz.
AUTHORS: Brandenburg H., Adam-Paffrath R., et al.
2008
TITLE: Das Demenz-Buch (chapter 5).
AUTHORS: Bowlby Stifton C. Verlag Hans Huber, 2008
CURRENT TOPICS COVERED
RESIDENTS - Quality of Life
CARE GIVER - satisfaction and stress level
RELATIVES - satisfaction and engagement
RESULTS and effects of operating a care oasis
CURRENT EVIDENCE
CENTER
CARE GIVER
• constant view and visual
communication causes
• increase of communication
• more contact
• more instructed activities
• distinct movement radius
• team building process at the beginning
• higher gratification
• less burn-out throuh higher
meaning orientation
• increase of job variation
• higher personal identification
ACOUSTICS
• higher emotional exhaustion
• higher physical and pyschological stress
• plane acoustic ceiling for
main acoustic ambience
• curtains / partition walls and
greenery for interventions
LIGHTHING
• circadian light studies
FINDINGS
EVIDENCE
There is substantial evidence for positive outcomes in an oasis for
• residents
• care givers
• relatives
Increase of Qualitiy of Life.
Expanded and intensive job requirement for care givers with higher overall gratification.
DESIGN DECISION
Research is in its beginning and spatial design decisions can rarely be based on evidence.
Evidence has mainly influence on furniture, materials and work processes.
ARCHITECTURE
A oasis is a care concept with specific spatial requirements, which expands the conceptual
possiblities for planners.
CURRENT LITERATURE
STUDIES
2012
TITLE: „Verbesserte Lebensqualität für demente Bewohner: Das Forschungsprojekt St. Katharina in Wien.“
AUTHORS: Charlotte A. Sust, Peter Dehoff, Dieter Lang, Dieter Lorenz; 2012
TITLE: “Vom Ruheraum zum bewegt(er)en Lebensraum“
AUTHORS: Anja Rutkröger, Renate Berner, Christina Kuhn, 2012
TITLE: Pflegeoase. Eine spezialisierte Betreuung von Menschen mit schwerer Demenz (PosBeD)
AUTHORS: Detlef Rüsing, Nicole Ruppert, Christian Mülller-Hergl, Odilia Plietker, 2012
TITLE: Evaluation des Schlafverhaltens in einer Pflegeoase im Vergleich zum Doppel- und Einzelzimmer
AUTHORS: Christina Kuhn, Renate Berner, Anja Rutenkröger, Dezember 2011
2011
TITLE: “Pflegeoasen: (K)Ein Lebensraum für Menschen im Alter mit schwerer Demenz.
AUTHORS: Brandenburg H., Adam-Paffrath R., Brühl A., Burbaum J., 2011. Abschlussbericht einer Evaluationsstudie
TITLE: “Innovative und herkömmliche Versorgungsstrukturen für Menschen mit schwerer Demenz im Vergleich: PflegeOASE. Unveröffentlichter Abschlussbericht für das Bundesministerium für Gesundheit und das Ministerium für Arbeit, Soziales, Gesundheit,
Frauen und Familie in Rheinland-Pfalz.”
AUTHORS: Schuhmacher B, Denkingenr H, Heine Y, Hils A, Klie T, 2011
2010
TITLE: Lebensqualität und Arbeitsmotivation in der Pflege schwer Demenzkranker. Evaluationsergebnisse einer Pflege.
AUTHORS: Becker S, 2010
TITLE: “Milieutherapeutische Effekte in der Pflegeoase”
AUTHORS: Jürgen Dettbarn-Reggentin und Reggentin, 2010
2008
TITLE: „Im Blick haben“, Evaluationsstudie zur Pflegeoase im Seniorenzentrum Holl.
AUTHORS: Rutenkröger A., Kuhn C.; 2008
CURRENT EVIDENCE
STUDIES
Becker 2011
DESIGN: descriptive longitudinal compare study, mixed method
RESULTS:
Quality of Life: increase of QoL for residents, reduction of negative associated daily life situations,
decrease of medication
Care giver: higher personal identification, increase of motivation
relatives: relief through presence
Brandenburg, Adam-Paffrath, et al. 2011
DESIGN: longitudinal compare study, mixed method
RESULTS:
QoL resident: less agression, agitation, depression and fear, more contacts with care givers for positive events
job satisfaction of care givers: higher emotional exhaustion, higher gratification
relatives: higher satisfaction with care, better communication/information, higher closeness between care giver and residents
Rutenkröger, Kuhn 2008
DESIGN: descriptive pilot study / pre-post-test-design / mixed method design
RESULTS:
QoL resident: better nutrition, increase of communication, less mobility, more attention, less apathy
care givers: higher physical and psychological stress
Rutenkröger, Kuhn 2010
DESIGN: longitudinal compare study, mixed method design
RESULTS:
QoL resident: increased QoL, less non-cognitive symptons
care givers: less burn-out through higher meaning orientation, more single contacts, increase of job variation
Schuhmacher, Klie et al. 2011
DESIGN: longitudinal compare study, mixed method design
RESULTS:
QoL resident: less pain, more positive contacts, more instructed activities, same movement radius
job satisfaction of care givers: team building process at the beginning, education in work according to resident needs
relatives: lack of privacy
SPEAKERS
Michael Schmieder
[email protected]
www.sonnweid.ch
Christian Feldkircher
[email protected]
www.firm-zt.com
CASE STUDY APPENZELL
“Alters- und Pflegezentrum Appenzell”
Appenzell, Switzerland
ARCHITECTS
Bob Gysin + Partner BGP Architects
[email protected]
www.bgp.ch