Five years after adopting the Spark of Life Philosophy to dementia care and three years after becoming the world’s first Spark of Life Centre of Excellence, New Zealand’s Mercy Parklands aged care home is continuing to report positive outcomes for residents with dementia, their families and staff. Helen Delmonte explains.
Between 50-60% of our 97 residents are living with dementia. There’s a small non-secure home environment area for 13 of those residents with dementia. We also provide for residents needing palliative and interim care, and those aged under 65. We employ 126 staff from a diverse range of cultural, ethnic, and socio-economic backgrounds, with 21 different nationalities represented.
On 14 February 2014, Mercy Parklands was officially recognised by Dementia Care Australia as the world’s first Spark of Life Centre of Excellence.
To become a Spark of Life Centre of Excellence an organisation must spend a minimum of two years strategically implementing the Spark of Life Philosophy and demonstrate that it has gone beyond the minimum standards for meeting the emotional needs of all individuals in its care.
The Spark of Life Philosophy
Spark of Life was developed by Jane Verity, Founder and CEO of Dementia Care Australia, and Hilary Lee, President of Spark of Life and launched in 2007. It is a ‘whole systems approach’ to dementia care implemented in residential and community aged care organisations to enable rehabilitation and ‘rementia’ (the regaining of lost cognitive and functional abilities) through enriching relationships and the culture of care in an organisation.
The focus is on the quality of the connection between the carer and the person with dementia and aims to foster kindness, compassion, empathy, respect and an attitude of unconditional love in interactions between care staff and clients.
One of its benefits is that it teaches how to implement the essence of Professor Tom Kitwood’s person-centred care – supporting each person as an individual with a unique personality, biography, physical health status, cognitive abilities and social psychology.
In 2010 I was among the first group of International Master Practitioners to graduate from Dementia Care Australia’s inaugural Spark of Life Master Practitioner Course in Perth, along with participants from Denmark, Germany, Canada, Singapore, New Zealand and Australia.
Implementing Spark of Life into Mercy Parklands’ organisational culture over the past five years has enriched the lives of our residents with dementia, enabling them to experience improvements in mental abilities, language, self-esteem, social interactions and emotional well-being.
Centre of Excellence criteria
In order to become a Centre of Excellence, we have had to meet specific criteria set by Dementia Care Australia, including:
- 100% ongoing support for the philosophy from the board, CEO and leadership
- Having at least one in-house registered Spark of Life Master Practitioner who is responsible for all Spark of Life education and implementation throughout the organisation, from the board and CEO to volunteers and family members, and who spends at least 50% of their work time in this Master practitioners are leaders, managers or educators within an organisation who have undergone the three-week certified Spark of Life Master Practitioner Course, run by Dementia Care Australia in Perth, WA twice yearly. The education includes understanding people with dementia and techniques for dissolving distressed behaviour and restoring dormant language.
- 70% of staff educated by their master practitioner in the three-day Spark of Life Practitioner
- Having an active Torchbearers program (Torchbearers are staff members from throughout the organisation selected to act as role models for the program and provide genuine on-the-spot appreciation and encouragement to their colleagues).
- A regular Spark of Life Club program for all residents that is evaluated every six months using the Creative-Expressive Abilities Assessment (CEAA) tool (Gottlieb-Tanaka et al 2008). (The CEAA is designed to obtain information about the expressive abilities of older people with dementia, focusing on a range of abilities that have shown improvement when elders participated in creative activity programs). The club program is an interactive, therapeutic group program used in residential care and day centres to address the social, emotional, cultural and spiritual needs of people at all levels of dementia, and can be adapted to suit those who don’t have
- Evidence that Spark of Life has been implemented in all areas of resident/client
- Completing and passing the Dementia Care Australia Spark of Life Self- Assessment process, which includes providing written and video evidence and evaluations of quality improvement, and resident, staff and family satisfaction.
The search for better care
Achieving Spark of Life Centre of Excellence status was the culmination of a five-year journey for Mercy Parklands and its staff, beginning in 2010, when we introduced the Spark 0f Life Philosophy to the organisation with the aim of developing our culture and environment to better meet the needs of residents with dementia and improve the understanding and skills of staff working with those residents.
I began working at Mercy Parklands in 2002 as an occupational therapist and over the next few years came to realise that while the number of our residents with dementia was increasing, our service was still focused on those who were cognitively and functionally able. These residents had an excellent social program, but we felt those with dementia were missing out on meaningful stimulation and interaction, especially if they had limited verbal communication. This was partly because we lacked the knowledge and skills to implement appropriate care for people with dementia. This may also have contributed to the high number of resident falls and incidents of distressed behaviour.
In 2009, Mercy Parklands embarked on a quality improvement project to investigate options to help address these issues and enhance the lives of our residents with dementia. At this time we became aware of the Spark of Life Philosophy and a group of us attended a seminar in New Zealand, presented by Jane Verity, where we learnt about the therapeutic Spark of Life Club Program and felt inspired to start implementing this for our residents.
Implementing Spark of Life
After purchasing and studying the Spark of Life Club program educational package, which includes a comprehensive manual and DVDs, we introduced the first Spark of Life Clubs for our residents with dementia. (We’ve since expanded this program to include all our residents if they choose).
Observations and feedback from staff and family members showing that the club members were more focused, engaged, contented and enjoying themselves gave us evidence that the program was going to benefit our residents with dementia and the motivation and inspiration to expand the Spark of Life Philosophy throughout the facility to include residents without dementia.
Impressed with the results of the club program, Mercy Parklands’ CEO and board supported me to undertake the three-week international Spark of Life Master Practitioner Course and then, in July 2010, committed to introduce the philosophy as a ‘whole systems approach’ throughout the organisation. I was appointed to the management team to lead the implementation.
Our aim was to create a supportive and understanding social and emotional environment to enable the potential for rehabilitation and ‘rementia’ (Kitwood 1997). Rementia is the recovery of lost abilities when the social and emotional environment becomes more understanding and caring.
We focused on providing appropriate services for the different needs of our residents, developing our workforce skills in supporting those residents, and improving clinical outcomes to reduce the incidence of resident falls and distressed behaviour.
We developed a culture change plan, identifying qualitative and quantitative measures to monitor our change progress, and a step-by-step process for implementing the Spark of Life Philosophy.
The CEO and management team worked to systematically embed the philosophy into all areas of practice, from policies and staff employment to special person-centred care initiatives.
Staff education has been a key component of our success with the philosophy. All staff receive an initial orientation to Spark of Life and can then undertake the education to become Spark of Life Certified Practitioners. At our facility the three-day course is run over six sessions, two to three times a year. All our management team, senior nursing staff, allied health and pastoral care teams and many health care assistants are now Spark of Life Certified Practitioners.
Staff also have the opportunity to become Spark of Life Torchbearers. Regular Torchbearer gatherings include team-building exercises and continued education about Spark of Life techniques and skills to help grow and maintain the positive energy and culture around the facility.
The club program
The therapeutic Spark of Life Club Program has been a major factor in improving our residents’ sense of well-being. Introducing and expanding this program required extensive redevelopment of our existing activities programs and social aspects of our community to better meet the emotional needs of the residents and ensure it adhered to the Spark of Life Club Program framework and principles.
We continued to add more Spark of Life Sunshine Clubs for residents with dementia and then refocused our other activity programs to give all residents the opportunity to belong to a club that suited their interests and ability level. ‘The Men’s Club’, ‘Young at Heart’ club, art and gardening clubs and ‘The Ark’ chapel club are now all part of our weekly program and we have 13 staff trained as club program facilitators. There’s a maximum of eight people in each club and two facilitators.
The facilitators are not ‘entertainers’ and we don’t do competitive activities or quizzes. The club program shifts the focus from residents being ‘entertained’ or passively involved in activities, towards having more active and meaningful engagement.
The clubs create a sense of belonging, bringing together people with similar interests and ability level. Each resident is invited to join a club which matches their interests and ability in areas such as communication, concentration and participation. The facilitators are taught specific skills to use with each activity and how to adjust them to each person’s level of ability so everyone can gain a sense of achievement. This helps people feel safe and able to contribute without fear of failure.
For example in the Level 1 Sunshine Club, for people with dementia who communicate non-verbally, the activities focus on things such as gentle loving contact, music, colour (eg lifting a parachute filled with coloured balloons or leaves) or gentle humour. Residents with good long-term memories are invited to join a club where members engage in a lot of reminiscence-style activities.
Each club has its own specific rituals and ceremonies and follows a set framework, with a welcome/beginning ritual, a main activity and an ending ritual (such as morning or afternoon tea, or a song), which help cement that feeling of safety and belonging. The Level 1 Sunshine Club begins with the members passing around a small heart-shaped cushion that ‘beats with love from one person to the next’ and residents will often place it on their heart as it’s passed to them.
The men’s club members begin by greeting each other with a handshake, while in another club passing around a giant balloon provides focus and energises everyone.
The club program provides opportunities to meet the Spark of Life Five Core Emotional Needs for individual club members: feeling needed and useful; opportunity to care; to love and be loved; to have self-esteem boosted by encouraging and supporting individuals’ positive qualities; and having the power to choose.
Positive outcomes of Spark of Life
Since introducing the Spark of Life Philosophy in 2010 we have demonstrated positive outcomes for our residents, including those with dementia, staff and families across a range of areas as a direct result of the philosophy. These include an exceptional reduction in falls, an ability to systematically dissolve distressed behaviours in a sustainable and lasting way, residents experiencing rehabilitation and rementia, staff being empowered and revitalised, and appreciation from families.
Club program benefits: Within weeks of starting the club program for residents with dementia we started to see positive outcomes with the awakening of dormant abilities, such as language and movement, and noticeable improvements in individuals’ level of communication ability and behaviour, both during the club sessions and at other times. Residents with dementia who did not normally communicate verbally started talking or interacting in other ways; we saw improvement in functional ability – residents who would normally sit passively were now picking up finger food, pouring tea for each other (we enabled this by having a number small teapots that residents could manage independently, instead of one large, heavy pot), passing around the cake, and picking up and looking at things.
Previously, we had not been giving people the opportunity to use dormant abilities and when we set up the environment and activities in a way that enabled them to do things we found those abilities had more potential to come to the fore.
Reduction in distressed behaviour: From 2009 the median incidence of residents’ distressed behaviour has reduced by 35.7% with the Spark of Life Philosophy being the key factor. For the past three years Mercy Parklands has been able to retain all residents with distressed behaviours, where in the past some have had to be transferred to external secure dementia units. Also, there has been no significant incidents of distressed behaviour for the past 12 months in the dementia-specific (non-secure) area.
Reduction in falls: Our falls prevention program uses the Spark of Life principles as the framework, with a significant decrease in falls since 2009. There has been a 48.6% decrease in the median incidence of falls, with a 58% decrease in falls with serious harm from 2014 to 2015. In 2013, our facility was chosen by the NZ Health Quality and Safety Commission to feature in a series of educational DVDs on falls prevention.
Resident satisfaction: In a 2015 internal resident satisfaction survey, the Spark of Life clubs were rated 87.5% important and enjoyable (the top rating) by residents who responded to that question. In a specific Spark of Life resident satisfaction questionnaire in August 2013, the residents were asked to score between 0 and 5 (5 being the highest) on five questions, which included whether they felt loved and understood, valued, needed and useful and joyful. The overall average score on the five questions from 50 residents was 86% scoring 3 or over.
Family satisfaction: In an independent report by Press Ganey (a company specialising in health care satisfaction and improvement in NZ and Australia) containing data from 36 Mercy Parklands residents’ families from an August 2015 survey, we scored 87.2 which was higher than the previous year. The activities at Mercy Parklands scored higher than 99% of the other facilities in the database, with Spark of Life Club facilitators and the clubs receiving positive comments in the survey feedback.
Staff satisfaction: The Spark of Life Philosophy has increased staff knowledge and skills and improved staff confidence and competence in finding alternative solutions to meeting residents’ needs and reducing distressed behaviour. A 2013 independent staff satisfaction survey by Press Ganey showed that Mercy Parklands’ overall mean score was in the 91st percentile nationally. Our staff retention score was 8.8 (a score between 1-10 indicates strong loyalty and limited staff turnover expected in the next 12 months).
Obviously we believe the benefits of holding the title of the world’s first Spark of Life Centre of Excellence are immense: making a significant difference in the lives of our residents and knowing we are doing the very best for them; good standing in our field; high occupancy; positive clinical outcomes; and staff with skills and commitment.
We’re currently working to introduce further initiatives such as the Spark of Life In Action project which includes reducing the use of behaviour-modifying medication by identifying and implementing meaningful Spark of Life Solutions as well as complementary therapies including doll, pet and music therapy. Our vision is to continue working alongside Dementia Care Australia to achieve these initiatives in order to maintain our Centre of Excellence status, and possibly even become the world’s first education centre for Spark of Life! ■
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Helen Delmonte is Allied Health Manager and Spark of Life Master Practitioner at Mercy Parklands, Auckland, New Zealand. Contact Helen at: helendelmonte@ mercyparklands.co.nz
To find out more about the outcomes from the program implemented at Mercy Parklands or the Spark of Life International Master Practitioner course, email firstname.lastname@example.org. The next Spark of Life Master Course will be held in Perth from 7-27 May this year.
Gottlieb-Tanaka D, Lee H, Graf, P (2008) Creative-Expressive Abilities Assessment: user guide. Canada: ArtScience Press.
Kitwood T (1997) Dementia reconsidered: the person comes first. Buckingham: Open University Press.