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The aged residential care programme is profiling some of the great work done in the sector. Here we look at the work of the care team at Enliven’s Kowhainui Home and Village in Whanganui (part of Presbyterian Support Central), which launched the organisation’s Māori health plan developed to better support the cultural and spiritual needs of residents and whānau.

Enliven’s Hauora Māori model aims to combine the four wellbeing elements of Te Whare Tapa Whā* with Enliven’s philosophy, which is based on The Eden Alternative® elder-directed model of care.

The Eden Alternative domains are identity, autonomy, security, meaning, growth, connectedness and joy, with a focus on creating a culture of ‘home’. The seven Eden domains, mapped against the four elements of wellbeing, form the Māori health plan – a single page document developed with the resident.

The Māori health plan’s implementation has been supported by an advisory group, comprising whānau, residents, staff, cultural advisors and local kaumātua. There have also been policy changes and all staff have been trained in the Treaty of Waitangi and Te Whare Tapa Whā.

Kowhainui Home and Village Manager Trish Boswell says taking a shared ownership approach has been critical to helping the team step up to the change.

'This approach enables sustainable and meaningful relationships within the team and with residents, whānau and the wider community.'

It began with a change in rostering to support better continuity of care through knowing all the residents and whānau well, but also to promote better work-life balance for the team.

'I invited each one of the team to meet with me and tell me their story – what matters to them about their work and their life outside of work.'

She says the rostering change wasn’t without its challenges, but it set the team up to be more resident-focused while at work.

'It was about getting back to basics, the reason we are here – for the residents, not for us. It helped to empower the team to initiate change to improve the experience of care for all their residents. It requires peer-to-peer accountability and shared ownership. We involved the team, residents, whānau and kaumatua at every phase of consultation, development and feedback on progress. Listening and observing how the residents respond has been amazing.'

Michelle Tui and Frances Craven are two of the team leading cultural assessment using the new approach. They say their role is to learn about the person, their whānau, where they come from, and what’s important to them. Other members of the team will learn to do this as the programme becomes more embedded and extends to other cultures.

Michelle, an enrolled nurse, says the new approach is about team building, building trust, and building each other up.

'There was an open-door policy with the previous manager, but Trish’s door is really open! I’ve never been in the office so many times! There’s good communication, good vibrations.

'We use Te Whare Tapa Whā in our mahi everyday – even a ‘kia ora’ or ‘mōrena’ from the staff is bringing smiles to the residents.'

Frances, the home’s recreation team leader, is relatively new to the role, having a background in social work.

'It’s about the people at the top walking the talk, everyone sharing their cultures, sharing their ideas, and the training in Te Whare Tapa Whā.

'There’s a great atmosphere of positivity and support for each other. We’re encouraged to use initiative and take our ideas to senior staff meetings.'

The changes are growing and evolving as staff, residents and whānau provide feedback.

For example, the team introduced water bowls outside residents’ rooms when they have passed to uphold tikanga and cultural rituals.

'We bless the rooms after a passing with karakia, but there was nowhere to wash our hands,' says Michelle.

'I suggested a water bowl outside the room with poti (potpourri) on top. Trish bought a marble table and a bowl and now we use this, and the family does too. All the Enliven homes do this now.'

Other developments include welcoming new residents and whānau with a powhiri, meals are blessed with karakia, and a korowai (cloak) has been created to be placed over the tupapaku (deceased) as they are farewelled from the home.

'The staff stand guard in respect as the body leaves. The family really appreciate that,' says Frances.

She and Michelle agree the changes have lifted the team’s mana.

'We always ask ‘how would you like your mum, your dad, your whānau to be cared for?’,' says Frances.

Michelle adds that working as a health care assistant is a tough job.

'You go home buggered, but you know you’ve made a difference. And the changes to the rosters help us come back to work refreshed. If we’re happy the residents are happy. We’re not here for us, we’re here for them. This is their home and we need to fit in with them.'

Trish says the sense of ownership and investment from the staff continues to drive momentum for positive change. Other ideas and initiatives to make the home feel more like home include the development of a play space for children, a memorial garden, a sensory room for residents and self-service breakfast nooks.

'I plant the seed but the rest is up to them. They own it.'

* The four elements of Te Whare Tapa Whā include te tahu wairua (spiritual wellbeing), te taha hinengaro (mental and emotional wellbeing), te taha tinana (physical wellbeing), and te taha whānau (family and social wellbeing).

Published: 21 Oct 2021 Modified: 13 Nov 2021