Tanya Bish has spent the best part of 30 years working in the aged care sector. After graduating from nursing school, her plan was to become a paediatric nurse, but she found herself in a crowded sector struggling to find work. She accepted a position with the Sisters of Mercy on the surgical ward, and soon came to realise that aged care was where she belonged.
“A lot of our patients were older people, and I really enjoyed that,” Bish told AgedPlus Magazine. “With aged care, you come into contact with such a diverse range of people. It’s their life experience – they’ve lived. When you take time to talk to people about their life, it’s fascinating.”
Bish enjoys the complexity and variety on offer in her current role as clinical director on the executive team at Metlifecare, which requires her to draw on both her expertise as a nurse and her leadership skills. She recently visited the Netherlands to learn about the ways in which the country is caring for its older adults, particularly those affected by dementia, and returned to New Zealand with plenty of insight into how changes might be made here.
“The Dutch are doing a lot of research into some really innovative technologies to give more freedom to those living with dementia,” said Bish. “At one care home, a fully renovated historic farmhouse where people with quite severe cognitive impairments were being cared for, new residents would wear a GPS tracker so the carers could see where that person naturally headed when they went for a walk.”
Staff could be alerted if residents strayed or deviated from their usual paths, allowing both an increased sense of freedom for residents, and peace of mind for staff and family who might be concerned about their safety.
“The carer could speak to the resident through the GPS device, and say something like, ‘Hey John, looks like you might be heading off in the wrong direction. Do you need a hand to get back for lunch?’ That’s a much more pleasant conversation than a ‘You’ve got to turn around’ directive,” Bish explained. “It was always done in a very dignified way.”
The devices are also able to distinguish between sitting down and falling over, a crucial point of difference when it comes to monitoring residents’ safety. In the coming decades, such devices are likely to become more sophisticated, potentially being integrated into ‘smart’ clothing so that residents need not feel encumbered by a physical tracking device.
Bish is now looking at how some of the technologies she saw in the Netherlands could be implemented in New Zealand, as well as lifestyle practices she witnessed on the farm such as animal care and gardening work, which she felt gave residents a sense of purpose.
“When things are institutional and people feel they’re locked in, they feel very uncomfortable and have a real desire to get out,” she said.
The visit reinforced Bish’s convictions as regards the benefits of Metlifecare’s homestead care model, implemented in care facilities over the past few years. By positioning suites around a small shared kitchen, residents are able to cook or bake for family during visits, sharing meals with loved ones when they choose. This pod design has even been implemented in Metlifecare’s first dementia community, Toi Toi at Papamoa Beach Village, which opened late 2019.
“In the ‘good old days’, we would never have done that because of the risks around hot water and sharp knives and so on,” Bish observed. “Yes, we always try to be careful around safety, but the theory is that if it looks like a home and feels like a home, then people will be more comfortable to stay.”
Bish’s hospitable attitude is reflective of a paradigm shift over the last few decades in the aged sector at large. Gone are the days of over-institutionalisation, with shower schedules, two hourly rounds a day for toileting, and rigid meal routines.
“That’s the polar opposite of what we aim to do now. As part of getting to know a new resident, we get to know their routine, and as much as possible care plans and care delivery are individualised to suit the resident,” she said.
“Staff are au fait with each person’s likes and dislikes, and we also work hard to keep their connection with the wider community. For example, if they had regularly gone to the RSA before they came into the home, we look at what we can do to help them continue with that.”
Of course, happy, healthy residents are only half of Bish’s remit. She is also responsible for ensuring her staff of around 200 carers and 90 nurses are happy and fulfilled in their work. By all appearances, she is excelling, with all established Metlifecare homes having received either three- or four-year Ministry of Health certification since Bish took office.
“Certification is a bit like a Warrant of Fitness for an aged care provider,” she explained. “Auditors come into a care home and chat to the residents and their families as well as staff. They go through resident and staff files to check if all the right processes have taken place, and they also look at staffing hours and quality initiatives.”
The auditors then write a thorough report from which the Ministry decides how long the care home will be certified for. This can be for as little as six months, up to the gold standard of four years, achieved by numerous Metlifecare care homes.
Despite her successes, Bish is keen to pass on the credit, praising her team and their meticulous attention to detail, care, and hospitality. But a great team requires a great leader, and it’s clear that Bish has found her calling in the aged care sector.
“It’s one of those things – until you do it, you don’t get it,” she said. “A career in aged care is exciting. There’s so much complexity and so much a nurse can learn and bring to it.”
As for her own career, while she’s no longer involved in the ‘hands-on’ nursing she used to fill her days with, she still loves visiting residents and staff and keeping her eye on new literature to understand improvements that could be made.
“Once a nurse, always a nurse,” she said. “It’s who I am at my core.”