Do we understand each other?
Dennis Bromley, Proprietor, Viewmont Terrace: Every person that comes into an SRS is unique. They all have their own set of circumstances, their own life story that got them to your doorstep, and you’ve got to take that into account.
Putting them all in the one box will never work. They're all individuals.
Jillian Brennan, Proprietor, Brooklyn House: I have people with intellectually disabilities, I have people with mental illnesses and I have one gentlemen in his 80s who has just started to become ill with dementia. And I have a range of people from the age of 18 to 86. So I've got a pretty diverse group of people here. I have people with schizophrenia, I have people with paranoid schizophrenia, I have people who have manic depression, Asperger's, alcohol, brain injuries, a couple of guys that have had car accidents that have ABIs.
Sue Gery, Proprietor, Alma House: We have such a variety of people living in our SRS. They range from people that have been institutionalised all their adult life to people that once led very busy, full lives.
They might have been - we've had a teacher, a banker, a plumber, an electrician, a car mechanic, a therapist, a doctor. They are all walks of life.
King Chen, Proprietor, Greenhaven: It is important to understand the background of your residents and the way to do that is during the initial referral process. Try to collect as much information about the resident as possible, whether it be about the simple facts, including the pension numbers and Medicare numbers, to their religion, their hobbies, and the sorts of social connections and family connections they have in place. It is all important to collect.
Sue Gery, Proprietor, Alma House: We start by the people that we take in. My criteria for who we take in is that they must fit in with our existing population, and not have a history of aggression, but fitting in with the existing population is really important. So, I guess that's a good start. And I think by trying to make people happy and occupied, we're halfway there.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Coming to know someone, building rapport and trust over time. You know, gaining trust is a really big part of the role, I think, so that then when someone does become unwell, proprietors really know how to help someone, at least maintain wellness.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: It’s very important to understand the residents' backgrounds as far as mental health status, behaviours or illnesses, so that you can actually be in a situation where you can empathise with them, you can respect where they’re coming from with different things, but also making sure you get the right medical attention, the right involvement from social workers or whoever it may be.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: There's a lot of wealth in people, there’s a lot of humanity in people, and we often forget who the person is because we get so consumed with the illness and the disability.
King Chen, Proprietor, Greenhaven: I believe that the key to maintaining harmony in any SRS is the avoidance of physical aggression and verbal aggression.
If you can prevent those two challenging behaviours, or minimise those two challenging behaviours, you can bring people from different age groups, different genders, different social backgrounds and family backgrounds together.
Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: You've got such a wide group of people all living together, it can be like an extremely complex soup when you’ve got them all together, and it’s really important for staff to have some basic understanding of the people they’re working with, even if they don't understand the particular diagnosis or illness they may have, it’s really important to get some idea of the person they are working with. That not only builds trust but also forms a bond and makes it easier to work with the person.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: Through the residential statement, we are able to identify the roles, rights and responsibilities of both the proprietor and staff, as well as the residents. So that's an important aspect when trying to spread yourself around, dealing with different people. But it is a good document for people to actually have so they can actually see that they do have the rights to do certain things, but with those rights come responsibilities. Dennis Bromley, Proprietor, Viewmont Terrace: I've just taken up, recently - I'd take about three or four of them up the street, we’d sit down and have a cup of coffee. I said to one of them actually, the four of them, "Tell me about your life." I found stuff out about their history that I never knew before. It gives me a different view of this person.
Jillian Brennan, Proprietor, Brooklyn House: To start off with, they’re paying your money, they’re paying your wages. They are the crux of your business. So you need to be able to read your residents, you need to be able to get on with your residents. But you also have to have that line where you can say, “Enough is enough.”

Common conditions and illnesses
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: Peoplethat live in SRSs are there, very often, because it is the most convenient or appropriate place for a person to live. Some people that live in SRSs have got extended family and have close contact with family. Some people are quite isolated. In terms of staff working with the residents - many of whom have high rates of mental illness, acquired brain injuries, age-related illnesses every single person in an SRS brings a different history, a different background, a different personality, different interests to the situation. To work well with people who live in an SRS, it is about getting to know them as individuals and tailoring the relationship you have to those individuals.
SchizophreniaSchizophrenia is an illness. It’s an illness where a person loses touch with reality when they are unwell.
A lot of people with schizophrenia are well most of the time so you wouldn't notice any difference, but when is a person is unwell, that losing touch with reality can involve delusions - that is, false beliefs, that they may be persecuted or watched, or a whole range of possibilities. It involves hallucinations, particularly auditory hallucinations, so hearing voice, but seeing things or smelling things that aren’t there, but to the person those things are absolutely real. It affects a person's thinking as well, so they're not able to process information as well, they're not able to remember things as well, they're not able to complete tasks as well. So it really gets in the way of every day functioning - simple things can become very complex or even impossible to do.
Acquired brain injuryJust as everybody in an SRS is an individual, a person with an acquired brain injury brings a history that was there before the acquired brain injury, they bring the degree and extent and individual response of that injury and then there are ways that they interact with the world that they have developed since they've had the injury. It's common but not always that we see difficulty concentrating, difficulty remembering, sometimes inappropriate responses, sometimes people lose inhibitions and so say things inappropriately or perhaps behave in an inappropriate manner, and sometimes they are not able to control those things.
Depression Depression is a sneaky illness. It sneaks up on people. So one of the concerns within an SRS, where people, because of isolation or other illnesses, age-related illnesses, other mental illnesses - depression can sneak up under people. It gets under our guard, so we should be on the lookout for it. And what it does is, it affects every aspect of a person's functioning. It affects their thinking, slows their thinking down, changes their thinking so that they start to think they're the reason that things are not going well around them. It affects the person's emotion. We know about sadness, but it’s more than that it’s things like hopelessness. They see no point in going on. It affects their behaviour - that slows it down. They have more trouble leaving their room, socialising with other people.
Age-related illnesses Age-related illnesses are as many and varied as you can make a list of, but we know some things are more common with age. The starting point for dealing with an elderly person who has a physical illness or mental illness or some decline is to remember that this person has a 70-year or 80-year history, in the first instance. And so they are an individual. They are different to everybody else with this same illness. Knowing a bit about the person and their past and who they were and who they are makes interactions better. If you know Joe was a soldier in World War II and that’s an important element of his history, or that Betty was a dressmaker, and you engage knowing that history, then the illnesses - sometimes they are long term, sometimes they are short term, but it makes the interaction a little bit easier.

Conversation or confrontation?
Enactment: What ones are racing today? So I've got a problem. OK, well do you want to talk about it? Alright. Alright, we will go outside. Take a seat. It’s not my fault. OK. What's going on?
Sue Gery, Proprietor, Alma House: Uncomfortable conversations with residents don't occur from time to time. They occur almost daily, sometimes. It's part of the nature of the business.
Jillian Brennan, Proprietor, Brooklyn House: I think you need to - if you are having an uncomfortable conversation, you have to be blatantly truthful - not rude but you need to be very truthful. Maybe, you know, someone who has got bad odour, body odour, you have to say, "When was the last time you had a shower? Do you think you could have a shower today?" Without saying to them, "You stink." You need to be respectful towards them. I think you just need to be honest.
Dennis Bromley, Proprietor, Viewmont Terrace: First step is, I sit down with them in a spot where there’s nobody else around. Then I’ve got to reassure them that I'm there to talk about this problem that we've got, and I say, "we", not just them, because their problem is my problem. And I let them know, I'm not being judgmental here, I’m not going to tell you off, I just need to explain the situation with you, and how can we get over it.
Sue Gery, Proprietor, Alma House: I had a 38-year-old, gorgeous female resident. She was really sweet and lovely. Kept to herself. She was quite withdrawn. I continued to try to talk to her. One day I took her out for coffee and we were talking and she looked very lonely and not very happy. What came out - and she said to me, "You know, I'm 38 years old and I used to have a lot of friends and now my friends don't want to know me anymore. They don't want to see me and they don’t return my phone calls and they don't - they are not there for me anymore." This made me feel very uncomfortable because I just felt her pain. I had to deal with that in a way that was real, because there was no point saying, "Well, you know, they’ll be there for you tomorrow." So we continued to talk and I had to say to her, "Well, sometimes people move on, and sometimes - these people probably have families and they have gotten on with their lives and now you need to get on with your life." So that was a very difficult conversation. However, she was happy that she'd been able to verbalise her feelings and that she’d had someone to listen to her.
Else Bromley, Manager, Viewmont Terrace: Yeah, the residents know they can come any time and talk to us. There's never really been time - sometimes if I'm busy, like on the phone or something, I will say, "Come back and I will talk to you later." But they all know that. They know they can go to any staff member at any time. Enactment: I wouldn't be saying if it wasn't true, OK? Alright, alright, I'll do that. Are you OK now? Yeah. You have calmed down? Yes, I've calm now. That's good. Oh, alright!
Sue Gery, Proprietor, Alma House: I think that giving people respect, privacy and the most important thing is trust - I think that’s really, really important in the relationships that we have with our residents, because a lot of them don't trust the world out there. They haven't had very good experiences in the world out there. So trust is a big, big factor.
When things get heated Enactment: Excuse me, Yvonne. I’d like to talk to you, and I’d like to talk to you now. What's the matter, Sonia? Somebody has been sleeping in my bed, and I don't like it. Who would be doing that? Michael and Tony. So I’ll need to go and talk to them. Well, they're not home at the moment, they took off, but if they were here I’d like you to have words with them.
Dennis Bromley, Proprietor, Viewmont Terrace: It can be very tough dealing with difficult situations, especially if they come become heated. But I think the one thing we’ve got to remember there’s a reason that it is happening, and we’ve got to find out what that reason is.
Sue Gery, Proprietor, Alma House: Is it their mental illness? Is it something physical? Are they too hot or too cold? Are they upset because they’ve had a personal situation that is churning on in their mind? Are they delusional? Are they hearing voices that are telling them that someone's trying to upset them? There are so many factors that could be involved. They could have a urinary tract infection.
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: The best way to defuse a heated situation is to recognise, firstly, if there is a trigger of some sort and remove that trigger or remove the person from the trigger - that could be another person, that could be a situation, that could be dinner not being what was expected. And those complex situations arise anywhere where there's people, anywhere where there’s individuals. It happens in families and it happens in SRSs.
Andrew Huntington, Proprietor, Cottisfield: You get to know a person's walk, you know. Just by their walk, “OK, something's not right with that person.”
Linda Huntington, Proprietor, Cottisfield: “Keep an eye out for them.”
Andrew Huntington, Proprietor, Cottisfield: Yeah, yeah. A certain look in their eye. They might get a stony look. You know, whether their pupils are dilated or fixed. Yep, their posture, their tone of voice. So there's lots of warning signs.
Linda Huntington, Proprietor, Cottisfield: When we first, sort of, meet them and all that sort of stuff, when they first come in, these are some of the things that we do talk to them about, about, “How do you like to be spoken to? What works best for you in situations when you're unwell?” Because most of them have been unwell in the past and most of them do actually know how they like to be spoken to when they're unwell. When we have problem behaviours or we have an aggressive resident, it’s about timing, about going after they've had their incident or whatever. It’s about going, "This is the time to go and have a chat to them about their behaviour."
Andrew Huntington, Proprietor, Cottisfield: Yes, yes. De-escalate, cool down, time-out first, then we’ll address.
Linda Huntington, Proprietor, Cottisfield: Choose a time that is appropriate to go and talk to them, where they are going to be more receptive to talking back to us about what's happened.
King Chen, Proprietor, Greenhaven: It is very important to try to avoid these situations in the first place, then you can pick up on these little signs and symptoms and say, "OK, maybe John Smith is going to have a relapse in the next couple of days." You could definitely request for an urgent psychiatric review, get the CAT team involved, get the family involved, maybe, or maybe sometimes ask for the GP, for extra home visits, to assess the situation, and we'll move from there.
Else Bromley, Manager, Viewmont Terrace: If I'm in the office and I hear shouting down the hallway, I just, yeah, I immediately go down to see what the situation is. But the majority of the time it can easily be resolved. The majority of the time it’s just misunderstandings between the two residents.
Dennis Bromley, Proprietor, Viewmont Terrace: When a situation gets very heated, and the residents are get very animated and loud, you’ve got to remain calm. You have to use your - the modulation of your voice is very important. If I SPEAK LIKETHIS THIS they're going to speak loud too, but if I speak like I'm doing now, it will have a calming effect on them almost immediately.
Else Bromley, Manager, Viewmont Terrace: When they are calmed down, I just get them to talk and to vent. Sometimes can it be frustration that is built up and they need somebody to talk to, so it is about giving them that time and that a little bit of attention. Then generally, they are happy to go about the rest of the day.
Enactment: I’m gonna pick up this right now and chuck it. No, it wouldn't do anyone good. Why not? No, it wouldn't do anyone any good. Why not? Sonia! Unless you do something, I'm gonna chuck this in your face. Calm down, Sonia. Why should I? Put that down. I will go and talk to them. Why? It always comes to me putting stuff down.
Why can't I just do it, hey? Why?
Dennis Bromley, Proprietor, Viewmont Terrace: When you get to the point that it is not working, you have to make a decision “Is this going to escalate into an act of violence?” When do you call the police? Probably sooner, and they'd rather that you phone soon, too. They’ve never said to me once ,when I had to call the police, they never said, "You have wasted our time." They always said, "We would rather you called us sooner."
Jillian Brennan, Proprietor, Brooklyn House: When a situation gets out of control, my first thought is of the residents. I have to get them - either the person that’s causing the problem out. If they won't move you just got to get everybody else away from them so it doesn't exacerbate, so someone doesn't get hurt, and make sure that the other staff are somewhere at hand, but in a place where they're safe.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: Top tips for handling heated situations? I think the first thing is to keep composed yourself. Not get emotional about the situation. Reassuring both parties that we can resolve the matter. I think that is pretty important - to let them know that you are, perhaps, in control of a calming situation. To address the situation in an area that’s away from other residents, and preferably with a second staff member present, just in case it does escalate, and clearly explain to people what their responsibilities are. But, also, during that phase, letting people have the opportunity to speak, so it is usually similar to a mediation-type thing, where everybody has to be quiet apart from the person who is speaking and they can say their piece.
It usually works quite well. Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: It might be a chance for them to release a lot of energy, a lot of negativity and also a point to get their voice across. For some people, the only way they feel like they can be heard amongst everybody else is to make these kind of statements and do these kinds of things.
Getting your residents involved
Enactment: What are youse doing, guys?
Talking. Talking! What does it look like? You look like a bunch of old women, sitting around here, especially you, Ann. Do you want a game of Uno. Alright, I’m in for that. You’ve got to show me how to play it. I don't know how to play it. Am I allowed to cheat? Yes. I can? Cool. Matt, show us how to do it.
Matt, do you want to hear a funny joke? Yeah. What has four legs and doesn't walk? I don't know. A table!
Jillian Brennan, Proprietor, Brooklyn House: Diversional therapy is extremely important for people who have nothing to do, because they - I mean, their whole life depends on what we can support and give them.
Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: What you tend to find in some of the facilities you go to is people sitting around watching TV.

A lot of people tend to spend a lot of time sleeping in their room during the day and then have trouble sleeping at night, so they go around knocking on doors for cigarettes, or want to converse or coffee and things like that.
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: Stimulation and interaction are essential.
They’re essential to good mental health, they're essential to being a social person, to being the person that I possibly can be. And so having activities, having possibilities, having choices is important to every individual, and an SRS is no different to that. In some ways, it is actually more important.
Phillip Martin, Proprietor, Sheridan Hall: It’s very important to have activities that involve residents' creative skills, especially when they're on the verge of dementia, and it seems to delay the onset. We had people who had never painted for 15 years painting again.
In fact, so excited were they to be able to it that the people had - some people had pictures in an art show!
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Look, I think if people are feeling well and connected, that has a lot of ripple effects into increasing participation, helping with anxiety and having what some would consider - normalising life - you know, doing what other people do which is quite important for people who can be quite isolated, due to a whole range of reasons, including because of symptoms of their illness.
Sue Gery, Proprietor, Alma House: Some residents love art and craft, so we have a little art and craft group. Some residents hate art and craft but they will respond to acting, so we have a drama group that they go to. Some love movies.
So we need to have a variety of different things that will stimulate them. Some don't want to do anything, and we try and work out what their needs might be.
Jillian Brennan, Proprietor, Brooklyn House: When I took over Brooklyn House,we had three staff. I now have 11. I have one employed specifically for diversional therapy. She does activities, she takes them to zoos, she takes them to the movies.
They have swimming groups, they have music groups, they go to choir. There's just a broad range of activities. It has diminished the behaviours at Brooklyn House by almost 100%.
Linda Huntington, Proprietor, Cottisfield: From a staff point of view, getting them out and doing activities with the guys shows them that they are not just task-oriented, they’re not just folding clothes, they’re not just making their beds, they’re not just helping them in the shower, they’re enjoying something with them.
They are not just telling them what to do or telling them, you know, “This is what I'm doing for you."
"I’m enjoying something with you." It shows the staff in a different way to them so they can get to know each other on a different level. We find that really helps with the residents feeling comfortable with talking to the staff about issues and not necessarily having to come to Andrew and I, as proprietors, and thinking that we're the only ones that can talk to them about things on a personal level.
Dennis Bromley, Proprietor, Viewmont Terrace: To get activities for people - like, structured activities that suits all of them - we actually have residents’ meetings which the assistant manager sets it up. She will do that and I insist I do not be there. I feel they will speak freer if I'm not there. Because they will speak - they will give her ideas what they want to do, she will record them, and then she come back to me. We see what is feasible and what can do as a group. Enactment: (Sings) # And everything will be fine # (CHEERING AND APPLAUSE)
For the record
Enactment: Mala, we have to fill in this incident report about Matilda going missing yesterday.
OK? It was 6 o'clock last night? Yes, 6pm. Matildaname: Smith. Yes. Can you remember what happened? I called her and checked in her room and she wasn't there.
Sue Gery, Proprietor, Alma House: An incident is an occurrence where a resident is at risk or either the resident's at risk or another resident’s at risk or a staff member’s at risk - these situations must be recorded.
Jillian Brennan, Proprietor, Brooklyn House: You need to do it at the time. You need to write it down, very factual. You can’t put in what you think or what happened other than the facts that actually do happen.
Enactment: Right, I don't know what’s happened up there but I’ve found you both wrestling around on the floor in the hallway outside of your room. You know we don't do that here, don’t you, fight? Usually you come to me if you’ve got a problem instead of getting angry like that. What started this? Well, I was just lying on the bed and Max came in and he didn't knock on the door, he just barged in.
Andrew Huntington, Proprietor, Cottisfield: Whether it’s problematic behaviour that we're addressing, whether it’s a complaint from another resident about that resident, it’s just explaining to them, explaining to them, a), why it is important to us to record, and why it’s important for the SRS to run. Quite often we find the response where you’ll see the light bulb will go off, or they really will start listening, is when you refer it back to another resident, so, “Your behaviour” or, “This incident” or, “This” whatever the situation may be “has had an effect on another resident.” That's when they, "Oh, OK."
Dennis Bromley, Proprietor, Viewmont Terrace: If you record an incident and then all of a sudden that person reports it to a third party, that third party comes in - it could be the Department of Health, Community Visitors “Show us the incident.” It’s there. They’re going to think, "Gee, they’ve gone on top of that. They’ve done it."
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: We feel it’s important to record an incident so we’ve actually got a log, we’ve actually got a record of something that’s occurred for future issues that could be raised based on that incident. We also record them so we can actually look at if there is a pattern emerging, so it might identify that somebody's behaviour needs to be addressed.
King Chen, Proprietor, Greenhaven: With the correct incident recording we will be able to review the care plans at the correct intervals, and the staff will be able to implement the correct care-planning approaches to provide better care.
Sue Gery, Proprietor, Alma House: There’s no question about it - you can’t run your business if you are not going to do what we have to do. And also, you can't rely on your memory. And also, in cases of dispute, it is written there in black and white. So you cannot rely on evidence of hearsay.
A cause for action Enactment:
Can I talk to you for a minute, please? Sure. I have a problem with Bruce in the next room. He’s playing music late at night and it’s keeping me awake when I'm trying to sleep. Do you want to make an official complaint? Yes, please. OK, well, would you like to come around here, and we’ll write it up.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Everyone who lives in an SRS has the right to make a complaint about something that they're unhappy with. It often gives proprietors an opportunity to actually review some of the services that they provide, and unless someone makes a complaint then the proprietor may assume or staff may assume that everything is going very well. So it’s an opportunity, really, for a proprietor to review, really, some of their practices, and to maybe make things better so that it allows for a relationship to be maintained that is a positive one.
Jillian Brennan, Proprietor, Brooklyn House: If people don't complain, there's obviously something wrong. I think there's no such thing as a perfect SRS. No such place. And complaints need to be dealt with so that you can improve your services.
Sue Gery, Proprietor, Alma House: We try and deal with complaints at Alma House as quickly as possible and as effectively as possible. We cannot always do it that way, and it depends on what the complaint is, but we do always try to do something about it.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: I think the best thing that works for us as far as dealing with a complaint is actually the timeliness. It is the thing of recognising and acknowledging the resident, letting them know you will do something about it and that you will investigate it. It might be that it is not substantiated, it might be a minor thing that needs to be fixed for them.
Or it could be a genuine complaint where we have to take further action.
Andrew Huntington, Proprietor, Cottisfield: Sometimes it can be quite deeper, too. Like, the initial complaint, you know - if you sit down and thrash it out with the resident, you know, where it is stemming from, the root of it may be - you might uncover a lot more.
King Chen, Proprietor, Greenhaven: We must take complaints seriously. I know, most SRSs, I would assume, want to provide a very good quality of service in order to maintain residents, maintain a very high resident retention ratio.
Therefore, you want to focus on maintaining that quality. If you don't take the complaints seriously, you are more likely to lead to some level of resident dissatisfaction.
They are more likely to move to other SRSs or other facilities.
Andrew Huntington, Proprietor, Cottisfield: Happy residents is a happy house - less behavioural issues. Happier staff, happier management, proprietors

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09 September 2015
Duration: 35:22

Stories and information about managing and living in a supported residential service

Under One Roof

Dennis Bromley, Proprietor, Viewmont Terrace: One of the things I really like about this job is to see how people progress through living here.
Linda Huntington, Proprietor, Cottisfield: What keeps us going here is having that sense of humour, having a bit of fun with the residents, knowing that you are making their lives better, and encouraging them to be the best that they can be. Keeping them well.
Jillian Brennan, Proprietor, Brooklyn House: Well, I've been in the nursing field since I left school. I don't know anything else, and I just love people, just love people. And I know I'm doing a good job, so it makes a lot of difference to the other people's lives.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: I get on very well with all the residents, we have a bit of a laugh. Obviously, there's a serious side of things you have to do. But generally, I think I'm seen as being approachable, I've built a good rapport with most of the residents, and I think they trust me.
Else Bromley, Manager, Viewmont Terrace: I love seeing them happy, which makes me happy. It just reinforces that I'm on track with my job and I'm doing my job right.
Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: The residents and the staff who are working and living under the same facility they are part of their home. It’s important that we never lose sight of the fact that, in Supportive Residential Services, that this is people's home too. And a lot of the residents look upon staff, managers and proprietors, as part of their immediate family.
King Chen, Proprietor, Greenhaven: A lot of my friends tell me that my job is difficult but I tend not to see it. I see my job as one that offers a lot of job enrichment.
Sue Gery, Proprietor, Alma House: No two days are ever alike. Every day is different, which is great. You never know what’s going to happen. I've always said we could make a movie of what goes on here every day. So that makes it pretty rewarding.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: You know, we need to remember that there is a person who lives there, and it’s their home as well. And to have some respect for the fact that that place may be someone's home, while a proprietor may perceive that to be their business place.
Andrew Huntington, Proprietor, Cottisfield: It could be you or I where you need to go to assisted living. How would you like the place to be where you lived? If it happened to you?
That is the way Linda and I think. If it happened to us, you know?
Linda Huntington, Proprietor, Cottisfield: How would we like to be cared for?
Andrew Huntington, Proprietor, Cottisfield: That’s right how would we like to be cared for?

Do we understand each other?
Dennis Bromley, Proprietor, Viewmont Terrace: Every person that comes into an SRS is unique. They all have their own set of circumstances, their own life story that got them to your doorstep, and you’ve got to take that into account.
Putting them all in the one box will never work. They're all individuals.
Jillian Brennan, Proprietor, Brooklyn House: I have people with intellectually disabilities, I have people with mental illnesses and I have one gentlemen in his 80s who has just started to become ill with dementia. And I have a range of people from the age of 18 to 86. So I've got a pretty diverse group of people here. I have people with schizophrenia, I have people with paranoid schizophrenia, I have people who have manic depression, Asperger's, alcohol, brain injuries, a couple of guys that have had car accidents that have ABIs.
Sue Gery, Proprietor, Alma House: We have such a variety of people living in our SRS. They range from people that have been institutionalised all their adult life to people that once led very busy, full lives.
They might have been - we've had a teacher, a banker, a plumber, an electrician, a car mechanic, a therapist, a doctor. They are all walks of life.
King Chen, Proprietor, Greenhaven: It is important to understand the background of your residents and the way to do that is during the initial referral process. Try to collect as much information about the resident as possible, whether it be about the simple facts, including the pension numbers and Medicare numbers, to their religion, their hobbies, and the sorts of social connections and family connections they have in place. It is all important to collect.
Sue Gery, Proprietor, Alma House: We start by the people that we take in. My criteria for who we take in is that they must fit in with our existing population, and not have a history of aggression, but fitting in with the existing population is really important. So, I guess that's a good start. And I think by trying to make people happy and occupied, we're halfway there.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Coming to know someone, building rapport and trust over time. You know, gaining trust is a really big part of the role, I think, so that then when someone does become unwell, proprietors really know how to help someone, at least maintain wellness.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: It’s very important to understand the residents' backgrounds as far as mental health status, behaviours or illnesses, so that you can actually be in a situation where you can empathise with them, you can respect where they’re coming from with different things, but also making sure you get the right medical attention, the right involvement from social workers or whoever it may be.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: There's a lot of wealth in people, there’s a lot of humanity in people, and we often forget who the person is because we get so consumed with the illness and the disability.
King Chen, Proprietor, Greenhaven: I believe that the key to maintaining harmony in any SRS is the avoidance of physical aggression and verbal aggression.
If you can prevent those two challenging behaviours, or minimise those two challenging behaviours, you can bring people from different age groups, different genders, different social backgrounds and family backgrounds together.
Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: You've got such a wide group of people all living together, it can be like an extremely complex soup when you’ve got them all together, and it’s really important for staff to have some basic understanding of the people they’re working with, even if they don't understand the particular diagnosis or illness they may have, it’s really important to get some idea of the person they are working with. That not only builds trust but also forms a bond and makes it easier to work with the person.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: Through the residential statement, we are able to identify the roles, rights and responsibilities of both the proprietor and staff, as well as the residents. So that's an important aspect when trying to spread yourself around, dealing with different people. But it is a good document for people to actually have so they can actually see that they do have the rights to do certain things, but with those rights come responsibilities. Dennis Bromley, Proprietor, Viewmont Terrace: I've just taken up, recently - I'd take about three or four of them up the street, we’d sit down and have a cup of coffee. I said to one of them actually, the four of them, "Tell me about your life." I found stuff out about their history that I never knew before. It gives me a different view of this person.
Jillian Brennan, Proprietor, Brooklyn House: To start off with, they’re paying your money, they’re paying your wages. They are the crux of your business. So you need to be able to read your residents, you need to be able to get on with your residents. But you also have to have that line where you can say, “Enough is enough.”

Common conditions and illnesses
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: Peoplethat live in SRSs are there, very often, because it is the most convenient or appropriate place for a person to live. Some people that live in SRSs have got extended family and have close contact with family. Some people are quite isolated. In terms of staff working with the residents - many of whom have high rates of mental illness, acquired brain injuries, age-related illnesses every single person in an SRS brings a different history, a different background, a different personality, different interests to the situation. To work well with people who live in an SRS, it is about getting to know them as individuals and tailoring the relationship you have to those individuals.
SchizophreniaSchizophrenia is an illness. It’s an illness where a person loses touch with reality when they are unwell.
A lot of people with schizophrenia are well most of the time so you wouldn't notice any difference, but when is a person is unwell, that losing touch with reality can involve delusions - that is, false beliefs, that they may be persecuted or watched, or a whole range of possibilities. It involves hallucinations, particularly auditory hallucinations, so hearing voice, but seeing things or smelling things that aren’t there, but to the person those things are absolutely real. It affects a person's thinking as well, so they're not able to process information as well, they're not able to remember things as well, they're not able to complete tasks as well. So it really gets in the way of every day functioning - simple things can become very complex or even impossible to do.
Acquired brain injuryJust as everybody in an SRS is an individual, a person with an acquired brain injury brings a history that was there before the acquired brain injury, they bring the degree and extent and individual response of that injury and then there are ways that they interact with the world that they have developed since they've had the injury. It's common but not always that we see difficulty concentrating, difficulty remembering, sometimes inappropriate responses, sometimes people lose inhibitions and so say things inappropriately or perhaps behave in an inappropriate manner, and sometimes they are not able to control those things.
Depression Depression is a sneaky illness. It sneaks up on people. So one of the concerns within an SRS, where people, because of isolation or other illnesses, age-related illnesses, other mental illnesses - depression can sneak up under people. It gets under our guard, so we should be on the lookout for it. And what it does is, it affects every aspect of a person's functioning. It affects their thinking, slows their thinking down, changes their thinking so that they start to think they're the reason that things are not going well around them. It affects the person's emotion. We know about sadness, but it’s more than that it’s things like hopelessness. They see no point in going on. It affects their behaviour - that slows it down. They have more trouble leaving their room, socialising with other people.
Age-related illnesses Age-related illnesses are as many and varied as you can make a list of, but we know some things are more common with age. The starting point for dealing with an elderly person who has a physical illness or mental illness or some decline is to remember that this person has a 70-year or 80-year history, in the first instance. And so they are an individual. They are different to everybody else with this same illness. Knowing a bit about the person and their past and who they were and who they are makes interactions better. If you know Joe was a soldier in World War II and that’s an important element of his history, or that Betty was a dressmaker, and you engage knowing that history, then the illnesses - sometimes they are long term, sometimes they are short term, but it makes the interaction a little bit easier.

Conversation or confrontation?
Enactment: What ones are racing today? So I've got a problem. OK, well do you want to talk about it? Alright. Alright, we will go outside. Take a seat. It’s not my fault. OK. What's going on?
Sue Gery, Proprietor, Alma House: Uncomfortable conversations with residents don't occur from time to time. They occur almost daily, sometimes. It's part of the nature of the business.
Jillian Brennan, Proprietor, Brooklyn House: I think you need to - if you are having an uncomfortable conversation, you have to be blatantly truthful - not rude but you need to be very truthful. Maybe, you know, someone who has got bad odour, body odour, you have to say, "When was the last time you had a shower? Do you think you could have a shower today?" Without saying to them, "You stink." You need to be respectful towards them. I think you just need to be honest.
Dennis Bromley, Proprietor, Viewmont Terrace: First step is, I sit down with them in a spot where there’s nobody else around. Then I’ve got to reassure them that I'm there to talk about this problem that we've got, and I say, "we", not just them, because their problem is my problem. And I let them know, I'm not being judgmental here, I’m not going to tell you off, I just need to explain the situation with you, and how can we get over it.
Sue Gery, Proprietor, Alma House: I had a 38-year-old, gorgeous female resident. She was really sweet and lovely. Kept to herself. She was quite withdrawn. I continued to try to talk to her. One day I took her out for coffee and we were talking and she looked very lonely and not very happy. What came out - and she said to me, "You know, I'm 38 years old and I used to have a lot of friends and now my friends don't want to know me anymore. They don't want to see me and they don’t return my phone calls and they don't - they are not there for me anymore." This made me feel very uncomfortable because I just felt her pain. I had to deal with that in a way that was real, because there was no point saying, "Well, you know, they’ll be there for you tomorrow." So we continued to talk and I had to say to her, "Well, sometimes people move on, and sometimes - these people probably have families and they have gotten on with their lives and now you need to get on with your life." So that was a very difficult conversation. However, she was happy that she'd been able to verbalise her feelings and that she’d had someone to listen to her.
Else Bromley, Manager, Viewmont Terrace: Yeah, the residents know they can come any time and talk to us. There's never really been time - sometimes if I'm busy, like on the phone or something, I will say, "Come back and I will talk to you later." But they all know that. They know they can go to any staff member at any time. Enactment: I wouldn't be saying if it wasn't true, OK? Alright, alright, I'll do that. Are you OK now? Yeah. You have calmed down? Yes, I've calm now. That's good. Oh, alright!
Sue Gery, Proprietor, Alma House: I think that giving people respect, privacy and the most important thing is trust - I think that’s really, really important in the relationships that we have with our residents, because a lot of them don't trust the world out there. They haven't had very good experiences in the world out there. So trust is a big, big factor.
When things get heated Enactment: Excuse me, Yvonne. I’d like to talk to you, and I’d like to talk to you now. What's the matter, Sonia? Somebody has been sleeping in my bed, and I don't like it. Who would be doing that? Michael and Tony. So I’ll need to go and talk to them. Well, they're not home at the moment, they took off, but if they were here I’d like you to have words with them.
Dennis Bromley, Proprietor, Viewmont Terrace: It can be very tough dealing with difficult situations, especially if they come become heated. But I think the one thing we’ve got to remember there’s a reason that it is happening, and we’ve got to find out what that reason is.
Sue Gery, Proprietor, Alma House: Is it their mental illness? Is it something physical? Are they too hot or too cold? Are they upset because they’ve had a personal situation that is churning on in their mind? Are they delusional? Are they hearing voices that are telling them that someone's trying to upset them? There are so many factors that could be involved. They could have a urinary tract infection.
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: The best way to defuse a heated situation is to recognise, firstly, if there is a trigger of some sort and remove that trigger or remove the person from the trigger - that could be another person, that could be a situation, that could be dinner not being what was expected. And those complex situations arise anywhere where there's people, anywhere where there’s individuals. It happens in families and it happens in SRSs.
Andrew Huntington, Proprietor, Cottisfield: You get to know a person's walk, you know. Just by their walk, “OK, something's not right with that person.”
Linda Huntington, Proprietor, Cottisfield: “Keep an eye out for them.”
Andrew Huntington, Proprietor, Cottisfield: Yeah, yeah. A certain look in their eye. They might get a stony look. You know, whether their pupils are dilated or fixed. Yep, their posture, their tone of voice. So there's lots of warning signs.
Linda Huntington, Proprietor, Cottisfield: When we first, sort of, meet them and all that sort of stuff, when they first come in, these are some of the things that we do talk to them about, about, “How do you like to be spoken to? What works best for you in situations when you're unwell?” Because most of them have been unwell in the past and most of them do actually know how they like to be spoken to when they're unwell. When we have problem behaviours or we have an aggressive resident, it’s about timing, about going after they've had their incident or whatever. It’s about going, "This is the time to go and have a chat to them about their behaviour."
Andrew Huntington, Proprietor, Cottisfield: Yes, yes. De-escalate, cool down, time-out first, then we’ll address.
Linda Huntington, Proprietor, Cottisfield: Choose a time that is appropriate to go and talk to them, where they are going to be more receptive to talking back to us about what's happened.
King Chen, Proprietor, Greenhaven: It is very important to try to avoid these situations in the first place, then you can pick up on these little signs and symptoms and say, "OK, maybe John Smith is going to have a relapse in the next couple of days." You could definitely request for an urgent psychiatric review, get the CAT team involved, get the family involved, maybe, or maybe sometimes ask for the GP, for extra home visits, to assess the situation, and we'll move from there.
Else Bromley, Manager, Viewmont Terrace: If I'm in the office and I hear shouting down the hallway, I just, yeah, I immediately go down to see what the situation is. But the majority of the time it can easily be resolved. The majority of the time it’s just misunderstandings between the two residents.
Dennis Bromley, Proprietor, Viewmont Terrace: When a situation gets very heated, and the residents are get very animated and loud, you’ve got to remain calm. You have to use your - the modulation of your voice is very important. If I SPEAK LIKETHIS THIS they're going to speak loud too, but if I speak like I'm doing now, it will have a calming effect on them almost immediately.
Else Bromley, Manager, Viewmont Terrace: When they are calmed down, I just get them to talk and to vent. Sometimes can it be frustration that is built up and they need somebody to talk to, so it is about giving them that time and that a little bit of attention. Then generally, they are happy to go about the rest of the day.
Enactment: I’m gonna pick up this right now and chuck it. No, it wouldn't do anyone good. Why not? No, it wouldn't do anyone any good. Why not? Sonia! Unless you do something, I'm gonna chuck this in your face. Calm down, Sonia. Why should I? Put that down. I will go and talk to them. Why? It always comes to me putting stuff down.
Why can't I just do it, hey? Why?
Dennis Bromley, Proprietor, Viewmont Terrace: When you get to the point that it is not working, you have to make a decision “Is this going to escalate into an act of violence?” When do you call the police? Probably sooner, and they'd rather that you phone soon, too. They’ve never said to me once ,when I had to call the police, they never said, "You have wasted our time." They always said, "We would rather you called us sooner."
Jillian Brennan, Proprietor, Brooklyn House: When a situation gets out of control, my first thought is of the residents. I have to get them - either the person that’s causing the problem out. If they won't move you just got to get everybody else away from them so it doesn't exacerbate, so someone doesn't get hurt, and make sure that the other staff are somewhere at hand, but in a place where they're safe.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: Top tips for handling heated situations? I think the first thing is to keep composed yourself. Not get emotional about the situation. Reassuring both parties that we can resolve the matter. I think that is pretty important - to let them know that you are, perhaps, in control of a calming situation. To address the situation in an area that’s away from other residents, and preferably with a second staff member present, just in case it does escalate, and clearly explain to people what their responsibilities are. But, also, during that phase, letting people have the opportunity to speak, so it is usually similar to a mediation-type thing, where everybody has to be quiet apart from the person who is speaking and they can say their piece.
It usually works quite well. Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: It might be a chance for them to release a lot of energy, a lot of negativity and also a point to get their voice across. For some people, the only way they feel like they can be heard amongst everybody else is to make these kind of statements and do these kinds of things.
Getting your residents involved
Enactment: What are youse doing, guys?
Talking. Talking! What does it look like? You look like a bunch of old women, sitting around here, especially you, Ann. Do you want a game of Uno. Alright, I’m in for that. You’ve got to show me how to play it. I don't know how to play it. Am I allowed to cheat? Yes. I can? Cool. Matt, show us how to do it.
Matt, do you want to hear a funny joke? Yeah. What has four legs and doesn't walk? I don't know. A table!
Jillian Brennan, Proprietor, Brooklyn House: Diversional therapy is extremely important for people who have nothing to do, because they - I mean, their whole life depends on what we can support and give them.
Jim Strongman, Lead Program Worker, SVVI-SRS Supporting Connections: What you tend to find in some of the facilities you go to is people sitting around watching TV.

A lot of people tend to spend a lot of time sleeping in their room during the day and then have trouble sleeping at night, so they go around knocking on doors for cigarettes, or want to converse or coffee and things like that.
Tony Hoare, Mental Health First Aid Trainer, Action Education Consultants: Stimulation and interaction are essential.
They’re essential to good mental health, they're essential to being a social person, to being the person that I possibly can be. And so having activities, having possibilities, having choices is important to every individual, and an SRS is no different to that. In some ways, it is actually more important.
Phillip Martin, Proprietor, Sheridan Hall: It’s very important to have activities that involve residents' creative skills, especially when they're on the verge of dementia, and it seems to delay the onset. We had people who had never painted for 15 years painting again.
In fact, so excited were they to be able to it that the people had - some people had pictures in an art show!
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Look, I think if people are feeling well and connected, that has a lot of ripple effects into increasing participation, helping with anxiety and having what some would consider - normalising life - you know, doing what other people do which is quite important for people who can be quite isolated, due to a whole range of reasons, including because of symptoms of their illness.
Sue Gery, Proprietor, Alma House: Some residents love art and craft, so we have a little art and craft group. Some residents hate art and craft but they will respond to acting, so we have a drama group that they go to. Some love movies.
So we need to have a variety of different things that will stimulate them. Some don't want to do anything, and we try and work out what their needs might be.
Jillian Brennan, Proprietor, Brooklyn House: When I took over Brooklyn House,we had three staff. I now have 11. I have one employed specifically for diversional therapy. She does activities, she takes them to zoos, she takes them to the movies.
They have swimming groups, they have music groups, they go to choir. There's just a broad range of activities. It has diminished the behaviours at Brooklyn House by almost 100%.
Linda Huntington, Proprietor, Cottisfield: From a staff point of view, getting them out and doing activities with the guys shows them that they are not just task-oriented, they’re not just folding clothes, they’re not just making their beds, they’re not just helping them in the shower, they’re enjoying something with them.
They are not just telling them what to do or telling them, you know, “This is what I'm doing for you."
"I’m enjoying something with you." It shows the staff in a different way to them so they can get to know each other on a different level. We find that really helps with the residents feeling comfortable with talking to the staff about issues and not necessarily having to come to Andrew and I, as proprietors, and thinking that we're the only ones that can talk to them about things on a personal level.
Dennis Bromley, Proprietor, Viewmont Terrace: To get activities for people - like, structured activities that suits all of them - we actually have residents’ meetings which the assistant manager sets it up. She will do that and I insist I do not be there. I feel they will speak freer if I'm not there. Because they will speak - they will give her ideas what they want to do, she will record them, and then she come back to me. We see what is feasible and what can do as a group. Enactment: (Sings) # And everything will be fine # (CHEERING AND APPLAUSE)
For the record
Enactment: Mala, we have to fill in this incident report about Matilda going missing yesterday.
OK? It was 6 o'clock last night? Yes, 6pm. Matildaname: Smith. Yes. Can you remember what happened? I called her and checked in her room and she wasn't there.
Sue Gery, Proprietor, Alma House: An incident is an occurrence where a resident is at risk or either the resident's at risk or another resident’s at risk or a staff member’s at risk - these situations must be recorded.
Jillian Brennan, Proprietor, Brooklyn House: You need to do it at the time. You need to write it down, very factual. You can’t put in what you think or what happened other than the facts that actually do happen.
Enactment: Right, I don't know what’s happened up there but I’ve found you both wrestling around on the floor in the hallway outside of your room. You know we don't do that here, don’t you, fight? Usually you come to me if you’ve got a problem instead of getting angry like that. What started this? Well, I was just lying on the bed and Max came in and he didn't knock on the door, he just barged in.
Andrew Huntington, Proprietor, Cottisfield: Whether it’s problematic behaviour that we're addressing, whether it’s a complaint from another resident about that resident, it’s just explaining to them, explaining to them, a), why it is important to us to record, and why it’s important for the SRS to run. Quite often we find the response where you’ll see the light bulb will go off, or they really will start listening, is when you refer it back to another resident, so, “Your behaviour” or, “This incident” or, “This” whatever the situation may be “has had an effect on another resident.” That's when they, "Oh, OK."
Dennis Bromley, Proprietor, Viewmont Terrace: If you record an incident and then all of a sudden that person reports it to a third party, that third party comes in - it could be the Department of Health, Community Visitors “Show us the incident.” It’s there. They’re going to think, "Gee, they’ve gone on top of that. They’ve done it."
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: We feel it’s important to record an incident so we’ve actually got a log, we’ve actually got a record of something that’s occurred for future issues that could be raised based on that incident. We also record them so we can actually look at if there is a pattern emerging, so it might identify that somebody's behaviour needs to be addressed.
King Chen, Proprietor, Greenhaven: With the correct incident recording we will be able to review the care plans at the correct intervals, and the staff will be able to implement the correct care-planning approaches to provide better care.
Sue Gery, Proprietor, Alma House: There’s no question about it - you can’t run your business if you are not going to do what we have to do. And also, you can't rely on your memory. And also, in cases of dispute, it is written there in black and white. So you cannot rely on evidence of hearsay.
A cause for action Enactment:
Can I talk to you for a minute, please? Sure. I have a problem with Bruce in the next room. He’s playing music late at night and it’s keeping me awake when I'm trying to sleep. Do you want to make an official complaint? Yes, please. OK, well, would you like to come around here, and we’ll write it up.
Silvia Borrelli, Lead Program Worker, SAVVI-SRS Supporting Connections: Everyone who lives in an SRS has the right to make a complaint about something that they're unhappy with. It often gives proprietors an opportunity to actually review some of the services that they provide, and unless someone makes a complaint then the proprietor may assume or staff may assume that everything is going very well. So it’s an opportunity, really, for a proprietor to review, really, some of their practices, and to maybe make things better so that it allows for a relationship to be maintained that is a positive one.
Jillian Brennan, Proprietor, Brooklyn House: If people don't complain, there's obviously something wrong. I think there's no such thing as a perfect SRS. No such place. And complaints need to be dealt with so that you can improve your services.
Sue Gery, Proprietor, Alma House: We try and deal with complaints at Alma House as quickly as possible and as effectively as possible. We cannot always do it that way, and it depends on what the complaint is, but we do always try to do something about it.
Peter Gibson, Proprietor, Merriwa Grove & Delaney Manor: I think the best thing that works for us as far as dealing with a complaint is actually the timeliness. It is the thing of recognising and acknowledging the resident, letting them know you will do something about it and that you will investigate it. It might be that it is not substantiated, it might be a minor thing that needs to be fixed for them.
Or it could be a genuine complaint where we have to take further action.
Andrew Huntington, Proprietor, Cottisfield: Sometimes it can be quite deeper, too. Like, the initial complaint, you know - if you sit down and thrash it out with the resident, you know, where it is stemming from, the root of it may be - you might uncover a lot more.
King Chen, Proprietor, Greenhaven: We must take complaints seriously. I know, most SRSs, I would assume, want to provide a very good quality of service in order to maintain residents, maintain a very high resident retention ratio.
Therefore, you want to focus on maintaining that quality. If you don't take the complaints seriously, you are more likely to lead to some level of resident dissatisfaction.
They are more likely to move to other SRSs or other facilities.
Andrew Huntington, Proprietor, Cottisfield: Happy residents is a happy house - less behavioural issues. Happier staff, happier management, proprietors