Background: Working with rural and remote communities can bring with it unique complexities that require thought, innovation and a special kind of flexibility. The more we provide support in these locations, the more we realise that taking a proactive approach is needed and that means actively searching for opportunities to support. This is what happened in Pukatja, SA.  

A single referral in this remote community prompted a comprehensive ‘all in’ approach by the DSA team and many of the local service providers. The initial referral highlighted concerns with multiple residents who had been physically aggressive and agitated for some time. The residents, aged between 71 and 94, had all moved into care within the last three years. Concerns included potential harm to staff and other residents, as well as resistiveness to being supported with personal care.  

Discovery and response: In a proactive move, the DSA consultant requested the referrer to identify additional residents with cognitive impairments and that were likely to need our support.  This inquiry resulted in a further four referrals expanding the scope of DSA involvement as a way of maximising resources when they next visited the area.  

A face-to-face team meeting was arranged, involving a diverse group: the doctor, clinical manager, three Personal Care Assistants (PCAs), the referrer, a representative from the nearest Memory Clinic, and two DSA consultants. The team spent four hours on-site observing residents and consulting existing documentation.   

Identified challenges: Several factors contributing to the residents’ behaviour were identified:  

• Mood disorders  

• Carer approach  

• Pain and possible delirium  

• Incontinence  

• Limited knowledge of habits and routines 
• Boredom  

The team noted a lack of detailed social and lifestyle histories for each of the residents however, evidence of past trauma affecting family connections was observed.  The consultants recommended exploring social histories for further insights. 

Interventions and strategies: The Dementia Support Coach provided practical strategies to manage responsive behaviours.  These included:  

• Using music on headphones to provide direction and some entertainment to resolve the observation of boredom.    

• Implementing night-time strategies to reduce agitation that frequently occurred at this time.  

• Introducing a baby doll that was particularly helpful for one resident and provided emotional support and companionship.  

• For one resident, it was observed that multiple staff were attempting to support this resident during personal care and this was confronting for that resident. Introducing some strategies to reduce the number of people needed, meant the situation was calmer and the resident was more responsive to this assistance.   

Community and family engagement: The team proposed arranging community church services to allow residents to see family members who couldn’t visit due to vaccination issues.  The GP agreed to contact the local Pastor for visits and communion.  Additionally, local choir music was provided via a music player and headphones, with an app used to play faith-based music and sermons in the residents’ language. 

Feedback and outcomes: The feedback from the referrer and GP was overwhelmingly positive, with expressions of gratitude for DSA’s swift and supportive intervention.  The referrer highlighted their excitement about the support and brokerage items provided and requested a return visit. The Memory Clinic praised the non-pharmacological strategies and the speed of their implementation.  

Services in remote settings are often used to a collaborate approach that looks to bend and flex on scope which often lends itself to innovation in teamwork. The work in this intervention successfully strengthened the partnership between the care home and DSA, enhanced collaboration with the Memory Clinic, and most importantly, improved the well-being of the residents. This case underscores the value of a holistic, multi-disciplinary approach in addressing the complex needs of individuals with dementia in remote care settings.