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Behavioural Management Units

What is it

Secure wards that provide a safe environment for older persons with dementia or delirium. The unit reduces the need for nurse specials (or 1:1 nursing), restraints or pharmacological sedation. Bed numbers are generally smaller compared to general wards, due to the intensity of staffing that is required for these patients, for example 10-12 beds.

How it works

The ward allows older people with cognitive disturbance to walk freely in a contained and safe environment. The unit involves multidisciplinary assessment, care planning and intensive treatment for older people with severe behavioural disturbance associated with dementia and/or mental illness.

The layout of the units varies, although all units had natural lighting, windows with an outside view and courtyards accessible for older people. Some hospitals had single rooms that helped to reduce disturbances caused by staff attending other patients in the same room.

Resourcing

Staffing consists of geriatricians, registered nurses, enrolled nurses, assistants in nursing, clinical nurse consultants, nurse practitioners, old aged psychiatrists/registrars, and allied health such as occupational therapists, psychologists, dietitians, social workers and physiotherapists. Nursing staff ratios are higher due to the extra needs and supervision required for dementia and delirium patients, for example, 1 nurse to 4 patients.

Success factors

  • Open plan design to allow all patients to be supervised from the clinical station
  • Environmental considerations to engage patients and create a calming familiar environment that simulates routine lifestyle activities and promotes purposeful activity. Examples include music therapy, pet therapy, orientation strategies, walking tracks, bird aviaries, men’s sheds and even false bus stops.
  • A secure environment that allows patients to walk around
  • Common areas for patients to interact 
  • Lighting appropriate to the time of day
  • Single rooms to reduce noise and disturbances
  • Encouragement of family and carer involvement, including visits.

Models in operation 

  • Concord, for up to 10 people
  • Sutherland
  • Planned for Hornsby.