Care Home www.chmonline.co.uk
January/February 2017
Management
Care Funding Council tax rise – just a sticking plaster? Competition inquiry Is this the game changer for care homes?
First impressions Why do care homes get it so wrong?
Care Home Awards The clock’s ticking to get entries in
Issue 65
Editor’s Letter
Care Home Management January/February 2017
Issue 65
Happy New Year - welcome to the January/February edition of Care Home Management
S
Annual Subscription £30.00 Where sold cover price of £4
o here we are. The start of 2017 and let me begin by wishing all our readers – in print and online - a very Happy New Year.
Editor/Publisher Alan Rustad
And for the care home industry what lies in store? A new spring in the step and an
optimistic outlook? Or is it more fear and concern of what lies ahead?
Design/Production Phil Cunningham www.creative-magazine-designer.co.uk Published by JNJ Media Ltd Croham Lodge, Croham Road, Crowborough East Sussex TN6 2RH
I wish it was the former but I suspect it is the latter. The news just before Christmas that councils would be allowed to increase the council tax precept to provide greater funding for social care has been welcomed - but only to an extent. Groups such as Care England are correct when they say ‘the government must understand that this is only an interim measure, and is a figure below that which the sector believes is necessary’. The debate should also include discussion of fairness. Council tax increases tend to
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hit the poorer greater. So, as our front cover shows, this announcement of some extra funding, while welcome, is nothing more than a sticking plaster on a serious issue.
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The incredible thing is that there is a fair measure of agreement about what needs to happen. Proper social care funding needs to be sorted out nationally in a funding solution that also takes account of NHS spending. They are all part of the same issue. When can we expect our politicians to take the longer term view? But while there has understandably been much concentration on the funding issues,
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the news that the Competition and Markets Authority have decided to investigate the care home industry may not have received the national media space it should have. It is no exaggeration to say that this really could be a game changer. The authority will examine such things as top up fees and self-funders subsidising local authority residents. The industry knows such practices – and others - are going
The Publisher holds all copyright and any items within may not be reproduced in any way, for any purpose, without the written permission of the Publisher. While every care has been taken to ensure accuracy, the information contained within this publication is based on submissions to the Publishers who cannot be held responsible for errors and omissions. The publisher does not necessarily agree with the views expressed by contributors and cannot except responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.
headlines sometime in the early part of this year. The industry had better be braced for some changes ahead. On happier matters, the deadline is looming for our first Care Home Awards. You still have time to get your nominations in by the end of January and there is further news of how you can do that on page 18. So here’s to 2017 – and I look forward to bringing you news in what will most
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on but who could really defend them? This investigation is likely to produce more big
January/February 2017
certainly be an eventful year!
Management
editorial@jnjmedia.co.uk
Care Funding
@Carehomemanage
Council tax rise – just a sticking plaster? Competition inquiry Is this the game changer for care homes?
First impressions Why do care homes get it so wrong
Care Home Awards The clock’s ticking to get entries in
Issue 65
Alan Rustad Publisher/Editor
January/February 2017 | Care Home Management 3
Contents
19
6 Funding Council tax to rise – but only a sticking plaster?
15 Visiting CQC spell out the rights of residents and visitors
8 Competition CMA probe welcomed by consumer groups
16 Developments Luxury care unveiled in Battersea
9 Ombudsman Record rise in complaints about care homes 10 Abuse Why do so many think it is rife in care homes? 12 Finance One in four homes may need a bail out in three years 14 Staffing Costs at an all-time high - NatWest
10 4 Care Home Management | January/February 2017
18 Care Home Awards Deadline looming - so get your entries in 19 NACC Care cook becomes chef 20 Care shows Organisers pleased with 2016 events 21 Case Study Joined up healthcare working in Leeds 22 Providing a warm welcome? Where care homes get it hopelessly wrong
12
24 Lighting Try occupancy sensors to control costs 26 Hand hygiene Education and products vital for home staff 28 Cleaning Show Previewing an important event for care homes
26
32 Helpline Free legal advice just a call away 34 Design revolution Making dementia accommodation future proof 36 Spirituality Caring for those of no faith 38 Sleeping Positions Ensuring residents can remain mobile 40 Events and Appointments Where to go and latest movers
34
42 Mattresses Homes have a recycling obligation
Staff Induction Training Video Package 22 accredited video based courses from only £60 per user BVS videos used by over 33% of all Care Homes • Over 12 hours of video Assessment Quizzes • Care Home and Domiciliary Care • Individual courses from £2.20 • Accredited and Certificated • Available Online, on DVD or to Download
This care home based DVD aims to provide substantial support in making sure your staff fully understand and comply with legal obligations as well as significantly improving their skills/knowledge in the area of infection prevention and control. This DVD explains important topics such as:
• • • • • • • • • • •
• • • • • • •
Chain of Infection Legislation and Guidance Systems to Manage and Monitor IPC Cleaning Equipment Adopting Good Practice Effective Hand Hygiene Use of Personal Protective Equipment
• Managing Individuals with an Infection • Handling & Storage of Specimens • Managing Laundry • Managing Waste (The National ColourCoding System, Sharps Disposal & Storage of Waste) • Staff Health
Video Lesson Plan (for DVD & Download) Handouts Care Certificate Workbook Care Certificate – Certificate Assessment Quizzes Care Certificate Assessor Document Care Certificate Guidance Document Care Certificate Mapping Document Care Certificate Framework Care Assistant Self-Assessment Tool Duration: 33 Minute DVD
The BVS Range Includes: Care Home Series, Domiciliary Care Series, Childcare Series, Dementia Care and Learning Disabilities.
BVS Training
Health and safety is a key training area. According to HSE, there are over 6000 reported injuries in a year to employees in social care. This new DVD explains health and safety procedures relating to all aspects of the topic within the care home, covering not only service users but also staff, contractors and visitors, making your home a safe place to work and live. Subjects include but not limited to:
INFECTION PREVENTION & CONTROL Duration: 27 minutes in 16 sections
IN THE CARE HOME
Legal Duties Competent Person Contractors Medication Fire Safety Security within the Home Who is at Risk? RIDDOR Dangerous Occurencies Diseases Missing Clients First Aid Infection Control COSHH Managing Waste The National Colour Coding System Sharps Disposal Clinical Waste
• • • • • • • • • • • • • • • • •
Blood Borne Infections Water Temperatures Legionella Safe Handling of Food Manual Handling Lifting Techniques Floors and Stairs Lighting Windows and Ventilation Lifts Smoking Electrical Safety Kitchen Safety Laundry Safety Stress Management Challenging Behaviour Health and Safety Check List
Duration: (Approx.) 45 Minute DVD in 38 sections.
The BVS Range Includes: Care Home Series, Domiciliary Care Series, Childcare Series, Dementia Care and Learning Disabilities.
Telephone: 0845 644 2866 Email: info@bvs.co.uk Website: www.bvs.co.uk
BVS Training
Warning: All rights of the owner of this video material are reserved. Unauthorised copying, hiring, lending, public performance, radio or TV broadcasting of this material is prohibited.
© BVS Training Ltd
©BVS Training Ltd
Training Pack Infection Prevention and Control in the Care Home
HANDOUT 5
CARE HOME HEALTH & SAFETY
WASTe MANAGeMeNT - UNDerSTANDiNG SeGreGATiON Training Pack reFereNce GUiDe TO cOlOUr cODiNG Infection Prevention and Control in the CareQUicK Home WASTE MANAGEMENT Understanding segregation
Contents Page 1 Page 1 Pages 1-2 Page 2 Page 2 Page 3 Page 3 Pages 3-8 Page 8
Quick reference guide to colour coding Description
Colour
How to use this Training Pack Trainer Introduction Notes Bibliography and Websites Tools Aims and Objectives Compatibility with Induction and QCF Units CPD Accreditation Lesson Plan Training Evaluation
Waste requiring disposal by incineration in a suitably licensed facility.
Waste which may be ‘treated’ or ‘rendered’ safe in a suitably licensed facility. May also be disposed of by incineration.
How to use this Training Pack
Cytotoxic and cytostatic waste requiring disposal by incineration in a licensed facility.
This Training Pack, containing a Lesson Plan and supporting material, has been designed to help you prepare and run an effective training session.
Offensive hygiene waste requiring disposal to a licensed landfill site. This waste should not be compacted.
The Lesson Plan outlines a suggested running order for the session which incorporates the use of this training DVD and also optional pause points where the trainer may wish to stop the DVD. This may be to facilitate a group discussion on a particular issue or carry out an exercise or activity to improve trainees’ understanding and retention of key learning points. The supporting materials referred to in the Lesson Plan could include case studies, group and/or individual exercises and information handouts. Handouts that can be photocopied are listed in the Handouts folder on the CD-Rom.
Domestic waste or municipal waste requiring disposal to a licensed landfill site. Recyclable components should be removed through segregation. Clear/opaque containers may also be used for domestic waste. Safe management of healthcare waste 7658:1.8: England (2011) http://www.spaceforhealth.nhs.uk/sites/www.spaceforhealth.nhs.uk/files/7658-England-7658%3A1.8%3AEngland.pdf
As you prepare for your session you may also wish to carry out your own independent research into the subject matter. Those that have limited training experience may also find it useful to refer to the Trainer’s Guide held on the CD-ROM. This aims to help develop an awareness of training issues and how to get the most benefit out of a training session.
Infection Control Training from Healthcare A2Z, www.healthcarea2z.org © 2011
Trainer Introduction Notes The supporting materials provide the trainer with a variety of activities including discussions, quizzes, case studies and practical demonstrations that help to emphasise the use of safe systems at work and the necessary guidelines to achieve best practice for infection prevention and control.
Telephone: 0845 644 2866 Email: info@bvs.co.uk Website: www.bvs.co.uk
Warning: All rights of the owner of this video material are reserved. Unauthorised copying, hiring, lending, public performance, radio or TV broadcasting of this material is prohibited.
www.bvs.co.uk
• • • • • • • • • • • • • • • • • •
CARE HOME - HEALTH & SAFETY
Infection Prevention and Control (IPC) is a key element in social care and is vital to the well-being of people that we support and care for. Good IPC practices must be consistently applied by all staff to best prevent and control infection, and to ensure the safety of residents in a care home environment.
INFECTION PREVENTION & CONTROL IN THE CARE HOME
All our Care Certificate Induction packages include access to these downloadable resources:
Depending upon the number of individuals attending the training session, it is recommended that sufficient time is given to the session so that topics raised in the DVD can be discussed and subsequently reference made to local policies can be examined. Alternatively, trainers can conduct shorter sessions of 30 minutes and concentrate on one individual topic area at a time, e.g., hand hygiene.
©BVS Training Ltd. Permission is given to photocopy for training purposes only when product is purchased.
Bibliography and Websites Bibliography DH (2009) Health and Social Care Act 2008 DH (2008) Health Care Act 2006: Code of Practice DH (2007) Essential Steps to safe, clean care NICE (2003) Infection control: prevention of healthcare-associated infection in primary and community care. Available on line at: http://www.nice.org.uk © BVS Training Ltd. Permission is given to photocopy for training purposes only when product is purchased.
Page 1
Deliver your training in-house • Cost effective • High quality Easy to manage and record • CPD accredited and certificated Over 70 individual courses also available Online, on DVD or to Download
0345 644 2866 January/February 2017 | Care Home Management 5
News
Extra funding ‘sticking plaster’ solution The government’s announcement that local authorities will be allowed to raise extra funding for social care received a downbeat welcome from the industry, with one leading player describing it as a ‘sticking plaster’ solution. The Communities Secretary, Sajid Javid (below), has, allowed councils to increase council tax by up to 6% over two years, ring-fenced for social care, with a maximum of 3% each year. He said the measure, when added to the £240 million taken from the New Homes Bonus, would mean £900 million extra for local authorities over the next two years to fund social care services. But industry leaders complained it does not go far enough. Care England said it would not prevent a further reduction of care home beds. Professor Martin Green, (left) chief executive, said: “While any new money to social care is of course welcome, the government must understand that this is only an interim measure, and is a figure below that which the sector believes is necessary. The government must look to work urgently with the social care sector to create a better system for the long term, which delivers the care citizens should be able to expect in the 21st century. Mike Padgham (left), chair of the Independent Care Group, said: “It is heartening that the government has at least acknowledged that there is a problem and made an attempt at putting more funding
towards social care. The problem is that increasing council tax over the next two to three years is not going to solve it - it is merely a sticking plaster, rather than a long-term cure. “What is needed is a root and branch reform of the whole way social care is funded and delivered in this country, which we have been campaigning for during the past decade or more.” Janet Morrison, chief executive of Independent Age, said: “This local government finance settlement represents a missed opportunity to set out a long-term strategy on sustainable social care funding. “A six per cent rise in council tax over two years, alongside a new support fund while welcome, will do little to paper over the cracks. This mechanism for funding social care is neither sustainable nor equitable in the longterm, as the Treasury Select Committee highlighted earlier this year. National Care Association chairman, Nadra Ahmed (left), said the extra cash may be too late to solve the care funding crisis. “The sums don’t add up. It is quite evident the independent care home sector cannot survive to serve social
6 Care Home Management | January/February 2017
care when local authority and clinical commissioning groups are reducing the funding per resident by eight per cent on average, while providers endure a seven per cent year on year increase in wage bills alone. “What’s more, any ‘quick fix’ measures of the kind proposed in the current debate fail to take account of those local authorities whose residents are most in need of care services, many of them exempt from paying council tax or qualifying for tax relief. Sadly, these proposals cannot begin to approach a solution to an endemic problem that threatens a care home sector already under threat from further austerity cuts.” Jeremy Hughes (left), chief executive at Alzheimer’s Society, said: “This is a national crisis that needs national leadership. The government is effectively washing its hands of it by passing the buck to local councils while providing no assurance that the money needed to fund care can be raised.”
January/February 2017 | Care Home Management 7
News
CMA launches review of care and nursing homes
The Competition and Markets Authority (CMA) has launched a review of how the care and nursing home market works, and in particular whether people are treated fairly. The CMA study will assess how people find the experience of choosing a care home, explore whether the current regulation and complaints system gives residents adequate protection, and examine how well care homes are complying with their obligations under consumer law. The CMA will look very closely at reports of potentially unfair practices and contract terms being used by some care homes to assess how widespread these concerns are, how they are affecting residents, and whether they are likely to
breach consumer law. With 430,000 older people in care and nursing homes in the UK, the CMA would particularly like to hear from care home residents and their relatives who have encountered issues such as unexplained or ‘hidden’ charges, unexpected fee increases, confusing requests for ‘top-up’ payments, or occasions when they feel that complaints have not been handled fairly. Andrea Coscelli (left), CMA acting chief executive, said: “Choosing a care home can be emotional and costly. It’s therefore essential that elderly people and their families have all the information they need to make the best possible choice, and then feel secure in the knowledge they will be fairly treated throughout their time there. “We are undertaking a thorough review of the sector to make sure it works in the best interests of those who rely on it. We want to hear from care home providers about the services they offer and any challenges they face, as well as residents, families and charities who have experienced what it’s like to
choose and live in a care home. Given the concerns we have heard about possible breaches of consumer law, we particularly want to hear from people who think they might have encountered unfair terms or practices.” The market study will also evaluate the effectiveness of competition between care homes in driving quality and value for money for residents and taxpayers. It will also consider how local authorities and other public bodies purchase and assign care home places, and how they encourage and shape local supply. Views are welcomed on any of the issues raised in the Statement of Scope by 5pm on Monday 16 January 2017. More details on how people can report their experiences if they feel they or their relatives may have been treated unfairly by a care or nursing home can be found on the reporting page.
Investigation welcomed by consumer organisations The Competition and Markets Authority investigation has been warmly received by several groups – most notably Citizens Advice, who had been calling for action. The national charity called for the CMA to investigate the care home market after its research found people were getting shock bills, having as little as a week’s notice about fees going up, and paying deposits that they were offered no protection for. Chief executive of Citizens Advice, Gillian Guy (left) said: “A lack of protections in the care market is exposing older people and their families to poor practices. 8 Care Home Management | January/February 2017
“Our research finds people are experiencing a number of problems with the care market including short notice of cost increases and hidden charges, for things like management fees, which can run into thousands of pounds. continued page 9
“People often have little choice but to pay these costs because moving the resident to another care home is simply too disruptive or distressing. In some instances relatives don’t make a complaint to the company because they worry that the resident could be treated badly. “Given people paying care bills in many ways have fewer protections than those buying a package holiday or as an energy customer, it is good that the Competition and Markets Authority will now investigate the care home market. In particular it’s important that the investigation looks closely at whether further regulation is needed.” Janet Morrison (right), chief executive of Independent Age, the older people’s charity said: “The CMA’s review of care homes, which we called for in our recent report on the sector, is very good news for residents and their families. It is very hard for them to know whether
they are getting value for money in care home costs and we regularly hear concerns about unfair contracts and unreasonable fee increases. “All this paints a picture of a sector that is often failing consumers who are at their most vulnerable. While we recognise that care providers operate against a backdrop of severe funding pressures, a CMA review of the sector should identify how it can work better for the older people and families who use it.”
Ombudsman reports big rise in care home complaints
Complaints and enquiries about residential care increased by 21% during the past year, according to the
latest review of social care by the Local Government and Social Care Ombudsman. While the report mostly examines home care, the Ombudsman reports that the demands on residential care are increasing, with most people choose to remain in their own home for as long as possible before considering residential care as an option. The reports says that because of this, it is perhaps inevitable that those moving to residential care settings tend to have more complex needs.
As a result, residential care homes have become a more specialised service, especially for people living with dementia or those at the end of life. The report says: “The complaints we receive often highlight a lack of personcentred care and poor communication with residents and family members and between the range of health and social care agencies that may be involved in a person’s care.”
January/February 2017 | Care Home Management 9
News
Personal experience is key for abuse and neglect concerns Over half of British adults (52%) believe that abuse and neglect in care homes for the elderly is common. Of those, many say their opinion is based on personal experience - either knowing someone in a care home (15%), working in a care home (5%), or hearing personal experience from others (25%). The findings come from research from Independent Age, the older people’s charity, which is calling for new measures to understand the scale of the problem. “While the research finds that most people’s negative view about care homes is based on media coverage, it is worrying that so many say they are basing it on personal experience,” says Simon Bottery, director of policy and
external relations at the charity. “We hear from care homes that they are already required to report against many different measures from different commissioners and, of course, the CQC. Yet we also know that the information available to the public about care home quality is very basic. “It’s essential we identify one core set of measures that genuinely provides an indicator of the quality of care and ensure that this forms the basis of all inspections and contracts. That will give older people, families and commissioners the most confidence that they are choosing the best quality care.” Independent Age wants the government to take responsibility
10 Care Home Management | January/February 2017
for collecting a basic set of core information about care homes to give earlier warnings of a home providing poor care. Better information and transparency about quality of care must be made available to the public when choosing care. Independent Age also wants the Department of Health to commission a social care staff survey similar to the NHS staff survey asking if staff would recommend the provider they work for and whether they have witnessed neglect or abuse. The report, ‘Shining a light on care: helping people make better care home choices’, also found that: 85% of adults say that they have not visited a friend or relative living in a care home in the past year. Of those adults who have visited a care home in the past year, 45% believe neglect and abuse to be common. 45% of adults would describe the overall quality of care in care homes as bad. 22% say that, if they wanted to find a care home for a relative or friend, they would not know where to go for information, including 1 in 5 (19%) of over-65s. 71% of people who believe neglect and abuse to be common cite media coverage of the care sector as a reason for this belief. A mystery shopping exercise, carried out for the report, highlighted inconsistency in the information that care homes were able to provide about their own services. This means that consumers struggle to know what questions to ask or what to look for when choosing a care home. Two in five – 40% - of care homes spoken to were unable to provide a ‘satisfactory’ or ‘good’ answer to all questions in the exercise. The research found that people reported very low levels of awareness of existing sources of information on care homes, and often struggled to trust information that they do find.
News
No respite from looming residential care crisis
Another gloomy report on the state of the care home industry says more than a quarter of homes are at risk of failure because of government underfunding. The report by Opus Business Services, a restructuring and insolvency firm, reveals a raft of major financial problems besetting care home operators, which at best will lead to compromises in care standards and at worst threatens a significant number of homes with closure or new ownership. Using data supplied by Company Watch, monitors of corporate financial health, Opus has reviewed the finances of 6,178 care home operators, who collectively run 96% of the UK’s residential care homes caring for around 300,000 elderly and vulnerable residents. More than one in four (1,718) of operators are at risk of failure, meaning that around 6,000 care homes could need a financial rescue within the next three years if their closure is to be avoided. At present, Opus believes the number of formal insolvencies is unlikely to rise sharply because most care homes are transferred to new owners by agreement with the creditors, thereby avoiding closure. However, unless public funding improves, it is questionable whether the sector has sufficient management or financial resources to cope with a surge in the number of homes being threatened with closure.
The entire sector earned annual profits of only £209 million, a return on capital of 3.3%. These figures cover periods before the introduction of the National Living Wage last April. Once that is included, Opus estimates over £400 million will be added to labour costs, threatening to make the sector loss making overall. The average annual profit per care home earned by operators is only £10,000. This is clearly insufficient to support the investment required to keep up with the rising care standards required by the Care Quality Commission or to justify the operational and financial risk involved. Anecdotal evidence suggests that many operators are looking to exit the sector, making the capacity shortage already being
‘negative equity’ of £671 million, a figure which has risen by 53% since March 2014. There are significant regional variations within the sample. Scotland has the best financial health ratings, while the Midlands has the worst. The South East has the most profitable operators, the North West has the least successful. Wales has easily the most dangerous levels of gearing, while London has the lowest. Nick Hood (left), business risk adviser at Opus Restructuring, said: “Care home operators are refusing to accept local authority funded residents because the fees are well below the cost of providing care. Sooner or later, privately-funded residents and their relatives will revolt against having to
caused by the ageing baby boomer generation worse still. Surprisingly, only 15% of operators borrow any significant amounts, but this minority have extraordinary levels of debt, equivalent to 121% of their net assets, well outside financial norms. The sector as a whole borrows £4.5 billion. Worryingly, 751 operators (12%) are ‘zombie’ companies with higher liabilities than the value of their assets. Between them they have
pay sky high fees to cross-subsidise publically funded residents. “The residential care sector, which looks after the most vulnerable in society, was barely profitable, even before the impact of the National Living Wage. Our research shows that far too many operators face a serious risk of failure and a deeply worrying number are in negative financial equity. Debt levels for those who borrow are far too high.”
12 Care Home Management | January/February 2017
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News
Staff costs in care homes at all-time high, says NatWest Get in touch
Whether you’re considering fee rates, occupa reducing your energy costs, are based throughncy levels or bed numbe increasing your rs, our healthc out the UK and discuss your are specialists are availab ambitions for your care home. le to visit you on site to
Care Home Be Report 2016 nchmarking /17
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results across the entire sector are being negatively affected. The report analyses data from 156 care homes, including both SME and corporate providers, and gives a geographic breakdown to allow for regional comparisons and make it easy for care home owners to benchmark their own business. The difference in fee rates in care homes throughout the UK is becoming more apparent. With the majority of residents in Northern Ireland and north of England paid for by the local authority, the average fee rates in these regions are amongst the UK’s lowest. The average fee among residential homes is £597 and among nursing homes it increases to £730 per week. For the first time the report includes children’s homes which represent a small but important part of the care home sector. Again, the main cost is staff which represents 56% of turnover. This cost is also reflective in the high fee rates of £3,631 which are associated Important Informat ion
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with this highly vulnerable group. Locality remains an issue for children’s homes as 55% of children are placed more than 20 miles away from their family home where on average they stay for two and a half years. Jeremy Huband (left), head of healthcare at NatWest commented: “In producing this report, which for the first time includes Northern Ireland and children’s homes, we have identified a number of norms. This helps us provide further support to our customers through being able to question any outliers to these norms that they may be experiencing. “We are proud to support this important, and growing, sector and I was enthused to see that the majority of operators we visited were extremely optimistic about what the future holds.”
This documen t has been prepared intended (the by National “Recipient”).This not constitut document has Westminster Bank Plc and e an offer or been delivered its invitation for and is not intended to the Recipien affiliates (together “NatWes the sale, purchase t for informat t”) for the a recommendation to form the basis of , exchange ion purposes any decision or transfer of by NatWest only. It does or evaluatio its own financial any investme that the Recipien nt, loan and tax advice t should participan by the Recipient and solely on its and perform should not be or asset te in any transacti own its own independ in this documen judgment, review and on. The Recipien regarded as analysis to determin ent investigation t should be t should seek research and Recipient; all construed as e its interest analysis, and of which the legal, shall rely Recipient acknowle tax, regulatory, valuation in participating in any transaction. dges that it or accounting Nothing should seek The content advice by NatWest from its own of this documen for the advisors. the right, but t reflects prevailin shall not be g condition obliged, to revise, based on informat s and update or replace NatWest’s views as ion obtained the accuracy at this date. from a number such content. and NatWest reserves of different NatWest has any kind, express completeness of all such sources and information. assumed, without prepared this documen or implied, is the documen No represen or will or has t independent t. Without prejudice tation, warranty been verification, be, relied upon , undertaking to the generalit authorised to be made as a promise or assuranc as to the y of the foregoing estimates, prospect e of or represen , nothing containeaccuracy or complete tation as s or returns ness of Recipient). The d in contained herein to the achievability or issue of this reasonableness this document is, or shall (or in such other proceed with document shall of any future written or any transacti not be deemed projections, on. to be any form oral information provided of commitm NatWest shall ent on the part to the not be liable of NatWest to for any direct, of relying on any statemen indirect or conseque t in in connection with the matters or omission from this documen ntial loss or damage to in this documen suffered by set any person t. By acceptin out herein. NatWest acceptst or in any other informat as a result g this documen ion t, the Recipien no liability for the actions or communications made The publicati t agrees to be of any third on party referred bound by the document shouldand distribution of this foregoing limitation document may, be aware of, s. responsibility in for any violation and comply with, applicab certain jurisdictions, be restricted le legal requirem of any such restrictions. ents and restrictioby law. Recipients of this National Westmins ns. NatWest ter Bank Plc. accepts no Registered in England No. 929027. Registere Authorised by d Office: 135 the Prudenti Bishopsgate, al Regulatio Prudential Regulatio n Authority London EC2M n Authority. and regulated 3UR. by the Financia l Conduct Authority and the
A surprise increase in the use of agency staff within the UK’s care homes has resulted in nursing home staff costs equating to 55% of turnover, according to NatWest’s Care Home Benchmarking Report. This major cost is felt by more than half the nursing homes, where it would be expected due to the shortage of nurses. However the report highlights that the rise in agency staff usage is also apparent in residential homes, with 41% of those surveyed using this service. As a consequence financial
One in eight care homes risk insolvency within three years Twelve per cent of care homes have at least a 30% chance of going insolvent within the next three years, according to research by Moore Stephens, the Top Ten accountancy firm. Moore Stephens says that care homes in the UK have been under considerable financial strain from rising costs and a lack of funding, despite growing demand for places. The company cites the introduction of the living wage for increasing the financial pressures, particularly for smaller homes. Moore Stephens also highlights government cuts to local authorities’ budgets, with estimates that fees paid by local authorities in England to care homes have dropped by close to a fifth since 2010. 14 Care Home Management | January/February 2017
Mike Finch (left), restructuring partner at Moore Stephens said: “It’s become increasingly difficult for care homes, particularly smaller providers, to keep up a consistently high level of care whilst breaking even or worse, remaining solvent. “The introduction of the living wage has increased the financial pressure on care homes to even higher levels, and this is only likely to continue as the living wage keeps increasing to reach the target of £9 by 2020. “This is creating an unsustainable situation in a lot of care homes, where more staff is needed to cater for the increase in demand but the money simply isn’t there to cover rising staff costs.”
News
CQC spells out visiting rights
The Care Quality Commission have clarified visiting rights for people living in care homes, their family and friends. It follows the research carried out by the BBC that showed how some people were being denied visits after highlighting poor care. The CQC acknowledge there are cases where relatives have experienced
visiting restrictions, or their loved ones have been forced to leave against their wishes, after raising concerns with those in charge of running care homes. They have produced information on visiting rights to help people feel better informed and make sure providers are very clear about their obligations. The chief inspector of adult social care, Andrea Sutcliffe, said: “Care homes are people’s homes. They, their family and friends should not live in fear of being penalised for raising concerns. “Good providers know this and we see plenty of excellent practice where managers and staff respond to complaints positively and make sure it is as easy as possible for people to visit their loved ones in a welcoming, friendly environment. “But we know this is not always everyone’s experience, with reports of visiting restrictions and people being forced to leave against their wishes. We also know that too many people
BBC Panorama secret filming exposes care home failures
A series of shocking incidents in nursing homes in Cornwall run by the Morleigh Group have led to four homes being
are frightened to raise concerns because they think this is going to happen. “We have published information to clarify people’s rights and our expectations of providers so that people living in care homes, their family and friends can be more confident that their concerns will be listened to and acted upon by providers responsible for delivering safe, compassionate and high quality care. “As we improve the way we monitor and inspect care services we will explore how we can collect information to give us a greater insight into this issue which we know worries the public and can be an important indicator of a service struggling to provide good care. This will help us to focus our inspection activity and encourage improvement. We will also continue to use our enforcement powers to take action against providers where appropriate for the benefit of those using services.” Panorama programme revealed one nurse saying she was giving morphine to a resident ‘to shut her up’. The footage was recorded by three reporters - one posed as a resident, the other two worked for Morleigh. Cornwall Council said it was ‘sorry that the standard of care provided by Morleigh Group has fallen far short of what residents, their relatives and the general public have a right to expect.’ Andrea Sutcliffe, the CQC’s chief inspector of adult social care, said she was appalled to have found that the Morleigh Group had allowed the quality of care to decline.
rated inadequate and put into special measures. The secret filming by BBC’s January/February 2017 | Care Home Management 15
News
Lifecare Residences unveils Battersea Place LifeCare Residences have unveiled the Albert Suites – a luxury care facility aiming to set a benchmark in aged nursing care for London. Situated adjacent to Battersea Park, the 30 exclusive suites are designed to offer an enriched quality of life amidst a discreet and dignified provision of care, tailored to the unique and personal needs of each resident. Residents will enjoy professional 24/7 care in the privacy of their own suite. All carers are trained to manage a breadth of complex care needs and circumstances, ranging from rehabilitation, short-term convalescence and post-operative support, to long-term nursing or palliative care. Richard Davis, LifeCare Residences’ CEO comments: “The Albert Suites at Battersea Place sets a new standard in bespoke, dignified nursing care for London. Offering residents peace of mind
that all facets of their care will be accommodated, we aim to build a new-found, enriched quality of life for each person, regardless of their circumstances. “It’s crucial to highlight the calibre of staff that we have to administer
highly complex and sensitive care to our residents in the Albert Suites, each of whom is credited for their personal warmth, empathy and optimism, appreciates the art of anticipation and is dedicated to delivering the highest standard of care.”
Planning permission granted for Established operator 66 bed home in West Bridgford adds Burnham-onLNT Care Developments has received planning permission to build a 66 bed care home on the site of the former Landmere Care Home in West Bridgford. It will provide residential and dementia care for those over 65 years. Demolition has already begun on site, with construction due to start March 2017 and a predicted completion date for January 2018. Once complete, the home will be a strong community facility, integrating with the nearby local shops, churches and schools. It will provide accommodation with fully en-suite bedrooms, spacious communal areas, and state-of-the-art amenities including a cinema, library, garden room and tea shop, all surrounded by landscaped gardens. Christine Cooper, project director
at LNT Care Developments, said: “We are delighted to be building such a fantastic care home in West Bridgford. We will be creating 50 jobs in the local area and providing a high quality resource for elderly people in the local community. The facility will incorporate intelligent dementia design and be eco-friendly by benefitting from ground source heat pumps, solar thermal panels and LED lighting keeping utility costs low.”
16 Care Home Management | January/February 2017
Sea home
Broughton Lodge Care Home in Burnham-on-Sea has been bought by Dharm Patel, an established operator of similar sized homes in the South East. Specialist business property adviser, Christie & Co brokered the sale on behalf of retiring owners, Mike and Mandy Matthews. Broughton Lodge was significantly upgraded and improved during their ownership to include a two storey extension with the recent addition of further bedrooms on the top floor taking the total to 18. Simon Harvey, director at Christie & Co, said: “The care market in the South West remains very strong with a wide range of sales taking place across the region.”
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January/February 2017 | Care Home Management 17
News
Care Home Awards - avoiding the New Year clutter Entrants now have until 26 January to get their submissions in as Alan Rustad reports.
At a time when so much of the news about care in the UK may be depressing to read, and perhaps even more depressing to think about, it is cheering to know that the team at the Care Home Awards is on the receiving end of good news stories. These are in the form of the submissions received from those organisations that have already entered the Care Home Awards for 2017. These submissions are from care homes - reporting on their investment in garden and outdoor spaces, on sporting, social or leisure activities, on investments and innovations for dementia care – and from suppliers submitting papers on their new products, or improvements to services, innovations in design and architecture to provide residents with ever-improving environments.
So, yes, there is plenty of gloom, but there are some fantastic stories being told, which the judges will appreciate for the efforts that have gone into those achievements. “No one need be intimidated by the Care Home Awards” believes organiser, Helen Burgin. “We are seeing so many different stories from so many different sized organisations from different parts of the UK that the entries are a good cross section representation of the care home sector. “But we are also aware that time is pressing and we have had several entrants requesting extensions to their deadline because senior personnel are away until around or after the official closing date. As a result, rather than agree a deadline for each entry, we have taken the decision to extend the deadline for all entries until midnight on
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26 January. We are sure this will avoid the New Year clutter and resolve any deadline problems.” The Care Home Awards are different from other awards in the care sector. They are business awards and celebrate excellence and success in the owning and running of care homes and also applaud the innovations and new and improved products and services from suppliers to the care home sector. Fellow organiser, Matthew Davies, has responsibility for compiling names of potential judges for the awards. “The final panels – one for the care home categories and one for the supplier categories – will be announced as soon as the entries are in and we can assess the exact balance of judges required for 2017,” he said. “Panel lists are still open and if anyone would like to be a judge, they can drop me an email with a brief CV to matthew.davies@ carehomeawards.com.” For anyone wishing to enter the 2017 Care Home Awards the process is completed online. Before completing the entry form, though, the organisers strongly recommend that an entrant prepares any written submission offline, first of all, before proceeding to start the online process. Each entry has to be submitted separately, as they each receive a unique number. As the entry form is completed, so each entrant is prompted to upload their submission relevant to that category, or to upload a good reference logo, or any supporting images or data. Helen Burgin is clear: “The Care Home Awards really are straightforward to enter, provided entrants follow the simple plan of action, starting with the preparation of the written submission, offline. There’s some very useful advice to be found on the How to Enter page on the website at www.carehomeawards.com.”
News
Cook becomes chef as NACC launches competition The National Association of Care Catering (NACC) has launched its 2017 search for the UK’s best chef working in the care sector. The name of the prestigious culinary competition has changed from NACC Care Cook of the Year to NACC Care Chef of the Year, in recognition of the culinary excellence and professionalism within the sector and the specialist skills and knowledge demanded of and demonstrated by chefs. Neel Radia, national chair of the NACC, said: “Care catering is a highly-skilled profession and it’s only right that our culinary competition reflects this, both in content and name. “Catering for the vulnerable and elderly is challenging and demands specialist skills, knowledge and responsibility. As people age their dietary needs change and a wide variety of special diets must be
recognised and catered for safely. It’s vital that care chefs confidently deliver the right nutrition and hydration, together with exceptional flavours and eye-catching presentation, to ensure the enjoyment and quality of life of those they feed. “Up and down the country, care chefs are doing this daily and the NACC Care Chef of the Year competition is a fantastic platform for them to demonstrate their culinary flair and talent, and to showcase excellence across the sector. All paper entries will be judged by a central judging panel that will be looking for innovation, costing, suitability for the environment, adherence to nutrition guidelines, taste and overall menu balance. Successful entrants will be invited to compete at the regional heats in March, where they will have 90 minutes to produce their dishes
and demonstrate their skill set under the watchful eye of the competition judges. The deadline for entries is Friday 3 February 2017.
Special2Us is a new small technology company focussed on creating easy conversations among the older and younger members of families – using digitsed photographs and documents to remember the past and celebrate the future. With the unique feature of being able to record voices and conversations, old black and white and colour pictures become the basis of precious family stories and relatives’ historical reminiscences - sharable (privately & securely) anywhere across the country or the globe. Special2Us is currently under review from Alzheimer’s Association SURPs groups and is keen to get further feedback from individuals and organisations prepared to test its services and technology. www.special2.us 020 7407 7300 January/February 2017 | Care Home Management 19
News
Care & Dementia Show 2016 declared a success growth in construction professionals. Chris Edwards, Care & Dementia Show brand director said: “Having redesigned the event completely for 2016 we were delighted by the response both from visitors and exhibitors. We set out to create a show that not only brought together the whole spectrum of organisations caring for older people but also resonated with people’s personal job roles.” The next Care & Dementia Show will take place on 10-11 October 2017 at NEC Birmingham.
UBM EMEA says the UK’s largest care of older people event, the Care & Dementia Show, has been declared a success after attracting 2,459 attendees to the NEC, Birmingham on 11-12 October 2016. The event achieved a four per cent growth in attendees, with industry professionals including residential
nursing and care home owners, homecare providers, local authorities and construction companies travelling to the NEC from across the UK. These professionals were joined at the show by 78 expert speakers and over 200 leading suppliers. Care & Dementia Show witnessed a 26% growth in care providers and 65%
Outstanding year for Care Roadshows
Care Roadshows, five one-day events from Glasgow to London, has declared the 2016 season a big success. The first of the shows took place in Glasgow, before moving on to Liverpool, Birmingham and Cardiff
and ending with the London show, held at Epson Downs racecourse. This was the first year that Care Roadshows collaborated with QCS as headline sponsor, who offered support throughout the journey. QCS provided hundreds of visitors with insights and
20 Care Home Management | January/February 2017
guidance about how to negotiate the maze that is providing a regulated care service. At each event Ed Watkinson, director of care quality, shared his wide experience of regulation to deliver a seminar on how to achieve outstanding ratings. “We found the events extremely productive and it was great to meet so many clients – both existing and new,” said Mr Watkinson. The dates for 2017 are: Glasgow - 28 March Liverpool - 9 May Birmingham - 4 July Cardiff - 17 October London - 14 November Full details for registration and exhibiting can be found at www.careroadshows.co.uk
Case study – Joined up healthcare
Leeds scheme brings timely support for care home residents – and drop in A&E attendance
Dr Keith Miller A pilot scheme set up by NHS Leeds West Clinical Commissioning Group (CCG) is helping care home residents receive proactive support to improve their health and wellbeing and is reducing emergency hospital admissions. The CCG developed its GP-led Enhanced Care Home Scheme in August 2015 working with 50 care homes and other professionals in west Leeds offering additional support for around 1,500 residents. Regular visits Residents, whose GP practices are taking part in the scheme, receive regular and more planned visits from a GP or nurse to review their healthcare needs. This includes timely access to a dedicated therapy team from Leeds Community Healthcare NHS Trust including physiotherapists, occupational therapists, a speech and language therapist and a dietitian. In addition, a medication review is offered for all new residents admitted to a care home or on discharge from hospital. Early evidence suggests that residents who are being supported by the proactive care team are less
likely to require emergency admission to hospital. Figures suggest that there has been an overall reduction of A&E attendances and emergency admissions of just under 5% from care home residents who are being cared for through the programme. One resident who has benefitted from the scheme is 79-year-old Terry Brook. Terry, who has Parkinson’s Disease, is a resident at Charlton Court Nursing Home and had difficulty getting out of bed, leading to a number of health problems including pressure ulcers. After receiving support from the therapy team, Terry can now be lifted out of bed and can sit in a wheelchair or on a high backed chair to have lunch or dinner. Reducing hospital attendance Dr Keith Miller, a GP in Headingley, Leeds who has developed the scheme, commented: “The GP-led scheme is ensuring better joint working between different healthcare professionals involved in looking after older people living in care homes in the area. Evidence suggests that it’s improving their overall experience of healthcare, as well as transferring new knowledge and skills to care home staff and reducing the need for hospital attendances.
“Feedback from care home managers, residents and carers is very positive, but there is still work to do.” Emma Heeson, project implementation lead for Leeds Community Healthcare Trust, said: “Supporting care homes to improve the quality of life for older people is such a privilege. Our scheme
enables staff to deliver services when it matters most to the individual and more importantly irrespective of who employs them. There is a huge focus on prevention as opposed to simply treating the problem; with an aspiration for maximising independence and making life not only more comfortable but hopefully more enjoyable.’’ Huge difference to residents Craig McDermott, manager at the Spinney Care Home, added: “The enhanced care home scheme has made a huge difference to the lives and wellbeing of our residents. Knowing they now have fast access to services enables them to lead a more comfortable and happy life. Previously, in some cases, we’d have to wait a number of weeks for access to services within a care home setting and now we’re lucky enough to have this fantastic scheme.
“We’d also have had to refer people to hospital for treatment but now it comes to us, making a huge difference to everyone and reducing impact on stretched resources at the local hospitals.” The Enhanced Care Home Scheme has been funded by NHS Leeds West CCG until August 2017 when it will be formally evaluated.
Community team
January/February 2017 | Care Home Management 21
by Karen Banfield, contact centre director at specialist outsourcer Echo Managed Services.
The power of first impressions……… where care homes are going wrong - and how to correct it As the age old saying goes: ‘First impressions count’. When individuals are choosing a care home for themselves or a family member, it’s likely they will be considering a shortlisted selection of options. Building trust and reassuring enquirers early on is therefore vital to ensure that families feel confident that a home could be the right one for their relative. However, it seems that not all care home groups are getting it right.
We recently undertook a ‘mystery shopper’ exercise, which saw us contact a number of UK care home groups to discover how they dealt with customer contact during an initial interaction. In this research, over half of the homes contacted failed to answer the enquirer’s needs in a professional and comprehensive manner upon first point of telephone contact. An additional 58% didn’t offer an appointment to visit a home and 45% of homes didn’t capture customer details upon contact. These findings pose a huge concern to the sector - if care home groups cannot effectively handle new residential enquiries, how are they supposed to stay afloat in an increasingly challenging market? It also raises another question: how can already stretched care home staff
22 Care Home Management | January/February 2017
provide great customer service for new enquiries, whist ensuring their time is spent as it should be – providing great care for existing residents? Lagging behind on new enquiries Customer contact has long posed a challenge for care homes, often falling low down on the already long priorities list. Stretched staff, budget cuts, staffing crises, and a generally turbulent environment mean that how enquiries from prospective new residents and their families are dealt with in the first instance often isn’t the number one focus. In this challenging market, increased knowledge of the impact of effective customer service and ensuring an easy and simple experience for each enquiry will become increasingly crucial.
First Impressions The whole experience of looking for a potential care home can be unsettling and confusing for families, and by not answering calls swiftly and effectively, not having the right information available, and not being empathetic, it’s likely that the enquirer will feel less sure about their choice and customer perception will be damaged early on. A transactional approach Traditionally, where there is a concerted effort with new customer contact in the sector, it tends to be predominantly transactional, rather than focused on proactively engaging the enquirer. Often, teams are trained only to complete basic tasks such as looking up nearby care homes and arranging for potential residents and families to speak to a care home manager. While it’s completely understandable that a lack of time and resource would lead to this, taking such a task-based approach not only serves to damage reputation, but can also lead to families choosing an alternative care home group. So how can care homes start to turn this around? Getting customer contact right first time, every time With large numbers of care homes facing ever increasing financial pressures, it’s never been more important for care homes to engage and convert prospective new residents - where there is the right match between the resident’s needs and the facilities of the home, of course. Therefore, more training and investment in customer service is a must. While some care home groups will choose to subcontract some, or all, of their customer contact to outsourcers with specialist knowledge of operating in the sector, others will invest in training in-house. Whatever route each care home group goes down, there are a number of key things which should be considered to ensure a great customer experience:
Moving from a transactional to a holistic approach A more holistic way of dealing with initial leads – which sets to streamline the customer journey and provide a consistent service - should be adopted. A glossy brochure is no substitute for a visit to a care home, therefore offering an appointment at the initial point of contact and being able to book it there and then is vital, as it’s likely that the visit will be a crucial aspect of an enquirer’s selection criteria. In order to achieve a holistic journey, queries should be dealt with by advisors that are highly trained in both customer service and the specifics of the care home sector. The customer contact team should understand the strengths and selling points of individual homes, which better enables them to match the customer’s requirements with what the care home offers. Having the right information available and being able to answer queries effectively will reduce the likelihood of dropout and may reassure enquirers that the care home could be the right choice for their family member. Finding the right people Employing the right people to deliver service is vital, as well as ensuring they are empowered and knowledgeable. Discussing a family member moving into a care home can be a difficult conversation, so it’s crucial that those dealing with these conversations are empathetic and understanding. To ensure advisors can provide this
sensitive service, recruitment practices and assessment centres should be geared up to select those with the right skill set and attitude in both customer service and the needs of the care home sector. Keep contact regular and consistent throughout the customer journey Regular communication is essential to properly engage customers. If an enquirer has booked a viewing of a home, for example, call them a couple of days ahead of the visit to ensure they have all the information they need for their impending visit. Follow up calls are also advisable, to offer them chance to ask any follow up questions or anything they forgot to ask on the day. This again, sets to reduce dropout rates, as well as ensuring enquirers are fully equipped with the information they need in order to make an informed decision. Ultimately, giving potential residents and their families the right first impression, in a sensitive an empathetic way, is vital in the increasingly competitive care home sector. Every company needs to provide great customer service and a comfortable journey – whether that’s through a well-trained in-house team, or through the help of a specialist outsourcer. Prioritising the above tips and advice couldn’t be more important in this uncertain time for care homes; a time where customer service could be a key differentiator. Failure to get this right from the start could not only damage reputation, but also result in prospective residents and their families choosing an alternative home on their shortlist.
January/February 2017 | Care Home Management 23
The Deferred Payment Scheme – keeping ownership of the house by Owain Wright, of Care Funding Guidance
As you may recall from our last edition, families really only have six different ways of paying for care to consider. To allow care home managers to put the various options to residents and their families, this time we’ll take a look at two options that are often used together and both of them involve keeping rather than selling - the house.
The Deferred Payment Scheme is where you approach your local authority and effectively ask them to pay for your care. If they agree (it’s quite a big if as we’ll see in a minute), then they will indeed start paying for your care but, at the same time, they will put a charge on your property. So for every pound of care fees that they pay there will be a pound of debt or mortgage on the property. The idea is that when the person requiring care is deceased the local authority can recoup its money. Local authority can charge interest It used to be that local authorities could not charge any interest on this arrangement but now they can although it is capped. The present cap is 2.15% per annum. The local authority can also apply setting up charges as well.
One of the big advantages to this scheme is that you don’t have to sell the property. However do be careful as in many cases you will have to sell the property later on in order to repay the loan. Also, there is no cap on how much you will owe the local authority so the cost could be high if care is needed for a number of years. One of the biggest downsides to the Deferred Payment Scheme is that a great many local authorities do not consider them a good use of council funds and therefore will not accept any applications. The rules state that they must offer the scheme but they do not have to accept an application.
fees. All seems straight-forward. And in many cases it is straight-forward and can work quite well. Do take care to try to accurately predict the net income that you will receive though as it will often be quite a bit lower than the headline rate suggested by the estate agents. From the gross rental income you will have to deduct management fees, taxation, repairs and insurance before you get to a net income that you can put towards the care costs. A reasonable average net income from renting is around 3% of the property value. So a £250,000 property might reasonably provide you with an income of around £7,500 per annum, although obviously this can differ depending on the specific circumstances.
Renting the property out This option can be done either on its own or in conjunction with the Deferred Payment Scheme. It is also one of the more straightforward of the six ways of paying for care and is one which most families initially turn towards. So, mum is in care and the house is now empty. You find a tenant, install them and receive an income which you can then put towards the care
Being a landlord is a thankless task Another thing to consider with this option is that the family themselves will basically have to act as quasilandlords and, as many people will tell you, this can often be a thankless task. But if you are intent on not selling the property then a combination of Deferred Payment Scheme and renting may work for you. www.carefc.co.uk
24 Care Home Management | January/February 2017
to the amount of natural light available. The adjustments are controlled through dimming or simply switching off the lights according to the required need.
Take care of costs and optimise lighting control thanks to occupancy sensors Paul Collins, project & technical support manager at Hager looks at occupancy sensor lighting control solutions which can help care home estates managers drive energy consumption efficiencies and lower energy costs, while still providing safe and flexible levels of lighting control. The Carbon Trust estimates that up to 40% of a building’s electricity use is accounted for by lighting, while the provision of energy makes up between 18% and 19% of the total expenditure to run a typical multi-user building such as a busy care home, according to the Centre for Climate and Energy Solutions. With pressure on operational budgets, optimising the amount of energy to safely provide the necessary functional levels of lighting within care homes must be welcomed. Therefore the installation and correct programming of flexible and highly reliable occupancy sensor technology can have a big impact on costs. What are occupancy sensors? The primary benefit of occupancy sensors is the ability to automatically detect the presence of people in a room and either switch on the lights, keep the lights on while the room is in use and then automatically switch the lights off when the room is subsequently
un-occupied at a pre-determined timeout period of, for example, 20 to 30 minutes. The solutions fall into two broad categories – presence and absence detection. Presence detectors will only energise a room’s lighting system when a person enters the room, and then switch off the lighting automatically when no movement is detected. Absence detectors switch on the light when a person enters a room, but on leaving, the detector switches off the lighting automatically after a time out period from the last presence detection. In both scenarios lights can, of course, also be switched off manually. The flexibility of the technology also extends to light levels, with integrated photocells allowing a room’s artificial lighting output to be adjusted according
Correct specification Specification of occupancy sensor coverage requires consideration of a number of issues. Firstly, adequate sensor coverage of total areas needs to be designed into the final specification so that so-called ‘dead spots’ are covered and both presence and absence-based solutions can fulfil expectations. This means ensuring enough sensors are installed within a care home so that entire rooms are catered for. Likewise, the system should be specified for sensitivity detection to ‘understand’ and deal with small movements versus larger ones. There is a significant difference between a system that is sensitive enough to detect small and regular movements of members of staff, perhaps using a computer at a desk, and the more motion-orientated sensoring required to support security vigilance of a location at night and capturing via motion detection instances of walking or waving of arms. Accounting for potential temperature changes Finally, specification of the correct system support needs to be mindful of potential rapid temperature changes within an area caused by central heating or cooling systems, for example. System flexibility provided by occupancy sensors can cater for both wall switch mounted control, as well as programming via controllers such as Hager’s EEK001. Occupancy sensor technology can be a powerful and effective tool for maximising energy efficiencies. It provides total control of lightingrelated energy consumption so only safe and sufficient levels of light are provided for a building’s occupant use, and wasted energy is kept to a minimum. Find out more at hager.co.uk/klik
January/February 2017 | Care Home Management 25
Bugs season - better hand hygiene for care homes
With many care homes trying to do ever more with ever fewer resources, keeping up with hand hygiene compliance can be a struggle. Paul Jakeway (left), marketing director at skin care specialist Deb, explains how strategically placed facilities, ongoing staff education, and the right skin care products can help.
Hand hygiene in care homes is not always what it ought to be: evidence cited by the Department of Health suggests that many care workers do not always decontaminate their hands when required – or that they do not always use the correct technique. According to the Care Quality Commission, some studies now suggest that the number of infections in care homes may be comparable to those in hospitals as a result. According to the Department of Health, hand hygiene should happen
after each and every “episode” of caring – immediately before and after there has been direct contact with a person, as well as after any other activity that might have contaminated hands. It should be an integrated part of the everyday running of a care home. Hand hygiene must not hinder daily routine In practice, it can sometimes be difficult to integrate a hand hygiene regime in a way that does not hinder
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the every-day business of running a care home. Providers are under considerable pressure to deliver ever more – in many cases with limited resources. Providers are expected to meet the complex needs of an ageing population, on budgets that are often under enormous strain. Increasingly, staff are asked to deliver significant efficiency saving. The financial and time pressures they operate under can have a negative impact on many aspects of their business – including their hand hygiene regimes.
Hand Hygiene What can be done to improve this situation? As the Department of Health stresses, accessible hand hygiene facilities are a crucial first step in any effort to increase hand hygiene compliance. If they do not exist, staff should bring this to the attention of the care home management immediately. If they do, care home providers should ask themselves, are our facilities at their most effective? Does their location make sense? How accessible are they? What stands in the way of staff using them as frequently as they should to assure maximum compliance? Modern dispenser design allows for much more flexibility when it comes to the location of hand hygiene opportunities. Rather than having one centrally located facility, which might require staff to walk through the building to have access, dispensers can be strategically placed throughout a care home, for instance at the exit or entry point to a resident’s room. This makes it much more likely for staff to use them regularly. Properly placed dispensers and accessible facilities are not enough to increase compliance. The Department of Health, the Care Quality Commission and the WHO all agree that ongoing staff education and training are absolutely crucial. Risks in ignoring hygiene Care home staff need to be educated about the risks of neglecting their hand hygiene. They need to know not only when or how often to wash their hands – but how. When are alcohol sanitisers appropriate, and when not? When should a soap product be used? Alcohol sanitisers, for example, are not suitable for use on hands that are dirty, contaminated and soiled (e.g. faeces, bodily fluids) or during outbreaks of diarrhoeal illness (e.g. norovirus or Clostridium difficile). In such cases, washing hands with soap and water is necessary. The WHO
says that quite often techniques are inappropriate even where compliance is high. Lack of knowledge, says the organisation, is one of the greatest barriers to better hand hygiene practices. The guidance the WHO publishes on this is known as the ‘Five Moments for Hand Hygiene’. It is one the highest clinical standards care providers can aspire to. This approach – which was developed based on the most comprehensive evidence-based document available on hand hygiene – aims for hand hygiene to be performed at the correct moments, and at the correct location, within the flow of care delivery. Education and training a priority To integrate such an ambitious regime into their everyday business, care home providers need to make staff education and training a clear priority. Which approach to take will depend on the type and size of the care home, but the Care Quality Commission says that practical training, mentoring and role modelling often work better than theoretical training. Innovative approaches might be rewarded. Easy-to-use training and educational kits are widely available these days, and they can help with demonstrations of hand washing techniques and the right use of products. E-Learning programmes are increasingly being used by hospitals, and could become popular with care home providers too. As the WHO points out, this form of distance learning can reduce the time and energy investment by the teacher and is very advantageous for easily monitoring the learning process. Get product choices right Choosing the right hand hygiene products is important too. The WHO admits that this can be a very difficult task indeed. Cooperation between hand hygiene product suppliers and healthcare institutions has shown that an ongoing conversation can
benefit both sides. Suppliers can provide cutting edge innovation, while healthcare providers report back what works and what does not work for them, as well as what their needs might be in the future. Hand washing with soap is a fundamental step in hand hygiene practice. Apart from removing any visible soilings from hands, a good hand washing technique will remove high levels of bacteria and viruses also present on the skin. Perfume-free and dye-free foam hand wash have proven to be good products for this. Hand sanitising is very useful in reducing microbial counts on visibly clean hands when access to running water is inconvenient. In care environments, alcohol is the preferred active biocide for skin sanitising without the need for rinsing. Effective hand sanitisers can kill up to 99.999% of common germs. Sanitisers can be provided through dispensers, or in personal issue packs so staff can carry around with them. Skin health – replenish natural oils It would be a missed opportunity not to think about the skin health of employees when implementing a hand hygiene regime. While hand washing and sanitising are the most important steps, there is a third element to a fully thought-through skin care system: restoring. Frequent hand washing makes it necessary to regularly replenish the natural oils and secretions lost from the skin via the use of a conditioning cream. For care home employees, maintaining good skin condition is vital to both their own long term health and the health of those in their care. Strategically placed, accessible facilities; ongoing staff education and training; and choosing the right skin care products – if all these go hand in hand care home providers can reduce the spread of germs and bacteria, raise the level of staff compliance, and improve the skin condition of employees.
January/February 2017 | Care Home Management 27
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The recent closure of a number of Wahaca restaurants throughout the UK highlights how easy a disease such as Norovirus can affect businesses – creating a huge financial burden and damage to your brand. It’s not just restaurants that can fall victim though, all public areas are at risk as the infection can be easily passed from individuals before they know they are infected and up to two weeks afterwards. Care homes are particularly
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28 Care Home Management | January/February 2017
Cleaning Show expected to double in size in 2017 Following the success of the Cleaning Show’s move to London in 2015, the 2017 event is expected to almost double in size. Over 100 industry-leading exhibitors who will be demonstrating their latest equipment and services include Kärcher, Nilfisk, KimberlyClark Professional, Industrial Cleaning Equipment, Steam Clean Systems, Kennedy Hygiene Products, Numatic, Jangro, Greyland, Rubbermaid, Nexon, Vacleansa, Vileda Professional and many others. A full list of exhibitors is available at www.cleaningshow.co.uk With over 4 months to go, hundreds of care home managers, facility managers and contract cleaners have already registered, please add the dates to your diary now and register for your pass online at: www.cleaningshow.co.uk The Cleaning Show is organised by the British Cleaning Council and the publishers of Cleaning & Maintenance Magazine.
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Cleaning Care Homes Care homes provide accommodation for some of the most at-risk members of the population. It is important to provide a safe and clean environment for residents and to reduce the risk of infection and disease. Creating a comprehensive and effective cleaning plan is an essential step to protecting residents, visitors and staff. A good cleaning plan should cover everything needed to maintain proper hygiene in your facility, ensuring that all staff members are aware of their roles and standards that need to be met. All cleaning plans will vary from facility to facility, but should cover accountability, training, clear instructions on how to perform the task, standards and frequency.
infection control. Cleaning removes visible soiling, while it does make a significant improvement to levels of harmful bacteria, it is also an important and necessary step to aid the efficient action of disinfectants. The StarPRO range of cleaning products are specially formulated to quickly and efficiently remove dirt and soil from all areas of care homes. The range includes products such as SP30 Hard Surface Cleaner, SP84 Carpet Spot and Stain Remover, SP50 Bio Laundry Liquid and SP10 Daily Use Toilet Cleaner. StarPRO products are available in ready to use, convenient trigger-spray bottles, angled-neck bottles and concentrates that offer great value for money.
Cleaning Cleaning is by far the single most widely used method of minimising the risk of infection; however when working in a high-risk environment such as a care home, it is important to recognise that cleaning and disinfection are two separate (but equally important) processes for
Disinfection Disinfection is the process of reducing the numbers of microorganisms on an object to a level that is not harmful to humans. Disinfection does significantly reduce the risk of infection with relative ease and convenience; however the correct choice of product is important for the required task. It is also important to note that most commonly used disinfectants do not normally kill pathogenic spores. StarPRO offer an effective line of disinfecting and bactericidal products such as SP25 Powerful Disinfectant Cleaner and SP12 Bactericidal Washroom Cleaner (both products are available as concentrates; SP26 and SP13 respectively). Catering Food preparation is another area where the correct choice of product is extremely important, as the hazards to residents can be both microbiological and chemical. StarPRO offer a range of products developed to meet
30 Care Home Management | January/February 2017
the needs of food preparation areas. The StarPRO range of products for catering applications is identified with a green flash on the label to designate catering. Amongst the products in the range are SP35 Catering Bactericidal Cleaner RTU spray, SP41 Hand Dishwash Liquid and SP38 Machine Dishwash Liquid. Handwashing Many studies have shown good hand hygiene is an effective way of preventing the spread of infection, which in a care home is very important. The most cost effective way
of keeping hands clean and free of transient microorganisms is frequent hand washing. StarPRO offer SP60 Everyday Handwash, SP61 Luxury Handwash and SP62 Antibacterial Handwash in both convenient 500ml pump dispenser packs and 5lt packs that can be used in refillable soap dispensers. SP63 Foam Handwash is designed to work in foaming handwash dispensers. Alcohol based hand sanitisers have their place, and are best used where hand washing facilities are unavailable. Many alcohol-based products can dry out the skin, but the StarPRO Handwashes have been formulated with moisturising ingredients to clean and care for your hands.
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Body Fluid Spillages Care homes are often subject to the spillage of bodily fluids; including blood, urine, faecal matter and more. It is important that these spills are dealt with quickly and that the area is thoroughly disinfected before coming into contact with residents or other people. When cleaning spilled bodily fluids, it is also important that workers use proper PPE (personal protective equipment) in order to protect themselves from possible infection. Following the removal of all visible soiling, areas should be treated with a disinfectant such as StarPRO Powerful Disinfectant Cleaner, which can be used on hard surfaces as well as carpets and soft furnishings. For spillages of blood, a bleach solution of 10,000ppm available chlorine is recommended in many NHS protocols. A solution containing 10,000ppm available chlorine is achieved by diluting SP90 or SP91 at a ratio of 1 part of product plus 3 parts water. Bleach based products should not be used to clean up vomit or urine spills, and bleach will damage carpets, upholstery and soft furnishings. Once the body fluid spillage has been removed and disinfected, StarPRO offer SP85 Carpet and Upholstery Cleaner and SP71 Odour Controller and Neutraliser to freshen surfaces and remove malodours.
Laundry and Linen Cleaning Proper cleaning of laundry and linens in care homes is essential, but with the correct equipment and cleaning solutions, cleaning fabrics can be a relatively simple area to control infections. It is recommended that industrial/ commercial washing machines are used to wash fabrics, and that they are properly maintained and periodically cleaned. As these machines have the drawback of using significantly more power than a household washing machine, costs can be kept down by using a laundry detergent that is effective when used at low temperatures. StarPRO Bio and Non-bio Laundry Detergent Liquid work well at temperatures as low as 30°C. They also offer an economically priced Fabric Softener and Oxi Stain Remover Powder for the removal of heavy soiling. If the item has been contaminated with bodily fluids, it must be washed separately from other items and washed at a high temperature. Following the wash, the machine should go through a rinse cycle before laundering any other items. If soiling is not removed after using StarPRO Oxi Fabric Stain Remover Power, then the item should be discarded.
Washrooms Clean washrooms and toilets are essential. StarPRO offer both ready to use trigger-spray bottles and concentrated cleaners to ensure sparkling clean basins and taps. SP10 Daily Use Toilet Cleaner and SP11 Heavy Duty Toilet Cleaner and Descaler are available in angle neck bottles and 5lt refill packs. Always familiarise yourself with the legal requirements for hygiene in care homes, as they are often updated. Cost Care homes require continuous cleaning to maintain proper hygiene standards, and over time, the costs for this can quickly add up. While there are a several different professional cleaning products offered at highly competitive rates, it is important to understand why these products are cheaper than competitors. Rather than using low-quality ingredients in products to lower prices (and effectiveness!), StarPRO instead hold the significant advantage of owning its own UK-based production facilities, which enables them to provide high-quality products at competitive prices. In addition, StarPRO sells its products directly to customers online, further increasing value for money. StarPRO products can be purchased directly from www.starprodirect.co.uk.
January/February 2017 | Care Home Management 31
Would some free legal advice help you? Then call the Care Home Management free legal advice line Do you have a difficult situation which you would like guidance on but you don’t know where to turn? You might have a difficult employee, on-going difficult relationship with a service user’s family member or questions about how to treat a service user. You might have questions about your relationship with your local authority. You might be unhappy with your CQC rating but don’t know who to speak to you. Most of the time you won’t need legal advice. But there will be some situations where you are looking for a helping hand. Social care providers have different needs to other organisations and their needs are very specific. That’s where the Care Home Management Free Legal Advice Line can help. The advice line is run by Hempsons, an award winning law firm committed to the health and social care sector. Hempsons has worked with social care providers for years and is able to support and advise providers about all aspects of their business activity including: CQC regulatory issues We have considerable experience working with social care providers (and regulatory bodies!) and we are keen to give straight forward advice on our clients’ prospects. We advise you when to challenge the regulator or commissioner and when to work with them to address deficiencies.
challenged a local authority’s decision in partnership with the Independent Care Group in North Yorkshire for the benefit of its members. Employment law Our employment law experts can help you with HR related issues, including employment claims and disputes, executive performance and terminations, pensions, performance and disciplinary issues, reorganisation and redundancy programmes, TUPE, whistleblowing and discrimination matters, as well as issues that arise out of a serious untoward incident. Healthcare advice We have experts across a range of health and social care specialities, including experts in mental health, mental capacity law, primary care contracting, community law and Court of Protection practice and procedure including Deprivation of Liberty. Whatever your query we will be able to help or sign post you to the right people. Coroner’s Inquests We represent clients at Inquests and in other inquiry environments. We appreciate that reputation and commercial interests are key and will ensure that your interests are fully and properly put before the Court or Tribunal.
Judicial Review We can advise you on challenging decisions, for example those of the local authority. We successfully 32 Care Home Management | January/February 2017
Corporate and Commercial We can support providers looking to expand their business, negotiate commercial agreements and contracts and tender for business or deal with commercial disputes. Dispute resolution We can help when things go wrong. We have experts in complex commercial disputes and any aspect of litigation including Alternative Dispute Resolution. Property Our property lawyers can assist with landlord and tenant issues, conditional sale and option agreements, estate management, landlord and tenant disputes, development and construction agreements, and refinancing. Some issues will be straight forward, and some will require more time. Hempsons, in conjunction with Care Home Management, is offering 15 minutes of free legal advice to providers. This allows us to have a brief discussion about your problem and signpost you to what your next steps should be. If you do need more time with us, we offer competitive rates.
Residential care providers and the Court of Protection (CoP)
needs are being assessed on an ongoing basis. Keep good records Make sure records are detailed and document the good work that you are doing with P.
those closely involved with P’s life will agree on P’s best interests, but not always. Where they disagree, the CoP can make the decision. You will likely come across the CoP where an application has been made to decide where P should reside and what care they should receive. Care homes are very rarely parties in Court of Protection cases, but their commissioners will be. However, there are things that the care home staff can and should do to support their commissioners and to secure their reputation as an effective service: Under the Mental Capacity Act 2005, where a person (P) does not have the capacity to make a decision for themselves, a decision will be made in their best interests. Most of the time
Be responsive The care home will be ordered to produce records. It helps if you provide all of them very promptly. Communicate with the care co-ordinator Problems can occur within the home which will sometimes be very relevant to the CoP case. Keep your commissioner up-to-date with problems and let them know if and when things improve.
Make sure care plans are up to date The parties to a CoP case will always want to see P’s care plan. A detailed, up-to-date plan shows P’s
Care Management Home
Fiona Easton-Lawrence Solicitor Hempsons T: 01423 724042 e: f.easton-lawrence@hempsons.co.uk
Leading Health and Social Care Lawyers
Free Legal Advice Line – 01423 724056 If you would like some free legal advice simply call 01423 724056 quoting ‘Care Home Management Advice Line’ or email socialcare@hempsons.co.uk Legal advice provided by Hempsons. Care Home Management and specialist health and social care law firm, Hempsons, have launched a free advice line for Care Home Management readers. The social care team at Hempsons are available to assist Care Home Management readers with a wide range of legal issues. The Legal Advice Line is open between 9.00am and 5.00pm, Monday to Friday and offers up to 15 minutes of valuable preliminary a advice on a range of issues social care providers face.
Charity law Commercial property Company law Contracts Corporate Law CQC regulatory Data protection Disputes and litigation Employment law Fundraising Governance and Constitutional Reviews Health and safety Information law Inquests and coroners Judicial review Mental health law Primary care contracting & community law Safeguarding Tendering
“Hempsons offered invaluable legal advice and support that led directly to the successful outcome of a challenging care home issue. They were clear and reassuring in their dealings with us, the charity, and the commissioner, resulting in an entirely satisfactory outcome. Strong legal support and an immediate response when required exceeded our expectations.” HS4LC January/February 2017 | Care Home Management 33
Assisted Living
The design revolution for future proofed dementia accommodation
by Jitsh Patel, project director, Kajima Partnerships.
In recent years a feature of the government’s healthcare policy has been the strong and welcome focus on dementia. At a time of great uncertainty for the NHS and social care, Jeremy Hunt, the secretary of state for health, has been unwavering in his commitment to improve the way we care for people with dementia and support their families. The National Dementia Strategy is focused on three key themes of raising awareness and understanding, early diagnosis and support, and living well with dementia. Millions of pounds have been made available to increase research into the causes of dementia, which will help to improve early detection, discover new treatments and ultimately, perhaps, a cure. The new models of housing What is less well known is that significant progress has also been made in developing new models of housing for people with dementia, with an emphasis on designing accommodation that is inherently future-proofed, to accommodate a person’s changing needs. Over the next five years the number of over 65s is expected to increase by 12 per cent and the number of over 85s by 18 per cent. Many will develop dementia, with up to one million expected to be living with the condition
by 2025, according to the Alzheimer’s Society. A generation ago, society considered that it was acceptable to transfer men and women diagnosed with dementia into residential care homes with little in the way of specific facilities or features appropriate for dementia. Today, partly thanks to the National Dementia Strategy in breaking down the stigma, building design for people with dementia has evolved significantly. Families are able to choose from a range of flexible living spaces that work for men and women through the different stages of dementia, from the onset of the disease to the moment that comprehensive care and support is required. Buildings are also designed to be able to incorporate the latest technology as soon as it is released from development. Flexible living spaces As our understanding of the progression of dementia has evolved, so too has our commitment to flexible living spaces. We are designing homes which enable men and women to stay where they are as their needs change, from low level care to potentially high care requirements, instead of having to continually move as their condition progresses.
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We can create different ability zones throughout the care complex, which might be as simple as adapting individual lounges or dining areas or as complex as creating ability dependent wings. A key aspect of designing for a cognitive impairment like dementia is to build on the strengths that residents still have. Design should not just aim to support their disabilities, but utilise their remaining abilities. Impacts on care quality A key issue in improving care is to better understand how the design of care home environments impacts on the quality of care. Features, layouts and facilities can help to maintain a resident’s remaining strengths, improve working conditions and provide a better care culture for staff, residents and visitors alike. Inherent flexibility ensures that structurally the accommodation can be adjusted to allow for changing care requirements. This enables hoists to be installed and doors to be widened whenever necessary. The technical, mechanical and electrical aspects of the building should also be designed to allow for the incorporation of new technology that can easily interface with infrastructure installed at the start. Cognitive decline brings with it a
Assisted Living whole host of seemingly intractable difficulties for the designers of care home products and environment. While much has been done to develop guidance and insights related to design for older people generally, there has been far less practice-based research carried out into the specific needs of people with dementia and the staff who support them. Three key principles in design strategies Cognitive Ability is improved by promoting the use of familiar and recognisable surroundings and activities that respond to residents’ deepest and earliest memories. Social Ability is addressed through the design of artefacts and amenities that create opportunities for residents and staff to interact more easily in activities of daily living. Physical Ability is promoted through design which unobtrusively compensates for disabilities such as mobility and vision which are prevalent among care home residents. Creating a sense of community Building design should aspire to engender a sense of community, incorporating facilities such as a shop or restaurant. This helps to support interaction and independence, and help to manage feelings of isolation and loneliness. Materials should avoid reflective or dark surfaces which could confuse perception. Patterns in flooring or paving should be used with care to avoid perceptual difficulties. There should be continuous level routes, with surface materials chosen to aid orientation and sense of direction. Circulation areas should be wide enough for wheelchairs, mobility scooters and pedestrians to pass each other with ease and safety. Avoid steps, because people living with dementia may have difficulty judging distance. Front and back gardens should be accessible, with garden sheds, allotments and small greenhouses.
Green spaces and gardens should be planted with small trees and shrubs that attract wild life. Outdoor spaces for small pets should be included. Outdoor sitting spaces with individually designed seating and sheltered conservatories and greenhouses should be orientated to sunlight allowing the body to manufacture vitamin D. Automation to preserve dignity and privacy Advances in assistive technology can significantly help to preserve the dignity and privacy of an individual for as long as possible. The idea that people can support themselves longer by the assistance of technical devices is
now reality. Automated technology, such as sensor lighting and water isolation devices can help to protect residents from something as simple as leaving a tap running, or provide medication reminders through automated prompts. Personal technology, such as Smart pads, enables residents to control their own immediate environment such as the lighting and temperature of their accommodation, more effectively. Technology can also alert care givers to any potential concerns – for example if a resident has not left the bathroom for an extended period of time, it could mean he or she has fallen. From simple self-care systems to tele-systems that help with disability or illness, mobile devices are becoming information systems that will, in the future, interface with the home in many more ways than is possible today. We can’t claim that by improving living conditions we can stem the rate of decline caused by dementia. People will experience good and bad days. There can be moments of real clarity and others where they exhibit severe agitation and annoyance. But it is important to be able to share and enjoy the good moments and help a person through the difficult ones.
All images of Oak Priory, Abbey Hulton, part of Staffordshire’s largest retirement complex. January/February 2017 | Care Home Management 35
Caring for non-religious residents’ spiritual needs In our last edition, Keith Albans, director of chaplaincy and spirituality at MHA, considered the spiritual needs of care home residents at Christmas. But what of those residents who are not religious? Here Keith looks at their concerns.
Spirituality is one of those concepts which is difficult to put into words – a fact that I’m all too aware of, as my role often requires me to explain it. Some people assume that it’s tied to religion, and whilst for some people it might be, for others it exists completely beyond religious frameworks and is made up of lots of contributing factors. In simple terms, spirituality is what brings meaning to life; it’s the thing that connects us to other people and to the world as a whole. So, just as older people require physical and mental care, it’s also important that their spiritual needs are catered for, whatever their beliefs. My role as MHA’s director of chaplaincy and spirituality involves ensuring that our dedicated team of chaplains are supported to provide spiritual care to all our residents. Sometimes, residents and families who don’t identify as religious might be reluctant to engage with chaplaincy as they feel it’s not there for them. But as a chaplain builds a relationship with a resident they can find ways to care for their spiritual needs in a way that is appropriate for them.
purpose and meaning. Often, they can start to get an idea about this just by walking in to someone’s room. Which books are on the shelves? What has the resident displayed photographs of? Which objects do they keep close to them? These can all be clues to discovering what makes a person tick. My father, for example, could recite large passages of Shakespeare from memory well into his old age. His love of poetry was an integral part of his identity, and sharing this with him formed an important part of his spiritual care. Many times, I’ve seen that it just takes a bit of time to identify a shared interest or two to spark a connection which can be built upon. One of
Individual interests First and foremost, the chaplains get to know residents as people, finding out what gives each person energy, 36 Care Home Management | January/February 2017
our chaplains fostered a bond with a resident which was based upon a mutual fondness of the place where the resident grew up. Being able to talk about the area inspired conversations which helped the resident to feel valued, understood and listened to – a vital component of caring for someone’s spiritual needs. Common ground In my experience, humans always have more in common with each other than we might first believe. Although people’s personal beliefs may differ, at heart I believe that we are all reaching out for connections and searching for purpose. Take, for example, end of life care.
For everyone, death is a profound moment which demands respect and dignity. And at this time, many people feel a particular longing for the comfort and human connections which spiritual care provides, whether they consider themselves to be religious or not. For the non-religious, the chaplain might take more of a background role, making themselves available should the person or their family require support. For others, just knowing that the chaplain has the time to spend with them, outside of rotas and schedules, can be a comfort in the most difficult of times. People of different faiths, or no faith, can also enjoy activities together whilst taking away different meanings. Spending time in a care home’s garden, for instance, could be a spiritual experience for someone without faith just as much as a religious believer. Whilst some might attribute a flower’s beauty to divine design, others might find meaning in feeling connected with the natural world. Ultimately, all of us are unique individuals and even two people who follow the same belief system might not require or want the same kind of spiritual care. Chaplains and care staff should take the resident’s lead when it comes to spirituality.
The New Year can also bring with it broad questions about meaning and purpose. This time encourages us to consider what we hope to do over the coming 12 months and beyond, but for care home residents who may be very unwell, it might be difficult for them to picture the future in a positive way. Anecdotally, many care home staff tell me that they see a rise in the number of residents falling ill or dying in January. Starkly contrasted with the festivities of the previous month, this can lead to many residents feeling downbeat if extra attention is not paid to their spiritual needs. Any excuse for a party A great way to combat the blues is to grab any chance to celebrate with both hands. This might involve some careful planning but it definitely pays off. Putting together a calendar of events to run throughout January can ensure that the month doesn’t pass by in blur of dark days and cold weather. Ice hockey, American football, skiing and bowls all have international competitions which run throughout the month. Why not show these in the television room and keep a leader board of which countries are winning? You could even throw a party for a group viewing of the final. Outside of sports, Burns Night is on the 25th – and you don’t have to be Scottish to celebrate! It could be fun
to host a Burns Supper with Scottish music, traditional costumes and tartan decorations. And for those who fancy a taste of haggis, why not include it on the menu? On a more day-to-day basis, even just noting that the days are getting longer could bring some much-needed sunshine to the first month of the year. Something as simple as saying “isn’t it lovely that it’s still light at this time?” could remind residents that spring will soon be here along with the bright colours and lengthening days it brings. Planting some hyacinth bulbs in the autumn or buying some which are beginning to shoot can be a real boost to people’s mood. A personal touch A good place to start is asking someone which three things they would definitely like to happen each day, and which three things they definitely wouldn’t want to happen. This can throw up some really insightful comments which will put care home staff well on their way to providing tailored spiritual care, in January and beyond. Fundamentally, personalised care and attention is what everyone needs, regardless of their beliefs. A little bit of thought can go a long way when it comes to spiritual care, and simply taking the time to find out what’s important to someone can help them to feel connected to the world.
January blues This time of year in particular can see residents become more eager to engage with chaplaincy. With the festive decorations packed away, the celebrations over and winter well and truly underway, the January blues can be a very real issue for many care homes. January/February 2017 | Care Home Management 37
The importance of night time positioning in the care home There is often a perception that as people grow older and become less mobile or develop conditions such as MS and dementia their body shape will change. As an individual loses mobility their body becomes vulnerable to adopting damaging positions which can cause their body to change shape over time leading to secondary complications. Simple changes such as shortening of the hamstrings leading to hip and knee contractures have a devastating impact on a person’s ability to stay mobile, to adopt different postures and to sit and lie comfortably. However, these changes are often avoidable and can be prevented with the right therapeutic interventions, according to Anna Waugh, from Simple Stuff Works. If we are going to be successful in protecting an individual’s body shape, we need to first of all identity who is at risk. Companies such as Simple Stuff Works are ultimately working towards prevention of body shape changes in the first place. We are often being asked to see people and supply equipment for individuals for whom body shape distortion, such as hip and knee contractures, have already happened. Ideally we would like there to be a level of knowledge, especially in people working in care homes, where people understand the person they are supporting has movement difficulties and is therefore at risk of potential body shape changes. Mobility – a key indicator An individual’s mobility is a key indicator of risk. If the person uses a wheelchair or requires hoisting the risk they face is high, the challenge we face is the acceptance that the
resulting complications are inevitable. Changes in body shape are an avoidable, expensive and painful secondary complication associated with movement difficulties. The way we approach this issue is to offer training to key staff members such as Lorna Peake, a service leader. Lorna attended a train the trainer course that provided her with the necessary awareness and knowledge to pass her training onto her staff to help them understand the importance of postural care and night time positioning. Said Lorna: “One of our residents at Lily Marriot House, Anthony, has cerebral palsy, he has profound learning disabilities and does not use words to communicate. He also has severe body shape changes. “I knew that Anthony would benefit from the use of a positioning system. Anthony has now been using this six months, he now sleeps on his back which is much better than sleeping
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on his side like he used to. He also appears to be far more comfortable and is easier to position.” Working together It is vital that staff learn to work together. Training is really important here because sometimes you have different support workers going to see the same person and they will often have their own way of undertaking certain care related tasks so there is a risk of limited continuity. Consistent training, such as our accredited online e-learning package, is key to standardising the approach used across care teams and ensuring people are getting the right information and support. It is essential to work with people who know the individual really well and to make sure that the positioning strategy is gentle, safe and humane. Wherever possible families should be involved and their valuable knowledge recognised. When therapy services
supply positioning equipment, they are supplying a whole package, it cannot be a case of delivering the system and leaving the staff to it. Things to consider include whether the staff have sufficient knowledge and whether they can put together a thorough safety plan which addresses potential risks. Success comes about when we combine the expertise in the use of the equipment, the therapist’s extensive knowledge of biomechanics and the compassion and dedication of care home staff who have extensive knowledge about the person. How has night time positioning evolved over the last 30 years? Back in the 1990s there was very little regard given to night time positioning, many people intuitively applied common sense and did the best they could to stop contractures by using pillows, teddies, towels etc. but it is only in the last 30 years or so that positioning equipment has started to be readily available, sensitively designed with people in mind, and therefore more widely used. Around the country you will find some areas where people really understand the need for night time positioning, but in other areas the knowledge is still limited. One reason for this could be that in some areas you may have one really enthusiastic therapist or nurse who has understood it, seen the need for it and ensured that it is an integral part of the care package, but the danger is if that therapist or nurse moves on their expertise are lost.
hence we are seeing more positioning systems going into residential care homes which is great. The need for night-time positioning in care homes is bigger than many realise. Preventing body shape distortion makes a huge difference to every aspect of a person’s life. They will be more comfortable, caring for them will be easier and more dignified and it can also prevent secondary health complications such as chest distortion and subsequent breathing problems and pneumonia. The base of our system comprises two layers of nonslip mesh between which supports are placed around the individual. The supports can be lateral supports, wedges, pillows or teddy bears, ensuring that this therapeutic positioning system is the most versatile solution available. As there is no noise, there is a greatly reduced chance of the person being disturbed if they need to be repositioned during the night.
Hygiene is of paramount importance and the therapeutic positioning system contains silver which has been proven to actively combat communicable diseases such as MRSA, Salmonella and E-Coli through the application of SteriTouch. The Simple Stuff Works positioning system won the British Healthcare Trade Association Independent Living Design Award in 2011 for its simplicity and ease of use. In the last 12 months Simple Stuff Works has not only won the British Healthcare Trades Association Best Established Product Award in 2015 and the Tamworth Business Awards 2015 for Manufacturer of the Year but the company was also a finalist in the Staffordshire Business Awards International Trade Category, only just losing out to pottery giant, Portmeirion. For more information from Simple Stuff Works call 01827 307 870, email admin@simplestuffworks.co.uk or visit www.simplestuffworks.co.uk
It is everybody’s business We need postural care to be everybody’s business, as well understood and accepted as pressure care. We need residential care home managers and staff to understand it and embed it within their practice so if one person moves on the team can continue to provide effective care. On the whole, we are starting to see more understanding of the need to position people therapeutically at night January/February 2017 | Care Home Management 39
Events and Appointments
Events line-up 13-19 March 2017 Nutrition and Hydration Week
https://nutritionandhydrationweek. co.uk/ 28 March 2017 Care Roadshow Glasgow
Hampden Park http://www.careroadshows.co.uk/ 28-30 March 2017 Naidex
NEC, Birmingham http://www.naidex.co.uk 9 May 2017 Care Roadshow Liverpool
Aintree Racecourse http://www.careroadshows.co.uk/ 12-13 June 2017 Care Forum
Wokefield Park, Berkshire www.careforum.co.uk 28-29 June 2017 Health + Care ExCel, London www.healthpluscare.co.uk 4 July 2017 Care Roadshow Birmingham
Villa Park http://www.careroadshows.co.uk/
Appointments LifeCare Residences appoints Nigel Sibley as new CEO LifeCare Residences, the international retirement village operator, has appointed Nigel Sibley as CEO. He will assume the role early in 2017 Nigel Sibley joins from McCarthy & Stone, where he was managing director of the company’s south east division. He will replace Richard Davis who will be returning to his home country of New Zealand next year after six years in the CEO role. Mr Davis will remain on the LCR Boards in the UK and New Zealand and will continue to be involved with the Associated Retirement Community Operators, the UK industry association. During his tenure, Mr Davis completed the sell down of Grove Place, a leading retirement development in Hampshire and oversaw the development and recent
Coverage Care strengthens with new board appointments Leading Midlands not-for-profit care provider, Coverage Care Services, which runs 14 residential and nursing homes in the Shropshire area, has further strengthened its board with the appointment of Val Beint and Debbie Price. Val Beint, a qualified social worker, takes up a new non-executive role. Val is a former corporate director for community health and wellbeing at Shropshire Council and assistant director
opening of LCR’s newest luxury retirement community at Battersea Place. Nigel Sibley said: “I am excited to be joining LifeCare Residences at such a dynamic time in the company’s development. Thanks to the firm foundation established by my predecessor, Richard Davis, I am confident of the future progress and long term success of our business.” of adult services at Dudley Metropolitan Borough Council. Debbie Price joined Coverage as operations director in 2015. She was
10-11 October 2017 Care and Dementia Show
NEC Birmingham www.caredementiashow.com/ 17 October 2017 Care Roadshow Cardiff
Cardiff City Stadium http://www.careroadshows.co.uk/ 14 November 2017 Care Roadshow London
Epsom Downs Racecourse http://www.careroadshows.co.uk/ 40 Care Home Management | January/February 2017
previously chief officer of Shropshire Partners in Care, an organisation that represents more than 200 independent nursing, residential and domiciliary care companies, for five years. As operations director, Debbie is responsible for delivering the strategic vision of Coverage Care through operational activity, supporting management and implementing new ways of working.
Events and Appointments
Two new regional operations directors for Caring Homes
Jo Head steps up as regional director
Caring Homes has made two senior operational appointments, further strengthening the management structure supporting its 61 care homes across the UK. Richard Hawes and Jane Prior join the company as regional operations directors. Both are registered nurses, in line with Caring Homes’ policy of appointing nurses in operational management roles. Jane is responsible for 24 elderly care homes in East Anglia, Kent, Surrey and Scotland, while Richard’s area encompasses 18 care homes principally in the South and South West of England.
Charity and care provider, The Fremantle Trust, has appointed Jo Head as regional director of older people’s services. Jo’s career with The Fremantle Trust began 15 years ago when she took on the role of an assistant manager. She went on to manage a further four homes before her promotion to a director role, responsible for half of the Trust’s older people care homes across Buckinghamshire and North London. Jo’s remit is to support care home managers while providing a strategic direction for the Trust. Her role will involve developing innovative ways of working and embedding the latest insights and sector knowledge into service delivery that is focused on high quality, person-centred care.
Comprehensive grab rail range can’t be beaten Leading inclusive bathroom solutions supplier AKW offers a comprehensive range of grab rails in many configurations for installation as a mobility support in bathrooms, particularly for the elderly and disabled. The grab rails include fixed and fold-up steel and plastic versions, some fluted for additional grip and others with a smooth grip. All the grab rails can support loads up to 15.5 stone (100kg) with heavy duty versions rated to a maximum load of 30 stone (190kg). AKW fold-up support rails – ideal for use in multiuser bathrooms – are available in white or blue for users with impaired vision. Cranked grab rails are manufactured from a longlasting cold drawn mild steel tube. They feature an offset design which allows the user to step up to and through the doorway without releasing the grip and avoiding the possibility of hand grazing. Newel rails, also made from cold drawn mild steel
Audley boosts land team Audley Retirement Villages has strengthened its land and planning team with the appointment of Alex Hales, who joins as planning manager. Alex joins Audley from Savills Oxford where he was an associate planner. Prior to this, he was area planning officer at Chiltern District Council, working closely with the Audley team. He played a key role in the planning process for Audley Chalfont Dene, which opened in April 2016 and has proved to be another successful addition to the Audley portfolio. Audley now owns 12 villages and manages two more providing over 1,000 properties. The number of properties is set to double over the next five years with Audley completing its current villages as well as acquiring new sites.
tube, offer a 90 degree turn around the newel post and provide additional grip while using stairs. Other versions in AKW’s inclusive range include flat end, angled (90 and 135 degrees) and floor-toceiling grab rails. AKW is market leader in designing and manufacturing showers for those with disabilities, wet rooms, accessible bathrooms and kitchens, with more than 28 years’ experience. The company offers free surveying services and advice for grab rail installation. See http://bit.ly/2ejEhlH for more details.
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Why care homes should not roll over on their recycling obligations Nick Oettinger, of The Furniture Recycling Group, comments on obligations to recycle bulky waste and how the circular economy model presents an alternative to landfill. It can often be a difficult task for care homes to remove, transport and dispose of mattresses and figures show that in the UK, only a small percentage of mattresses are recycled responsibly, with 7.5 million discarded to landfill sites – usually the cheapest, quickest option. From a policy point of view, end of life (EOL) mattresses have long been perceived as a problematic waste product, not least because of their size and cumbersome nature. Difficult to handle, mattresses fall under the category of bulky waste; awkward to manoeuvre, expensive to transport and breakdown. Every year in the UK we throw out around 1,600,000 tonnes of what is defined as bulky waste. Approximately 19 per cent of this falls into the textile category, largely made up of sofas and mattresses, with the majority of items being sent to landfill instead. Bans being imposed Despite landfill tax having pushed up the cost of putting rubbish in the ground in the last 10 years, it remains arguably the cheapest and most straightforward option for bulky waste. However, the UK is experiencing an over dependence on landfill. Due to the worrying impact this over dependence has on the environment,
bans have already been imposed in many EU countries. As far as mattresses are concerned, an on-going European Union Waste Management Policy Review Process may soon affect UK Government policy on mattress recycling, with the bed industry, and those connected with it such as care homes, set to face - at some stage - a legislative requirement to dispose of EOL mattresses in an environmentally acceptable way. Headway is already being made, with statistics showing that in the UK 450,000 mattresses were collected for recycling in 2012 and just a year later, this had increased by 30 per cent. But despite the increase, this still only accounts for a small percentage of the total mattress disposal in the UK. Landfill the cheapest option While on the surface, the reasons for this slow evolution and widespread acceptance of mattress recycling among care homes is largely cost associated as there is no doubt that landfill remains the cheaper option, other barriers do exist. These include the lack of outlets and services that could help care home owners, managers and their teams dispose of mattresses, as well as the uncertainty around the design and composition
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of mattresses to recycle their components. Having already recycled 700,000 mattresses since launch, The Furniture Recycling Group has identified both a social and business case for partner industries in the care home sector to take notice of their responsibilities regarding mattress disposal. Become a trailblazer! We offer care homes the chance to put in place a policy, ensuring they are best placed to respond to any new legislation that comes into force, or perhaps to be seen and credited as leaders and trailblazers in the industry – paving the way for responsible business practice and advocates of the circular economy. We are keen to work with partners in the care home sector to draw on the principles of a circular economy – where resources are recovered and recycled back into new resources – to educate and inform on the benefits of making good on old mattresses. It is our vision that the UK’s end of life mattresses be turned back into the very products they were – increasing environmental sustainability and tackling the landfill problem. For more information on recycling mattresses responsibly and efficiently, visit www.tfrgroup.co.uk/
DO YOU CARE?
About the care home sector? About raising standards? About receiving the credit you are due for excellence and innovation?
WE DO!
As your residents, we do. We want you to win a Care Home Award so there are 5 things you need to do:
1 2 3 4 5
Write a brief, descriptive paper in English, offline
Extended deadline for entries:
JANUARY 26, 2017
For details of categories, sponsorship opportunities and how to enter go to:
www.carehomeawards.com
Complete the Care Home Awards Entry Form, online Upload your written paper when prompted by the Entry Form, online Click “Submit” to send your Entry Form and written paper, online Pay the entry fee when requested, online IN ASSOCIATION WITH
If you need help, or have any questions, please call 0330 635 5005 or email: helen.burgin@carehomeawards.com SUPPORTED BY
January/February 2017 | Care Home Management 43
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