‘My home is my castle’ It is about status, ownership, privacy and identity
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�Our home has become a way of signalling who we are. The symbolic value of how we live has detached itself from the utility value of the past decades.� - Siv Raun Andersen, Anthropologist, 2004
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Why is it, then, that when people move into a care home such considerations no longer seem to apply? www.institute.nhs.uk | Assisting the NHS in transforming healthcare
We are ambivalent about old age. People are living longer Number of older people is increasing Society has the means to prolong life
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Culture of Care A reflection on how care homes need to shift their culture...from patronage to engagement www.institute.nhs.uk | Assisting the NHS in transforming healthcare
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
The next 30 minutes Background on care homes Insights & Creating change that sticks Example of what we are working on
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
When you hear ‘care homes’ Scandals Poor quality Money grabbing Less relevant In decline Is there a viable future? www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Speaking to someone who considered whether they would want to live in a care home: “I have a fear of living like this when I am old�
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Future projections of our ageing population predict that older age groups are growing much faster than the rest of the population: By 2050, twice as many people aged over 85 and overall costs will increase fourfold. Future demand for long-term care services will grow rapidly: There are 400.000 residents in approx. 18.500 care homes now. By 2050, no of beds needed for elderly care is expected to double to just over a million. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Source : National Care Association
How will the country care for the growing amount of older people? Who will provide it? Who will pay for it? www.institute.nhs.uk | Assisting the NHS in transforming healthcare
8 % of care is funded by the NHS 41% privately by the individual 51% by local Authorities UK Councils are tightening their eligibility criteria and rationing social services to make ends meet. The great majority of people with low or moderate needs receive no support from Councils.
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Source : Laing & Buisson UK 2011
Residents who will use care homes more in the future are said to have ‘high levels of needs’: The average age of a resident is 85 years 75% are classified as “severely disabled” 70% have dementia 40 % are said to have depressions 66% have cognitive impairments They are a much older and frailer population than they were in the past
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Source : My Home Life
The care home of the future will need to become a central part care solutions. It must be radically different from current propositions and offer: Flexible care packages responding to personal needs; Affordable solutions to citizens and the state; Flexible use at the point of need.
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Image source : Hogewey
Although there is a sense of crisis that care service are reaching breaking point, ageing presents huge opportunities to develop new models of care outside of care homes (for people with low to moderate needs) which: Harness increased willingness of families & friends to provide informal care; Recognise that people due to medical advances can stay at home for longer.
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From flexible care in your home to the flexible use of a care home we will need a variety of future scenarios...
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But, we will also need to mobilise existing resources. “We have recognised the need to make improvements in our care home for a very long time but we have never been sure where to start and how to do it.� - Care Home Manager
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Evidence suggests that the culture of a care home Evidence suggests the culture of a care home directly directly affects thethat quality affects the quality oflive life of those who live and work there of life of those who (Reed et al,there. 1997). positive culture is characterised as one and work AA positive where the ethos of care is centred on the individual, based on culture is characterised as one evidence of what makes for good care and continually where the ethos of care is effective a changing centred onwithin the individual and health and social care context (Manley et al, 2004). their relationships.
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Source : Reed et al, 1997 and Manley et al, 2004
Evidence suggests that the culture of a care home directly affects the quality of life of those who live and work there (Reed et al, 1997). A positive culture is characterised as one where the ethos of care is centred on the individual, based on evidence of what makes for good care and continually effective within a changing health and social care context (Manley et al, 2004).
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Creating small interventions which help to of build relationships and a Evidence suggests that the culture a care home directly culture. existing affects the quality of life ofcaring those who liveMobilise and work there resources bycharacterised valuing different (Reed et al, 1997). A positive culture is as one perspectives and fosteringbased creativity, where the ethos of care is centred on the individual, on andand innovation from within. evidence of what makes forlearning good care continually effective within a changing health and social care context (Manley et al, 2004).
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From ‘patronage’ Evidence suggests that the culture of a care home directly affects the quality of life of those who live and work there to engagement. (Reed et al, 1997). A positive culture is characterised as one where the ethos of care is centred on the individual, based on evidence of what makes for good care and continually effective within a changing health and social care context (Manley et al, 2004).
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What is important to people in care homes? Some key insights www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 1 Feel safe and secure Residents: safe and free from harm, pain and discomfort, and know they receive competent and sensitive care. Staff: free from physical threat, abuse and criticism, and work in secure conditions of employment. Relatives: confident in care home staff’s ability to provide good care, and have access to support networks when required. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 2 Have a sense of continuity Residents: consistent care from the moment they come into the care home, people to understand them as a person Staff: time and access to the stories & information that lies in people’s past, exposure to good role models and environments of care. Relatives: be able to maintain involved in the life of their relative www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 3 Feel like they belong Residents: be able to form or maintain meaningful relationships, be part of a community or group, as desired. Staff: feel part of a team and recognised in their contributions. Relatives: be able to confide in trusted individuals to feel that you are not in this alone. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 4 Have a purpose Residents: opportunities to engage in purposeful activities which facilitate the passing of time, and tie in with their personal interests and past. Staff: clear set of goals to which to aspire – individually and as a team. Relatives: feel involved and that that they are still part of the resident’s care www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 5 Sense of achievement Residents: feel they can make a contribution and can meet meaningful and valued goals. Staff: be able to provide good care, feel satisfied with one’s efforts Relatives: need to know the care home ‘has done its best’ to provide the best possible care to their loved one. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
# 6 Feel valued & important Residents: feel significant and valued as a person. Feel like they matter. Staff: feel like their efforts are valued and significant in the wider context. Relatives: need to feel that one’s caring efforts are welcome and appreciated. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
As we continued our work to help design for these needs, we learned some important lessons about how to create cultural change that sticks:
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Don’t try and force cultural shift. Start small.
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“One member of staff had written that she likes line dancing, and one of the relatives came and asked her if she wanted to go with them!� Small interventions started to trigger significant behavioural changes improved communications and increased confidence that making changes is not that difficult and that it can be fun too
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Draw on the positive aspects of culture.
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
By drawing on cultural strengths we tapped into the deep rooted concern about residents and their wellbeing and the desire from staff and relatives to get more involved in making improvements.
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Involve people at all levels. Work with and within their cultures.
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
We learned taking that time to listen to people’s stories, opinions and experiences is what people found most helpful in order to create a more positive culture. It made them feel valued and important.
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
We developed a tool called ‘My Story’ which gives care home staff the time and encouragement they need to listen to someone’s stories and draw insights for making improvements.
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
al Emotion n transitio support. ives t a l e r g n Assisti sition n a r t e h in t process
‘Expert’ relative s Pro vi din g a dvice on what to think abo ut, w hat to expect
Transition days. Days where future residents can get to know the surroundings
package. On services provided, who works there,who lives there, what to bring, prices...
nto ‘Jo urney I sation r e v n o c ’ e r Ca uc h m s a g n i r e gath as infor mation the possible on e care d b o t n o s r e p for
Reintroduce daily routines (washing, gardening - things people used to do before coming to the care home) www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Clear info
Flexible hours. Where some people join activities before they become residents?
Bob. It was through the simple activity of listening to relatives that staff was able to find out about Bob’s past routines. Bob wouldn’t stop his night time wanderings and eventually a member of staff came up with the idea to manage his behaviour by giving him a torch and clip board and getting him to come along on night time rounds, to check the security of windows and so on.
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My Story
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Improved communications during shift and handovers Better relationships between staff, residents and relatives Increased confidence and ownership in making changes Sense of involvement Reduced ‘back-end’ work and increased time spent with residents
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The framework Measure
Capture
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Understand
Improve
Getting Started
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Small change is ok. But we need lots more of it.
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Thanks. julia.schaeper@institute.nhs.uk @juliaschaeper www.institute.nhs.uk | Assisting the NHS in transforming healthcare