Giving care home residents control over their lives

Enabling care home residents to choose how they spend their time may sound unfeasible, but providers using individual service funds are proving that it can be done, says consultant Helen Sanderson

Doreen Ponsonby (right) uses her individual service fund to attend church

 

Key features of an individual service fund

1. All or part of a personal budget is held by a provider on an individual’s
behalf where the money is restricted for use on that person’s support and
accounted for accordingly.

2. No specific tasks are predetermined so that the personal budget holder is
empowered to plan with the provider the who, how, where, when and what
of any support provided.

3. There is flexibility to roll money/support over into future weeks or months
and to bank support for particular purposes.

4. The ISF is accompanied by written information that clearly explains the
arrangement and confirms any management costs to come from the
personal budget.

5. There is portability, so the personal budget holder can choose to use the
money in a different way or with a different provider.

Source: Choice and Control for All, Groundswell Partnership, 2012

 

Delivering personalisation in a care home means figuring out how people who live there can have as much choice and control as possible in their day-to-day life. This means, for example, they are supported to decide when they want to get up, rather than this being determined by staff; when they want to have breakfast, instead of a set time for everyone; and how they want to spend their time, rather than just choosing whether to join in with a group activity or not.

Individual service funds (ISFs) are a mechanism for people to have control over their service. Best practice in using an ISF means that people can choose what they spend their time or money on; where; who they want to support them; when they use it; and they can specify how they are supported. This may sound impossible in a care home setting, but some early pioneering work reveals that it can work with leadership and a commitment to completely re-think how staff time is used, and therefore how rotas work.

Individual support allocation

It has to start with an allocation of money or time to individual service users. At Bruce Lodge, a home for 43 adults living with dementia in Stockport, the provider, Borough Care, and the commissioner, Stockport Council, worked out what they could try to allocate each individual. At Bruce Lodge, we decided that each person would have an allocation of two hours per month, and we needed to find these two hours without additional funding.

The next step was to help people think about how they wanted to spend their two hours. The manager, Lisa Martin, worked with Gill Bailey, consultant with Helen Sanderson Associates, to meet individuals, and their family where possible, to discuss how this would work. They asked about good days and bad days, and what people had enjoyed in their life in the past, and what they would do if they could in the future.

One-page profiles

From this, a one-page profile, describing what matters to the individual and how they want to be supported, was created, together with an idea of how they wanted to spend their two hours.

Residents are now using their time in many different ways. One is going out on a boat; another is going to make a scrapbook of her life and travels; while another wants to attend services at the church where she used to be an assistant verger.

To match staff to residents, all staff did one-page profiles too. Matching individuals and staff around shared interests is a win-win: for the person they are doing something that matters to them with someone who is enthusiastic about it, and for the staff they have an opportunity to share a hobby or interest at work.

Challenges and solutions

The main challenges are finding time and changing the culture. Finding the time both to do the initial meeting with the person and their family to develop the one-page profile, initial training with staff in one-page profiles, and also to juggle and adapt the rota to deliver both the individual time and the day-to-day tasks.

 

Case study: Winifred Baguley, resident, Bruce Lodge, Stockport

Bruce Lodge manager Lisa Martin and consultant Gill Bailey spent an hour with Winifred Baguley and her two daughters to develop her one-page profile.

Winifred’s daughters described their mother as a “real home-maker”, and together, they decided that what would make her happiest was to be involved in cleaning and tidying at Bruce Lodge.

The next decision was who she wanted to support her. The easiest choice would have been to use her key worker or whoever was on the staff rota that day. But Bailey and Martin wanted people to be able to choose who supported them with their individual time, based on shared hobbies and interests; the housekeeper proved the natural choice for Winifred.

Winifred can now be heard singing aloud as she polishes, mops, washes up and carries out the chores she did so routinely in her own home before she moved to Bruce Lodge. The increase in well-being is clear and her daughters have noticed that she is happier, chatting more, using fuller sentences, sleeping better and is generally “more alive”.

 

The cultural change is moving from a very task-focused ethos, to one that values taking time to reflect what matters to people and to deliver support the way they want it (according to their one-page profile).

The solutions are determined leadership, partnership with the local authority, and a willingness to try and see how far you can go with current resources. Expertise and training in person-centred practices are also crucial and the foundation to making this change. The home’s manager has to be a coach and a champion of person-centred practices, and continuously give staff feedback on how they are doing.

Direct payments for residential care

From next summer, councils and providers will be able to further test this approach when the government begins piloting direct payments in residential care.

Helen Sanderson leads the consultancy Helen Sanderson Associates (HSA), which works to promote person-centred practice. Her work with Stockport Council and Borough Care to develop ISFs in Bruce Lodge was nominated for outstanding care product or innovation 2012 at the National Dementia Care Awards.

Improve your practice

Community Care is holding a conference on safeguarding adults in care homes and other residential settings on 4 December. Book by 30 November for a discounted place.

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Care home managers offered tool to personalise care

Making personalisation work in residential care

Good practice: Dimensions’ journey to personalisation

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