Promoting good practice in residential care homes

The My Home Life project has established eight pillars of good practice that it is promoting among care homes. Vern Pitt reports on some of the homes held up as examples to follow

As part of a bid to make savings, the Department of Health recently called on councils to reduce their use of residential care. This drew an angry response from care provider umbrella body English Community Care Association and charity Action on Elder Abuse.

However, given that hundreds of thousands of people, mainly pensioners, will require residential or nursing care in years to come, defining what constitutes high quality care is vital.

The My Home Life project aims to do just that. Founded by Age Concern/Help the Aged, it brings together academia, charities and the care home sector to establish eight pillars of good practice.

Here we look at four care homes that the project has identified as exemplifying some of these principles.

Managing identity

If you visit the Sutton Valence Care Home in Maidstone, Kent, looking for Fred Newin there’s a good chance you’ll find him working in the garden. But when he arrived at the home he was frail and depressed.

For the first three months he was reluctant to talk to people and would stare out of the window all day. Eventually, staff found out that he used to be a keen gardener, so they asked whether he would like to maintain some of the home’s flower beds. The change was dramatic, says manager Carla Wilson: “He was much happier, much more interested in what happens in the home. We have a sunflower growing competition for residents and he helps with that.”

Giving him a reason to get out of his wheelchair has also seen him learning to walk again and his new found independence sees him also tend to a neighbour’s garden.

“He has still got the same problems as when he came in; he still requires nursing attention but mentally he’s a lot better,” says Wilson.

Contact Sutton Valence: 01622 843999

Sharing decision-making

If you want to make a decision you call a meeting, right? Jeannie Carlson, manager at Simeon Care for the Elderly in Bieldside, Aberdeen, disagrees. “People are averse to meetings. A lot of decision-making in our experience is informal,” she adds.

To engage residents in decisions they do what many other groups of people living together do, discuss it over a meal.

One example of this is planning Christmas dinner. Some years this has been served in a large dinning hall with most of the residents; other years it has been in two smaller rooms, which provide a more intimate setting.

Carlson says: “Their preference is based on what they used to do, but also on where they are at now because people’s feelings about things change as they get older and what they know they need.”

Proposals are then put to the residents so differences and individual needs can be ironed out. “Rarely does everybody want to do everything together but the important thing is we find out what’s meaningful to you,” says Carlson.

Contact Simeon Care: 01224 862415

Good end-of-life care

Harry Daley,* his wife Alice and his family didn’t want him to die in a hospital as his doctor had recommended. But staying in Critchill Court care home in Frome, Somerset, where he had lived for four years, presented a challenge because both Harry and Alice had dementia.

Manager Sue Steeds explains the decision to support him at Critchill Court: “We can offer better end-of-life care for people who don’t need medical interventions than in a hospital ward which can be very disorienting and alien for people with dementia.”

The staff were very conscious of involving Alice in his care and had to use their knowledge of her behaviour to read her reactions to this news because her dementia impeded her communication. “We will never know exactly what Alice was feeling or thinking,” says Steeds.

At the same time the home worked closely with a local hospice and district nurse to organise and provide the minor medical interventions needed. Throughout, Alice was able to sleep in the same bed as her husband and although she had dementia the focus remained on Harry’s dignity.

Contact Critchill Court: 01373 461686

Positive culture

At Mavern House Nursing Home in Melksham, Wiltshire, Lilly and Mable are kept cooped up in the back garden with the chickens while Tody wanders between other residents’ rooms. Thankfully Lilly and Mable are sheep and Toby is a cat.

Two and a half years ago Mavern House started trying to make a change to the way they worked to promote spontaneity and give residents a less organised, less institutionalised life.

Part of that involved having pets. Not everyone shared this vision. “Our staff turnover was huge in the first year. We weren’t scared of that because we knew that would happen,” recalls manager Sara Young.

Today, residents have breakfast whenever they like, flag down the ice cream van in the summer and play impromptu games with other residents. Uniforms will soon be phased out to further dissolve the barriers between staff and residents.

Young says this has led to a reduced need for antidepressants and sedatives. For one woman with dementia who was very withdrawn the change was palpable. “She was looking us in the eye and just answering yes or no; that was more than she had said in years,” says Young.

Contact Malvern House: 01225 708168

*Not his real name

Practice points

Managing transitions into a care home

● Arrange trial visits if possible.

● Assign a staff member to the resident to help manage the transition.

Managing identity

● Give residents choice and control, for instance over their dress.

● Encourage residents to share memories.

Creating community

● Engage relatives and the local community in the running of the home.

● Promote intergenerational work with children.

Sharing decision-making

● Avoid regimented routines that restrict residents’ freedom.

● Beware patronising/demeaning language.

Improving health

● Make mealtimes a positive experience to tackle under-nutrition.

● Build partnerships with local NHS services.

Supporting good end-of-life care

● Where possible, have a member of staff/volunteer sit with the resident at all times.

● Help loved-ones who the resident wants to see with transport/accommodation.

Keeping the workforce fit for purpose

● Provide staff with space for reflection.

● Encourage staff to learn together in the home rather than use external courses.

Creating a positive culture

● Staff work as an effective team with some blurring of roles.

● Make relatives part of the care home team.

Full details from www.myhomelife.org.uk/ProjectThemes.htm

Promoting better practice in care homes

My Home Life director Tom Owen describes the project’s bid to support improvements at care homes throughout the UK

My Home Life (MHL) is a UK-wide movement aimed at promoting quality of life in care homes for those living, dying, visiting and working in care homes for older people. The programme is led by the care home sector in partnership with Age Concern and Help the Aged, City University and Joseph Rowntree Foundation.

At the heart of the programme is an evidence-based vision which articulates the vital role that care homes play in supporting our frailest citizens. Over 50 academic researchers worked with practitioners to review the research and practice evidence on what works well in care homes.

Underpinning the evidence base is the principle of “relationship-centred care”, developed by Mike Nolan, professor of gerontological nursing, and colleagues at Sheffield University.

This acknowledges the importance of fostering positive relationships between residents, relatives and staff as the foundation to quality of life.

MHL has spent the last three years communicating these examples of good practice to the sector. With over 3,500 care home practitioners now signed up to our network and all the major care home representative groups strongly supporting the programme, MHL is now seen as the voice for quality in the sector.

As well as supporting managers transform the culture of their care homes across a number of authorities, the programme also aims to help commissioners, social workers and health practitioners to understand how they can better support care home staff, who otherwise feel unsupported, isolated and undervalued in the work they do.

MHL is also working with the national dementia and end-of-life strategies for England in ensuring that care homes are helped to take forward their implementation. MHL has also received funding from the Welsh government to roll-out the programme. In Scotland, relationship-centred care is now being embedded within the regulatory framework.

Overall, the value of MHL is that it is being driven forward by the sector itself; it recognises that care homes can be a positive option, that there is some excellent practice and many skilled practitioners out there, that we all need to support care homes to help them to deliver to their potential.