Person-centred reviews for older people in care homes

Person-centred reviews are the norm in learning disability services, but older people can now benefit from an approach that bases their care on what they want, finds Natalie Valios

Care home owners Sheila Mannion and Steve Mycroft brought their experience of learning disabilities services  to looking after older people (pic Neil O’Connor)

Person-centred reviews are the norm in learning disability services, but older people can now benefit from an approach that bases their care on what they want, finds Natalie Valios

When Sheila Mannion and Steve Mycroft took over as the co-owners of private care home Oakwood House in Tameside, Greater Manchester, nine years ago, they were surprised at the institutionalised way in which it had been run. Coming from learning disability backgrounds, the regime applied to its older residents was contrary to the way they were used to working, which focused on promoting independence, choice and control.

“Historically, homes like ours had been run like institutions because it was more convenient to do so,” says Mannion, who is also the home’s manager. “Beds were made in the morning and, if the residents were unwell or tired, they weren’t allowed to use their beds during the day because everything had to be kept just-so. Staff couldn’t see anything wrong with that, but we thought it was appalling.”

The home and staff have come a long way. Now, they are one of a few organisations using person-centred reviews with older people (see panel, facing page). This process identifies what is important to an older person now and in the future; and the type of support they need to achieve it. Professionals discuss with the individual and their carers or family members what good support would look like, including what is and isn’t working from everyone’s perspective.

As every older person receiving social care services has a statutory annual review of their care package, the idea of a person-centred review is to give them more control over what they need and want from their care package. The process is not limited to statutory reviews and can be used in day services or for informally reviewing what is and isn’t working.

Although person-centred thinking has long been immersed in learning disability services, for older people it is a relatively new development, says Helen Bowers, director of older people and ageing at the National Development Team for inclusion (NDTi): “Although there has been lots of good work to introduce the concept, practice and tools, they are only really happening in a few places with a few people.

“Those local authorities that are doing a lot to make personal budgets and self-directed support work well for older people have gone further to ensure that a person-centred approach is an integral part of the process.”

This is true of Bath and North East Somerset Council. Here, 420 people aged 65 or over had used or were using personal budgets between 1 April 2009 and 31 January 2010, and most have had person-centred reviews of their budgets.

“A big difference from the service user’s point of view is that the review addresses their needs and wants, to provide more flexible and less prescriptive support,” says Sandrine Humphreys, personal budget mentor in adults’ services and housing at the council.

“It’s the next step to making someone happier. In the past the review was more of an administrative exercise. Now it starts with a conversation with the user about what is important to them and for them and they feel listened to.”

The preparation process for a person-centred review gives older people the chance to think about what they want to say. This is particularly important for a generation that often prefers not to complain. Apart from those who have to attend the review in a statutory capacity, the older person can invite whom they like. The process starts by setting a tone around what everyone “likes and admires” about the older person, before discussing what is and what is not working about their care and support.

“The function of the ‘working’ and ‘not working’ tool is to build an agenda for action that is going to make a real difference in people’s lives,” says Gill Bailey, lead on person-centred thinking and older people at training and development consultancy Helen Sanderson Associates. “It is self-directed support in the purest sense because it is based on what they are saying is important to them.”

This is in direct contrast to the traditional approach to care planning and reviews, which is professionally led and based on sorting out problems relating to the older person’s condition, rather than taking a holistic look at their life. Sometimes this can just be a phone call or a 10-minute visit to ask whether everything is OK.

Bailey says: “Older people say to me, ‘they come in, I don’t know what they’re writing, they tick boxes and then they go and nothing changes’.”

The personalisation agenda is here to stay, as the government’s adult social care vision, published last month, made clear.

But, in older people’s services particularly, a cultural shift is needed to put the individual at the centre of the care process. Bailey says: “If choice is restricted and support stays in the same traditional manner, older people’s lives will not improve.”

Case study: ‘She wanted a chandelier in her room, so we put one in’

Initially, it was a culture shock for staff at Oakwood House when Sheila Mannion started introducing person-centred thinking tools, but they adapted when they realised it was for residents’ benefit, she says.

Every resident now has a one-page profile, which is a way of finding out what is important to them and how they want to be supported. This process has fed into person-centred reviews: “The traditional review just asked a certain number of questions. A person-centred review is the difference between me saying to someone ‘you are coming to Oakwood House, this is how we do things here, you’ll soon get used to our routine’ and saying ‘how do you want me to support you?’,” says Mannion.

“Does someone want to get up when they wake up? Do they want breakfast in bed or in the dining room? Do they want to be involved in activities? We might know what is important for someone – nutritional food, enough fluids – but we have to find out what is important to them.”

Residents, such as Lucia*, who were at the home before Mannion took over, have noticed the biggest changes.

Lucia arrived at the home after having a stroke. By talking to her, her daughters and friends, staff found out what was important to her and recorded it on her one-page profile. Lucia likes toiletries and to be well-dressed; she enjoys watching TV, reading magazines and chatting to people, but only when she feels like it.

She also likes to get up for breakfast with staff support, but now and again appreciates a lie-in. “With the previous owners no one was allowed a lie-in, and everyone had to go to bed at a certain time,” says Mannion.

The first major change for Lucia came after her person-centred review. “We were looking at what wasn’t working and I mentioned that her room was small and we had a larger one available that would work better with her wheelchair,” says Mannion.

“The room is upstairs but there is a lift. We had it redecorated. She wanted a chandelier so we put one in. She loves it and calls it her apartment.”

What was working included family visits; being made a fuss of, especially when having her hair done; and talking about current events because she likes to read Hello magazine and watch Strictly Come Dancing and Dancing on Ice.

“My role is to make everyone’s life as happy as it can be,” says Mannion. “I don’t have a magic wand, but to the best of my ability I give people what they need to be happy. It’s about giving people what they want, not what you think they want.”

* Not her real name

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