by Claire Blankenship
Four years ago Central Bedfordshire Council put forward a plan for modernising its existing care home provision with the aim of achieving this by 2020. Its plan was to work with developers and providers to replace the outdated care homes owned by the council with new homes providing modern facilities. With this aim in mind, the MANOP team (Meeting the Accommodation Needs of Older People) was set up to commission this and other housing related projects.
As part of this, a dedicated moves team was set up to support residents to move to their new homes, consisting of a dedicated moves social worker, a project manager and an occupational therapist. I was appointed as the social worker to the team having previously worked in one of the council’s community social work teams.
Lessons learned on care home moves
- Consult residents and relatives on the move and make sure their views count.
- Assess the risks of the move and mitigate them.
- Get to know residents, relatives and existing care home staff and build trust.
- Do life story work to help new staff get to know residents.
- Draw up a checklist for the day of the move for each resident.
- Review needs soon after move.
- Do not rush the move.
So far, the moves team has transferred older people from two of our existing homes to modern homes run by independent providers. We are currently in the process of consulting on the future of a third home.
As a member of the team I’ve gained some invaluable insights into what’s worked well and some of the lessons learnt. Here’s a brief overview:
Preparing for the move
The first step was to undertake a consultation with the residents and relatives of each of the homes. As many of the residents had a mental health diagnosis, it was important to carry out a mental capacity assessment to see if they were able to understand the nature and the purpose of the consultation. Rather than carry out the mental capacity assessment as a separate exercise, I used it as a starting point. I would then follow on with the consultation questions if the resident had capacity to make relevant decisions. Even if the resident didn’t have capacity, I could still gain their views about a possible move with the support of family, staff they were familiar with or an advocate. Their views were usually included in the consultation report unless it was deemed in their best interests not to include them.
It is well-known that moving to a new home is a stressful life event. With this in mind, the MANOP team developed a Risk of Moving tool based on widely recognised factors of what could impact on a person’s ability to cope with moving to a new environment. Factors such as hearing or visual impairments could, for example, lead to an increased risk of isolation in an unfamiliar environment. Psychological factors such as a person’s ability to understand the move could potentially increase feelings of disorientation and loss of control.
In trying to mitigate these risks we developed a checklist to ensure that, for example, a resident’s hearing aids were working on the day of the move. We asked a lady who was visually impaired what colour scheme she would like in her new room and how she would like it laid out, with the aim of her settling more quickly and of minimising her risk of falls. We helped residents who lacked capacity to understand the nature of the move by taking them in advance to their new home and arranging for them to have lunch with the new staff. We made a photo book of the new home and regularly looked through the book with residents, reinforcing what it looked like before they moved in. The success of this approach became clear when one of the residents, on the day of the move, insisted that she’d always lived in her new home.
It was a huge benefit having a dedicated occupational therapist in our team. She identified the transport needs of each resident in preparation for the move. She also assessed any changes in equipment needs and ensured equipment was in place in the new home before residents moved in. Some of the learning around this is that it is important to be clear who is responsible for the provision of equipment – there were some grey areas and differences of opinion on whether it was the council’s or the home’s responsibility for certain items.
As the moves social worker I was responsible for assessing each resident to ensure that their needs could be met in the new home or to explore alternative options where appropriate. Some residents’ needs could not be met in the new home, particularly if it was a residential home and they had developed nursing needs. The closure of the existing home was also the trigger for a few residents to move nearer to their families, which sometimes meant finding them a home in another county.
Finding an out-of-county home often meant liaising with out-of-county colleagues to locate a list of homes, speaking to their contracts team about the rates they paid their homes and negotiating with the homes themselves to agree a weekly rate.
Once the decision had been made to close the home, the moves team based themselves in the existing home. This worked well as it meant we got to know the residents, family members and staff really well and they could approach us easily to talk about any issues or concerns. Some residents had an existing social worker when the moves team became involved. The existing social worker may have been involved in reviewing an existing resident, for example. One of the key learning points here was to have clear boundaries between my role and that of any existing social worker. It was subsequently agreed that I would take over the case once I began assessing for the transfer to a new home.
Life story work
We encouraged residents and their families to complete life story books capturing their life histories. This proved to be a moving experience for some families as they dug out childhood photos of their loved one. For me it was liberating to get away from paperwork and get back to old-fashioned social work – talking to people about their life histories. The life story books went with them to their new residence and provided the new staff with an immediate glimpse into their lives.
One thing that proved really beneficial was an About Me page for each resident. This gave very brief but essential information on the resident at a glance. Information might, for example, include choking risks, allergies or personal preferences. One lady for example, liked to have night time snacks in her bedside cabinet and felt distressed if they were not in place. Although this sort of information was included in the care plan, it takes time for new staff to embed this knowledge and this was a really effective way of sharing vital information quickly.
Making the move
We designed a moves checklist for each resident and this was shared between the MANOP team and the manager of the existing home. This provided practical information about the time and date of the move, the mode of transport and who would accompany the resident on the day of the move. We made a note of any special requirements – one gentleman needed cream biscuits en route to his new residence to help minimise distress, another lady with dementia had her favourite carer go with her in the ambulance to an out-of-county home.
We held regular meetings with the providers of the new home throughout the process to discuss any issues that arose and how these could be addressed.
One of key learning points was the importance of the existing home documenting any outstanding hospital, GP or continence appointments so that the new home could follow these up. We also realised that relatives would benefit from a checklist about their responsibilities, such as notifying the bank of the change of address or providing suitcases for the move, where possible.
We quickly learned that a slower approach to moves worked best. Initially we thought that moving four people a week was reasonable but it takes time for a new home to get to know its new residents and so it was agreed that moving two people a week was a more viable approach.
Importance of reviews
Research has found that the first three months following a move are the most stressful. With this in mind, I carried out reviews regularly within that time period: within forty eight hours, to iron out any immediate issues, and after one month and three months. Most residents took several months to settle in and initially missed their previous home. What appeared to help most in settling in was forming good relationships with staff and other residents. One resident, who had refused to come out of his room in his old home, related really well to the approach of staff in his new home. He now spends most of his day out of his room and engaged in activities with other residents.
At the end of each moves project, the project board looked back over lessons learnt and adapted the process for the next time. One thing we’ve definitely learned is that no two homes are the same and we never stop learning!