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Promoting Quality of Life in Care Homes

My Home Life: Wiltshire

Professor Julienne Meyer


So...what do we think about care homes?

•Scandals?

•Poor quality?

•Money-grabbing?

•Undesirable?

•Less relevant?

•In decline?


Number of care homes (CQC, 2010)


Older people in care homes • 400,000 older people

• Average age 85 years

• 66% Cognitive impairment

• 40% depression

• 75% classified “severely disabled” (OFT 2005)

• Massive increase in dependency levels

• Generally unable to remain in the community


Funding• £446 state fee for care

homes (older people)

• Hospital bed = £2,051

• Children’s home = £2,408

• Care home (LD) = £748

• 28% third party top-up

• Saving the NHS £billions

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Workforce• ½ million employed in care

homes

• Care-assistants £6.56 per hour

• Lack of funding for training

• Paid less than those looking after our rubbish

• 66% NVQ2

• 39% feel unappreciated by public (Skills for Care)


Unsupported, isolated, mistrusted•4 changes in regulation in 10 years

•“Feeding the system rather than feeding residents!”

•High levels of personal stress


Quality?•On-going improvements over the past decade (CSCI)

•Steady improvements around risk-taking,voice, choice & control

•If supported, care homes can deliver remarkable outcomes!


The future...•Vital part of care spectrum

•Demand increasing (40,000 beds needed in next ten years)

•Greater specialism

•Reducing pressure on NHS

•A sector that is emerging as having the potential to deliver quality for our frailest citizens in community and in care homes


Older people in care homes • 400,000 older people

• Average age 85 years

• 66% Cognitive impairment

• 40% depression

• 75% classified “severely disabled” (OFT 2005)

• Massive increase in dependency levels

• Generally unable to remain in the community


The future...•Vital part of care spectrum

•Demand increasing (40,000 beds needed in next ten years)

•Greater specialism

•Reducing pressure on NHS

•A sector that is emerging as having the potential to deliver quality for our frailest citizens in community and in care homes


My Home Life Programme UK

Promoting quality of life for those living, dying, visiting and working in care homes for older people.


SupportAge UK, City University, Joseph Rowntree & Dementia UK

Other key organisations:

Relatives & Residents Association

National Care Forum

English Community Care Association

National Care Association

Registered Nursing Home Association

Care Forum Wales

Scottish Care

Independent Health & Care Providers

National Care Home R&D Forum


Phases of My Home Life

Phase One: Vision(2005-7 – HtA)

Phase 2: Dissemination(2007-9 – BUPA)

Phase 3: Implementation(2009-12 – JRF, DH, LA, City Bridge etc)


MHL VisionPersonalisation1. Maintaining identity2. Sharing decision-making3. Creating community

Navigation4. Managing transitions5. Improving health & healthcare6. Supporting good end-of-life

Transformation7. Keeping workforce fit for

purpose8. Promoting a positive culture


Relationship-centred careSecurity: to feel safeBelonging: to feel part of thingsContinuity: to experience links and

connectionsPurpose: to have a goal(s) to aspire

toAchievement: to make progress

towards these goalsSignificance: to feel that you matter

as a person

Positive relationships within the home and across the community of practice


The value of the vision• Evidence of what customers (residents)

want

• Articulates the expertise of the sector

• A framework for identifying evidence of good practice for self-regulation

• Accentuating positive (disassociating from bad press)

• Evidence base to inform commissioning and regulation

• Driven forward by the care home sector itself


Activities

•Synthesising evidence•Empowering leaders•Developing resources•Creating networks•Supporting change•Maintain momentum


Best Practice• She’d been very poorly for a couple of days,

and in the middle of the night the staff came and woke me up and said “We think Betty hasn’t got long. Do you want to come and say goodbye to her?” So I put my dressing-grown on and went down the corridor and they left me with her. I climbed on the bed next to her and put my arms around her and told her what a good friend she had been to me. She died in my arms’.


My Home Life Spirit

•Building upon energy, enthusiasm and best practice out there

•Collaborating, sharing, realising a vision for change


Aims of MHL Wiltshire•Provide learning experience for a small number of care home managers (Leadership and Support)

•Identify and reduce the barriers to QoL across the wider system (Community Development)

Celebrate and share good practice across care homes

•To create a movement in Wiltshire which celebrates positive practice


Leadership: 4 day course• Open to all deputies and managers of care

homes

• 4 day intensive training: reflective practice, stress management, change management, evidence based and relationship-centred practice

• Safe, confidential support on your personal journey of improvement


Support: 12 months Action LearningSafe environment to learn from each other (share)

Allow time to focus on a real issue in depth (reflect)

Learn how to listen and question (non-judgemental)

Consider how the issue can be resolved (link to action)

Commitment to feedback and learn (process and outcomes)

Key questions include:

What is happening? What should be happening? What is stopping it happening? What can be done to make it happen?


Community Development strand

• Identify what care homes want to work on with local authorities

• Identify what local authorities want to work on with care homes

• Run appreciative inquiry workshop to help resolve a shared issue of concern

• Leave care homes and local authorities working in better partnership


What managers say….“We’ve all got the same kind of problems cropping up, it’s great to know you’re not alone and when we talk through the problems, the solutions become clearer.”

“It’s been really helpful for my personal development as well as beneficial to the home….it’s giving me the confidence to stand up for doing things right, it’s very motivating.”


What are the benefits?

‘It’s like turning on a light bulb, suddenly things become clear’

• Managers tell us they are changing hugely• They are engaging with their staff differently• They are engaging rather than avoiding the emotion of

relatives• They are avoiding being caught up in the anxiety and

stress caused by external demands• They feel part of a wider movement for change!


Contact DetailsMy Home Life Programmehttp://www.myhomelife.org.uk

Prof Julienne Meyer, Exec DirectorTom Owen, Director

City University LondonAdult Years DivisionSchool of Health SciencesNorthampton SquareEC1V 0HBLondon, United Kingdom

Tel: +44 (0)20 7040 5776Fax: +44 (0)20 7040 5529Email: [email protected]

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