SPECIALIST CARE PROVIDERcare

Cost effective residential care for women with eating disorders

Vivre Care is a progressive eating disorders specialist care group, providing individualised client pathways for more purposeful futures. Our aim is to facilitate personal growth and the development of effective life skills for women suffering from eating disorders in a confidential and comfortable environment.

Our directors have over 25 years combined experience in both the private and public care sectors, with many years spent specialising in eating disorders. Since the launch of our first residential care service in 2007 we have assembled a highly specialist care team, all of whom have several years of eating disorders experience. As a team, we utilise different therapies and approaches to produce individually tailored care packages that will provide our clientele with the tools to live a happier life.

We are committed to meeting the challenges of specialist health care and adhering to the highest possible standards. We are regulated by the Care Quality Commission (CQC).

Value for Money

At Vivre Care we aim to work collaboratively with commissioners, referrers and families to reduce the total cost of eating disorders care. Our specialist residential programs offer cost effective alternatives to traditional residential treatments, with no compromise on quality.

Stockwood House is a female-only, residential home specialising in the care of adults with severe and enduring eating disorders. The aim is to provide specialist help to continue care from in-patient admission, focussing on illness management rather than unsustainable weight restoration.

Stockwood House is purposefully designed to treat individuals who are severely ill, to the extent that they cannot safely or adequately be treated as outpatients, but have utilised acute inpatient treatment to the best of their ability. Individuals admitted will range in age from early to late adulthood, and will benefit from a multi-disciplinary approach.

The programme specifically focuses on the requirements of clients with an enduring eating disorder by initially understanding the unique needs of this client group, and thus will include modest goals, that will attempt to re-socialise them with a lifestyle marked by appropriate living and the containing of anorexic behaviour and attitudes. Individual counseling/therapy is built on, and group therapy is continued. An emphasis is placed on the management of the illness that is client-focused, with achievable goals.

Clients are supported around the clock by a specialist multidisciplinary team comprising of a qualified mental health nurse, a specialist dietitian, an occupational therapist and a full compliment of trained care support workers. Clients are also offered alternative therapies in group and 1:1 settings such as art therapy. The care approach aims to offer a high level of support, but also nurturing self-care and independence.

Each client has their own large bedroom, some of which are en-suite, and allocated according to risk assessment and availability. There are also a variety of shared spaces for the clients to use, including lounge areas, dining areas and a garden.

Our multi-disciplinary approach comprises of an initial assessment, consisting of a nursing, social and dietary evaluation. This includes an analysis of anthropometrical and biochemical findings, and the reviewing of the psychiatric evaluation as provided by the referrer. The assessment also focuses upon the current needs and future goals of the client.

Admission Indicators:

1. Severe eating disorder pathology (for example as demonstrated by repeated inpatient admissions). 2. Significant decomposition of an individual’s mental status such that they are unable to function or take appropriate care of themselves. 3. Prior to referral for admission, attempted/failed outpatient stabilisation. 4. The individual is medically stable. 5. The individual is agreeable to admission; and, will cooperatively participate in the services provided. 6. The individual is competent to give informed consent.

At Stockwood House we aim to offer a range of therapeutic interventions to complement both our philosophy and the specific aims of the client.

Therapeutic interventions include:

• goal setting • group therapy • anxiety management • problem-solving • nutritional rehabilitation • psycho-education • re-socialisation • self esteem • food skills • complementary therapies • arts therapy

As a registered care home catering for both health and social care needs placements at Stockwood House can be funded solely by the referring PCT or in tandem with social care.

Stockwood House

For further information including sample care plans and up to date costings, please call 01582 557755 or email: info@vivre-care.com

Testimonials

“Stockwood House treats me as an individual and supported me in making decisions to change.” Kerry, aged 39

“Stockwood House has helped me to be more independent with going out and using transport, maintaining my weight and eating a wider variety of food.” Marie, aged 44

“Although I have battled at times, I know that the advice given by the staff is right for me and that they have my best interests at heart.” Kate, Aged 31

“Stockwood House has taught me to be part of society again and to not be held back by my illness. I know now that it is possible to have a life and manage my food at the same time.” Linda, Aged 29

“Although my weight has fluctuated in my time here, the support and structure offered by Stockwood House has enabled me to stop the continued decline and maintain my admission weight.” Abigail, aged 41

“I am more conscious of how short life is and how much I am missing out on whilst being realistic about what I hope to achieve long term.” Jo, aged 33

The aim of Ellenbrook House is to provide graded and tailored support to eating disorders clients demonstrating the ability to live in a semi-independent fashion, whilst still requiring specialist multi disciplinary input.

The function of Ellenbrook House is three-fold:

1. “Step Up” – Increased supervision for clients struggling in community settings, suitable for early interventions to avoid inpatient admissions.

2. “Step Down” – Continued care post inpatient admission, suitable for early discharge clients or lower weight rehabilitation. Residents that have “stepped down” from Stockwood House can maintain the social links that they have forged in the community and continue to pursue their employment and leisure activities, thereby minimising the potential trauma associated with relocating and changing to a reduced support environment. Further continuity will be achieved in the staffing of the new facility in terms of care support workers and specialist interventions, thereby further reducing the risk of relapse.

3. “Respite Care” – Short term support for vulnerable eating disorders clients.

Ellenbrook House is a self-contained living space located opposite Stockwood House. Each client has their own, well-decorated bedroom, some of which have en-suite facilities. There are also a variety of shared spaces for the client to use, including lounge, sun room, kitchen, bathroom and garden.

Admissions are subject to a holistic evaluation by a member of our clinical team. The assessment will also focus upon the current needs and future goals of the client.

Support is focused around meal times, coupled with ongoing multi disciplinary input. An outline of the support structure is as below:

• Care staff on hand daily to offer supervision and support for the preparation and consumption of all main meals: one and a half hours over breakfast, two hours over lunch, two hours over supper and one and a half hours for night snack. This support will be graded over time and in accordance with each individual’s work/social commitments

• Sleep-in Care Support Worker every night, with on-call staff 24 hours a day

• Weekly one to one sessions with the Nurse, Dietitian and OT

• Ongoing weight, biochemical and cardic monitoring

As a supported living proposition, invoicing for Ellenbrook House can be tailored to suit the funding parties with accommodation and personal care invoiced separately and funded directly by the client themselves, via housing benefits or a combination of all three.

Ellenbrook House

For further information including sample care plans and up to date costings, please call 01582 557755 or email: info@vivre-care.com

History of presenting case

Kerry, a 39 year-old female had Anorexia Nervosa Restricting Type diagnosed at 17 years old. She had numerous admissions in hospital settings since 2001 and was referred to Stockwood House in late 2007.

Medically, Kerry had a type 1 heart block and has previously had a cardiac arrest, suffers severe osteoporosis, severe OCD, depression, amenorrhea, anaemia, hypoglycaemia, hypothermia and Raynaud’s syndrome.

ED behaviours

• restriction of calories, skipping meals - daily • obsessional walking for up to 16 hours - daily • binging and purging – every 3-4 days • severe OCD – food types, calories etc

Previous treatment summary

• 11 admissions to hospitals since 2001 • total of 6.5 years in hospital settings between 2001 and 2008 • longest stay was for approx. 2 years • longest stay outside of hospital was 8 weeks • admitted under section 3 - self discharged once rescinded • self discharged against medical advice • began absconding • generally admitted when collapsed/unable to walk, and discharged at a low BMI • unable to be contained well by local community team as she would DNA appointments/avoid contact

Stockwood House Treatment

Kerry came to Stockwood House after a 1.5 year admission to an EDU. Her admission weight to the EDU was 25.6kg (BMI = 9.6), and she was discharged to Stockwood House at 34kg (BMI = 12.7). Her prognosis from the EDU was very poor, untreatable.

1:1 sessions:

• Art Therapy x 1 session weekly • Dietetic x1 session weekly • Occupational Therapy x1 weekly • Nursing sessions x2 weekly

Groups :

• Post lunch group - daily • Residents group x1 weekly (weekly social and other outings are discussed and agreed) • Pamper group x1 weekly • Menu planning group x1 weekly • OT group x1 weekly • (Crafts and media groups not attended by Kerry)

Nursing summary

Due to Kerry’s OCD sessions were customised in terms of content, timing and environment. She would struggle when she was challenged and become

defensive/agitated at times, often verbally abusive. She became calmer when she had more purposeful things in her life and was able to reduce walking gradually until able to work full-time at desk job, with 2-3 hours walking daily. Kerry attended organised socials to the cinema, bowling, day trips to various parks, theatre in London, a day trip to Dublin (via airplane) and an overnight holiday to Brighton.

Key/support worker summary

Kerry’s weekly sessions were done during a walk where they reflected on what was going on in her life both within the home and externally often seeking reassurance that she was doing the right thing. Kerry found ‘another ear’ that was not regarded as ‘management’ helpful, and enjoyed occasional coffees out.

OT Summary

Kerry was encouraged to start computer course, and aided in CV formulation, extra computer training, and researching local voluntary agencies. Kerry then worked voluntarily in recruitment, which turned into a paid position, eventually moving from part-time to full-time. Kerry managed very well with a variety of transport services, had her driving licence reinstated by the DVLA and purchased her own car.

Dietetic Summary

Kerry found sessions difficult, and preferred to meal plan herself, with the dietitian overseeing her. She progressed through a tailored 4-stage dietetic rehabilitation programme designed to increase food confidence and independence, shopping and practical skills.

Kerry was able to change from her binging twice weekly, to stopping 3 months into her admission.

Conclusion

Discharge BMI: 13.7

Discharge: To local area for 1 year placement in warden controlled accommodation.

Current status: Still in accommodation, happy, weight increasing, in a relationship, has regained much of her independence, continues with full-time employment, now able to safely manage her anorexia and OCD to a much greater degree, spending more time with her sisters and their families and has fully integrated into her community.

Outcomes

• No readmission to hospital • Significant saving during period at Stockwood House in comparison to hospital inpatient fees • Reduced follow-on care cost • Reduced clinical risk • Increased carer satisfaction • Increased patient satisfaction

Stockwood House - Case Study

SPECIALIST CARE PROVIDERcare

Vivre Care Ltd, Stockwood House 1 Cutenhoe Road, Luton Bedfordshire LU1 3NB

Tel: 01582 557755 Fax: 01582 702050 Email: info@vivre-care.com

Stockwood House Ellenbrook

House