Health and Social Care Committee
HSC(4)-06-12 paper 2
Inquiry into the Residential Care of Older People in Wales - Evidence from My Home Life Cymru
Introduction
The My Home Life programme has been active in Wales since the latter part of 2008 and is funded through the Voluntary Sector Small Grant facilitated by Health Challenge Wales. The aim of My Home Life Cymru is to promote the improvement of the quality of life of those who are living, dying, visiting and working in care homes for older people. My Home Life also aims to celebrate existing good practice and promote care homes as a positive option for older people. Since the end of 2008 until this time, the programme has been working intensely with 38 homes from across the country. These homes are representative of the whole care home sector in Wales in that they cover:
· 18 local authority areas
· 31 independent sector homes (including small and national providers)
· 3 local authority homes
· 4 third sector homes
· Homes in both rural, urban and semi-urban areas
· Welsh language homes
· Faith homes
· Homes of varying capacity, ranging from 7 to 100 residents
· Homes that cover a variety of services:
o Residential care
o Nursing care
o Respite care
o Day care
o Older people mental health (EMI) care
Events, training and resources
Over the last 3years, My Home Life Cymru has hosted a number of events around the country to raise awareness of the programme and develop the My Home Life Network of homes:
· Annual conferences every year beginning in 2009. This year’s event takes place at the Metropole Hotel in Llandrindod Wells on 27 March. These conferences have had an average attendance of 113.
· A National Seminar was held in Cardiff in November 2010, which included presentations by many of the leading names in the UK care home sector including David Sheard and Prof. Mike Nolan. This event attracted an attendance of 185.
· 8 regional seminars we held between March 2010 and May 2011. These were held across the country and had a combined attendance of 175.
· 7 manager’s days have been held since April 2009. These events were targeted at the 38 homes that form the core of the My Home Life Cymru network.
· In response to identifying some development needs among these homes, several training events have taken place throughout the country:
o Ensuring human rights in care homes
o A whole home approach to activities in care homes
o Open your heart to see me – supporting people with a dementia
o Getting to know you – life story and reminiscence work in care homes
o Low Impact Functional Training (LIFT)
The development of resources has been an integral part of our work in Wales. These resources include:
· Our quarterly newsletter which is sent to all care homes for older people in Wales
· www.agecymru.org.uk/mhlc These pages contain up to date news and links to documents, presentations and other valuable information.
· ‘Getting to know you’ booklet. This was published to accompany the training delivered in 2011.
· ‘Open your heart to see me’ booklet. This was published to accompany the training delivered in 2011.
· My Home Life Cymru booklet. This introductory booklet helps care home staff, residents and their families to understand the My Home Life approach.
· My Home Life Cymru Good Practice Guides. This is a suite of 8 guides that investigate the My Home Life themes:
o Maintaining identity
o Creating community
o Sharing decision making
o Managing transitions
o Improving health and healthcare
o Supporting good end of life
o Keeping workforce fit for purpose
o Promoting a positive culture
· My Home Life Cymru is developing a ‘Care Home Checklist’, which will support individuals and their families to plan ahead for the move into a home.
· ‘Developing Volunteering in Care Homes’. This publication will aid care homes, volunteers and volunteer organisations to work in partnership to encourage the support and development of volunteers in care homes.
We will continue to develop resources in partnership with care homes to address the changing needs of the care home sector in Wales.
All of the activity mentioned above has helped to establish My Home Life Cymru in Wales and the care home sector has increased its engagement with us accordingly. Up to this point, the number of homes that have shown an active interest in the programme is 225. This number is almost 30% of the sector in Wales. These homes have attended events, volunteered to be part of the programme and also actively responded to our resources.
Listening to providers, residents and relatives
My work with the core 38 homes has included visiting all of them and spending time with staff members (managers, owners and all levels of staff), residents and their relatives/ visitors to the home. This has given me an insight into the unique perspective that each of these groups hold in relation to their role in the life of the care home.
No matter the size of the home and the number of residents, each home is delivering very similar services. They are also supporting a client group which presents them with the same needs. The relatives and visitors group also looks the same throughout the country. The staff teams face the same issues and the management teams are subject to the same legislation, regulation and local authority scrutiny. However, this does not mean that every home is the same. On the contrary, each home has its own approach and personality. The approach is heavily influenced by the background of the senior staff team e.g. nursing/ health background, social work and client group experience. I have encountered many managers and staff who come from a learning disability service background. In these cases the individual has brought an enhanced understanding of ‘value’ to their services. The development of learning disability services over the past 25 years has produced many professionals who work from a strong values base and they have taken this with them into their present roles.
The care home sector in Wales is mostly made up of small independent sector providers. Their position is one that is valuable and yet precarious. As a small organisation, they do not benefit from the support that comes from being part of a larger organisation e.g. national provider, local authority. This regularly means that the manager does not receive the support they need. This comes in the areas of service development, adjusting to new legislation, regulatory requirements etc. Also, the area of peer support is key to a homes development. Managers that are linked by a common employer usually have a support network to aid them in their roles. However, managers without this circle of support tend to struggle. This imposed isolation has been addressed in many areas by the setup of provider forums and other networks. However, these groups often get caught up with the ongoing issue of fees and never really address the main areas of support that are key to a manager’s role.
My Home Life Cymru is endeavouring to develop its network on a regional and national basis. The original 38 homes are at the core of this development and we will look to engage with more homes in the coming months and years.
There are still a good number of homes in Wales that are comparatively small in comparison to the rest of the market. The larger the home, the more financially viable it will be, but the smaller homes and also the homes that are split into small units can offer an environment that is more conducive to developing a ‘homely’ atmosphere. When a home/ unit is small and there is good continuity in the staffing arrangements, the atmosphere lends itself to the development of good relationships in the home. The residents have less staff to get to know and visa versa. The relational aspect of care home life can not be underestimated. When staff members, residents and their families work together, this can lead to the development of relationships that help in the delivery of services that really are moulded around the resident.
The Senses Framework (Nolan et al 2006), looks at the issue of quality of life of those living in, working in and visiting long term care settings for older people. The framework identifies the Six Senses that inform quality of life for all. Each has a sense of:
· Belonging
· Security
· Continuity
· Purpose
· Significance
· Achievement
My Home Life Cymru is encouraging homes to develop the relationship centered approach that encourages staff to look at how they do what they do. They can then adjust their approach accordingly to concentrate on quality of life issues, not the care tasks that they have to perform. Regularly, staff within the home see their role as carrying out a list of tasks that are mostly related to care. Supporting residents to get the best out of their lives means more than just being supported with their personal care.
The approach of the home to the service it provides is crucial in developing and maintaining a good quality of life for all associated with the home. During my visits to the 38 homes throughout the country, I met many residents and their families who have experienced living in and visiting more than one home. This can be due to a variety of reasons:
· A resident moving from a residential home to a nursing home
· A resident whose changing needs are best met in another environment
· Residents may also move to be closer to family members
· A resident may move due to a home closure
All of those I met mentioned that the home they were living in/ visiting now was their best experience of a care home. Their previous experiences ranged from ok to poor to very poor. As all care homes for older people deliver very similar services, I asked, ‘what made the difference in their experience of a good home?’ The answers from all of the individuals I spoke to are listed below:
· ‘It’s the people’
· ‘It’s the approach of the home and those who work there’
· ‘It's how they do what they do’
· ‘It's how they are with you’
· ‘It ain’t what you do, it’s the way that you do it’
The journey that families and new residents have to take as newcomers to the care homes arena can be a difficult, arduous and painful one. The pathway that leads to moving into a care home can have its start in several places:
· A patient in hospital is not able to return home due to the extent of their needs and the availability of support
· An older person can no longer care for themselves at home
· A family may reach a crisis in that they can no longer provide the support needed to care for their loved one
· An older person and/ or their family may be advised by a professional e.g. GP; social worker, that a care home is the best option in meeting their/ their loved ones needs
This period of transition into the home is fraught with difficulty. When going through a social worker, the older person or their family may be given a list of homes to choose from. They are not usually given any information about the home other that what it might cost them. Regularly, they are given a very limited period of time to come to a decision as to which home they are going to choose. In this situation, how does an older person or their family know how to identify the best home for them? How do they tell a good home from a not so good one? Why do they need to be limited to just a few homes to choose from? This transition period is emotionally traumatic for the family and resident-to-be. Regularly, they are told, ‘I’m afraid you/ your loved one will have to move into a home’. The way in which the message is conveyed reconfirms the negative view that most of the population has toward care homes.
My Home Life Cymru is developing a resource for those who are beginning their care home experience, to aid them at that difficult time.
Staffing
Many staff in care homes are doing a wonderful job in supporting residents who may present them with challenges. Older age, frailty, physical and mental illness and disability, emotional anguish and frustration (from both residents and their families) and regularly coping with the death of residents who they have come to know well, makes the job of working in a care home an extremely difficult one. In addition to this, the majority of staff receive remuneration that is not far above the minimum wage. Staff training can also not hit the standards that it should, with many only receiving the minimum of training in core areas e.g. health and safety, manual handling, first aid etc.
Conclusion
The care home sector in Wales is a varied one with providers facing multiple challenges. However, there may be other areas in which they face challenges such as rurality, isolation from support and negativity from the community.
The political drivers that have seen an emphasis being put on older people staying in their own homes for longer, has meant that new residents coming into a home, are doing so with more complex and multiple needs. This is putting increased pressure on providers and their staff teams.
The public’s view of care homes has generally been a negative one and yet their expectation of homes continues to increase. The new generations now moving in to care homes are bringing with them lifestyles and expectations that will seriously challenge services. The increase in dementia among the older and younger populations will require an enlarged and expert workforce who have adequate and continued support.
My Home Life Cymru as part of Age Cymru aims to work with the sector in identifying the needs and areas of development of homes, and subsequently support them to support those who are living, dying, visiting and working in care homes for older people in Wales.
John Moore, My Home Life Cymru Programme Manager
7 February 2012