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Care Home Week 18: Celebrate Success

In the social care sector, perhaps more than any other, celebrating success is just so important. All too often the narrative around the sector in general is relentlessly negative and we are so caught up in fighting for solutions to the problems that we forget about all the brilliant work being carried out day in day out by the thousands of people who work in care homes around Scotland. 

So, pause for a minute and think about the things that are going well and the positive impact the workforce are having.

To illustrate the point, below we hear more from Balhousie, who have had a recent run of success. Have a read and think about what your organisation is achieving - if you want to shout about it - let us know and we can celebrate during Care Home Week 18!

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Care Home Week 18: An Enablement Approach

Continuing today’s Workforce theme of 2018 Care Home Week, it’s great to share an example of a new approach being taken in Aberdeen to train all front line staff, including those working in care homes, in supporting people to regain life skills and contribute positively to their quality of life.

About Aberdeen City’s Enablement Project

At the Care at Home conference recently, the Cabinet Secretary for Health and Sport, Shona Robison, spoke about Hamish, who had been supported by Aberdeen City’s Enablement Project to develop his own interests and to become much more active in his daily life. Scottish Care in Aberdeen City has developed an approach to personalised planning and working with support teams to create enabling support plans, which focus on a whole person approach and the optimising of their abilities.

What is an enablement approach?
Enablement supports older people and people with disabilities and long-term conditions to regain and maintain their life skills. This approach motivates individuals to participate in their daily life activities. Evidence shows that using the Enablement approach leads to improved personal abilities and encourages people to see themselves as their best assets.

Scottish Care received funding to develop an enablement model in independent and third sector organisations. The project provided staff with training and support across care homes, care at home services, supported housing and community projects. The approach has been very effective and has brought about changes in practice and in services provided.

What do we do?
All front-line staff in an agency are trained to implement a whole person approach that supports the individual in the optimising of abilities. We promote a whole-system culture change to provide ’the right support for the right person at the right time’. Providers are supported to fully embed the model across the whole organisation.

Enabling Support Plans Which Transform Lives

This model of support is not time-limited and is open to anyone. In contrast to short term re-ablement models, which exclude a high percentage of people already in receipt of services, enabling support plans for those with complex needs work on a whole person model: sensory, physical, psychological, cognitive and environmental, and the benefits are significant.

Scottish Care’s Enablement Project in Aberdeen City employed a senior Occupational Therapist and a Project Lead to work with organisations in the older people sector to support whole system culture change in providing an Enablement approach. We focused on all staff and all clients to:

  • Deliver initial training on enablement
  • Provide on-site support for staff
  • Identify and embed the use of resources and tool kits
  • Provide expertise with links to relevant local and national projects
  • Collect qualitative and quantitative data to capture outcomes
  • Use case studies to evidence contribution and attribution
  • Explore links to both improved recruitment and retention in the sector.

Most service users in the organisations we worked with reduced their dependency levels. In care homes, there was a reduction in challenging behaviour and residents enjoyed increased activity and a better quality of life. Outcomes improved, in particular, for individuals with dementia and cognitive impairments.

  • Workers became skilled in assessing, task analysis, small-step goal setting and writing personalised support plans to deliver a consistent approach
  • Communication, reporting and supervision systems within the organisation and with partners improve
  • An Enablement module was developed and piloted
  • Partnerships were developed with other projects such as NHS Falls Programme, Medication Management, Walks for Life and Wellbeing Team.

The Enablement project is currently working in partnership with NHS Grampian staff to develop a foot care project in the West locality of Aberdeen.

Find out more here:

Julia White, Sha’yo Lai, Marnie Macdonald
Aberdeen City

 

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Care Home Week 18: Workforce Blog from Katharine Ross

Let your actions be stronger than your excuses

For the past 8 weeks, I’ve managed to do something I thought would be impossible:  I’ve cut sugar out of my diet.  Now, I won’t go into the health and lifestyle reasons behind this bold decision in this blog, but if you catch me tucking into a tub of almonds at a meeting sometime soon I’ll happily discuss metabolism and insulin spikes with you in more detail!

In an office where I had a meeting last week I noticed a poster advertising a local boot camp which was enticing new members with the phrase ‘let your actions be stronger than your excuses’.  If I’m completely honest, I felt a surge of pride.  Who’d have thought I had such willpower!

I should emphasise that it’s not just refined sugars I’ve shunned.  Oh no.   I’m carefully avoiding all food which contain oodles of sugar but which is marketed as ‘low fat’ and ‘healthy’.  Also, a significant number of my meetings as the National Workforce Lead for Scottish Care take place in coffee shops which always have an enticing array of pastries and I must admit to having a terrible soft spot for almond croissants.  Mmmm…almond croissants…..

Anyway, back to the blog.

There is a growing recognition that the health and social care infrastructure in its current format is not delivering human rights based care and support to older citizens living in Scotland.  The system is broken and one of the reasons is chronic staff shortages.  A recent Scottish Care workforce research report entitled ‘The 4 Rs’ confirmed our fears; fewer people are entering the social care sector and more people are leaving.

And they’re not coming back.

The workforce that do stay are at breaking point, desperately trying to provide compassionate and person focused care – but finding themselves crumbling, physically and mentally, under unsustainable pressures.  This was captured in another Scottish Care report entitled ‘Fragile Foundations’.

I believe that the failure to embrace integration and to actively engage the independent sector is at the heart of the present-day problem.  85% of care homes in Scotland are independently owned and there are almost twice the number of people living in care homes in Scotland than there are in hospitals.    A new report about the economic impact of the adult social care sector highlighted the fact that the sector contributes £3.4 billion to the Scottish economy.

However, I’m not seeing much action to embrace the reality – and potential – of working in a collaborative, integrated way.

There always seems to be some excuse….

Don’t get me wrong, at a local level there are several examples of effective integration projects which are taking place.  There are two remarkable projects currently progressing which involve Scottish Care providers and the Prince and Princess of Wales Hospice – exploring anticipatory care plans and how best to maximise the potential of the new palliative and end of life care educational framework.  From a workforce perspective, it’s extremely encouraging that we’re involved in more cross sectoral activities and work closer than ever with the Scottish Government, the SSSC, Health Care Improvement Scotland and the Care Inspectorate on both operational and strategic developments and improvements.  Relationships are being built and meaningful changes are being seen.  This is all very positive because it’s widely acknowledged that transformational change is needed – not a little tinkering around the edges – if we are to maintain and improve health and social care provision.

However, tinkering around the edges is what I continue to see.

Strong decisions and policy implementation are eschewed in favour of “guidance”.  Health continues to dominate our national political discourse to the detriment of the social care sector.  Decisions are being made at a local level which could have significant unintended consequences to our dedicated, skilled yet dwindling workforce and providers.  Only last week the Edinburgh Health and Social Care Partnership announced a new approach in their attempt to address the significant number of older people waiting for a care package or who are inappropriately staying in hospital when their needs would be better met in their own home or a care home.  This approach is going to rely on relatives providing more preventative interventions and being more pro-active in their relative’s care. I would welcome a discussion with the HSCP to find out more – as I have a concern that an unintended consequence of this proposed approach is that it sends out the message that ‘anybody can do social care’.

Well, they can’t and it’s a very dangerous assumption to think that they can.

Care at home providers are now looking after vulnerable people who often have extremely complex physically and mental health conditions.  The workforce undergo a significant amount of training to enable them to carry out their job safely and competently.

Care home staff are delivering extraordinarily complex care and are actually the largest providers of palliative and end of life care in Scotland.  Sadly, this is still largely unacknowledged.  Our report Trees that bend in the wind shone a light on the needs of the workforce who are, day in day out, providing solace to hundreds of people in their last days and hours of their life.

So: have we come to a point where we can’t accept any more excuses for not embracing integration in a way that will transform the lives of the workforce and the people they support and care for?

 

Katharine Ross, National Lead – Workforce Matters

@kguthrieross

 

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Care Home Week 18: Focus on 4 Rs

It is day three of Care Home Week 18 and today we are focusing on workforce. We thought this would be a great opportunity to share the findings of a recent Scottish Care report: The 4 Rs - The open doors of recruitment & retention in social care.

The report shows:

  • Employers have seen an almost 20% increase in those over the age of 45 applying for care vacancies.
  • Providers are operating a wide range of workplace benefits and initiatives to help with the retention of staff, most of which are premised on the importance of giving staff a voice and a sense of value.

However, it also highlights:

  • 63% of staff who have left the sector in the last year did so within the first 6 months of employment, mostly because of mutual unsuitability identified by the employer and employee.
  • Providers believe the lack of responses to advertised care vacancies plus competition with other employers and sectors to be the main reasons for recruitment difficulty.

You can read the full report below:

The 4Rs Report

Scottish Care’s National Workforce Lead, Katharine Ross said:

“A career in care is not the same for everybody but it needs to be available to everybody. This report captures the employment journey of so many committed, dedicated and skilled individuals of different ages, backgrounds and experiences working in care homes and care at home organisations across Scotland.

"However, it also shows the reality facing the care sector:

  • The reality of trying to develop, train, qualify and lead a workforce against a backdrop of task and time commissioning, fifteen minute visits and the persistent denial by policy and decision makers of the true cost of delivering dignified, person led, preventative care and support to older citizens across the country in care homes and care at home organisations.
  • The reality that the potential of health and social care integration is yet to be realised in Scotland and we continue to see the confliction of a health or social care workforce.
  • The reality that a largely unappreciated and undervalued social care workforce, delivering compassionate care to individuals with multiple complex mental and physical illness, is at breaking point.
  • The reality that fewer people are choosing to work within the sector, and more people are leaving.

“Only by acknowledging these realities will we be able to shut the door through which dedicated and skilled individuals are flooding out from, and create conditions where people enter, stay, develop and thrive in the care sector. It is the only way to ensure the development of a rights-based, dignified social care system for the tens of thousands of older people receiving care in their own home, or in a care home.”

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Care Home Week 18: Anne’s Story

As part of today's Human Rights celebrations to mark the second day of Care Home Week 2018, we're delighted to share a real example of human rights in practice in a Fife care home.

Anne's story, told by care home manager Sam Boyd, demonstrates how human rights are about the daily prioritising of choice, control, participation and dignity in supporting care home residents to live fulfilling lives.

Anne is 71 and has been a resident at Elizabeth House for the past year.

She has always been outgoing and enjoys living as independently as possible.

Staff and management have worked closely with Anne over a number of months to develop a lifestyle that suits her whilst maintaining her safety and dignity.

Anne is an active participant in the home's activities and has taken specific responsibility for certain tasks such as changing notice boards in the home.

More recently Anne has added to her responsibilities by accompanying our day care staff each afternoon on our mini bus to take our day care clients home.  She ensures that everyone is accounted for and not only relishes the responsibility but enjoys the company of our day care clients and staff.

After a careful risk assessment process, which included several trials, Anne now arranges her own transport to take her shopping once or twice a week. These trips can last from an hour to an entire afternoon.

Later this month Anne is going to see a tribute show of her favourite band, The Rolling Stones.

Anne feels her life has been considerably enhanced by taking this person-centred approach and she looks forward to even more varied and stimulating times in the future.

 

 

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Care Home Week 18: Let’s get creative – guest blog by Edith Macintosh

Blog: Let’s get creative and celebrate Care Home Week 2018

By Edith Macintosh, Head of Improvement Support

As we celebrate Human Rights day as part of Care Home Week 2018, we're pleased to share this blog from Edith which talks about the importance of residents' right to creative opportunities and the resources available to support this.

We’re delighted to be joining in the celebrations for Care Home Week 2018. It is a great opportunity to raise awareness of Scotland's care homes, the people who live and work in them, their role in local communities and the opportunities care homes offer to enhance the lives and wellbeing of a wide range of people.

The Care Inspectorate works closely with care homes, not only because we are a scrutiny body but also because we are an improvement body. In fact, we have a formal responsibility for furthering improvements in the quality of care to help ensure people’s experiences of care are the best they can be. Our improvement work goes hand in hand with our scrutiny role. Our inspections are increasingly focused on improving the experiences and outcomes for people, not just compliance against procedures and older standards.

Right now in care homes across Scotland we are involved in so many innovative projects that help to give people the opportunity to live life to the full and as they would choose in order to flourish and live it well. These include our Care About Physical Activity (CAPA) improvement programme commissioned by the Scottish Government to help older people in care to move more often, collaborative work to reduce pressure ulcers in care homes and our improvement resources Spotlight on Dementia and Spotlight on Bowel and Bladder, to name but a few.

Arts in Care is another really important resource that helps to enhance the quality of life and health of people as they get older by promoting the arts and creative engagement in care homes.

We are all creative, whether we think it or not – everything we do in life has some element of creativity about it. We all have different creative abilities but, as work on this resource revealed, no matter what age or stage in life we are at, being creative can bring meaning, purpose and fulfilment to people and help them to live well.

Arts in Care was launched by the Care Inspectorate, in partnership with Luminate and Creative Scotland, back in 2016. Since then, it has been wonderful to see the growth of these expressive arts activities in care homes. We are increasingly seeing the evidence of how participating in the arts and creativity can have a transformative effect on a person’s physical, mental, emotional and social wellbeing.

The pack helps care staff to provide opportunities for people experiencing care to enjoy a good quality arts experience in the care setting or with the local community.  It also encourages care services to link with professional artists. Examples include using technology such as iPads to make music, storytelling and poetry workshops, singing and dance projects and visual art activities.

Greta, a lady living in a care home who was involved in developing the pack, spoke about how she had used her hands to be creative all her life and still loved it, she was also one of the people who helped to write a lovely poem called Bird Watching, which she recited at the official launch.  Some people spoke about how the creative arts helped them to manage some of the symptoms of their ill health and others said it meant they connected more with people and places because of it.

Clearly creativity is a powerful tool to help us to pursue wellness and remain resilient in life and in many cases restore joy that perhaps has been lost or is not often seen.

  • If you would like to find more information and resources from the Care Inspectorate on improving care for people visit The Hub website.
  • For more information about the CAPA programme and to find the latest news, case studies and resources visit the CAPA website.

The Care Inspectorate’s Improvement Strategy 2017-2019 is published on our website.

Edith Macintosh

@EAMacahp

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Care Home Week 18: Being Human

Marnie MacDonald from Scottish Care, Aberdeen City presented at the Being Human Conference hosted by C-Change Scotland, which focused on Human Rights and Self Directed Support. Scottish Care was part a range of influential speakers on the subject as well as stories from individuals whose lives have been transformed for the better. Scottish Care covered the topic of Enabling Human Rights.

During 2013-2016 Scottish Care was involved in a major piece of work, prior to the current engagement project, on Enablement.

The Enablement Project focused on personalised planning and working with teams to create enabling support plans. Enabling support plans are holistic assessments of the service user and their abilities, with the focus being on a whole person approach and optimising of abilities.

An enabling support plan captures all necessary needs and information about an individual:

  • Physical
  • Sensory
  • Cognitive
  • Spiritual
  • Environmental

With recording the necessary information and providing it to all staff, this ensures a consistent form of support and allows changes to be monitored and addressed, whether positive or negative, effectively.

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Care Home Week 18: Human Rights blog from our CEO, Dr Donald Macaskill

I am very pleased to be writing this blog for the second ever Care Home Week. I’ve been asked to write about human rights and admittedly it’s a theme I have commented on not a few times since I took over as Scottish Care CEO in April 2016.

Indeed there has been a lot that’s changed in Scottish Care in that time. Carlyn Miller developed two fantastic human rights conventions alongside people who use services and supports; she also wrote a great report on the implementation of self-directed support using the PANEL human rights model; we’ve had two Care Cameos directly touching on human rights issues – one on dementia and another on social care and human rights in general; and in August we will be publishing a report on human rights and technology in care.

In addition Scottish Care has been delighted to partner the Life Changes Trust in a new grant scheme which has enabled some care homes to access grants to enable them to embed human rights projects. As these start we look forward to being joined in the future by a colleague to further promote the work of human rights in care homes across Scotland.

Outside of Scottish Care the creation and now the implementation of the new National Care Standards is evidence that Human Rights are very much at the heart of the delivery of care home services in Scotland.

So a huge amount has already happened and yet more is still taking place. With all this positive direction, however, I have cause to reflect upon the words of Eleanor Roosevelt, Chair of the United Nations Human Rights Commission who said after the United Nations Declaration of Human Rights had been developed seventy years ago this year:

“Documents expressing ideals carry no weight unless the people know them, unless the people understand them, unless the people demand that they be lived…”

I suspect that that is where we are at in Scotland in general and in the care home sector in specific at this moment in time. I am convinced that without an extensive national awareness campaign that people who are resident in care homes will remain largely ignorant of their rights and the new rights-based Standards. But it goes even further than awareness raising.

We have absolutely no chance of achieving a truly human rights based system of care and support in Scotland unless we are as a society and as politicians in particular prepared to put a resource behind all the good words and human rights rhetoric. Dynamic change and re-orientation to embed rights demands the acknowledgement that financial resource is needed.

It’s needed so that our fantastic care home staff can become human rights workers in their job of care and support, learning how to balance competing rights, and how to further promote dignity, choice and autonomy in the work they already do.

It’s needed so that we adequately resource, from a human rights perspective, the delivery of increasingly complex and demanding care home services, delivering person led care across the range of conditions and co-morbidities, from dementia to delirium; from multiple sclerosis to muscular dystrophy.

It’s needed so that we properly resource our nursing staff not only so that we have sufficient numbers of them but also that we can re-envision their role at the heart of human rights based clinical care.

Care homes are fantastic places where individuals are able to live their lives to the fullest until their very last breath. From the moment they enter till the moment they leave they have the potential to be supported in a human rights setting – but the reality of that requires a human rights based approach to resourcing and budgeting. It speaks ill of a society where 24/7 nursing care is being delivered at a cost of £4.10 an hour.

Human rights are the life-blood that courses through all care and support in a care home or elsewhere. But just as a human being needs nutrients and energy to maximise potential so too human rights need to be fed, nurtured and resourced. They cannot remain paper based aspirations.

We have come a long way, we have the Conventions, the legislation, the Standards, the policies and the projects. All that remains to paraphrase a fellow human rights contemporary of Eleanor Roosevelt is to ‘give us the tools and we will finish the job.’

Enjoy Care Home Week

Dr Donald Macaskill

@DrDMacaskill

 

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Care Home Week 18: Human rights resources

Today is the second day of Care Home Week, and is the day where we will be highlighting the important role that human rights play in care homes across Scotland.

In many ways, Scotland is leading the way in terms of human rights in social care. Not least given the introduction of the new Health & Social Care Standards: My Support, My Life in April 2018. These Health and Social Care Standards set out what we should expect when accessing health, social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld.

The Standards are underpinned by five principles; dignity and respect, compassion, being included, responsive care and support and wellbeing.

The Standards are based on five headline outcomes:

• I experience high quality care and support that is right for me.

• I am fully involved in all decisions about my care and support.

• I have confidence in the people who support and care for me.

• I have confidence in the organisation providing my care and support.

• I experience a high quality environment if the organisation provides the premises.

Care home services for adults are the first services to be inspected against these new Standards.

Scottish Care has also done a lot of work around human rights in the last year, including the publication of a range of Care Cameos:

 

Human Rights & Social Care is written by Judith Robertson, Chair of the Scottish Human Rights Commission, and is based on the speech she delivered at Scottish Care's inaugural evening lecture.

Human Rights & Dementia is authored by Anna Buchanan. Director of the People Affected by Dementia Programme of the Life Changes Trust and considers how human rights law can be practically applied to improve the lives and support of those living with dementia and their families.  Scottish Care has been working closely with Anna and her team and we are looking forward to announcing some exciting news around human rights, dementia and care homes in the coming weeks. 

Let's Talk about... Sexuality features contributions from a range of experts in the fields of sexual health, dementia and human rights to examine how we ensure that sexuality is recognised as a fundamental right and component of someone's identity, regardless of age, diagnosis or care circumstances.

It is essential that we keep the conversation around human rights going and Scottish Care remains committed to celebrating, promoting and upholding human rights during Care Home Week and far beyond it.  

Do you have a resource to share, a story to tell or a question to ask around human rights and care homes?  Get in touch this week!

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Care Home Week 18: Moving More Often (CAPA)

One of the myths about care homes is that once you start living there you no longer exercise or move around. If anything can dispel this myth it is the CAPA programme!

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Moving More Often

The new CAPA ‘Moving More Often’ resource is an easy to read guide for older people experiencing care in their own homes to enable them to move more every day.  The resource was produced to enable care at home staff to support those they care for to move more regularly and to improve their health and wellbeing. It can also be used by care home staff to support those they care for. 

The resource can be downloaded at http://www.capa.scot/?page_id=962  or for a free copy call 0345 600 9527 or email [email protected]

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 CAPA Moving more often presentationFINAL