Constantly Adapting – The Changing Nature of Care Homes

Care homes have, for many years now, been changing how they operate, and this has been well documented throughout these years although it was still not widely known among the general populace.  Covid-19 has started to highlight this work to a far greater degree, and it has also created a time of rapid change within these care homes to adapt again to the ‘new normal’ that we are currently experiencing.

At the heart of these care homes are the workforce, social care nurses, care and support workers, care managers, kitchen staff and domestic workers.  Today on Scottish Care’s Care Home Day we are looking to thank these workers and take time to really reflect on the work that they do and most importantly the work they have done in the last few months since Covid-19 arrived.

Thankfully now we have the platform of social media to really highlight the kind of dedication, commitment, and compassion that the social care workforce has embedded in their nature and in their practice when delivering care services.  This has shone through in the actions of those workers who have for example stayed for periods of time in their care homes with residents to reduce the risk of the virus being brought into the care home.  There was the ‘Dedicated Dozen’ made up of 12 care workers who made the decision to move into their care home for a #32dayshift to protect their residents and the wonderful stories that came from their experience.  Other care homes had staff make the same commitment and the overwhelming theme of their stories was the increased closeness of relationships they had built during those times with each other in their staff teams and with the residents.

These examples and others show the huge dedication of social care staff who continually make personal sacrifices, not seeing their own family members and being away from home to deliver that care and to best protect those most vulnerable at time they greatly need it.  In general care home staff have worked tirelessly coordinating shifts and ensuring that the amount of footfall within care homes has been reduced as much as possible.

Staff have continued to adapt to the necessary confines of the guidance that has been produced to ensure peoples safety.  This has been extremely difficult for care staff who have had to make sure that residents stay in their rooms to comply with social isolating.  Given that most of these residents are extremely fragile with various comorbidities and often complex dementia this has been a hugely emotional time for both staff and residents and care staff have remained the staunchest of defenders of those they support.  Care Home staff have continued to highlight that the importance of a good quality of life, of meaningful relationships and human contact for older people remains the same as for everyone else and that the removal of this contact has had such a significant impact on individuals who live in care homes.

This is another reason that Care Home Day is so vitally important to recognise this work and to offer reassurances to people that care homes remain safe and dedicated to the importance of inclusion and good quality of life for everyone.  Those currently supported in care homes and their families have seen firsthand and can attest to the dedication of these staff.  Care workers who have stepped up and taken further that role of providing comfort, support and care when needed and when families have been unable to be there particularly for those at the end of their lives.

This same energised approach is now being used to plan and set up visiting with family members desperate to see their loved ones after so long.  Gazebos have been purchased and risk assessments carried out, another great deal of work undergone to ensure residents can be supported to safely make contact again with the outside world.  Dealing with additional problems of wind and rain and those gazebos being chased down streets, the care sector somehow always manages to laugh at their challenges along the way.  Once again I cannot express how much of a fight care homes have put up to ensure equality as much as possible for their residents and have highlighted the unfairness and disparity of approach against those simply because of the setting in which they live.

Care home activity coordinators have been working hard to come up with new ideas of entertaining residents and providing much needed stimulation within the restrictions of social distancing and all with the use of extra PPE such as face masks.  Technology is being increasingly explored to see how it can be used to its fullest and the workforce has responded with enthusiasm for the task ahead, introducing innovative ideas and approaches to working with people.  White boards have been used by residents to write messages on and then shared through social media and tech devices such as ipad’s.  This has helped with staying in touch and connecting to family and friends and has also reminded the world that the residents in care homes are still thriving.  The sentiment has definitely been that keeping distance from each other is not ideal but there are still plenty of laughs and fun to be had.

Care Managers especially should be shown heartfelt gratitude and appreciation for the manner in which they have held everything together and during a time when they were experiencing their own high levels of anxiety while giving much needed reassurance to their staff teams.  Care home managers have shouldered the bulk of the responsibility, making tough decisions on a daily basis and putting into place the strict measures needed to keep residents and staff safe using guidance that was constantly changing.  These managers should receive awards not scrutiny for how they have risen to the many challenges and have kept the morale of staff, and those they care for, going through this complicated and frightening experience.

In light of all this, it is my request that the same dedication, compassion, and support is given to these workers.  Staff who are hitting a point of exhaustion, who need to talk through their experiences and make sense of what they have been through and have witnessed.  The health and wellbeing of these workers is of paramount importance and there is stark evidence to show the ongoing impact of the pandemic on the workforce if these supports are not made readily available when needed.

Thankfully, there is a great deal of work going on in the space of staff wellbeing and Scottish Care will continue to actively participate in these conversations and to fight for support and appropriate resources for the social care workforce.  We aim to show how much regard and respect we hold for care workers, care managers, social care nurses and other members of the care home workforce who truly epitomise the meaning of the word care.

Caroline Deane

Workforce Policy and Practice Lead

Care home as community.

If you look up the dictionary you get loads of definitions for what a community is. Its described variously as a unified body of individuals who have common interests living in a particular area; or its defined as the geographical area itself or pictured as a body of persons of shared and professional interests scattered through a larger society, and so on.

But actually, when I think of the word community it combines all that sense of space and place, of people and belonging. When I picture community, I see faces and folks, a sense of togetherness and attachment; a sense of arrival and coming home rather than travelling to a destination. For me a care home is a superb living example of what a community is all about.

Today is Care Home Day and I am very pleased to be able to write a few thoughts on what a care home community is all about.

In the last few months we have seen witnessed in our care homes a story which has shown the absence of the characteristics which make up a normal care home. These are places of interaction and engagement, full of banter and gossip; spaces where people come and go, of busyness and belonging. If you want to seek solitariness and silence your average care home is probably the last place you should go.

In the last few months, however, as the pernicious Covid19 virus began to impact upon the whole world, care homes have become places of quiet; of curtailed activity and limited engagement; locations which have sought to isolate individuals in a desire to protect and keep them safe. Far from being places of busyness they have become withdrawn, far from being places which reach out and pull the wider community in, they of necessity have had to shut their doors and seek to keep out family and friend, young and old alike.

That is one story of the last few months. It is a hard story whose lessons we must learn and whose pain we must feel. But care homes even in these hard times have still been places of community. They have seen and heard words of love, care and compassion; they have witnessed the gentle presence of comfort in the midst of fear; solace at times of sadness and reassurance in moments of anxiety.  The staff in our care homes have gone beyond calculation in their dedication to those they support and residents themselves have sought to support one another in these challenging days.

A community is not just a physical place or even the gathering together of people with shared interest. A community is a place where you can be wholly who you are without pretence or mask, where your humanity can be honest, and you can be comfortable in your own skin. I have lost count of the folks who have said to me that moving into a care home was the best thing that they had done in their life. From loneliness they have found company, from isolation they discovered a sense of togetherness, from mental distress they gained restoration. That is the real sense of community in care homes in ordinary times.

It is hard to think of normal times when we are still in these strange days but despite all attempts of Covid-19, there is a beating heart within a care home which is pulling us back to those better times. There is a rhythm of comfort and care which despite challenge reminds us that care homes are communities where the best of what it means to be human is on display every day. Care homes will again become places where song and togetherness, exercise and competition, encounter and memory sit together and ruminate over time. They are places where people dream not solely of the past but of what tomorrow might hold. They are places where there is such brilliant original artistic and literary creativity. They are places where the young learn the lessons of age and where those old in age are enabled to become young in heart. This is the real story of community in our care homes.

So today as we recognise Care Home Day, we thank all involved in the last few months, we remember the sadness , loss and the hurt, but we also promise to work together in all our local communities to place our care homes in the heart of not just our concerns but of our daily living. Let us wrap round our care homes and let them find a place in the centre of all our communities.

Dr Donald Macaskill.