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Care Home Week 18: Project ECHO

It is indisputable that delivering care in a rural setting is vastly different to doing so in an urban environment. The saying goes that necessity is the mother of invention and those working in the social care sector in the Highlands would say that it is the geographical challenges that have shaped and driven the need for innovation, adaption and change in the region. 

Below we hear more about a telementoring project set up by the Highland Hospice.

#carehomeweek

Project ECHO at Highland Hospice – Working With Care Homes

At Highland Hospice we have been facilitating ECHO communities of practice since 2016, supporting care homes, out of hours practitioners, community specialist nurses (Macmillan Nurses), community pharmacists and more recently, remote and rural GPs.

Project ECHO began in New Mexico (USA), successfully increasing the ability of rural primary care clinicians to deliver “complex speciality care in the area of Hepatitis C.” It is now used for a wide variety of diseases including diabetes, asthma, and rheumatological conditions, and is proven to improve care.

The heart of the ECHO model™ is its hub-and-spoke knowledge-sharing networks, facilitated by specialist teams who use multi-point videoconferencing to conduct virtual ‘clinics’ with community providers. In this way, care home staff, primary care doctors, nurses, and other clinicians learn to provide excellent specialty care to patients in their own communities.

Participants benefit by receiving evidence-based, best practice guidance through expert presentations and by sharing their experience through the presentation of case studies. Facilitated discussion ensures that the ECHO mantra ‘All teachers and all learners’ is upheld.

To date, through ECHO, we support 20 care homes across the Highlands who wish to learn and share their experience in topics, chosen by themselves, related to palliative and end of life care.

In a recent evaluation of Project ECHO carried out by the University of the Highlands & Islands Department of Rural Health & Wellbeing, six care home staff were interviewed and their comments evaluated.

Generally, interviewees felt they needed support and advice to deal with palliative care, which can be a large part of the care they provide.  As care home staff do not necessarily have medical backgrounds, they value being able to just “pick up the phone” for advice.

Care homes, particularly in the Highlands of Scotland, can be located in rural areas that are a long distance from any specialist services. Research showed that being rural can lead to the feeling of being a “lost cause at the end of the valley”.

As an attempt to try and meet some of this need, Project ECHO was positively evaluated by care home staff who described a range of specific ways that they had changed their daily practice as a result of participating.

One manager had ordered fans straight away for residents with breathing difficulties following a session on breathlessness. Another described devising and introducing palliative care plans following discussion with District Nurses, GPs and families. This manager felt that these plans have had positive impacts on daily life in the home because they allow staff to pinpoint a resident’s needs more easily, without having to look through a whole care plan.  There was also a feeling of confidence to approach end of life care at the ‘moving in’ meetings with new residents and families.

Falls prevention and communication (ie use of talking mats; language and phrases to use with patients) were also identified as areas of increased knowledge for care homes.

Highland Hospice has recently been granted a licence as one of 11 (to date) global training centres or ECHO ‘Superhubs’ sited in the USA, Canada, South America, India and the UK. Highland Hospice is the only Superhub in Scotland, and we hope to replicate the experience of other areas of the world where Project ECHO has been described as a “revolution in medical education and care delivery.”

If you wish to learn more about Project ECHO please visit the University of New Mexico’s website (https://echo.unm.edu/) and if you would like to discuss ways in which Highland Hospice might help you develop your own ECHO communities of practice (in any healthcare field, not just palliative and end of life care) please contact either Sharan Brown (Project Lead) at [email protected] or Jeremy Keen at [email protected].

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Care Home Week 18: Guest Blog from Hospice UK

Cicely Saunders, the founder of the modern hospice movement said, ‘You matter because you are you. And you matter to the end of your life.’

We could add to the end of that quote, ‘no matter where you are’. Whether someone is in a care home or a hospice, they have an equal right to palliative care, and every person providing that care should be equally valued.

At Hospice UK, we recognise that care home and care at home staff are at the forefront of delivering palliative and end of life care, though many may not call it that. We also recognise the toll such care can take on staff who can feel unsupported and undervalued, as Scottish Care revealed in its major workforce report ‘The Trees that Bend in Wind.’

Hospice UK is the national membership charity for hospice care in Scotland, and across the UK. Our mission is to enable hospice care to transform the way society cares for the dying and those around them. Part of that work is to highlight and promote the benefits of joint work across care settings and expertise.

For example, over 37,000 Scots live in care homes, many with complex palliative care needs. With need set to grow against a backdrop of shrinking budgets and workforce challenges, we conducted a survey of Scottish hospices and found that 85% are engaged in some form of joint work with care homes, with member hospices keen to do more.

Examples of joint work include:

  • Technological ‘hub and spoke’ knowledge exchange and support like Project Echo where a hospice team works with a number of care homes across a wide area.
  • Hospices have developed a wide range of formal and informal training such as foundation level palliative care, Quality End of Life Care for All, communication skills, dementia focused care, complementary therapy, anticipatory care planning, debriefing techniques for emotional staff support and early identification tools. Hospices also offer bespoke and ad hoc training to social care staff such as pain management for people with cognitive impairment.

But there is so much more happening. Hospice and social care teams are increasingly working together across a range of settings with a range of objectives in recognition of the strength in collaboration.

The learning and support is two way: hospice staff have much to learn from social care colleagues. This joint work is about professionals with a wide range of expertise coming together to share resource, experience and strength to ensure the very best care is given to every person in need, and the people who care for them.

We know that partnerships between hospices and social care providers improve people’s end of life experiences and reduce avoidable hospital admissions. However, our research suggests there are barriers that can stop these partnerships reaching more people such as low awareness of the benefits of such partnerships and short term funding models.

Increasing awareness of what hospices, care homes and care at home teams do, and could be doing together is key to widening access to palliative care. At the same time, we want to see Health and Social Care Partnerships supporting joint work in their areas, and ensuring there is enough money to sustain joint work over time.

Collaborative working across providers is not just a nice idea. It’s absolutely crucial to supporting staff to deliver and sustain the best care to ensure everyone has access to palliative care at the right time, no matter where they are.

Eilidh Macdonald 
Policy and Advocacy Manager Scotland, Hospice UK

For more information on what hospices in Scotland do and about their work with care homes, visit www.hospiceuk.org – Hospice UK’s 2017 report: ‘Hospices and Care Homes in Scotland’ can be found in the Briefing and Consultations section.

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Care Home Week 18: Adapt to Physical Activity

The Care Inspectorate (commissioned by the Scottish Government) leads the ‘Care…about physical activity (CAPA) improvement programme’. Working with eight partnerships across Scotland, the programme will run until October 2018 and the CAPA team will build on the skills, knowledge and confidence of social care staff to enable those they care for to increase their levels of physical activity and move more often. Organiser hope that social care staff will also discover ways to be more active themselves. 

Developing and spreading work to improve physical activity participation in these care services through the CAPA improvement programme supports the Scottish Government’s 2020 vision of maintaining people in their own home or in a homely environment, prevention of ill health and admission to hospital and supporting self management.

Taking on the learning from CAPA can be hugely beneficial for care home residents but doing so is a process of adaptation for many. After seeing the tremendous advantages of moving more often, below we hear more about how to embed CAPA outcomes when the programme concludes this autumn.

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Maintaining and sustaining improvements key to CAPA legacy

In this film clip Louise Kelly, Improvement Manager talks about sustainability, how important it is for older people to feel fitter and healthier and to be able to move more every day and what we all need to do to make sure this happens. 

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Care Home Week 18: Change & Adaptation Blog from Margaret McKeith

If you could change one thing what would it be?

How often have you been asked that? Probably as often as “If you won the lottery, what would you do?” or “If you had three wishes, what would they be?”

Even I, the eternal optimist, have realised that a lottery win is very unlikely and that the chances of a genie springing out of a magic lantern is zilch.

Resigning myself to these two facts, what I can do is acknowledge my ability to create change and hope that I use this ability to both my advantage and to the advantage of others.

Whether they have an impact on only me or on others, whether they are significant and transformational, whether they are so slight they are barely noticeable, whether they are made on impulse or the result of long and careful planning, whether they are the result of situations out with my control, each and every one will make a difference of varying degree. My hope is that whatever change I make, the consequences will be positive.

If I was given three wishes, perhaps always making a positive difference to others would be one of them.

I am in no way unique, each and every one of us has the ability to change and adapt and to make “that difference”.  

Those of us who have been involved in health and social care for some time (longer than I am prepared to admit!) are used to change. No matter what role we play, we are continually changing and adapting to the environment we work in and to those around us.

This week we are celebrating care homes and the people who live and work in them. On being asked to write a blog on “change and adaptation” I thought about these people and considered what to focus on. I could have written about changes in technology and equipment, changes in registration requirements, changes in dependency levels, changes in expectations, changes in legislation and employment law and so on, but I haven’t.

 Although these all undoubtedly necessitate adaptation and change, I want to take the opportunity to acknowledge the “change” moving to live in a care home has on a person and their families and on the skills and dedication of the care home staff involved in supporting them through that process. Having the ability to support a family well during this time of transition is absolutely crucial. Providing this support requires a chameleon like ability to change and adapt as well all know that no two people or their circumstances are alike.

Some family members may have an enormous feeling of guilt and think they have let their loved one down while others view their loved one going into a care home and an exciting and positive new adventure. Sadly, in my experience, the former is more likely.

Negative media coverage, often biased and ill-informed, do not help. Though incidents of poor care in unsatisfactory surroundings do exist they are fortunately very much in the minority. Sadly good news and celebrating good care does not always sell newspapers, so is not always what springs to the publics minds when they hear the words “care home”.

The dedication of those working in care homes must be highlighted. Their commitment to making changes which result in a positive outcomes of those they support, their ability to continually adapt their approach and use different skills to best meet the individual needs of those in their care, their ability to adapt and respond appropriately to highly sensitive and often emotionally charged situations, their quest to gain further knowledge and expertise and their relentless drive to make a positive difference must be acknowledged must be and celebrated.

If the words “care home” immediately conjured up the public’s visions of happy, stimulated, active, valued, involved older people living in bright, stimulating, safe environments then the prospect of a loved one going into care would be much less daunting.

I mentioned earlier us all having the ability to make change. One I, and my colleagues in the Partners for Integration and Improvement team within Scottish Care, can make and strive to make is to change the impressions the public has of our sector. By highlighting and sharing good practice and by supporting innovation, we hope we are making a difference. We feel we owe that to our colleagues working on the front line.

Going back to my three wishes, if I was granted these, one would be that the myths that Karen Hedge (National Director, Scottish Care) discussed in her blog earlier in the week, would be completely and utterly busted.

Let’s make that change.

Margaret McKeith

National Lead, Partners for Integration

@MargaretMcKeith

#carehomeweek

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Care Home Week: the role of care homes in supporting solace

In the fourth day of Care Home Week 2018, we're focusing on change and adaptation in the care home sector. 

One of the most significant changes in recent years has been the complexity of care required and lengths of stay of care home residents, with many care homes now delivering high levels of palliative and end of life care.  

Care Home Week is therefore a good time to highlight the critical role of care homes in the last days, weeks and months of someone's life and their ability to support someone to have a good death.

The care, compassion and skills of care home staff are highlighted in Scottish Care's 'Supporting Solace' project including the Trees that Bend in the Wind report.

We encourage you to use Care Home Week as an opportunity to explore the Supporting Solace resources, to celebrate care homes' role in high quality palliative and end of life care and to consider how care homes and their staff can be further involved in partnership working, knowledge exchange and resource sharing in this vital area of care and support.

 

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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

 

#carehomeweek

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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

 

#carehomeweek

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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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