The project and research aims to improve the understanding of the issues impacting the care and support of people at home across Scotland.  Working across sectors and with national and local partners, it will support an improved understanding of the challenges and the reasons behind them.  It will produce an evidenced based, informed set of recommendations to address these challenges.  Throughout it aims to identify and evaluate innovative and sustainable models of care and support at home, workforce compositions and commissioning and procurement methods.

Throughout the study some key principles have emerged. The research has shown that Health and Social Care Partnerships (HSCPs) and providers are struggling to deliver services where there is a continuing increase on demand both in terms of volume of people and more complex needs.  The evidence suggests that services for older people are much less outcomes focussed and personalised and that if things to do not change this pressure will only result in reduced quality services for older people in Scotland

In order to alleviate pressure on the system whilst delivering the best quality and outcome focussed support we need to start thinking a little differently. Although a lot of the principles outlined in the research are not new, it is about ensuring we deliver consistent quality services across Scotland.

Services and systems which focus on prevention and promoting independence deliver better quality support.  Some of the evidence suggests people with individual budgets or just more choice and control actually have reduced packages of support.  A one size fits all approach is much more common in older people services compared to other adult social care.  This is unfair and unnecessary.

Services which are joined up and include a holistic assessment process also produce better outcomes for individuals and reduce resource requirements. This assessment process should also have Technology Enabled Care embedded into it. It is not about replacing the human aspect or cutting costs. Although evidence shows TEC can provide cost savings. It is about promoting self-management and independence.

We need to empower the frontline staff to be able to make decision and have level of autonomy to make services flexible.  This does reduce pressure on the system and ensures people receive the most appropriate support at the right time.

We also need to have a strength based approach to assessment, support planning and managing ongoing support.  Understanding someone’s own capabilities, their networks and the community provisions can change their life whilst providing clear efficiencies in the system

These things are not easy – otherwise we would all be doing it.

There are financial challenges and in some cases change will require upfront cost and restricting a system. However, long term a focus on prevention, self-management and strengths will provide savings whilst continuing to meet people’s needs. But the whole thing works when we recognise each stakeholder’s role and value their contribution.

We need to be brave – think differently.  Share information and best practice.  We also need to understand we can deliver personalised support in the current financial climate if we all work together.  Care and support at home services are literally changing lives and will continue to do so.  The value of the work being carried out cannot be underestimated and I hope we continue to create a system that delivers on more people’s outcomes.

Quotes from individuals when asked, 'what difference does your care and support at home service make to you?':

‘It has been phenomenal’ – Carer for elderly mum and partner

‘I couldn’t have managed at all’ – Individual in older person’s service

‘I really appreciate every day they are here’ – Individual in older person’s service

‘Everything! No way I could do without it’ – Individual in older people’s service

‘I wouldn’t be able to get washed, dressed or even do my make-up. Stuff other people take for granted’ - Individual with physical disability

‘It cheers me up’ – Individual in older people’s service

‘It stops you having to go back to hospital. It keeps you sane’ – Individual in mental health housing support service

‘I wouldn’t be here without it -’ Individual in learning disability service.

 

Maggie Dowe

Care and Support at Home Development Officer

@socworkscot

#homecare17

I was fortunate to be asked to judge this year’s Care at Home Annual Care Awards for Scottish Care.  This is a humbling and daunting task not only given the number of entries for the individual categories but also in having to choose a winner when so many dedicated and inspiring people have contributed to supporting and caring for people at home.

As someone who has worked with the sector for several years I am well aware of the challenges and complexities of providing individual, person-centred, quality care in someone’s home environment.  People working in this sector have to possess a broad spectrum of abilities and a caring compassion for fellow human beings. 

I live in a small quiet rural village in South Ayrshire and there are a large number of retired and elderly amongst the population.  I have a neighbour with dementia and know of another resident in my street who is bed ridden and been house bound in the 4 years I have lived there.  In walking round the village in a morning, lunchtime or early evening there is always a hive of activity with numerous care at home workers arriving at various cottages and houses to carry out their duties.  What strikes you is how cheery and friendly they are no matter what time of day and in hearing them opening the door and warmly greeting the resident inside.  What that must mean to the individual receiving the visit cannot be imagined.  Never mind the care, even just that interaction and a friendly face must be a huge tonic.

These rural villages have many people who have grown up there and probably never moved far.  They are part of the fabric, the community, the very demographic that attracts people to retire to the country.  How different it would be if they could not be cared for in their home.  The nearest care home facility is small and 4 miles away with the remainder some 10 miles plus within the nearest main town.  Many of these people still manage out to the local village shop or to the church and continue to support village activity and the community.

The positive impact therefore not only for the cared for but also the wider village is significant and is probably underestimated by the very dedicated people who provide the necessary care. 

So a judge tasked with picking a winning care at home business or a care at home employee is indeed put in a difficult position because so many do so much every day, seven days a week, every week of the year for someone’s neighbour, friend or family member.

 

Derek Breingan

Head of Health and Social Care Sector UK
Corporate and Structured Finance
Clydesdale and Yorkshire Bank plc

@DerekBreingan

#homecare17

Do you know an extraordinary individual who receives home care support?  Tell us about them!  #homecare17

Hamish, 82, has Parkinson’s Disease but remains cognitively sound. For four years he has had support visits three times a day: morning personal care, lunch time and a combined teatime/night settling visit.

Every morning, Hamish walked with his Zimmer frame to the bathroom sink where he stood to shave himself. He then went back to his bedroom to wait for his support staff to arrive. They would bring him a basin of water and soap and help him to wash. They would then dress him and he then walked to the living room where he sat in his riser/recliner chair. Hamish agreed very cautiously to try changing his routine to a more enabling one and his personalised support plan was put in place.

2 months later:

• He was totally independent with his morning routine, washing himself at the sink in the bathroom and dressing in the bedroom. He needed assistance only to put on his shoes.
• He set out his own clothes, something he did not do before. He also wiped down the sink after his daily wash.
• He asked to learn how to operate the washing machine and always had a fresh load for staff to hang up.
• He made his snacks and drinks by himself and asked for a tray for his Zimmer frame so he could carry it from kitchen to living room. He wanted to learn how to operate the microwave.
• For the first time in two years, he ventured out alone to the local shops to buy his newspaper. In the warmer weather, he planned to spend time in his garden.

#homecare17

Preventative home care support is also about identifying the additional support needs of individuals and signposting them to additional and innovative ways in which they can have these needs met.  Often, these needs relate to nutrition and companionship.  Here we share one way in which home care and community initiatives can work in partnership to best support individuals.

Do you like the idea of a friendly neighbour bringing round a lovely home cooked meal and stopping in for a chat? If you do, then it is about time you heard about Meal Makers!

Meal Makers bring together people who love cooking and their community (‘Cooks’), with older neighbours who would appreciate having some delicious home-cooked food delivered to them (‘Diners’).  Meals are most commonly shared on a weekly basis, but they can occur fortnightly, monthly or just now and again - how often meals are shared, and when they are shared is decided between the Cook and Diner. There is no cost for receiving meals, the only cost associated with Meal Makers is a £5 annual membership fee.

The community food sharing project was originally launched as a pilot in Dundee in August 2014 and proved to be an instant hit across the city. It has since been launched in Glasgow, Perth and Kinross, Renfrewshire, Edinburgh, Stirling, Scottish Borders and North Ayrshire.

People across Scotland are loving being a part of Meal Makers, as they have been making great friends and eating delicious food through the project. If you are interested in joining Meal Makers then get in touch and they will match you with a Cook who likes the same food as you and lives within your local community, or if you would be happy to cook an extra portion and would like to volunteer please contact them on:

0800 783 7770 or [email protected]

Here is what some Cooks and Diners have to say about the project:

“Maggie makes some really delicious dishes, but it isn’t just about the food, it’s about friendship, too. It doesn’t sound like much, but it’s something I really look forward to each week. It’s strange to think that a year ago we didn’t know each other, yet now we’re good neighbours.” Pam – Diner

“I was so nervous when I delivered the first meal to my diner, Edith, in case she didn’t like it. In fact, she has turned out to be an adventurous diner who likes most of the same things as me despite our 60 year age gap!” Nancy – Cook

“What a great service meal makers is. I really enjoyed my chats with Rosaline and the food she is providing is fantastic.” Alice - Diner

#homecare17

I started out my adult working life as a care assistant in an Eventide Home – as they were called back then.  Our residents were much fitter than people living in care homes or being supported by care at home staff today.  At training sessions we used to speak about ‘visible’ and ‘invisible’ work – where the former was about tasks and activities that were easy to identify and describe – often involving ‘doing things’ for people or carrying out ‘housekeeping’ tasks.  Whereas work described as ‘invisible’ was much harder to describe and define – often because it was very individual to each resident and tended to be about the relationship you had with the person and what mattered to them.  It often involved stepping back and having a conversation.  Not easy to quantify or see as immediately being ‘busy’!

Today we recognise the value of having conversations with people – finding out what matters to them, finding out how best to support them with whatever that is.  This forms the basis of current policy around building community and individual strengths for health and wellbeing, and underpins legislation which puts the person at the heart of health and social care.  And yet, with pressures on hospital services – both planned and emergency – all too often staff supporting people can find themselves still ‘doing to’ with tasks and activities for the person.

I decided to train as an AHP whilst working in my first job, and have subsequently worked in both health and social care.  I am now working in Scottish Government as the national AHP Lead for Early Intervention.  This is an exciting post as it gives me the opportunity to carry on work I have been involved in for about 9 years – how to give people personalised help, information, advice and signposting to enable them to be as active and independent as possible for as long as possible.  Of course ageing is inevitable, but how we age is not – we can shape how we age – with the right information, advice and support we can make the most of our circumstances and keep active, healthy and independent which will help us have a better experience of ageing.  This is a major theme of our AHP national Active and Independent Living Programme (AILP).  By finding out where people are on their own Lifecurve™ – by asking which of the 15 activities of daily living they can or can’t do without help - we will have better conversations with people about what matters to them in keeping active, healthy and independent.  We can then work in partnership - with people themselves and with colleagues across the sectors to support people with the right kind of intervention – including what kind of support people want at the end stages of their life.

It is very exciting to see Scottish Care collaborating with the Lifecurve™ work – the results that you will add to the existing 15,000 responses will really help shape health and social care services – so they are focussed on individuals and what matters to them – and encourages active, healthy and independent living for as long as possible.

Susan Kelso

AHP Lead Early Intervention (Scottish Government)

@susankelsoAHP

#homecare17

It is important to highlight the good work that is being done in care at home and housing support services across Scotland and I am pleased to support the inaugural Home Care Day and, in particular, to be initiating today with a focus on high quality care.

We all recognise how important it is to enhance lives and improve wellbeing for a wide range of people. It is also important that we can enable and support people to live well in their own homes and be part of their local community.

High quality care is about listening to the needs of the people we care for and about providing the best possible experience. High quality care is about supporting improvement and working in partnership to support new models of care. And, for the Care Inspectorate, high quality care is about working with providers and many others, to provide public assurance to people and communities.

Scotland’s new Health and Social Care Standards enable us to achieve this. Rather than being relevant (just) in regulated services, the new Health and Social Care Standards are relevant across all health and social care provision. They are significantly more rights-based and outcome-focused than the standards which were developed some 15 years ago. The keen focus on human rights and wellbeing is one of the features that make the Health and Social Care Standards unique and innovative, something that will support good care.

As the Care Inspectorate develops new approaches to scrutiny and improvement, the Health and Social Care Standards will play an important role in our wider work on inspecting care and reporting on the difference it is making for people. We will use the new standards to continue to champion high quality care wherever we find it and to work closely with providers and support them to improve, where needed.

We are currently developing a new inspection framework which will use the standards to set out the impact we expect care to have, and the key enablers of good care we expect to be in place. Our inspection framework will be clearer about what we expect to see in different service types and will be capable of being used for self-evaluation by care providers too.

I am sure that you will now be getting familiar with these new standards and thinking about what these mean for you, those that you care for and overall quality and service provision. Our expectation is that from April 2018, all care services, social work services, local authorities, integration joint boards, community planning partnerships and community justice authorities will take account of the new standards when planning, commissioning and delivering high quality services. To support good care, over the next year, we will continue to work with providers, commissioners and Scotland’s committed and skilled social care workforce.

The new Standards will form the basis of our future inspections but they are not just designed for scrutiny. They are explicitly designed to support the way services are planned, commissioned, and delivered, and to be used in supporting improvement too.

To me, the Standards will support high quality care by helping to reinforce that assessment of quality is not be whether a minimum standard is met but whether the experience and outcomes for people are positive. I would like our partnership working to enable services to creatively solve problems and to improve through innovation.

I hope Home Care Day will be a huge success and I will be following today’s discussions with interest.

Karen Reid
Chief Executive, Care Inspectorate

#homecare17

Ines Garcia Pena has been a CAREGiver at Home Instead Senior Care Glasgow North now for just over six months. She’s providing vital support for seven of our regular clients who she’s visiting several times a week.
Ines goes out and cares for our lovely clients in their own homes, helping them with everything from companionship to help around the house and personal care.
All of this enables them to stay independent for much longer ensuring a better quality of life.
Here at Home Instead Senior Care, we focus on a personal and friendly experience and we want to be so much more than just a service. We want to be that person our clients look forward to seeing every day and Ines plays a huge role in achieving that.

What did you do prior to starting with Home Instead?

In my native country of Venezuela, I was an employment solicitor and I used to negotiate collective agreements and arbitrate conflicts between employers and employees/unions.
Here in Scotland, I have mainly been a full-time mum to my two daughters, although a couple of years ago I worked in the care sector looking after at risk children and young adults.

Why did you decide to be a home care worker?

I wanted to help our clients to have the best quality of life possible and I firmly believe that there is nothing that can guarantee this as much as continuing to live in their home amongst all familiar surroundings and treasured memories.

What does your job mainly involve?

Some of my clients require personal assistance, i.e. Bathing and dressing, whereas for others I support with meals preparation or companionship. As the care provided by Home Instead is individualised according to the needs or requirement of each of our clients, no two shifts or days are ever the same.

Are your clients able to get out and about when you’re not visiting them?

Most of my clients have beautiful families that look after them, take them out to various places and if possible on holidays.
There is one very regular client who insists on going out in whatever weather to get her shopping, she loves her independence and her ability to still take care of herself!

Do you prefer being a home care worker, rather than working in a care home?

Of course! People are always happier at home.

What is the best thing about being a home care worker?

There are many things, but I think for me is the privilege of getting to know them and to share their memories with me. They have such wonderful stories to tell, I love just sitting down and listening to their experiences, adventures and life in general.
Being a CAREGiver for Home Instead has enriched my life in so many ways and getting to know these incredible individuals has been a true honour.

 

#homecare17