The challenges of delivering services in care homes

Executive Director of My Home Life, Professor Julienne Meyer discusses the challenges of delivering high quality services to older people living in care homes. Professor Meyer will be speaking at Age UK’s Services for Later Life Conference on 12 July 2012.

Find out more about Age UK’s Services for Later Life Conference

Find out more about the My Home Life project

Delivering dignity

This blog was contributed by Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care.

After many years’ service in health and social care I have seen much in both to be proud of. I have witnessed excellent examples of compassionate care, met many dedicated staff and seen how high-quality services have transformed lives.

Yet I have also been deeply saddened by the knowledge that in too many cases care has fallen short of these standards, letting people down when they are vulnerable and most in need of help.

Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care
Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Carecare has fallen short of these standards, letting people down when they are vulnerable and most in need of help.

That is why I have been delighted to co-chair the Commission on Dignity in Care; an independent commission established by Age UK, the NHS Confederation and Local Government Association to bring together expertise from right across the care system, including nursing, social care, medicine and commissioning with the voices of older people and their families.

Our aim was to help health and social care sectors to find long-term solutions to tackling poor care that work on the ground.  We recognise that this is a difficult task, there are no silver bullets. Instead we wanted to understand the roots of poor care and find ways to support people to take action in their own organisations.

Today, just a little under a year since we began, we publish the Commission’s final report Delivering Dignity. The report’s main message is clear. Leaders in the health and social care sector must drive a “major cultural shift” to tackle the underlying causes of poor and undignified care of older people throughout care homes and hospitals.

The NHS already has ‘never events’, things that are considered so serious they should never happen, like operating on the wrong part of the body. The Commission has recommended ‘always events’,  things which should never be forgotten and should be considered as basic rules for the delivery of dignified care in every hospital and care home.

This may all sound a bit theoretical at first glance. However our report has made 37 clear recommendations for steps that could practically be taken by people at every level from front line staff to board members. Ultimately it is the individual actions of people in the system doing the right thing which adds up to major change.

Delivering dignity will mean changing the way we design, pay for, deliver and monitor care services as the numbers of older people in care continues to grow. Alongside the consistent application of good practice and the rooting out of poor care, we need a major shift in the system to ensure care is person-centred and not task-focused.

This will require empowered leadership on the ward and in the care home, as well as a lead from boards and senior managers. It will also mean changing the way we recruit and develop staff working with older people.

We have to work with older people to shape services around their needs, and listen to patients and residents and their families, carers and advocates so we learn from their feedback and continually improve dignity in care.

We are also clear that it is the leaders of health and social care who are responsible for driving better quality care.  Regulation and government action has a critical role to play, but it cannot alone deliver the cultural and organisational change that may be necessary.

In February we published an interim report to consult on our proposed recommendations. We were overwhelmed by the hugely positive response it received, with over 230 responses from across the health and social care sector, patient groups, members of the public and professionals. This clearly demonstrated to me just how passionately people feel about getting care right for older people.

Our next challenge is harnessing this passion and commitment to drive forward implementation of our recommendations.

I don’t underestimate the scale of this task and know we won’t see changes overnight. But from the very beginning we were determined that this wouldn’t be just another report that sat on shelf gathering dust.

In the autumn we will be launching an action plan. We will be seeking to work with people from across the health and care system, professionals and older people to make sure change happens.

Find out more about the work of the Commission and read the final report

Find out more about Age UK’s Care in Crisis campaign

Calling for your views on the Dignity in Care interim report

This blog was contributed by Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care.

Over the past few years we have seen report after report detailing shocking examples of care in our hospitals and care homes. In 2011 the Health Service

Dianne Jeffrey CBE DL, Chairman of Age UK and Joint Chair of the Commission on Dignity in Care

Ombudsman published its report Care and Compassionwhich told ten heartbreaking real life stories of older people subjected to undignified, degrading and harmful care. But the report was clear these ten accounts were the tip of the iceberg – they were not exceptional or isolated cases. So this begs the question ‘what exactly is going wrong in our hospitals and care homes? And what can be done to put it right?’

A determination to provide at least some of these answers led Age UK to join forces with the NHS Confederation and the Local Government Association to set up the Dignity in Care Commission. Our aim is to draw a line under the past, and focus relentlessly on what can be done in future to ensure each and every older person receives high-quality, dignified care. 

The Commission has now published their interim consultation report. We have heard expert evidence from right across the care system, including older people and their families, nursing, social care, medicine, management and commissioning. We have heard a great deal about the problems in the system and the impact on older people. But we have also heard much that is positive, highlighting where people are working with compassion and dedication to get it right.

This report is not a repetition of well-documented problems. Neither is it a best practice guide, much excellent work already exists and we have no desire to reinvent the wheel. Instead, we have focused on how to tackle the underlying causes of poor care which too often means excellent practice and innovation does not flourish.

We now welcome views from the public, professionals and organisations across the system on the detail of this report. We want to know whether there is anything fundamental that we have missed, or whether we should go any further in the changes we recommend and why. Most importantly, we want to know what we can do to make sure these changes take place. This is not a report intended to sit on our library shelves, we are committed to working collectively to bring these recommendations to life.

Read the interim report and submit your views

Find out more about the launch on the Age UK website

The Future of Care Homes?

This blog was contributed by David Richardson, Strategic Programmes Delivery Manager for Age UK. David develops and tests innovative services that address the needs of older people.

There’s an expectation, almost a mantra, that the future of caring for individuals with increasing support needs lies in their own homes. Tailored care packages will be delivered seamlessly and altered to meet changing individual need and preference. Care homes are redundant. Does it not sound a little utopian?

What does this mean for real people living in real communities?

Most domiciliary care packages address physical needs, although of varying quality and quantity. They are less successful in meeting psychological and social needs. Being at home all day with a succession of “help” is still a lonely and isolating experience with long term consequences for wellbeing. We are very good a deciding what is best for older people (that is those at least 20 years older than one’s self). But do we really know? The recent Joseph Rowntree Foundation (JRF) report A Better Life – what older people with high support needs value casts some much needed light on this neglected area.  

Is the move to providing yet more care in a person’s own home possibly driven by other considerations, perhaps the often expressed guilt of “have to put mother in a care home?”

There is another way. Residential care homes have provided safe havens for those with high support needs for many years. A few, rightly vilified by the tabloid press, have produced appalling experiences for their residents. Rather more provide a “satisfactory” level of care while a minority provide exemplary support. What defines satisfactory I don’t propose to unpack here – not least since it depends on your perspective.  There is another way.  The other way is emerging from the collaboration between City University and Age UK which is My Home Life.

My Home Life works towards just that – where living in a community is the chosen home for each individual, in the same way that they might have chosen to move house. Hence this initiative. In their new home residents are able to express voice, choice and control over their care and support. Still too utopian? Over 4,000 registered home managers, the National Care Forum together with other key care home organisations and regulators don’t agree.

Over the last four years My Home Life has developed an extensive evidence base of existing best practice in care homes. It promotes care homes as a positive accommodation option for older people where resident centred care delivers profound improvements to the quality of life experienced by care home residents. The chosen agent for change is care home managers themselves.

Care home managers undertake a structured leadership and management training programme which helps them to take a different view of their own domain. A common thread from their action learning groups is their identification that task-based approaches to delivering care are restrictive, not just for residents but actually for their staff; tasks become activities.

Typically, it takes two years to change the philosophy and practices of care delivery in a care home. Philosophy? Empowering care staff to think about what they need to do rather than processing tasks takes time. Adopting best practise over ‘drugs rounds’; embracing risk-taking for residents and opening the doors to the wider community also take time and challenges “but we’ve always done it this way”.

Putting residents firmly at the centre of all activities is empowering for the whole care home community – residents and their families, care staff, visiting health and social care professionals, regulators and commissioners.

The nagging utopian theme is still there, especially for care home operators and owners who have to get a return on their investment. There is strong anecdotal evidence that My Home Life has a positive impact on the ‘bottom line’. Staff turnover reduces, retention improves, sickness absence reduces. Void rates improve. This combination has a strong effect on margins and encourages investment in the training.

Commissioners in a number of local authorities have identified this collaborative programme as a powerful tool to improve safeguarding in care homes by driving up positive practice. Effectively, every member of the care team becomes a champion for residents who also have their own voice heard.

Improving the lives of some of the most frail and vulnerable older people approaching the end of their life is challenging. My Home Life provides a gateway to doing that. The future needs for those with increasing physical and emotional needs can be met in their own home – a home in the community where others are on hand to provide support.

Age UK are calling on the Government to reform the social care system. Find out more about Age UK’s Care in Crisis campaign and how to sign up to our petition.  

Read more about the My Home Life programme

View a presentation about My Home Life