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

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