New kind of reality show improves health in care homes

30 August 2017
Holistic assessment is not always associated with fun but that is the approach Wakefield’s enhanced care homes vanguard is taking.
 
The vanguard is supporting staff and residents in care homes and supported living schemes.
 
Addressing a session at the recent HealthplusCare event, the vanguard’s senior project manager, Lesley Carver, said: “We have been following NHS England’s enhanced health and care homes framework but holistic assessment is the USP of our vanguard.”
 
However, the team has been imaginative in developing those assessments – including using video diaries that not only give insights into what residents enjoy and what is important to them but also, according to Carver, “make them feel the star of the show”.
 
“We call the video concept ‘pull up a chair’. It was developed by Age UK and it’s about listening to the residents – finding out what it was like at home and what would make a difference in their lives. We use the LEAF tool to assess quality of life as it’s not just about bingo and bowls.”
 
They have also introduced dementia mapping which involves assessing a group of residents as they undertake daily activities over several hours.
 
“That allows us to identify the challenges that each resident faces, mapping social and physical surroundings affecting the person in a positive or negative way,” Carver explains.
 
The enhanced care home vanguard sites aim to tackle loneliness and fragmented care, by joining up services for older people in supported living schemes and care homes.
 
As well as identifying health care needs and new ways of meeting them, the Wakefield assessment process has improved general wellbeing by organising more activities in the home and excursions outside it.
 
“We get to know the residents in a truly person-centred way,” Carver says.
 
Recognising that care homes cannot provide everything a person needs to improve their health and wellbeing, the assessment results shape the strong relationships that the vanguard and care homes have built with community anchors. Community anchors are centres offering a variety of clubs, classes, and events aimed at helping older people improve their health and wellbeing.
There has been a dramatic impact on demand for health care services from residents of the first 15 care homes involved. The first 12 months saw falls of 13% for emergency admissions, 6% for A&E admissions and 5% for ambulance callouts.
 
Carver said this was against a background of increased activity across all three measures for the general population.
 
More people who have had holistic assessments are dying in their preferred place of care – a recognised indicator of the quality of end of life care.
 
The vanguard has now grown to cover 27 care homes and six extra-care facilities.
 
Carver says the latter accommodation, while maintaining older people’s independence, brings its own challenges for residents.
 
“We are working with a supported living scheme with 27 one bedroom flats to slow down progression into residential care. Residents do have their own front door but many are socially isolated so we did ‘pull up a chair’ and ‘portrait of a life’.”
 
The vanguard is built around a new multi-disciplinary care home support team which includes a general nurse, a mental health nurse and a physiotherapist. The team meets each week to develop personally tailored care plans for the older people they are working with.
 
It has helped build confidence in care home staff through ad-hoc training sessions and advice.
 
The vanguard has also been working to ensure that each care home is served by a named GP practice by the end of 2017.
 
Download the full edition of Commissioning Excellence September 2017.
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