Culture of Care

‘My home is my castle’
It is about status, ownership,
privacy and identity

www.institute.nhs.uk | Assisting the NHS in transforming healthcare

”Our home has become a way
of signalling who we are. The
symbolic value of how we live
has detached itself from the
utility value of the past
decades.” - Siv Raun Andersen,
Anthropologist, 2004


Why is it, then, that when
people move into a care
home such considerations no
longer seem to apply?

We are ambivalent about old age.
People are living longer
Number of older people is increasing
Society has the means to prolong life


Culture of Care
A reflection on how care
homes need to shift their
culture...from patronage to
engagement

The next 30 minutes
Background on care homes
Insights & Creating change that sticks
Example of what we are working on


When you hear ‘care homes’
Scandals
Poor quality
Money grabbing
Less relevant
In decline
Is there a viable future?


Speaking to someone
who considered whether
they would want to live in
a care home: “I have a
fear of living like this
when I am old”


Future projections of our ageing population
predict that older age groups are growing
much faster than the rest of the population:
By 2050, twice as many people aged over 85
and overall costs will increase fourfold.

Future demand for long-term care
services will grow rapidly:
There are 400.000 residents in approx. 18.500
care homes now.
By 2050, no of beds needed for elderly care is
expected to double to just over a million.

www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : National Care Association

How will the country care
for the growing amount of
older people?
Who will provide it?
Who will pay for it?

8 % of care is funded by the NHS
41% privately by the individual
51% by local Authorities

UK Councils are tightening their eligibility
criteria and rationing social services to
make ends meet. The great majority of
people with low or moderate needs
receive no support from Councils.

www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : Laing & Buisson UK 2011

Residents who will use care homes more
in the future are said to have ‘high levels
of needs’:

The average age of a resident is 85 years
75% are classified as “severely disabled”
70% have dementia
40 % are said to have depressions
66% have cognitive impairments

They are a much older and frailer
population than they were in the past

www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : My Home Life

The care home of the future
will need to become a central
part care solutions. It must be
radically different from
current propositions and offer:
Flexible care packages
responding to personal needs;
Affordable solutions to
citizens and the state;
Flexible use at the point of
need.

www.institute.nhs.uk | Assisting the NHS in transforming healthcare Image source : Hogewey

Although there is a sense of crisis
that care service are reaching
breaking point, ageing presents
huge opportunities to develop
new models of care outside of
care homes (for people with low
to moderate needs) which:
Harness increased willingness
of families & friends to provide
informal care;
Recognise that people due to
medical advances can stay
at home for longer.


From flexible care in your home to
the flexible use of a care home we
will need a variety of future scenarios...


But, we will also need to
mobilise existing resources.
“We have recognised the need to
make improvements in our care
home for a very long time but we
have never been sure where to
start and how to do it.” - Care
Home Manager


Evidence suggests that the
culture of a care home
Evidence suggests that the culture of a care home directly
directly affects the quality
affectsof those who live of those who live and work there
of life the quality of life
(Reed et al, 1997). A positive culture is characterised as one
and work there. A positive
where is characterised as one
culture the ethos of care is centred on the individual, based on
evidence of what care is for good care and continually
where the ethos of makes
effective within a changing health and social care context
centred on the individual and
(Manley et al, 2004).
their relationships.

www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : Reed et al, 1997 and Manley et al, 2004

Evidence suggests that the culture of a care home directly
affects the quality of life of those who live and work there
where the ethos of care is centred on the individual, based on
evidence of what makes for good care and continually


Creating small interventions which
Evidence suggests that the culture of a care home directly a
help to build relationships and
affects the quality of life ofcaring who liveMobilise existing
those culture. and work there
resources by valuing different
perspectives and fostering creativity,
evidence of what makes for good care and continually within.
learning and innovation from


Froma‘patronage’
Evidence suggests that the culture of care home directly
to engagement.
affects the quality of life of those who live and work there
evidence of what makes for good care and continually


What is important to
people in care homes?
Some key insights

# 1 Feel safe and secure
Residents: safe and free from harm, pain and
discomfort, and know they receive competent and
sensitive care.
Staff: free from physical threat, abuse and criticism,
and work in secure conditions of employment.
Relatives: confident in care home staff’s ability to
provide good care, and have access to support
networks when required.

# 2 Have a sense of continuity
Residents: consistent care from the moment
they come into the care home, people to
understand them as a person
Staff: time and access to the stories &
information that lies in people’s past, exposure
to good role models and environments of care.
Relatives: be able to maintain involved in the
life of their relative

# 3 Feel like they belong
Residents: be able to form or maintain
meaningful relationships, be part of a
community or group, as desired.
Staff: feel part of a team and recognised in
their contributions.
Relatives: be able to confide in trusted
individuals to feel that you are not in this
alone.

# 4 Have a purpose
Residents: opportunities to engage in
purposeful activities which facilitate the
passing of time, and tie in with their
personal interests and past.
Staff: clear set of goals to which to aspire –
individually and as a team.
Relatives: feel involved and that that they
are still part of the resident’s care

# 5 Sense of achievement
Residents: feel they can make a
contribution and can meet meaningful
and valued goals.
Staff: be able to provide good care, feel
satisfied with one’s efforts
Relatives: need to know the care home
‘has done its best’ to provide the best
possible care to their loved one.

# 6 Feel valued & important
Residents: feel significant and valued
as a person. Feel like they matter.
Staff: feel like their efforts are valued
and significant in the wider context.
Relatives: need to feel that one’s
caring efforts are welcome and
appreciated.


As we continued our work to help
design for these needs, we learned
some important lessons about how
to create cultural change that sticks:


Don’t try and force
cultural shift. Start small.


“One member of staff had
written that she likes line
dancing, and one of the
relatives came and asked her if
she wanted to go with them!”

Small interventions started
to trigger significant
behavioural changes -
improved communications
and increased confidence
that making changes is not
that difficult and that it can
be fun too


Draw on the positive
aspects of culture.


By drawing on cultural
strengths we tapped into
the deep rooted concern
about residents and
their wellbeing and the
desire from staff and
relatives to get more
involved in making
improvements.


Involve people at all
levels. Work with and
within their cultures.


We learned taking that
time to listen to people’s
stories, opinions and
experiences is what
people found most
helpful in order to
create a more positive
culture. It made them
feel valued and
important.


We developed a tool called
‘My Story’ which gives care
home staff the time and
encouragement they need
to listen to someone’s
stories and draw insights
for making improvements.


Clear info
‘Expert’
al relative package. On
Emotion Pro vi din s
n g a dvice services provided,
transitio on what
to think who works
support. abo ut, w
hat to there,who lives
ives
Assisting relat expect there, what to
ition
in t he trans bring, prices...
process ‘Jo urney I
nto
ation
Ca re’ convers
ch
Transition days.
gath ering as mu
Days where future as
infor mation
residents can get the
possible on
to know the care d
p erson to be Flexible hours.
surroundings for
Where some
people join
Reintroduce daily activities before
routines (washing, they become
gardening - things residents?
people used to do
before coming to
the care home)


Bob.
It was through the simple activity of listening to
relatives that staff was able to find out about Bob’s past
routines. Bob wouldn’t stop his night time wanderings
and eventually a member of staff came up with the idea
to manage his behaviour by giving him a torch and clip
board and getting him to come along on night time
rounds, to check the security of windows and so on.


My Story


Improved communications during shift and handovers
Better relationships between staff, residents and relatives
Increased confidence and ownership in making changes
Sense of involvement
Reduced ‘back-end’ work and increased time spent with residents


The framework

Measure Capture Understand Improve


Getting Started


Small change is ok.
But we need lots more of it.


Thanks.
julia.schaeper@institute.nhs.uk
@juliaschaeper

Culture of Care

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (11)

Semelhante a Culture of Care

Semelhante a Culture of Care (20)

Último

Último (20)

Culture of Care