Coming at it from a different angle ....

[Tender Face]

I think I have mooted this point before, but now have more time to progress it .... and keen for ideas on how to do it ...

In a nutshell, mum is in quite a fantastic care environment (Nursing Unit opposed to EMI) ......they have several residents on the unit with varying degrees of dementia - as with mum - where the physical nursing needs are greater than their dementia needs and therefore can 'accommodate' them .... (perhaps that in itself makes a difference?)

I am becoming more involved in campaigning and rather than complaining about the horrors of what has gone wrong, what I have witnessed of and in other 'care' homes (I use that term loosely!) or hospitals, wonder if I can use the 'what is so right' to try to achieve some change to bring other places and care services up to the same standards?

Trouble is I can't seem to define for myself the 'what is so right' ... and why every person who needs the care my mother does deserves the standard of care she is now afforded .....

It is something almost intangible .... sure, the place is well equipped, care plans accessible to carers and regularly updated, all those 'practical' things some seem to have to scream for ....... it is more about a 'culture' or 'atmosphere' of respect and dignity - indeed affection ........

Is that about staffing ratios? Recruitment criteria? Management? Training in palliative care? Dementia awareness?

I admit I am the first to scream and shout when something is wrong .... but there is something so 'right' about this care home and it should be a beacon for others ... how to make it that way and improve things for others by focussing on the very positive? How to raise awareness that these standards can be achieved - so why should others fail to achieve them .....?

I am sure someone can think of something better than my first idea of telling the CSCI?

Any thoughts welcomed, Karen

 

[jenniferpa]

I think you're spot on about the situation when nursing needs are greater than dementia needs - although not much good happens when you're dealing with dementia I think I was fortunate that as my mother's dementia increased, so did her nursing needs, and perhaps most importantly, her mobility decreased. It meant she could be in the least restrictive environment.

I'm thinking (or rather typing) out loud here and I don't want to stretch this analogy too far, but it has occurred to me that it's a bit like taking care of a baby, rather than taking care of a toddler. People talk about how tough the care of an infant is, the broken nights, the need to be on call constantly, but it's not nearly so stressful as dealing with a toddler who is constantly into stuff and who can constantly be putting themselves in harms way.

Hmm let me think about this some more.

 

[BeckyJan]

Hello Karen:

Full marks for giving your time and energy into this - I do hope you get the support you need.

Just a quick response but maybe I will think of more as we go along!

wonder if I can use the 'what is so right' to try to achieve some change to bring other places and care services up to the same standards?

I spoke to someone only today about the attitude of 'carers'. Some see it as a vocation and caring comes naturally and they are not necessarily seeking high reward (but they should be paid well). Some go into the 'care' industry as a final resort - no other job available We need to enhance the care industry by giving those employed within it respect, not treating them as second class citizens - give good training as with nurses and then good pay.

it is more about a 'culture' or 'atmosphere' of respect and dignity - indeed affection ........

Not sure if this is what you are seeking, but its a start.

Good luck.

Jan

 

[Tender Face]

Good analogy, Jennifer - at worst mum and her fellow dementia sufferers on the unit tend to 'borrow' things .... with mum it's paper towels and other people's glasses, with Edna it's knives and forks from the restaurant etc, Mary just paces up and down the corridor looking lost but is actually blissfully happy pacing up and down, Vida has occassional outbursts of shouting at people in strange languages ....... all pretty harmless stuff compared to the aggression we know can happen ... and of course, all so weak because of their individual nursing needs that they are really no threat to anyone when they can shuffle about on their 'steals'!!!!! ...

But what to me is so important is how these individual 'foibles' are respected and managed ...... and the whole atmosphere of care and understanding seems to extend to fellow non-dementia residents (who quite frankly must be sick and tired of having mum pinch their spectacles or Vida shout at them from her wheelchair!!!!!) but treat the situation with such good humour ....... whether that is sheer luck of their personalities or the culture fostered in the Unit - or probably a bit of both?

I accept this may be very different to 'purely' end-dementia care ... but it is dementia care none-the-less, and for people with complex medical needs / palliative care needs to boot ..... and I really want to applaud and promote the standards I am witnessing .....

Thanks, Karen

(All names changed of course! - and thanks for your encouragement, BeckyJan!)

 

[connie]

Would that all homes could get it 'right'.

Lionel is in an EMI unit, not nursing, although we now have continuing care because of his nursing needs.

would agree with:

Quote:
it is more about a 'culture' or 'atmosphere' of respect and dignity - indeed affection ........

also very much

Dementia awareness?

The consultant who visited Lionel last week, and took him off his Alzheimers meds (after 7 years) also said to staff "that had Lionel been anywhere else he would have expected him to have died 6 months ago". I know what he meant, but the staff have treated Lionel as though he was their dad/brother/husband/friend.
They have always looked at Lionel - the man.

Yet, it should not be a lottery as to the level of care.

 

[Tender Face]

Connie, in part I think this is the key to my thinking ..... the NH mum first went in as emergency respite because of her throat infection (yeah right it was cancer as I suspected, as many will know the saga!) was as costly as the one she is in now ...... if we split purely down to monetary terms ... how can one 'care provider' deliver care so much differently to another for the same cost? (Whether self-funding or not).

So perhaps there are budgetary issues and how wisely money is invested directly or indirectly for the residents or directly or indirectly to the staff?

Perhaps there are links with NHS and / or training providers and how closely they work with doctors / consultants / palliative care teams where necessary?

I have wondered is it down to people? But the 'general' staff at mum's current NH are from the same (good-hearted!) 'catchment' area as previously although just across the border in another PCT ..... so it is about staff motivation?

I have seen 'new residents' admitted in the brief time mum has been there and marvelled at the change in people .... one lady obviously having suffered a stroke and being coaxed and nursed to someone almost (wonderfully!) unrecognisable from the fragile lady who was first admitted, another dementia patient who wailed and 'chunnered' constantly to herself to a lady who is now relaxed enough to sit amongst other residents and enjoy the 'ambience' and simply smile with obvious contentment ....... my mother is already defying her prognosis ... and emotionally well ......

What it comes down to? First item on presciption huge TLC!!!!! So why do some care homes attract these people who can deliver that and others not?

Sorry, thinking out loud ..... but thanks for all the contributions ....

I maybe should be asking the manager of the home these questions?

Karen, x

 

[JPG1]

You can never be accused of TWITTERING! No way.

Karen, after what your Mum and you have been through, we are delighted to hear that you have found that thing we all look for: a ‘fantastic care environment’. If only every single one of us could use those same words. We will get there! We will achieve it!

What a lot of questions! So, as is our newly acquired habit, we will step backwards before stepping forwards.

“What is so right” sounds good to us, and “Why is it so right” sounds equally good to us, with your permission.

So, may we invite you to ask the oldest question on earth: What – Why – When –Where – How .... and WHO? (But not necessarily in that order.) And, if you can solve that one, then you will be Damed! (Not damned, but Damed!)

Our discernible difference between the “what” and the “why”? Acknowledge that, the “What” may vary from person to person, from dementia victim to dementia victim, from ‘care’ home to ‘care’ home (like your use of delineating single quote marks!), from relative to relative. And the “why” can perhaps only vary from location to location, from ‘care’ service provider to ‘care’ service provider, from ‘responsible’ council to ‘responsible’ council, from local authority/PCT/Social Services to local authority/PCT/Social Services.

Intangible? No, definitely not. If you can discern that “something” that makes it all work for your Mum, then we should all be able to discern similar “tangible somethings”. We do, surely, discern those “somethingS”, and we all like to think that we have “made a difference”, but how do we all make those “discerned somethings make a difference”?

That is what we are working on at the moment, so if we achieve anything that you may like to hear about, we will send it your way.

We, like you, have experience of enormously well equipped ‘care’ home, but care plans were not accessible to carers, regardless of how often carer may have needed access. Nor were carers accessible to care plans, for the simple reason that the paid-carers didn’t even know there was such a thing as a care plan. So they could not have been required to access it/them. Updated? No chance.

Is it the prevailing “culture”. Yes, in our experience. Most definitely. It is absolutely essential, in our personal experience, that the ‘culture’ is right from start to finish.

From Government (Are you listening, Mr Brown, and we mean LISTENING?) down to Local Government/PCT to Social Services to Care Home Provider to CSCI to Manager to Staff to every single person responsible and involved in the establishing and providing and controlling and monitoring and running of services.

It should not be the responsibility of the dementia victim or his/her family/relatives etc to be working so hard to achieve a caring community, a genuinely caring community. (And if it is, then the word ‘caring’ needs to be re-defined. Because we know we all CARE, we know that.)

A few quotes from CSCI: source of these quotes are available only from ourselves, as they are close to our heart:

“The role of CSCI as the regulator for adult social care is quite different where matters of complaint are concerned.” ………. “Our obligation is to ensure the compliance of a care service with the provisions of the CSA, Regulations and NMS.”

“We regulate, inspect and review all adult social care services in the public, private and voluntary sectors in England. We inspect adult social care services against national minimum standards set by the Government. The inspection system we use is called ‘Inspecting for Better Lives’. Further details can be found at our website on the following link: http://www.csci.org.uk/about_us/registering_and_inspecting/inspecting_for_better_lives.aspx

The Regional Registration Team would have assessed the application from (care service provider – name not disclosed in this post) in respect of (care home not disclosed in this post) against specific criteria to determine whether the applicants have integrity, are of good character and whether they are physically and mentally fit to be registered. A manager must also show that they have the appropriate qualifications, skills and experience necessary to manage the service. The premises will also be inspected to make sure it is suitable for the people who will live there.”

CSCI is soon to vanish … to be replaced by another CSCI possibly in a different form, wearing a different cloak of invisibility, but hopefully with locally required TEETH!

You asked “But what to me is so important is how these individual 'foibles' are respected and managed”.

Precisely! How many times have we been told by staff in so-called extra care sheltered housing, and then in the Assessment Ward, and then in the ‘care’ home (sorry, Karen, the word ‘care’ is one we find difficult to use at the moment!) that our dementia victim is “confused, can’t find the way back to the bedroom, keeps asking to go home, keeps stuffing tissues here-there-and-everywhere, keeps pacing the corridors (as if that is something that one would not have expected a person who has always loved walking to do!!), continually will not eat “peas” and keeps vomiting if peas are required to be eaten (as if we had not told them that peas should not be placed on the plate!).

There is a definite distinction between the word ‘care’ when related to ‘dementia’, and that word ‘care’ when related to any other single disabling condition, be it age, be it physically disabling conditions, be it mental health problems (apart from dementia), be it a cancer, arthritis, obesity, child-related, or be it an immune-system-enormously disabling condition, all equally life threathening, all requiring ‘care’ …. Complex needs come and are different for each of our persons, for each of us, as they emerge … year by year, day by day, hour by hour, on occasion.

Well, you may well know what we mean.

The fact that the other residents of your Mum’s care environment are able to cope with the idiosyncrasies/foibles of others is a tribute to your Mum’s care environment, and to all those other persons living there who may have learned … over the years of their caring lives … to cope with and to handle and to deal with … whatever came their way. And to respect those less fortunate than they, and we do hope you will understand that we understand what a hospice is all about. We salute each and every one of those true fellows of your Mum, and that we also salute those true fellow-carers-of-and-for your Mum.

We found too that our co-fellows were able to handle whatever they were presented with … but the staff were not able to do so. Not part of their training, their learning, their education, the culture present.

But we found also that, sadly, they were not able to LEARN from THE RESIDENTS, those co-fellows by whom they should have been taught to learn. If only those support workers had been taught to be receptive to … the signals, the learning … those pleas sent to them.

So, Karen, we contribute to your thread by saying that we also are working to achieve that which you are so obviously working to achieve. And we will do all we can to assist.

With apologies for a long response, but as we said, that is what we are working to achieve: that thing called C A R E.

CARING ... C A R E ....

 

[jenniferpa]

You know - you might get a more accurate answer if you asked the staff. I mean I could almost certainly write what a manager would say, and it might well be accurate, but I suspect if you asked the manager of the first home the same questions you'd get the same answer.

In practice I suspect it's a lot less to do with formal training (although that helps) but more to do with 1) leading by example and 2) valuing care staff as much as the bottom line. I don't think that means paying extravagant salaries (although it wouldn't hut) but more to do with respecting their expertise and their time. I know from talking to care workers that one thing that irritates is when they don't pay enough to attract permanent staff yet end up paying agency workers far, far more in order to have coverage.

 

[BeckyJan]

:rolle

So why do some care homes attract these people who can deliver that and others not?

Some managers manage people, some just manage.

Jan

 

[JPG1]

and some Managers don't manage at all.

 

[Margarita]

So why do some care homes attract these people who can deliver that and others not?

If you want to dig deep find out why the staff are better in some place.

Your going to have to have to ask the staff
how they are treated by their management, do they need to be trained have a qualification even if it’s an NVQ or do the management offer them to train them up as they are working for them so giving them better prospects .

As I feel its all down to ( I may be wrong )

Investing in there staff, sending them on training programs,so raising the moral of the staff also having staff meeting valuing there opinions, so better communication between the staff so working as a team all working with one Goal in mind giving high standard of care to the their clients in there care.

 

[Kayla]

I think the most important thing in a Care or Nursing Home is that all the staff treat the residents with respect and as people, even if communication is difficult. The Matron at my Mum's Nursing Home knew all about Mum when I visited, because she was involved in the day to day care of everyone in the home. The staff training seemed to be very good and there were sometimes training courses in Dementia Care held at the Home.

On one occasion my mother had been distressed and the cleaner had sat with her and talked to her until she calmed down. It was considered part of everybody's job to reassure patients if necessary. Mum often commented on how kind the staff were and she seemed to recognise individuals, even if she didn't know their names.

Many of the carers were really nurses, but had been trained abroad and were learning English and taking courses to improve their qualifications, so they could nurse in this country. I found the staff at Mum's Nursing Home were very pleasant to talk to and they seemed genuinely interested in learning more about caring for elderly patients.

My only concern was that there should have been more activities organised and opportunities for social interaction between residents. However my mother made friends with an old lady who visited her room most days and they enjoyed each other's company.

My mother's nursing needs were greater than her dementia needs and so she was cared for in the General Nursing floor of the Home, rather than the Dementia Unit. She seemed to get on very well with the staff and was still able to hold a reasonable conversation and even make jokes.

I think the nurses were shocked and saddened when Mum died suddenly last year. I would have appreciated the support and advice offered at the Nursing Home to have been available while Mum was still in her own home, as it was good to be able to share problems and responsibilities with professionals.

Kayla

 

[JPG1]

Coming at it from the right angle!

What a good idea! And coming at it from the right angle!

Article located on following website (amongst many others of interest, some positively encouraging, others less so) :

http://carehomes.whereforcare.co.uk/viewallarticles.php

Older people will be care home watchdogs – article dated 22/02/2008

OLD people's residential homes in Leeds are in future to be inspected by the people who really matter – older people themselves.

In a pioneering move, pensioners are to be recruited to visit residential care homes and nursing homes throughout Leeds, to carry out an audit of how well people's dignity is promoted and protected by care and nursing staff.

The "dignity watchdogs" will interview residents and staff and make an assessment of how much respect and courtesy those being cared for receive, how their rights as individuals are upheld, how their privacy is protected and how people are able to complain without fear of reprisal.

It is all part of Dignity in Care, a national Government-led campaign to promote high-quality care services.

As part of the campaign, Leeds City Council, Leeds Primary Care Trust and independent care home owners have come together to work with Age Concern Leeds.

Age Concern will recruit, train and support a group of older people to visit care and nursing homes to conduct the dignity checks.

Carol Wardman, chief executive of Age Concern Leeds, welcomed plans being made for the audit.

She said: "We are delighted to be involved in this important project.

"Dignity in the care of older people is at the heart of all that Age Concern does. Respecting dignity, choice and individuality, often in the smallest of ways, can make all the difference to the quality of life of someone in residential care.

"I hope that this project will raise this issue to all those involved in choosing and providing care."

The dignity watchdogs will be trained to observe and record instances in which staff may be, for example, patronising towards residents, using first names without permission or delivering personal care – such as changin
g dressings – in a lounge rather than the privacy of the resident's own room.

The findings from the project will be used to develop better practice and to help plan better services for older people in Leeds.

Coun Peter Harrand, the council's executive member for adult health and social care, said: "Dignity and respect should lie at the heart of all services for older people.

"An audit of this kind has never before been done in care and nursing homes in Leeds and its findings will be carefully analysed so that, where changes in behaviour are needed, we will make them.

"The people who will be carrying out this audit will all be volunteers and who could do this job better than older people themselves?

"They will be making an important contribution to making sure people who are in care in Leeds are valued and treated with all the politeness and good manners they deserve."

 

[Tender Face]

Absolutely brilliant link, JPG1! - and just what I was looking for ... when I first used the word 'beacon' I was mindful of my son's school and wondering that Care Homes might follow the same example of striving for excellence ......

Thank you! Off now to do a LOT of homework!!!!!!!

Thanks to everyone for their ideas,inspiration and support ...... Karen, x

 

[Taffy]

Full marks for giving your time and energy into this - I do hope you get the support you need.

I couldn't agree with Jan more.



Karen, the awareness is definitely there but the saying, The elephant in the room. comes into play.

Attitude has a lot to do with care standards in care facilities. A good manager puts together a dedicated team. For this to be possible they have to have the resources made available to them, I think that this is where most problems lie, not enough funding.

Most care facilities have share holders, I don't need to tell you their only interest is making good returns on their investment. Lots of relatives are not happy with being deceived into believing that what was promised in the way of care didn't eventuate. What other business can get away with such false advertising?

The most vulnerable are always easy prey it all comes down to principle, some humans are well equipped, others.... it is just about gain. Somehow, they all have to be kept HONEST!

I admire your courage to begin.

Love Taffy.

 

[JPG1]

Action actioned!

Regarding earlier post, and “coming at it from the right angle!”

Article located on following website (amongst many others of interest, some positively encouraging, others less so) :

http://carehomes.whereforcare.co.uk/viewallarticles.php

Older people will be care home watchdogs – article dated 22/02/2008

We emailed the suggestion and link to our local Councillor yesterday.

Reply received this morning from Councillor to say they are very keen on the idea and that they will put “a motion to the next council meeting calling on the council to bring it in”.

Small motions can make all the difference between constipation and action, in our opinion.

 

[TinaT]

Thanks for the link JPG - it is very interesting to read the various articles and thanks for the thread Karen; it has opened up a good discussion.

xxTinaT

 

[Tender Face]

Small motions can make all the difference between constipation and action, in our opinion.

JPG1, (took me a while to get that! ) ..... that proves what can be done .... without having to volunteer countless or regular hours some can't always commit to however much they would wish .....

I was once taught in business to try to improve each 1% by 1% instead of trying to improve the whole ...... the whole would necessarily see the improvement?

My first little stab at contribution to Age Concern (writing a couple of articles for their Carer's Newsletters) has been met with great feedback and the selection of offerings thus far should be published next time round ..... be warned you other creative souls - I will be after you!

Taffy - can you tell me what the Elephant in the Room means? It sounds like a great title Sorry, to be so ignorant .....

So many ideas to follow through .... it's hard to feel excited against the backdrop of where mum is right now ...... but thank you all for your continued encouragement ... if it's only 1% of 1% I'm damned if I don't make a difference ....

Love and thanks, Karen, x

 

[JPG1]

“I was once taught in business to try to improve each 1% by 1% instead of trying to improve the whole ...... the whole would necessarily see the improvement?” = small motions can make all the difference!

The Elephant in the Room = something you really can’t fail to notice, so anyone who pretends that the elephant isn’t present in the room is ignoring the important and concentrating on trivia, rather than dealing with the main problem. (Is that right, Taffy?)

 

[Taffy]

The elephant in the room....

Taffy - can you tell me what the Elephant in the Room means?

The Elephant in the Room = something you really can’t fail to notice, so anyone who pretends that the elephant isn’t present in the room is ignoring the important and concentrating on trivia, rather than dealing with the main problem. (Is that right, Taffy?)

Yes.... this is right!