Let's Change from ‘Being in a Home’ to Being ‘at Home’.

Do we pay enough attention to the ‘home’ part of care home?

Take a moment to think about what ‘home’ means to you, after all a home is more than just a dwelling place – e.g. house, flat etc. – it is about you. It is the place where you, hopefully, can retreat to, a place filled with memories, a place decked out in the style you like and filled with your things. It is not just a building but a fundamental part of your character and both sociologically and psychologically an important part of your life.

When we go into another person’s home we look around and make judgements about their character, their life, their likes and dislikes etc. and then make judgements on how we feel we will get on with them by making comparisons to our own home.

Yet if it becomes necessary to move a vulnerable person into a care home is there enough thought about the human aspect of a home rather than it just being a ‘placement’.

And what of moving into a care home?

It is well documented that one of life’s greatest stresses is moving home, yes there are the stresses of mortgages, solicitors etc. but the psychological change also creates stress, e.g. how do I create my home in this new house? How do I make it so I am comfortable here?

When a vulnerable person is moved from their home into a care home, for whatever reason, how much thought is given to that transition especially given the additional stresses involved that have forced the need to move in the first place.

Age UK have said that care homes are damaged by a culture of negativity (http://www.ageuk.org.uk/latest-news/care-homes-damaged-by-culture-of-negativity/) and this is certainly true in terms of reports of abusive behaviour and the general perception of care homes as places of ‘last resort’ and while I whole-heartedly agree with the Age UK recommendations I would, perhaps, suggest that we need to add to this the aspect of it being the person’s home and that it is vital that any individual feels ‘at home’.

We can have the most professional, caring staff, but if a person does not feel ‘at home’ there is always going to be difficulty in adjusting to their life in the care home. This may lead to depression, challenging behaviours or just a general malaise and dissatisfaction with life.

How would you feel if you had to live in a place you did not feel comfortable in? Many people have had to because of abusive relationships etc. but for the majority of us can we really comprehend what it is like to have to spend day after day in a place where we did not feel ‘at home’.

There is a need for care homes in the social care system and, in one sense, they should be the ‘last resort’ choice and only consider when it is a danger for a person to live alone and there are no other care alternatives possible. But when it is necessary care homes should not be merely a placement but a real home alternative. Many care homes provide this homely atmosphere yet many do not. Equally those that do may not be the type of home that appeals to the individual and every care should be taken to make sure that the choice of home reflects the individual’s needs, traits and characteristics to ensure the best possible outcomes in their new life.

We need to work to change attitudes, we need to create a new culture of care, we need to change from ‘being in a home’ to being ‘at home’.

Focus on Elderly Care

Over the last four years the number of people receiving council funded adult social care services has fallen by 17.5% and, given that in certain areas such as people with learning disabilities the numbers have increased, the majority of the decline in funded services has hit older people who are targeted under ever tightening eligibility criteria for Local Authority service.

This, of course, flies in the face of what we know about the population in general, the population is increasing and people are living longer so, in fact, we should be seeing an increase in the numbers of people accessing funded social care services, therefore we are seeing a bigger decline in services than the figures initially suggest, even if the numbers were to remain static it would, in real terms, still be a decrease.

Unfortunately much of the policy obsession (obsession used in a limited sense!) is focused on implementing the Dilnot proposals and focused on how much individuals should pay for their care. What this misses is the numbers of people who have no way of paying for their care and are entitled to local authority funded services, the numbers of which are decreasing at an alarming rate despite the fact they should be increasing.

In cases where older people do not meet ‘eligibility’ criteria the role of providing care and support goes to family and friends who, in essence, provide a free service for the state or, if they receive carers allowance, for the princely sum of £58.45 a week (subject to providing a minimum of 35 hours care - so £1.67 per hour!) and many do not receive the allowance because they have an ‘overlapping’ benefit. Research by Carers UK and the University of Leeds shows that, over the past ten years the number of those providing care has increased by 9% with the biggest increase in those aged over 65.

There are costs to looking after someone on a full time basis, particularly when it means giving up full time employment, not only are there the financial implications but also there is evidence of impact on health, well-being and social exclusion. There is help available for carers and many receive local authority assessments but, in terms of the wider social care picture, very little has been done to redress the increasing numbers needed to meet the shortfall in local authority provided services.

Despite these facts the plight of the most needy older people is still being overshadowed by the focus on who pays for care, and while this is important it is only a small part of the overall social care picture.

We need to widen the social care debate at national level which is why I have started an petition call for a Cabinet Minister for social care – I hope  you will take the time to sign  and pass on to others - http://epetitions.direct.gov.uk/petitions/39701

Calling for a Cabinet Minister for Social Care

I have set up an online petition calling for a Cabinet level Minister to be appointed for Social Care (click here) which I hope  you will sign  and which I hope  you will pass on  to friends and colleagues.

Why?

Around one in five of the population is affected by the decisions made by Government on Social Care and given that such a large portion of the country is involved it seems only right that they should have the appropriate representation at the highest level.

I say around 1 in 5 because the figure is hard to estimate and it could well be higher. Carers UK estimate that there are 6.4 million people in the UK providing unpaid care for loved ones (details here) and, naturally, there are a similar amount being cared for. The latest figures from the NHS Information Centre state that there are 1.4 million people in England receiving local authority funded care services, although this figure does not include those receiving continuing care funding from the NHS, additionally these figures are for England only, so the number is increased when the other countries are taken into account. They are then increased further by the unrecorded numbers who fund their own care services.

In addition, the latest figures from Skills for Care tell us that there are 1.6 million paid workers in adult social care. So, in a Nation that has a population of 62 million, one in five may well be a conservative estimate.

At present Social Care is presided over by a junior minister within the Department of Health and, whilst there is no doubt a strong link between health and social care, this fails to encompass the greater range of social care requirements of the people that need social care services.

Social Care is not a homogenous service. It includes services for the elderly, for those with learning disabilities, those with mental health issues or those with physical disabilities, yet, at present all these services are the responsibility of a junior minister.

Social care also encompasses much more than just health services, it includes housing issues, benefit payments, community issues, for those under the age of 65 employment services come into the equation.

As the population ages social care will be a greater part of life with even more people either using or providing services. It is time now for Government to fully recognise social care as a major part of social policy in this country and appoint a Minister to the Cabinet to take responsibility for it.

The e-petition link again - http://epetitions.direct.gov.uk/petitions/39701 I hope  you will  take the time to sign it and that  you will spread the word  to your colleagues and friends

Thank You

Personalisation and Being Human

You would probably agree that there is a part of you that enjoys time alone to relax and reflect yet at times you enjoy the company of others and, if you were being honest with yourself you do, perhaps, enjoy the attention others give you.

Perhaps, at times, you feel that you are not using your full potential in some aspect of your life and that those you are with fail to understand how much more you can offer and improve yourself.

Maybe there is a hidden part of you, one that you can’t reveal to anyone that holds a regret in life, a choice made wrong which, on one hand, is seemingly trivial yet on the other is one that has lived with you for a long time.

We are all the same, and the above holds true for most of us but the degree to which it applies may vary, yet they are fundamental part of our make-up.

Yet do we pay enough attention to these aspects of being human when delivering social care?

Personalisation is the key to delivering good quality social care yet the key to personalisation is understanding what it is to be human and understanding how we tick. Unfortunately the basic training of care work does not include this aspect of understanding which is so vital if quality care is to be universally delivered.

Core training consists of health & safety, infection control, food hygiene, etc. The Skills for Care Common Induction Standards go further but beyond induction training how much training do the majority of care workers get in understanding the individuals they are working with.

There is, of course, a tendency to stereotype people who need social care services (as in all aspects of life) using generic labels such as ‘learning disability’ ‘dementia’ ‘old’ and so on. Such labels have their uses and stereotyping is a human trait which allows us to form our own identity but in delivering care services and treating people with dignity and respect such labels represent just one aspect of who the person is. Although this one aspect may have significant impact on other areas of their life the person who needs social care services is still a person with the many individual quirks, nuances and subtleties that make us all slightly different but with the same underlying aspects of what it is to be human.

Obviously the immediate tool for learning about a person in order to provide personalised care and support is communication. Effective communication is essential, especially about listening to the person about their likes and dislikes but it needs to go further to understand a person’s desires  dreams and hopes. For example if we want to promote a person’s self-esteem we have to understand what that means to the individual, self-esteem involves personal beliefs and emotions not merely the likes and dislikes which are the standard part of any care plan.

Being a person is a complex thing and delivering quality, personalised care and support relies on understanding the individual not merely their personal preferences but also their values and beliefs which form their individuality. Those responsible for delivering care and support services are those on the front line of care and it is essential that their training includes more than the safety and physiological aspects of life.

You would probably agree that if you needed social care services that you would want services that understood what you needed, delivered by people who know when you need company or when you need to be alone, people who knew how to motivate you yet understand when you may be pushed too far, people who understand what dignity and respect mean to you. Isn’t only right then that we should apply this principle to all social care users.