Dementia care support vs. Local Authority care & accommodation strategy: Its all about perception!

Dementia has become a media buzzword over the last decade as the appreciation for the difficulties those who suffer with the disease has become more prominent and the understanding has increased. Many local authorities have continually identified the need for increases and improvements in the care of those with Dementia and related illnesses. Yet the real course of action is the polar opposite of this analysis. With ever decreasing care funding and the hands off approach to social care offered from Central Government officials, with the obvious downgrading of Social Care as a concern (with the greatest respect) by recent cabinet changes since Brexit – it all seems to be media lip service to a genuine social and community issue we are facing right here right now!

 

Multiple national campaigns are out there from sources such as Alzheimer’s Society and Dementia Friends as a subsidiary, focusing on some of the main points:

 

The bottom line

 

·       Dementia is a major global health problem; in the absence of a cure there is increasing focus on risk reduction, timely diagnosis, and early intervention

·       Primary and secondary care doctors play complementary roles in dementia diagnosis; differential diagnoses include cognitive impairment due to normal ageing and depression

·       Cost effective drug and non-drug interventions such as cognitive stimulation therapy exist that help to delay cognitive deterioration and improve quality of life; information provision and practical support are also important

·       Discussions about a person’s wishes for future care should occur at an early stage of illness while the person has mental capacity

·       Family carers of people with dementia are at high risk of physical and mental illness as a consequence of caring and they require equal attention and support

 

With all this in mind and the wide understanding of Dementia as growing concern in that is in the public minds the 2 issues to do have a clear synergy. The truth is that the private sector and specifically residential environments such as Care Homes and Extra Care facilities will be the ones that will and are being innovative to ensure a positive reaction to the ever growing elderly population.

 

Society will need to embrace the private care sector fully because there is simply not enough focus on how this will be funded or how the growing numbers of people that will need support. Innovative solutions are out there in every county but access to them is not evidently understood. Embracing the funding opportunities and the need to ensure that long term care financing is available is becoming a reality and not an after thought. All of us at some point will need to consider how and whom we will be paying for our care for loved ones or ourselves. The after thought that “don’t worry the government will pay” is not the case and hasn’t been for sometime. More needs to be done to aid the understanding at public level about the affordability and access to financing care in later life. With ever increasing demands being pressed and austerity measures in place as publicly indicated the overall landscape is not necessarily clear to all who are not in the sector on a day to day basis.

 

Many local authority accommodation strategies are contradictive by assessing the need for people to stay in their own homes but this is a dangerous method putting too much emphasis on time & task home care agencies who are pushed to their limits of capacity.  The fundamentals of Dementia and the needs of care in this area are around support, companionship and the need to always being available in many cases the need for one 2 one support is paramount. The question here is how can this be achieved when people are isolated in their own homes with the prospect of causing themselves more harm as their illness begins to debilitate them further over the coming months and years,

The stigma of care homes and care environments publicly needs to change dramatically with many private sector care organisations offering excellent care services and facilities which include not only tangible offerings such as bistros, ensuites, cinemas and medical equipment. But also the intangible benefits of 24/7 focused staff teams who are experienced in this area support backed up with external schemes offered by organisations such as Oomph! (http://www.oomph-wellness.org ) and Ladder to the Moon (www.laddertothemoon.co.uk) – who work with Care Groups to develop meaningful measured human engagement designed to enhance lives and deliver true humanistic benefits in reminiscence and responses.

These types of access to facilities and services are simply not available to those who are almost advised to stay in their own homes. These individuals simply miss out on the life enhancing benefits being offered in outstanding care environments across the UK. This is the ultimate conundrum – as gone are the days of the old fashioned residential home – care homes are multi purpose care services with an innovative edge focused on the person not the purse. Obviously the financials need to be right when addressing where people may spend their time living but this should not have a cost when all is considered.

The Care Quality Commission (CQC) the regulatory body of the are care and health services across the UK consistently backed these types of services with the increase in Outstanding services evidencing the use of innovative people engagement services in the care being delivered. Having accessing to multiple services when dealing with Dementia and associated conditions are only going to help improve the quality of life of individuals and this is clearly being demonstrated across the care sector with extreme valour. So why is it that this not common knowledge.

The theory I have deduced (albeit an opinion) is that professionals and government officials have not been keen enough to ensure the wider public understanding that Health and Social Care are two completely different fields. We live in a country where we are fortunate to have a National Health Service, which defies logic everyday offering FREE healthcare to all that need it. Which sadly blurs into the fact that also Social Care is an extension of health. Indeed, maybe it should be but realistically this simply is not the case. Social care is the long-term support function for health and this is becoming ever present as we develop bed-blocking problems within the NHS hospital services. Social Care can be the shining light that picks up the long-term issue and encourages development in care scenarios.

As discussed in an article that supports this statement by Paul Burstow at the Guardian: Why has this been explored more as a major political issue? Most MPs acknowledge that social care is unfinished business, but this has not translated into sufficient political pressure. At a basic level, this is because most people make no distinction between social care, care and support and what the NHS does. It still comes as a shock to many families that social care is not free. Most people make no care plans because they have discounted the chances of ever needing it.

Today the most visible advocate for social care funding is the NHS England boss, Simon Stevens. He told the NHS Confederation conference earlier this year that social care, rather than the NHS, should be at the front of the queue for financial aid. Of course there is a healthy dose of self-interest in this. Health and social care are two sides of the same coin – underinvest in one and you undermine the other.

But this is clearly down to the perception the public is given, the care sector itself and government departments must embrace social care services for what it can do but in the same breath encourage those who need to use it how it can accessed more efficiently. Private social care enterprises will be the ultimate problem solving body in this conundrum and soon everyone will need understand it!

THE BIG C - COMMUNICATION

So when you begin to look at communication, why so late on? Well its because communication between employers and their employees is almost the final string of the bow as many of the initial tasks become a working reality. If you were to ask any employee about a key challenge within their current work environment most often communication issues will top of the list - or maybe 2nd behind benefits. There is so much available on the subject out in the ether but not all seemed to be adhered to sadly. So why do businesses still face issues when it comes to communication? Especially in the sometimes unvalued Care Sector.

Many believe this is in fact because it is always reviewed from the communicators / business owners point of view rather than that of the listeners / employee’s point of view. Any communicator must understand the needs and perspectives of those in which they wish to communicate with. So the information in which is being shared with any individuals must be of interest, useful or simply relevant to their daily activity. We go to that word “engagement’ again - is the communication engaging employees to listen and process effectively, or sadly are they just switching off.

Some points for communication can include these following 4 steps heavily discussed in Dale Carnegie's training on Leadership and management.

1.     Entertain - Make the verbatim interesting to listen to, be humorous or include interesting facts related to the subject matter. I personally have always found video a great way to engage during communication especially in large groups. With multiple clips on any subject matter available on YouTube it is always a good engagement tool to link in a pithy video into your communications. During sales briefings on getting the most out your day - I would always refer to a clip from the Will Smith film “In the pursuit of Happyness” the film has great moment about selling and how to achieve more in less time. It worked overtime to get people on board to next part of the communication.

2.     Inform - Once people are engaged make sure it is then informative in the next steps. The last thing you need is a meeting for meetings sake; this gets your and your teams nowhere and essentially wastes time.

3.     Convince - Make sure that the people your are engaging with listen and take on board the specifics of your communication. Compelling people to act on the communication, or indeed encourage the additional input with the current meeting. Remember discussion is good.

4.     Communicate to Action - This is the next step, the energy behind the communication. Always having an outcome in mind before communicating is essential to allow some measurement on whether the communication was successful and whether it needs changing for the next attempt. A goal must be communicated for the individuals to achieve.

More often than not what happens is that an action or measurement is never identified by the communication. What will likely happen is a disappointment from the communicator / presenter because the goal they wanted is not achieved. Furthermore frustration from the employees as they are confused by the communication as not demonstrating a benefit to them or their work environment. The next steps must be clear and concise, well planned in advance of the communication. This preparation will bring more valuable outcomes for all concerned.

There are risks still with communication with a desire to always avoid telling or what I call one-way contact. I was brought up with this and from the very first paragraph it has been discuss that you can’t order people around and expect the best results. You always have to be concerned about who is listening and what are their perspectives in the communication. Some may think this is a lot to put into a message but you have to look at the risks of not doing it properly, poor delivery of communication will only lead to one definite outcome - no passion for delivery, poor outcomes and a frustrated workforce. So like or not you have to engage with employees on their level getting them to buy into whatever you are selling.

So communication is business critical for a businesses success, as business leaders everyone can continually improve their focus and purpose of communications. Always presenting an ideal of why the communication is important, clear concise points, which benefit those who are listening in a way which achieves an outcome. 

In your next meeting follow a couple of simple new steps and see how you get on this time with what return you gain:

First, actually plan the discussion, pinpoint your outcomes and engage them with the listeners. Second, find some interesting content whether it be video or event quotations from well known outlets (these are easy to find on the internet) and finally engage in discussions on the goals for the listeners allowing them to buy in to the message at hand. This will work for every meeting, 1-2-1 or presentation you intend on communicating in.

Life stories in dementia care: we all have a story and cannot be understood without it

In Jonas Jonasson’s book The Hundred-Year-Old Man Who Climbed Out of the Window and Disappeared, the protagonist faces scepticism when he recounts the tale of his daring escape across the Himalayas. “You crossed the Himalayas? At a hundred?” exclaims the prosecutor. “No, don’t be silly,” responds Allan. “You see, Mr Prosecutor, I haven’t always been a hundred years old. No, that’s recent.” 

Jonasson uses the life story of the 100-year-old man as a vehicle to tell a story about 20th-century history, but I read this novel while immersed in a research project looking at the use of life story work in dementia care. For me the message was clear: we all have a story, and no one can be understood by how they appear today out of the context of that story.

Life story work typically involves helping people to make a record of some aspects of their life, most often in a book or template, although more creative approaches do exist, including the use of IT and stop frame animation. Increasingly, life story work is being promoted as an important tool for enhancing person-centred dementia care. However, when it comes to specifics, there is little agreement.

A care home may ask a resident’s family to write a summary of their life using a list of prompts, while a community team works with an individual to make a collage about their life, and both could call it life story work. Perhaps the most important distinction is that when some people talk about life story work they mean an activity that is led by the person with dementia, to celebrate and preserve memories. Others mean a process led by professionals with the aim of aiding communication and increasing staff understanding.

Not everyone wants to be reminded of their past, and different people may come up with alternative accounts of the same person’s history. Life story work has many complexities, and when you add dementia into the mix things can get tricky. However, enthusiasm for life story work is high and claims for its positive effects are increasing.

To explore these claims, the Social Policy Research Unit at the University of York conducted research into the potential costs and outcomes of life story work in dementia care. This is not easy when there is such variation in practice. We collected information from six care homes that were all introducing life story work for the first time. Even with the same training, each care home did it differently.

When we asked people with dementia, family carers and professionals about good practice, the first thing that struck us was that, despite the hype, not everyone wants to make a life story. They may also have different views from staff about what their life story book/film/collage is for. It was felt that beginning the process early could enable people with dementia to take a more active role and communicate how they would like their story to be used. If staff were involved, one suggestion was that they could try making a life story document of their own to see how this feels and what issues arise.

Improving the quality of care and making it more person-centred often has associated costs. The greatest cost to the care homes introducing life story work was staff training, ranging from £950 to almost £1,600. After this initial outlay, however, the average cost of actually creating and using a life story book was relatively small: we estimated around £37 per resident over 16 weeks. Of course, costs will vary with different approaches.

The most significant effect we detected was an improvement in staff attitudes towards people with dementia in care home that introduced life story work, together with a hint that residents themselves felt better. However, the work was intentionally exploratory and to understand the full implications we recommend reading the final report, which will be published later this year and will be available through the SPRU website.

The key message from the people we spoke to was that whether life story work enhances dementia care depends to a large extent on what the people involved want to get out of it. If it’s intended to improve understanding in care settings, staff need the time and opportunity to use the information. If it’s about celebrating life and preserving identity, people with dementia need support and opportunities to do this their own way.

This article presents independent research funded by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Carers – The UK’s unsung heroes – What can we give back?

The UK’s 7m unpaid carers are amongst the most giving people we know.

They are all around us, caring for mums, husbands, daughters, sons, brothers, grans, friends….the list is endless, and they do this free of charge and unconditionally because they have an emotional connection with the person they care for.

Anyone can be a carer, a 7 year old boy helping his mum with her cancer treatments, a 90 year old woman supporting her husband with dementia, a 30 year old dad caring for his daughter born with cerebral palsy or a 60 year old woman caring for her dad who is old and frail.

3 in 5 of us will be a carer at some point, carers are all around us, propping up our health and social care systems, preventing winter deaths, keeping people out of our stretched A&E departments, providing a wide array of nursing and personal care tasks and ensuring people with care needs don’t become lonely and isolated.

Along with caring, unpaid carers have their own lives to lead at school, at work, with family and in the community, but they just keep on giving, sometimes at great personal cost to their own health and wellbeing. In fact the economic value of their gift is estimated at around £135bn every year, and its growing as our demography changes and we all live longer.

So, we should all ask ourselves, what can we give back to carers?

This blog was produced by @LuenThompson, who is the Director or Marketing and Communications at the @CarersTrust.

Who Cares about the Care Sector?

The results of a National Care Association survey of independent Care provider members has shown that 24% of care providers could exist the market.

The very people the care sector relies on to provide high quality care are being squeezed to the point where many are considering and exit from the sector, which could create a serious bed shortage and have serious repercussions for the wider NHS.

The National Care Associations predicts – due to the £375 m black hole in state funding – such an exit could equate to the loss of 40,000 beds in the independent social care market. and the worsening of the bed blocking crisis already in evidence across much of the NHS.

The NCA points to a critical shortfall in the average council funding of about 8% for a typical care home placement care home placement as the significant contributory factor in the likely exodus of care providers. This underfunding together with the impact on Care Sector overheads of the introduction of the NLW National Living Wage in April 2016 is seriously eroding the viability of many care homes businesses.

Without increasing funding from local councils in recognition of the true cost of care the predicted market crash will spell the end of the road for many independent care homes … In short under very real threat is a UK support service which is essential to local government and NHS care provision.

More detail of the reports can be found in the following Links

100 days and counting

Impact of Budget Survey 2015

George Osborne MP