The Scottish Government has today published My health, my care, my home – a healthcare framework for adults living in care homes. There is a lot to digest in the 63-page report but I have picked up some key points to think about (writes Debbie Thrower).
Family, friends and community
A diagram (on page 14) shows just how important family, friends and community are to the well-being of a person in residential care. 'There are many different individuals and professionals who support the health and well-being of an individual living in a care home, and these can be represented by concentric wheels around the person.'
The report states: 'Contact and engagement with families and friends greatly enhances health and wellbeing. Based on feedback from stakeholders and families, the Scottish Government considers that Anne’s Law (page 13) should provide people who live in adult care homes with the right to see and spend time with a named visitor or visitors at all times. They will have the same access rights to care homes as staff, while following infection, prevention and control procedures. Anne’s Law will be incorporated into primary legislation in the National Care Service Bill, due to be introduced by the end of this parliamentary year.'
'The Health and Social Care Standards set out what people should expect when receiving health and social care in Scotland. Two new standards were introduced in March 2022 to ensure that people living in care homes have their right to maintain contact with people important to them in their care and support upheld.'
There is a recognition of work to be done in the light of effects on relationships post-pandemic.
'As the COVID-19 pandemic took hold families felt a physical and emotional separation from their relatives living in care homes. Care home staff and managers have also experienced a huge range of emotions, loss and change whilst ensuring the safety of the people they care for.'
'In response TIDE (Together In Dementia Everyday) have created two Recovering Relationships toolkits, one for families and friends and one for care home staff and managers. These toolkits are for anyone who knows someone living in a care home in Scotland or for anyone who works with care providers in Scotland.' Relationships initiative
'These toolkits focus on different areas of communication and relationships with lots of practical hints and tips designed to support you to take the first steps to improve and renew your relationships.'
Psychological wellbeing and spiritual support
'Upholding people's psychological well-being and connections to a spiritual life are fundamental principles of person-centred care. Knowing 'what makes life worth living' and facilitating support for everyone's right to live according to their beliefs and fulfil their emotional, psychological and spiritual needs start from confident conversations with the person and those close to them. Their wishes should be reflected and upheld and regularly reviewed via their plan.'
'Spiritual care is an integrating aspect of holistic, person-centred care; affirming that fear, anxiety, loss and sadness are all part of the normal range of human experience within health and social care. By supporting individuals to explore challenging questions relating to change, mortality, meaning, purpose and identity we can help individuals to (re)discover core values and beliefs. When such matters are expressed, identified and addressed, people living in care homes can experience a greater sense of enablement, personal wellbeing and resilience in the context of illness, disease and life-changing or other social issues.' (pages 22–23)
Low mood, anxiety and depression
'Admission to a care home can be associated with multiple losses and represents a major life transition. It is important to distinguish between the transitory low mood and sadness that may be related to a change in circumstances, compared with enduring depressive disorders.'
'Agitation is a physical sign of anxiety and can manifest in shouting or other displays of stress and distress, particularly for people living with dementia. Loneliness is a factor in low mood, which is why it is so important to understand what and who are important to a person, and to plan their care and days collaboratively. Low mood and depressive disorders often precede development of dementia and symptoms can be difficult to tell apart. Management begins with a careful assessment to determine cause, followed by a range of therapies which may include activity based interventions, psychological or pharmacological interventions.'
Among the recommendations are references to spiritual and religious care, for example:
'Religious and philosophical beliefs in relation to food and diet should be enquired about and catered for.
'Psychological and spiritual aspects of healthcare should be assessed and regularly reviewed within care plans.
'Individuals should be supported to maintain links in their local community which enables cognitive stimulation, mobility, independence and communication.
'All health and social care staff must be provided with support and training in communication to improve confidence and skills in conducting these meaningful conversations.'
Families and friends
'It is particularly important that families and friends are kept informed, involved and supported as their loved one is approaching the end of their life. Clear compassionate communication and unrestricted visiting are key to achieving this. Care home staff are best placed to lead in this area, as they have established relationships with the people that are close to the individual. However, the GP and other members of the MDT should be available to support the care home staff and speak with family and friends when required.'
Dealing with loss
'Those who work or live in care homes describe the strong bonds and connections that develop between staff and those living in the care home, and so the death of an individual can have a profound effect on everyone. Care home staff will often have to break the news that someone has died whilst they are still coming to terms with the information themselves.'
'Scotland's first bereavement charter was published in April 2020. This describes what good bereavement support and care looks like. This bereavement charter is particularly pertinent to people who live and work within care homes and should be used to guide the support that is offered to those who are bereaved.'
'Effective leadership at all levels is integral to ensuring that the health and well-being outcomes of people living in care are met. As part of our online survey just under half (48%) of respondents highlighted the value in having good leadership but this was counteracted by 41% suggesting that leadership in care homes could be better.'
'The Scottish Government recognises that having a strong leadership in place within the Health, Social Work and Social Care workforce can improve the culture and the wellbeing of staff and also lead to better care and outcomes for the people who use services. That is why in August 2022, we are launching a National Leadership Development Programme (NLDP), which will build on the work of Project Lift, and complement existing leadership development and support on offer within health, social work and social care workplaces. The Programme will be focused on developing compassionate, collaborative and inclusive leadership at all levels across the health, social work and social care system.'
'A range of Leadership support programmes and resources across Scotland are available to care home staff and managers via the SSSC’s Step into Leadership website.'
This is just a start. As the report concludes, 'Following publication of this framework we will embark on a period of engagement and collaboration with key stakeholders from across the sector to effectively implement and deliver the recommendations outlined in the framework.'
You can download the whole report here.