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The Sheltered Housing Network Supporting All Involved in The Provision of Sheltered and Supported Housing |
Health & Social Care Provision
Health & Social Care Provision
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RESIDENT PARTICIPATION IN Health & Social Care Provision A Workshop Report Wednesday
19th April
2002, 10.00am ‑ 4.30pm
INTRODUCTION
The
future potential of Sheltered Housing focuses on the provision of health and
social care support to create 'a home for life':
Whilst
discussions take place at a national level between ministries and quangos
involved, and at the local level between care providing agencies, little seems
to be done to involve the recipients of care and support, and, in particular
residents of sheltered housing
In
our own previous Workshops, we have on many occasions discussed residents'
participation in:
We
have not previously discussed residents' participation in health and social
care issues; residents continue to be viewed as passive recipients of care.
Why should this continue to be so?
Support
and care provision is very personal and individual;
But
residents have a collective interest in ensuring that their own scheme (and
others provided with the same management structure) is, as far as is possible,
a 'home for life'; that as they grow more frail and dependent support will be
available to enable them, if they so wish, to continue to live in the scheme
rather than move to a residential care or nursing home (such a move not only
has financial implications but signals a marked loss of independence).
Residents
ought therefore to have a say in the type and level of support and care
available within their scheme and the manner of its provision
What
input might residents, therefore make?
Over 100
participants attended the Workshop, well over a quarter of them being
Sheltered Housing residents, with the majority of the remainder being scheme
or line managers. In the
morning session two projects were presented at length together with a third
brief presentation. The first of these described a large scheme offering a
wide range of care and support services, with substantial resident
participation; the second described a Best Value exercise; the third, shorter,
presentation outlined resident participation in the move towards
extra‑care provision.
PRESENTATIONS
"Empowerment
:
Myth or Reality" ‑ Angela
Bradford, Assistant Director The ExtraCare Charitable Trust, assisted by Derek
Chawner and Joyce Bough, residents of Berryhill Village ‑ a scheme of
nearly 150 units in Stoke‑on‑Trent
The
Extra Care Charitable Trust evolved 15 years ago from Coventry Churches HA; it
is a Coventry based organisation working in the Midlands to provide various
levels of support within a housing environment, though it also manages, today,
some nursing homes. Currently the Trust has 37 schemes, accommodating some
1200 older people, employing a similar number of staff and involving 1000
volunteer helpers. The Trust's philosophy is to offer services, up to the
levels provided within residential care and nursing homes, to older people in
their own accommodation so that they don't experience the trauma of moving as
their needs increase, usually marked by loss of independence. The provision of
care and support is backed with a wide programme of activities enabling
residents to contribute to the life of the scheme. A feature of ExtraCare
developments is the pre-planning that takes place before the opening of a
scheme. From a data base of over 9000 interested potential residents,
workshops and consultation days are set up in the selected localities (400
people attended a recent day in
Northampton). These events explore perceived needs, embracing design features,
activities welcomed, preferred tenure (at Warrington both rented and leasehold
properties are included) and the levels of care and support sought.
Such
pre-planning involves all aspects of provision of the type of meals to be
provided and their cost, the charges to be levied for various activities, the
charges of purchased domestic services. At Berryhill Village, for instance,
many of the activities were already ongoing before the residents moved into
their new home.
The
vision of the residents of what they expect from their scheme is co-ordinated
with those of other providers - Social Services, Health and Housing
Five
levels of support are identified: from a minimal need of domestic support to
the equivalent of nursing care. All flats within a scheme can meet all levels
of support ‑ one does not need to move if one's support needs change.
Flexibility enables a person to move both upwards and downwards in support
level; close collaboration exists with social services
Berryhill
Village has a staff of 30 embracing care and support tasks, housekeeping and
catering administration. Also included are a well‑being advisor, fitness
instructor and volunteer co‑ordinator. The aim is to involve all
residents in the management of the Village; 'street' meetings are held monthly
The
Well‑being Centre, including chiropodist, optician, dentist, is
available both for residents and also older people in the neighbourhood
At
Berryhill Village, a well being advisor has been engaged from fund raising
events; it is hoped that the PCT will finance the continuance of the project.
The advisor offers annual screening to identify health risks. In recent months
it was found that 20 Berryhill Village residents had diabetes ‑ but none
knew about blood testing or dietary needs; a special interest group has been
developed which has resulted in all those residents achieving acceptable blood
glucose levels. Similarly those with raised blood pressure, urinary infections
etc have been identified and supported. These support groups also serve an
important social function
Those
residents with the lower levels of support needs are able to access specialist
staff at all times
Angela
provided two case studies of residents who came to Berryhill Village after
very serious acute illnesses or surgery but who, through the support and
activity provided, achieved much greater levels of independence
Each
of the speakers emphasised the wide range of care and activities available to
residents. Any support plan is designed with the full agreement of the
resident and reviewed monthly, 3 or 6 monthly. Residents are strongly
encouraged to set goals for themselves (eg: to walk without a frame within the
month). The Village offers them opportunities to achieve their goals
The
ExtraCare Schemes demonstrate that, within a sizeable community a wide and
flexible
array of support services and activities can be offered. Individuals have a
wide range of choices open to them. Collectively they can oversee this range
of choices to ensure that it meets most of their needs "A Different Kettle of Fish" Sharon Mitchell, Business
Review Manager, Atlantic Housing Group
Sharon
Mitchell described the approach to Best Value adopted by Eastleigh HA, in
partnership with Fernhill Care Ltd, as part of a Housing Corporation BV Pilot
in March 1999 Labels, such as Investors in People, Quality Assurance, Charter
Mark, Crystal Mark are used as symbols of quality in the workplace. The label
Best Value connotes of the 4C's: Challenge, Comparison, Consultation and
Competition. One must see Best Value as an integral part of the process of
service provision ‑ not an add‑on extra What is extra‑care?
It encompasses frail older tenants, some of whom need relatively little
support, whilst others need higher levels of care and support to maintain
their independence. This project involved 117 tenants in two higher schemes.
Extra‑care aims to promote independence, dignity and choice and to
provide a home for as long as is wanted. Support is provided on site for 24
hours a day. Quality is assured through employment of staff with NVQ levels 2
or 3; all are already employed, with no casual employees. Care is bulk
purchased through a contract established via social services. Individually
tailored care packages can include washing and dressing, toileting and
bathing, food preparation and medication and tailored to meet individual needs
This is a very different type of service from that usually subject to review
‑ eg: property maintenance and repair. It is a 'soft' service in which
exact quantitative measurement is difficult; it is based on personal
relationships; performance indicators are not well established and there is
little or no comparative baseline information. In a fiercely competitive
market , information is tightly guarded and it is difficult for tenants to
make an input. There is a large number of stakeholders involved in providing
and using extra-care services Who are the stakeholders and how might they be
involved? This project's strategy aimed to support and facilitate the ir
involvement, recognising their complexity. A range of involvement options must
be adaptive and flexible, maximising the linkages to wider tenant
participation and community involvement A matrix was devised which mapped the
power and interest of the several stakeholders. One need not spend much time
involving quadrant A but one must target one's resources to those in quadrant
D
Mapping
Power and Interest
To
amplify: Different Stakeholders may be involved in different ways
...
For
Example
...
Other
agencies and community groups need to be embraced ‑ eg: Help the Aged,
Association for the Deaf, Cancer Relief, MacMillan Fund etc
There
are obstacles in involving some stakeholders in the partnership. Frail older
people are often unable to participate fully and wider views must be
incorporated through proxies. The very number of stakeholders produces
problems
A
variety of formal and informal techniques of involvement were used in the
project. 40% of the tenants took part in one to one interviews; three small
groups were established and 14% of tenants took part in focus groups. An
Advisory Board embraced key players; outside organisations formed a
Consumer Panel. Scheme Staff could not be used as interviewers but they were
made to feel comfortable with the process and were encouraged to cite
obstacles to development, opportunities for improvements What
Worked? Front end planning took time but provided a focus for the project.
Stakeholders, especially the tenants, drove the process. Good practice was
shared and linkages maximised. Family members and carers acted as advocates In semi
structured interviews people were asked to rank what issues they felt to be
important, and these were then compared with satisfaction levels
Focusing on What Matters
Performance / Importance
Matrix
A
series of Soft Pi's was developed
In developing these themes one must be careful of one's interview technique and be sure that one compares like with like Comparison and bench
marking is very difficult. Service providers may collude in providing data.
The quality of care provision is difficult to judge. In this project 39
similar organisations were contacted to form a Benchmarking group; only 21
responded and most of those seemed interested only in finding out what
Eastleigh HA was doing, rather than provide information about themselves
Eastleigh
HA developed its own Care Self Assessment model to enable comparisons to be
made, to foster continuous improvement, to challenge'mind sets' and enable
cost deficit analyses to be made
Stage 1
involved a Benchmarking Matrix
Stage 2
involved Self Assessment
Stage 1
Benchmarking Matrix
SHN Scan Note – Regretfully
we were unable to get this chart to scan effectively and therefore the display
on our web site is distorted. 1 .
Can customers choose who
1 1
is involved in helping plan
their care plan
* Yes/No 2.
Can tenants themselves
1 1
1
choose what care is provided
from a 'pick and mix' range of
care options within a
predetermined budget?
Yes/No 3.
Do customers have their own
1 1/2
%
s
personal copy of their care plan
U)
4. ......
in a format which meets (D their personal needs ‑
ie large
%
U) (D print, audio tape, braille?
U) 2 Yes/No 5. Do you offer services
tailored
6
4%
4%
%
41/2
4
5
4
(D
to meet cultural and different
needs of the area you
represent ‑ namely:
Black and minority ethnic
groups? ‑ Yes/No
Dietary needs ‑ Yes/No
Toileting needs ‑ Yes/No
Religious needs ‑ Yes/No
Physical design of the
building ‑ Yes/No
A gender based bathing
service ‑ Yes/No 5. Are personal care plans
1
1
1 formally
reviewed with customers at least quarterly?
* Yes/No 00
The
importance of different attributes was ranked and multiplied by the scores
achieved in each, in order to give an overall quality index The
outcome of the project was an ability to challenge one's own work, to avoid
complacency even though one's own standards were high The
project was costly! Savings made as a result of the exercise were but a half of
its total costs; therefore the scope of a project is vital if you want to create
economies of scale. Challenges remain in sustaining involvement, monitoring
progress and reinforcing cultural change within the organisation "From Multiculturism to Extra‑Care"
‑ Michelle Jogee assisted by Dorothy Miller and Mohammed Hosein ‑
Abyssinia Court: Hornsey HT
Abyssinia
Court was developed seven and a half years ago specifically as a multi cultural
scheme; V. of its residents are Asian
(including Kurdish from Iran and Iraq, Farsi from Iran, Chinese, Bangladeshi and
Indians from India and the West Indies), a third Afro‑Carribean and a
third White from various European countries. Though quite lavishly provided with facilities many of these have remained under
used and the scheme has operated substantially as Category 2. But it is now
planning to introduce extra‑care services. The Court has successfully
developed its multi‑cultural image and gained much national repute. A
Tenant/Resident Association, ACTRA, has existed from the August 2000. About two
thirds of residents regularly attend its meetings. Religious festivals
of all faiths are celebrated ‑ there is usually one such event each month.
Recently a multi‑faith programme has been established. A most harmonious
multi‑cultural atmosphere has been created. Some residents have moved on,
because of their frailty, to residential care homes; and many of these have
subsequently the home could not meet their cultural needs ‑ eg:
appropriate meals, dressing or companionship, one returned to Abyssinia Court.
Abyssinia Court therefore strives to meet their higher care needs. For six
months discussions have been on‑going with LB Haringey to provide an
extra- care team. All correspondence from
the Court comes from the Chair of ACTRA; ACTRA officers
are present at all meetings with the Council; the Commissioning Manager attends
ACTRA meetings concerned with extra‑care. Jointly a care agency has been
selected as sole provider Michelle will work closely with the care team (she has
always closely monitored care packages of those residents not speaking English;
she and the care team will endeavour to assign care workers appropriately as
religious and cultural beliefs demand. Michelle believes that the cultural mix
and tolerance existing within the scheme has done much to mitigate the tensions
that commonly arise between the active and the very frail residents
Summing Up ‑ Christine Thompson ‑ Elderly Services Manager,
Family HA
In
summing up some of the key messages arising from the presentations, Christine
highlighted:
In discussion it was noted that residents would feel under valued if but one page of the Tenant Handbook was in braille or a foreign language ‑ though this page often indicates where a full version could be obtained. Hard copies were usually produced as requested. Many older residents for whom English was a second language were not literate in their mother tongue; for these a tape version was advantageous Family
involvement in care and support was welcomed; at Berryhill, for example, family
members were often active in Village activities. But it should always be agreed
with residents who should be called in an emergency, who should hold the spare
key. Residents should have a choice.
DISCUSSIONS:
TOWARDS GOOD PRACTICE In the
afternoon small workshop groups, participants were invited to consider three
issues What
forms of care and support might residents need to enable them to remain within
this scheme? How
might residents actively influence or promote the provision of such care and
support, by collectively articulating their needs, suggesting modes of service
provision and monitoring and evaluating these? An
affirmation that care and support provision is a proper issue for resident
participation and involvement
The
points raised by the six groups have been aggregated into a single narrative: Perhaps
not unsurprisingly, there seems to have been no dissent from the view that
residents ought to be involved that they have a collective interest in the level
and mode of support provided within their scheme
General
Principles In the
course of their discussions participants provided a lengthy, and expected, list
of services which should be available. In particular however they stressed five
themes:
Reliability:
All services provided must be of a good standard and reliable; the mode
of their provision should be
24
Hour Care:
Support should be available throughout 24 hours ‑ either by a
scheme manager on duty, scheme manager living on site but off duty, a sleep over
care team worker, or central control alarm system
Flexibility:
There should be flexibility within the
Personal
Choice:
Whilst
co‑ordinated delivery of care and support within a scheme by a designated
team, by a single GP etc, might make for efficient delivery, residents should be
free to make any personal arrangements ‑ eg: to retain their former GP,
home help etc.
Information
There
is a pressing need for information about services available:
Communication
In
this, as in almost every situation, the need for extensive communication was
stressed:
What
Residents might do
A
variety of initiatives were suggested:
Monitoring
and Evaluation
Residents
should continually monitor service provision within their scheme:
Collective
Action
Collective
Action has a positive impact within a scheme:
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