How can people who live in care homes have choice and control?

Four years ago I was presenting at a Laing and Buisson conference on care homes. My presentation was  towards the end of the day, talking about the importance of relationships, choice and control. Every presentation before me, without fail, focused on showing amazing dementia-friendly designed buildings and talking about good, respectful care. I felt like I was in the wrong place, with a different tribe who valued different things. However, after the conference I was asked to help to review one of these new flagship care home, lets call is Marble Manor. Two months later I travelled south to meet the people who lived there, the manager and staff. My first impression was that the building looked incredible, and as I walked in, it felt as sumptuous as a four star hotel. The bedrooms were warm and welcoming, and also had the slightly sterile feel of a hotel bedroom. At lunchtime I was invited to eat at the  dining room, which equaled many of my local restaurants, with a wine menu too.

When I met the people who lived there, they were cutting up coloured paper to make Christmas decorations. One staff member moaned to me that,

“The walls are all newly decorated, so we can’t put these decorations up. I don’t know where we can display them.”

Out of earshot of the staff member, one of the people who lived there muttered to me,

“This felt like being at primary school all over again.”

I asked how people spend their time. There was an activities programme, like the Christmas decorations, that people could choose to take part in. This was extensive with music appreciation evening, and trips out. At Marble Manor, you have a beautiful buildings and gardens, and you can choose which of the activities on offer you want to do. Can we go further than this?

I volunteer at a local care home a couple of times a month.  If Marble Manor looks like a four star hotel, this one, Bruce Lodge, probably looks two star, but they have focused on choice, control and relationships. They wanted to see how far they could go in enabling people to have more choice and some control oIMG_7718ver what they did, where, who with, when, and how they were supported. Here is an overview of how they did this.

What: People in the care home did not have an individual budget, and did not have any resource that they could control. Without any additional resources, they decided to give each person a ‘budget’ of two hours a month to decide what they wanted to do and who would support them to do it. When I shared this at a conference, my colleagues in learning disability services were politely derisive and challenged whether 2 hours was even worth it. When I share this at conferences with colleagues from older peoples service they wonder how Bruce Lodge could have possible done that. At Marble Manor they told me that this was not necessary as people could have staff time whenever they wanted it. This was not the reality when you spoke to people who lived there. They felt fortunate if staff spent time with them, and it was at the staff’s discretion. At Bruce Lodge it was an entitlement, and the person was in control of when and how they used their ‘budget’ of time.

Where: People could use their time to go where they wanted, and we proactively encouraged people to go out. If they could get there and back within two hours they could do it. People at Marble Manor went out when a relative took them out, or when there was a group outing.

When: People could choose then they wanted to use their time. People could also choose to use their time in different amounts, learning knitting for half an hour a week, going out for an hour twice a month, or swimming and tea and cake afterwards once a month.

Who: People could choose who they wanted to support them for those two hours, and if they were not able to do that, the manager matched then to a staff member who shared that interest. This was one of the biggest challenge – moving from roles (“you are the key worker so you do it’) to matching people based on relationships and shared interests. This short film shares how this was achieved.

How: Obviously, having choice and control over how you spend two hours a month is not enough. At Bruce Lodge everyone had a one-page profile describing what matters to the person and how they want to be supported. The ‘how you want to be supported’ became the job description of the staff. Here people were starting to direct their own support, on a day-to-day basis. This was reviewed with the person and their family.

This was how one care home worked towards involving people in decisions about their life, in how they wanted to be supported (and recording this as a one-page profile), in how they wanted to use their time (a ‘budget’ of two hours a week) and who they wanted to support them. I look forward to two hours a month just being the beginning, and getting to two hours a day. This may sound unaffordable in the current climate, without extra funding. The manager at Bruce Lodge achieved this within their current resources, and in Flintshire, we are working with commissioners and home care providers to go from achieving this in one care home, to all the care homes there. If you want to know more about the ‘how’ you can read about it here.

It is no surprise that older people want choice and control over their lives. This is at the heart of personalisation and the vision for care fir for the twenty-first centruy. The conference was four years ago. I hope that at the next conference I go that that is focussed on care homes, that we talk more about  choice, control and relationships in care homes, as well as excellent buildings and good care.

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