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Enhanced health in care homes vanguards

Lesley Carver, the Senior Project Manager for the Care Homes Vanguard
MDT team being awarded the recent “Team of the Week” award from Mid Yorkshire Hospitals NHS Trust
MDT team being awarded the recent “Team of the Week” award from Mid Yorkshire Hospitals NHS Trust

Connecting Care vanguard – delivering care innovations to support care home residents in Wakefield

There are six enhanced health in care home vanguards offering older people better, joined up health, care and rehabilitation services. These vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representative groups. Over the next few issues of Care Talk we will take a look at each of the vanguards.  This month we hear from Connecting Care, Wakefield District

Wakefield district has an estimated population of around 333,759. 12% of the population are aged over 70, and it is predicted that by 2021, over 22% of people will be aged over 65.

Under the NHS England national New Models of Care Programme, Wakefield was selected as the only district in the country to take forward two vanguard programmes, which operate under the partnership-led Connecting Care programme.

Connecting Care delivers one of six Enhanced Care Home vanguard sites in the country and aims to tackle loneliness and fragmented care by joining up services for older people in supported living schemes and care homes. The vanguard is led by NHS Wakefield Clinical Commissioning Group (CCG) and is made up of, and supported by, a range of NHS, voluntary, housing and social care organisations from across the Wakefield economy.

The vanguard addresses issues around the increasingly ageing population of the district. It recognises the pressures this puts on the local health and social system, while focusing on the value of caring for elderly people as close to home as possible.

What are we doing differently?

Since the care home vanguard launched in 2015, we have introduced new ways of supporting both staff and residents in care homes and supported living schemes, overall developing a number of unique elements within our care model.

In particular, there are two aspects of the model which have played an integral role in improving quality of care and outcomes for residents.

Multi-disciplinary care home support team (MDT)

The creation of a multi-disciplinary care home support team (MDT) has been at the centre of our vanguard activity. This team is made up of many different healthcare professionals, including general nurses, mental health nurses, healthcare support workers, physiotherapists and an occupational therapist.

The team meet every Monday, where they design personally-tailored care plans for the residents they are working with. Each team member brings a different specialism to the table, which allows the team to build up a complete picture of how best to help each patient, truly delivering the Connecting Care vision of providing “person-centred” care.

Sue Robson, a mental health nurse within the team, expands on the value that an MDT team can bring: “Our multi-disciplinary approach acknowledges that mental health can be impacted upon by a range of factors including physical health.

“An example of this was a bedroom-bound care home resident who was struggling with her mental health. The team conducted an assessment and worked with our physiotherapist to provide the correct seating so she could sit in the lounge with other residents, overall impacting on better mental health for the resident through social interaction.”

Another unique aspect of the MDT is the relationship its members have built with care home staff. The team have built confidence in care home staff through ad-hoc training sessions and advice. Such sessions include Posture, Position and Pressure training, and provide care home staff with the confidence to handle, stretch and mobilise residents, which overall has improved their quality of life.

Holistic care approaches

The use of holistic assessments and tools for the care of residents is a valuable aspect of our model. It identifies that a person’s health and wellbeing depends on a very broad range of factors.

Portrait of a Life (POAL) is an example of a holistic tool used within the vanguard care homes. The POAL toolkit focuses on life-story work, to support carers and care home staff to engage with residents who have health and/or social care needs, such as dementia. This helps them to build their confidence to communicate effectively and support these individuals.

Following a holistic assessment by a member of the MDT, options are considered about the best way to meet residents’ needs. We have acknowledged that care homes cannot provide everything that someone might need to enhance their health and wellbeing, so part of our model has involved building links and relationships with the local Community Anchors.

Community Anchors are independent (generally registered charities) multi-purpose organisations, based in geographically defined neighbourhoods and used by the whole community. Community Anchors have now paired up with care homes in the district to provide health and wellbeing activities for care home residents both in the community and in the home. Examples of these include:

  • Residents at Croftlands Independent Living Scheme enjoyed a 1940s tea party at St. George’s Community Centre. The tea party was held in the dementia café, and six residents were taken over to enjoy the event
  • Community Anchors have provided volunteers to deliver group activities, such as chair-based exercise, as well as befriending residents and supporting them to follow their interests.

The holistic assessments have made a significant difference to the care that is provided to residents, this has been recognised during a recent CQC inspection of one of the care homes, where staff were praised for their person-centred care and focus on individuals. Residents have also expressed their enjoyment of the holistic activities. 90-year-old Marjorie explains: “We do get encouragement, and lots of people come. We get clothes parties and jewellery parties… all sorts of things.”

What results are we seeing so far?

From April 2016 to March 2017, the vanguard saw reductions in terms of A&E and hospital usage statistics from residents using Mid Yorkshire Hospitals NHS Trust.

The below reductions are against a district-wide control group (those care homes that are not within the vanguard):

Emergency Admissions 13% reduction
A&E Attendances 6% reduction
Ambulance Call-outs 5% reduction
Bed Days 28% reduction

In addition, since the vanguard has launched there has been an incredible reduction in supported living scheme residents having to move into residential care. In 2014/15, 38% of residents had to terminate their tenancy and move into residential care. However, in 2015/16, this has reduced to 0% across the schemes within the vanguard, allowing residents to stay as independent as possible for longer.

Seeing an improvement in our residents’ outcomes was a key driver for this project and part of achieving these reductions involved working innovatively and through partnership working.

What challenges are still ahead?

Care cases are now more complex than they used to be and care home staff require more skills and support to be able to manage them. Our vanguard focuses on upskilling and supporting care home colleagues to develop the confidence and skills required to meet these complex needs; with training sessions from the MDT team being a key part of this. However, problems with staff recruitment and retention at care homes, alongside financial constraints, can often result in time pressures for care homes to be able to release staff to attend training.

The MDT team recognises this challenge and is therefore working flexibly and innovatively to deliver training and support to care home staff. For example, we have produced a suite of short training videos for staff, covering a range of topics including falls, dementia and diabetes. These are hosted on YouTube so care home staff can access these via their phones or computers at a time that is suited to them.

 

For further information on the Connecting Care programme and to follow the journey of the vanguard please visit: connectingcarewakefield.org/ or follow our Twitter page @NHSVanguardWake

 

The Portrait of a Life Toolkit is available as an e-learning resource. Please visit: http://www.southwestyorkshire.nhs.uk/quality-innovation/initiatives-projects/portrait-life-elearning/ for more information.

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