Development of a framework of outcomes for people living in care homes

JIT / Scottish Borders, SCSWIS 2010 – 2011

Up until early 2010, activity around the development and implementation of Talking Points had focused on adults living in the community. Whilst people living in care homes had been included in several partnership areas, no specific attention was paid to the applicability of the outcomes framework for use with this population. Furthermore, there was concern from a range of national stakeholders, including Scottish Care, the then Care Commission and the Scottish Government that the Talking Points approach be tested by care providers for use in a care home context. To address these two gaps in evidence, two pieces of development work were initiated:

  1. A year long pilot of Talking Points in three care homes in the Scottish Borders
  2. A four month project reviewing the applicability of the Talking Points outcomes for service users for use with people living in a care home.

The Scottish Borders care home pilot found that Talking Points was applicable in care home settings and reinforced ongoing work to embed person-centered and enabling approaches to providing care and support. The pilot also identified a number of challenges in taking forward outcomes approaches in care home settings, which broadly reflect those identified in the community. Alongside this pilot, the applicability of the framework of outcomes for use with people living in a care home was explored through a review of relevant literature and focus groups and individual interviews with 15 older people living in care homes. This research led to the identification of a number of additional outcomes relevant to care home residents. These are summarised below

People living in a care home

Quality of life

I feel safe and secure: The person feels safe and secure in the care home and in their community. The person is as far as possible physically safe from harm, including risk of falling. The person also feels emotionally safe and can rely on care home staff and others to support them when they feel less safe. Relationships with other people who live in the care home may have an impact on experiences of safety. Where significant concerns about risk arise consideration should be given to a risk assessment being undertaken.

I see people: The person feels that they have enough contact with significant other people and that they have opportunities for social participation, if they choose to (to avoid isolation). This can include family, friends, other residents and staff. Individuals have some choice over who they spend their time with in communal areas of the care home.

I have things to do: The person has opportunities to undertake activities which interest them, both in the care home and outside the home (if they wish). This can include hobbies, voluntary work and education opportunities, where that is possible.I live life as I want and where I want: The person is able to plan and have control over their daily life, such as what they wear, when and what they eat and how they spend their time. The person has ability to reach key decisions about their life and future recognising the limitations of living in a group environment/ setting

I stay as well as I can be: The person feels that they are as physically and mentally well as they can be, given any illness or condition they have. This includes being supported to stay clean and comfortable, having access to appropriate and nutritious food and drink and support and treatment when the person becomes ill, and the management of any long term conditions, including managing medication.

I have a nice place to live: The person feels that they live in a pleasant and homely environment. This includes the space inside the home, any outside space and the environment in which the home is situated.

I belong to a community: The person is able to participate in the community of their choice. This may be the community within the home or a community that they previously associated with before coming into the care home, e.g. local church group. The person is able to participate in community life regardless of illness and disability.

Process

I am treated as an individual: The person feels that they are recognised as an individual in their own right, with individual needs, aspirations and preferences. Their experiences and achievements are recognised and respected.

I am valued and treated with respect: The person feels that they are valued as someone who has something to contribute and are respected and treated with warmth and consideration.

I have a say in decisions about my care and support: The person’s views are taken into consideration in deciding on the support they receive and how the routines in the home impact on their life. This includes the use of sensory and communication aids as appropriate. The person is supported in anticipatory care planning (‘thinking ahead’) , to ensure their preferences are known.

I am supported to live well and plan for a good end of life: The person has the opportunity to plan for the end of their life, including where they would like to die and the arrangements for after they have died. This process may be facilitated by the use of a specialist care pathway.

I am listened to: The person feels that their views about their own situation are listened to by staff and their communication is supported. This includes the use of sensory or communication aids as appropriate.

My family and friends are involved if I want: The person feels they are able to involve their family and friends in their life, including making decisions about and providing care and support. There is recognition of the importance of the continued relationships and the role of family and / or friends as the person moves into the care home

My privacy is respected: The person is able to be alone when they choose and to receive care and support and pursue interests and relationships in private.

I can trust staff and rely on them to respond: The person feels that they can rely on staff to do what they say they will and to ensure that care and support that they need is in place. The person feels that services respond to their changing needs and that they can rely on services to respond if particular difficulties arise.

Change

My skills are improved: Relevant where staff are supporting the person to regain skills and capacities

My confidence / morale is improved: The person is working towards dealing positively with changed life and health circumstances, and/or personal and societal attitudes towards ageing, ill health, long term conditions, disability and dying. This outcome may be particularly important when the individual first moves to a care home and at the end of life.

My mobility is improved: The person is working towards improved ability to get around within the home and/or outside (includes equipment, adaptations, therapy, transport)

My health has improved or my symptoms are reduced: Experiencing fewer symptoms, feeling less depressed or anxious, improved sleep and improved relationships. Symptoms continue to be managed to enable the person to approach the end of life in comfort and to have a good death. Where the person has dementia, they are supported to manage the impact of the cognitive impairment on their health and well-being.

I have settled in to where I am living: The person is working to establish their life in the care home and to adjust to the changes associated with a move to a care home. This may include taking time to come to terms with feelings of grief or loss associated with leaving a previous home.

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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