The office

image

John Burton,
who has managed a variety of care homes, looks at the only part of a children’s
home that isn’t therapeutic. Noting that most of our own homes don’t have an
office but “residential homes” generally do, he asks: why?

At one level, it’s fair enough: we must keep money and other
valuables, medicine and confidential records somewhere safe and secure. After
all, you don’t keep your cleaning chemicals in a locked COSHH cupboard at home,
but you do have to in a children’s home.
If the use of the office was restricted to the absolute essentials, it
wouldn’t be the problem that it often is.

The problem with the office in a children’s home is that it can
very quickly become the centre of the home and the trouble-spot – the location
of argument and incident. It’s the one room in a home that isn’t therapeutic.

Many children’s homes now claim to be “therapeutic”. Some are and
some aren’t. The therapy we are talking about is contained in the good
experience of living together and relationships with grown-ups who really do
care about you. So, cooking, food and mealtimes, getting up and going to bed,
watching TV and playing games, going off to school and being welcomed home,
gardening and enjoying outdoors, talking together and just being together,
being happy and sad, coping with pain, anger, envy, resentment, disappointment,
emptiness and loss, and so on … this is the therapy of a children’s home.
Just as being a good parent to one’s own children is very demanding, so being a
reliable and loving grown-up to the children of parents who have usually – and
for whatever reason – failed their children can be even more demanding.

In making a restorative and healing relationships with children,
therapeutic residential workers are giving children the chance to be
emotionally held and supported, to heal and make attachments, to grow and take
charge of their lives. Such work takes place in the kitchen, sitting room and
garden, in their bedrooms and bathrooms, in the hall and on the stairs, out
shopping or walking in the park together. While the work must be planned and
structured, much of it is done by simply being with the children and, when you
are not with the children, by holding the child in mind.

Diversionary
delinquency

Even in a really good home, it’s common to find staff in the
office when the children are around. If the staff are in the office, the
children are likely either to want to be in there with them or, finding
themselves at a loose end and unconnected with staff, they may stray into
harming themselves with all manner of diversionary delinquency. 

The office should not be a staff room, a bolt-hole, or a fortress.
It’s not somewhere to get away from the children but that is how it’s used. The
excuses range from having to write up records (including the blasted “log book”
every five minutes), answering the phone, dealing with money/petty cash,
checking the rota, doing the handover, making appointments, talking to “head
office” … the list is endless. But, let’s face it, somewhere deep down
underneath it all, in the murky depths of our unconscious defences, is simply
getting away from the children.

Therapeutic work doesn’t really get going until there’s a
therapeutic structure to work within. There are times when it’s OK to get the
office work done but much of what is done in the office now should be done
elsewhere. Take handovers for example. Why would you hold such a potentially
richly therapeutic meeting away from the children? They should be involved.
It’s not uncommon for staff to be locked in the office having a handover, while
the children are peering in the window or banging on the door. If you must get
petty cash for travel or whatever, sort it out before the children get up and
have it ready for them. One of the most predictable sources of unproductive and
harmful incidents is children being in the office and picking up keys, phones
etc. I’ve known homes where eggs have been kept in the office because they’ve
been thrown around. That seems like a total abandonment of therapeutic
principles and aspiration.

Outside expectations and demands don’t help. If your external
managers, or social workers, or inspectors think that you should be in the
office whenever they call, they are adding to and reinforcing your own
avoidance of the children’s needs and the therapeutic task. As always, the
misuse of the office is a whole system issue and outsiders need to reflect on
the part that they play in it.

Reflect on this and ask yourselves:

·       
How is the
office used in your children’s home?

·        Where do you hold your handover meetings and are the residents involved?

·       
What views do
the children have about staff being in the office?

Post your thoughts to share with Forum members

Where is the customer in residential care services?

residentialforum:

Des Kelly OBE, Trustee of the Residential
Forum, reflects on a workshop that asked whether the residential care market
was a myth or reality.  He shares the
flavour of contributions and concludes that the customer can easily get
overlooked in the worlds of regulation, commissioning and procurement.

I
admit I wasn’t sure that ‘Residential care market – myth or reality?’ Would be
a theme to generate the sort of lively discussion we are used to at Residential
Forum workshops. But it turned out my doubts were completely unfounded and the
debate was a stimulating as ever!

The
event held on 4 and 5 May 2017 started with presentations from John Kennedy
(The Residential Forum), Margaret Flynn (NISB Wales) and Jonathan Stanley (NCERCC).
Their combined input proved to be more than sufficient to spark the engagement
of the attendees at the workshop.

There
was universal agreement that efforts to create a market for residential care
services – whether for older people, adults or children or young people – had
not been successful. Whilst splitting commissioning from providing had
introduced competition and stimulated new providers, especially in the
independent sector, the result has been something of an imperfect market which arguably
does not operate in the interests of consumers. The market for residential care
services has always been a monopsony as the local authorities have, and
continue to be, the main purchaser of services.

The
mechanisms that generally monitor and control the entry and exit from the
market don’t work in the same way in the care sector. Local authorities
effectively set and maintain the price paid for the service. In addition, there
is no financial regulator for the care sector either at local or national
level. There has been little consumer legislation to protect people receiving
residential care and the levers of control remain rather limited. If any
thought is given to the issue at all it is assumed that the inspection process
will pick up any shortfalls.

Margaret
Flynn argued in her presentation, drawing on a major review of provision and
challenges in Wales, that when safeguarding concerns are overlaid on
residential care it highlights the cracks in the system. She suggested that the
evidence required to close care homes is such that few are actually pursued to
closure with operators exiting the market by other means.

Jonathan
Stanley suggested that residential child care is a socially constructed sector
made up of a series of markets. He felt that there is no real commissioning
only procurement. As price is always the dominant factor and social value
rarely seems to feature. Furthermore, there is little sector development and
limited innovation. The introduction of competition per se was regarded as a
good thing for residential care according to John Kennedy. However, shaping and
managing the market had proved difficult for local authorities and consequently
the outcomes were uneven which has had an impact on supply, choice and quality.

Who
is the customer?

All presenters highlighted the
dominance of price and the lack of meaningful commissioning. The absence of
consumer power in residential care was considered an indication there is not a
true market. Neither choice nor control are sufficiently well-developed. In
fact, agreeing who is the customer in relation to residential care services is
not always straightforward. This compounds the power imbalance that exists.

An
effective market may depend on the user and the purchaser being the same
person. That would certainly make being an informed consumer more meaningful.
Without a system of consumer- directed influence over residential care, caused
by the dominance of local authorities as the major purchaser, market shaping
and market management has rarely been developed in an effective way. Issues of
consumer power and control are important. So too, the purpose of residential
care services and the availability of alternative forms of community support
services. A market model implies the ability to exercise choice together with a
knowledge of alternatives.

The
workshop groups explored a range of factors including the role of regulation,
workforce issues, finding, information and marketing. Two key themes emerged:
the need to drive consumer sovereignty and the need for greater leadership for
the residential care sector. Both aspects are vital to create a responsive and
flexible ‘market’ of provision. Some participants felt that licensing providers
and regulating commissioning would be beneficial. The need for citizen-led
approaches was advocated in which residential care facilities might be regarded
as community assets – now that would amount to innovation!

The
Residential Forum is keenly interested to hear from you – as customers, workers
and stakeholders – how care homes can be a positive choice within the social
care ‘market’. Any suggestions then do click on: submit a post

What is the best initiative to support your residential service?

residentialforum:

Tracy Wharvell is
the Development Director at the National Care Association and a Residential
Forum member.  Her career in social care began over thirty years ago
as a practitioner providing social care, but now she asks how well NHS
initiatives are meeting
the aim of
supporting care homes.

Have you been asked?

There are significant amounts of funding coming
from health to support residential care homes to support improvements, in order
that care homes can help the NHS to reduce admissions and improve discharges
from hospitals. For example, support from sustainable transformation
partnership (STP), NHS England’s Enhanced Support for Care Homes, and the
recent £2 billion announced by the government.

What they all have in common is they are using initiatives from the
highly acclaimed vanguards, which found improvements through several
initiatives in locations where funds and energy were focused.  Was it the
initiative, or the focus on cultural change, and development of partnerships
and relationships?

Red Bags

The Red Bag scheme from Sutton is one of these initiatives, which
appears to be rapidly spreading across the country.  The Red Bag approach
has been designed to keep the care home resident’s belongings (clothes,
glasses, medication and notes) with them as they transfer from the care home,
to the ambulance to the hospital and back again. Great I hear all managers
saying, this will save me time tracking down lost property.  Sounds good
doesn’t it, that is until your resident is on a ward with many other red bag
holders. When the personalised approach of having a distinguishable bag will be
easier to track down.  A thought at this point; How will it feel for the
resident being labelled as a care home resident by the red bag?

Will this service really help care homes to improve their service or is
it a visual gimmick, for the NHS that puts another complicated process into an
already complicated system. Given the cost of rolling out this initiative
across the country, as a Residential Care Home Manager would you have chosen
this initiative if you had the choice or would you chosen a commitment from
health to respect the residents belongs (at no cost), the money to be spent on
training, or better access to clinicians, or something else.  

What would be your choice? Let the Residential Forum know http://www.residentialforum.com/
and feel free to comment through this blog site.

Most of all make sure you engage with your Clinical Commissioning Group
about initiatives and ideas that would support both your care home service as
well as the NHS.

Just when is residential care not residential care?

residentialforum:

 

Nick
Johnson, former Chief Executive of the Social Care Association, social care
practitioner, manager and member of the Residential Forum considers some of the
challenges to the purpose and image of residential care home living.

Many years ago, when trying
to define whether a couple were cohabiting for benefit entitlement, the
criteria were, “common roof, common table and common bed” – simple and clear.

In the case of residential
care, the judgement we made at the Council placements panel was on the need for
care throughout the 24 hours of the day. Anyone who did not need night time
intervention, could be supported at home.

That criteria have become
highly sophisticated with the regulators describing in more detail the
specifics of care and support to begin to narrow further the need for regulated
support which might equate to the need for a residential solution. This has led
to the reduction in residential care bed numbers and the de-registration of
many previously registered care settings because they have been deemed to not
be providing ‘personal care’ – especially in the Disability and Mental Health
sector.

Fearful

In every case, the working
age residential placement is temporary, rehabilitative and anticipates a return
to a more ordinary and inclusive life. For most older people, the move into a
residential home is the last move they will make and carries with it the growing
shadow of death. It is this that might make it so fearful but in fact, the fear
is not that at all but rather the likely experience of being in a residential
setting as perceived from exposes that they and their family have watched on
TV.

Generally, we choose where
we live, driven by our income, the demands of our job and the locality of where
we grow up or work. Historically, residential homes would have fulfilled a
continuity to this process with the choice to give up one’s home (often nearly lifelong)
was a choice based on the desirability of being part of a community of people
with support needs but more importantly, social networking needs.

Ironically, all the social
networking needs that enhance our lives, now fall outside regulation. People
living in supported housing may receive a lot of support to shop, access the
community, manage their domestic chores and discuss their options on any
decision, may receive more direct one to one support than a person living in a
care home but the service is outside regulation because no ‘personal’ care is
delivered.

Most regulation has its
purpose founded principally on ‘protecting the public’ – not first on quality.
The idea that any business setting out to offer support to a group of people
needing their offer should first be tested on their risk of harm to their
customers. And yet, the danger of residential care is far better known to the
public than the excellent care that thousands of people receive in the last
place they live or the place they underwent a recovery package from a trauma or
illness, prior to moving to a new address.

Toxic brand?

It may be that ‘residential
care’ has become a toxic brand and we need to rename it and re-brand it, just
like city companies do when things have gone wrong and their reputation is
lost. It may be that supported living is a better description and less arduous.
In many of these places that already exist in extra care housing, for example
the amount of care and support received in these unregulated settings is more
than would be delivered in regulated care.

The removal of bureaucratic
boundaries, regulatory lines, and budgetary gates would all help the image and
purpose in choosing to live in community rather than alone at various moments
in our lives.

Any thoughts on steps that
would assist enhance the residential care brand then lets us know at the Residential
Forum http://www.residentialforum.com/
or through a response to this blog

Where is the customer in residential care services?

image

Des Kelly OBE, Trustee of the Residential
Forum, reflects on a workshop that asked whether the residential care market
was a myth or reality.  He shares the
flavour of contributions and concludes that the customer can easily get
overlooked in the worlds of regulation, commissioning and procurement.

I
admit I wasn’t sure that ‘Residential care market – myth or reality?’ Would be
a theme to generate the sort of lively discussion we are used to at Residential
Forum workshops. But it turned out my doubts were completely unfounded and the
debate was a stimulating as ever!

The
event held on 4 and 5 May 2017 started with presentations from John Kennedy
(The Residential Forum), Margaret Flynn (NISB Wales) and Jonathan Stanley (NCERCC).
Their combined input proved to be more than sufficient to spark the engagement
of the attendees at the workshop.

There
was universal agreement that efforts to create a market for residential care
services – whether for older people, adults or children or young people – had
not been successful. Whilst splitting commissioning from providing had
introduced competition and stimulated new providers, especially in the
independent sector, the result has been something of an imperfect market which arguably
does not operate in the interests of consumers. The market for residential care
services has always been a monopsony as the local authorities have, and
continue to be, the main purchaser of services.

The
mechanisms that generally monitor and control the entry and exit from the
market don’t work in the same way in the care sector. Local authorities
effectively set and maintain the price paid for the service. In addition, there
is no financial regulator for the care sector either at local or national
level. There has been little consumer legislation to protect people receiving
residential care and the levers of control remain rather limited. If any
thought is given to the issue at all it is assumed that the inspection process
will pick up any shortfalls.

Margaret
Flynn argued in her presentation, drawing on a major review of provision and
challenges in Wales, that when safeguarding concerns are overlaid on
residential care it highlights the cracks in the system. She suggested that the
evidence required to close care homes is such that few are actually pursued to
closure with operators exiting the market by other means.

Jonathan
Stanley suggested that residential child care is a socially constructed sector
made up of a series of markets. He felt that there is no real commissioning
only procurement. As price is always the dominant factor and social value
rarely seems to feature. Furthermore, there is little sector development and
limited innovation. The introduction of competition per se was regarded as a
good thing for residential care according to John Kennedy. However, shaping and
managing the market had proved difficult for local authorities and consequently
the outcomes were uneven which has had an impact on supply, choice and quality.

Who
is the customer?

All presenters highlighted the
dominance of price and the lack of meaningful commissioning. The absence of
consumer power in residential care was considered an indication there is not a
true market. Neither choice nor control are sufficiently well-developed. In
fact, agreeing who is the customer in relation to residential care services is
not always straightforward. This compounds the power imbalance that exists.

An
effective market may depend on the user and the purchaser being the same
person. That would certainly make being an informed consumer more meaningful.
Without a system of consumer- directed influence over residential care, caused
by the dominance of local authorities as the major purchaser, market shaping
and market management has rarely been developed in an effective way. Issues of
consumer power and control are important. So too, the purpose of residential
care services and the availability of alternative forms of community support
services. A market model implies the ability to exercise choice together with a
knowledge of alternatives.

The
workshop groups explored a range of factors including the role of regulation,
workforce issues, finding, information and marketing. Two key themes emerged:
the need to drive consumer sovereignty and the need for greater leadership for
the residential care sector. Both aspects are vital to create a responsive and
flexible ‘market’ of provision. Some participants felt that licensing providers
and regulating commissioning would be beneficial. The need for citizen-led
approaches was advocated in which residential care facilities might be regarded
as community assets – now that would amount to innovation!

The
Residential Forum is keenly interested to hear from you – as customers, workers
and stakeholders – how care homes can be a positive choice within the social
care ‘market’. Any suggestions then do click on: submit a post

What is the best initiative to support your residential service?

image

Tracy Wharvell is
the Development Director at the National Care Association and a Residential
Forum member.  Her career in social care began over thirty years ago
as a practitioner providing social care, but now she asks how well NHS
initiatives are meeting
the aim of
supporting care homes.

Have you been asked?

There are significant amounts of funding coming
from health to support residential care homes to support improvements, in order
that care homes can help the NHS to reduce admissions and improve discharges
from hospitals. For example, support from sustainable transformation
partnership (STP), NHS England’s Enhanced Support for Care Homes, and the
recent £2 billion announced by the government.

What they all have in common is they are using initiatives from the
highly acclaimed vanguards, which found improvements through several
initiatives in locations where funds and energy were focused.  Was it the
initiative, or the focus on cultural change, and development of partnerships
and relationships?

Red Bags

The Red Bag scheme from Sutton is one of these initiatives, which
appears to be rapidly spreading across the country.  The Red Bag approach
has been designed to keep the care home resident’s belongings (clothes,
glasses, medication and notes) with them as they transfer from the care home,
to the ambulance to the hospital and back again. Great I hear all managers
saying, this will save me time tracking down lost property.  Sounds good
doesn’t it, that is until your resident is on a ward with many other red bag
holders. When the personalised approach of having a distinguishable bag will be
easier to track down.  A thought at this point; How will it feel for the
resident being labelled as a care home resident by the red bag?

Will this service really help care homes to improve their service or is
it a visual gimmick, for the NHS that puts another complicated process into an
already complicated system. Given the cost of rolling out this initiative
across the country, as a Residential Care Home Manager would you have chosen
this initiative if you had the choice or would you chosen a commitment from
health to respect the residents belongs (at no cost), the money to be spent on
training, or better access to clinicians, or something else.  

What would be your choice? Let the Residential Forum know http://www.residentialforum.com/
and feel free to comment through this blog site.

Most of all make sure you engage with your Clinical Commissioning Group
about initiatives and ideas that would support both your care home service as
well as the NHS.

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