Fun for all ages: intergenerational work with Thomson Court Care Home and Apple Tree Nursery on Bute

by Laura Dobie, Knowledge and Information Skills Specialist

“Let’s see what I can do to get it.”

Sadie, a resident at Thomson Court Care Home in Bute, is playing hoopla, and is determined to score. Sitting on either side of her are some children from the local nursery, cheering her on: “Go Sadie!”

This is just a normal Wednesday afternoon at Thomson Court, where the residents have regular visits from the children at nearby Apple Tree Nursery.

Inspired by the example of a care home in Canada that had co-located a staff nursery to increase resident contact with children, Unit Manager Sheila Scott wondered if there was the potential to do something similar at Thomson Court. Sheila had noticed that many residents in the home were not seeing their great-grandchildren on the mainland, and Appletree Nursery, where her daughter Stephanie works, is very proactive in working with the community.

Getting the ball rolling

The children first visited the care home in summer 2015, when they helped to paint the fence and planted sunflower and lettuce seeds. ‘Cameron’s Auntie Nan and her friend Sadie made sure that we painted it all,’ reads one of the quotations from the day. The initiative was such a success that it has led to a regular programme of indoor and outdoor activities between the care home residents and the children.

The nursery staff have compiled a floor plan with photographs and feedback from all their sessions, which map activities to health and wellbeing outcomes to demonstrate their beneficial impact. The care home also keeps its own activity records, although they are increasingly using the nursery’s Facebook page to share photographs from the sessions with families.

Looking back over the past couple of years, it is inspiring to see the breadth and variety of activities that have taken place in the care home: ‘dooking’ for apples at Halloween, music and movement sessions, baking and biscuit decorating, puppets and nursery rhymes, and a raspberry tea, to name but a few. At Christmas the children made gifts for the residents and table mats for their Christmas dinner, and Santa came to visit them all. The children have also made cards for the residents for Valentine’s Day and Mother’s Day, and there are plans for the residents to attend a concert at the nursery this Christmas.

Fundraising efforts

The nursery has also helped to raise money to pay for resources that support the residents’ wellbeing. They held a bake sale, which raised enough money to pay for a therapy doll for a resident who has dementia, and the children helped to choose the doll that was purchased. They also raised funds for a material cat and a pram, which are calming for residents.

Benefits for young and old alike

The nursery and care home staff have observed that the intergenerational activities are having a positive impact on both the residents and the nursery children. Sheila comments that the regular Wednesday sessions provide a good break for residents in the afternoon. The residents choose whether or not to attend, and one resident who initially was not interested in joining in the activities because he has a lot of family of his own living locally started to come along when he saw how much fun everyone was having! The daughter of one of the residents has commented that the children ‘generally light the place up’, and that both the residents and the children love it.

Lesley-Anne Lee, the nursery manager, observes that ‘our weekly visit to our Thomson friends has given children new experiences and emotions’ and they appreciate that the residents are teaching the children ‘maybe without them realising’. She also comments that ‘the bond between the vast age differences is a joy to see.’

The nursery children have forged close friendships with the residents, and one of the nursery pupils, Maisie, who has now moved up to primary school, formed a particularly close bond with Barbara, and enjoyed painting her fingernails. ‘Barbara is my friend, she’s my best girl,’ she said, and her father observed that ‘Maisie loves Thomson Court.’

P1020695

Learning about life

The regular visits have made the children more aware of disabilities, and helped them to learn about the whole of life, including its end. The children visited one of the residents’ rooms to look at old photographs and learn about what her life was like when she was younger, and they have also started a memory garden at the nursery to commemorate residents who have passed away.

Sheila comments that most of the residents have dementia, which affects their ability to communicate, and that the children help to bring them out of their shell. One resident, who previously did not talk very much, became very animated when the children visited.

After an hour packed with games, and a break for cake and juice, it is time for the children to head back to the nursery school. ‘I want to stay at Thomson Court because it’s so much fun,’ pipes up one of the children. Thanks to the hard work and commitment of the staff at both the nursery and the care home, it is easy to understand why they do not want to leave.

To find out more about the intergenerational work at Thomson Court, contact Sheila Scott, Unit Manager: Sheila.scott@argyll-bute.gov.uk

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Tackling fuel poverty: how Home Energy Scotland supports older people with frailty

Advisor

by Ian Mountford, Communications Executive, Energy Saving Trust

The ihub Frailty and Falls Assessment and Intervention tool highlights a fuel poverty check as a key consideration when determining if someone is in a safe and suitable environment. Individuals experiencing fuel poverty often find it difficult to heat their home, and are worried about their fuel bills.

Support

If you have identified an individual who needs support, a good place to start is by speaking to Home Energy Scotland. Funded by the Scottish Government and delivered by the Energy Saving Trust, their network provides free, impartial advice to help older people with frailty to:

  • save energy;
  • reduce heating costs;
  • access nationwide or local energy efficiency schemes;
  • maximise their income; and
  • identify and access any support available from their energy supplier.

Some households have saved £1,000 a year, and others have qualified for free heating and insulation.

Online referral

Home Energy Scotland welcome referrals and partner with a number of organisations that make use of their easy-to-use online referral portal, where clients can be securely referred and useful feedback can be obtained on referral outcomes. More information on the referral portal can be found in this short video.

Their trained advisors are located in five centres across Scotland, and give advice over the phone or in person. In addition, their community liaison teams support partner organisations with a range of advice and resources.

HES Homecare Pilot

Householders in the Moray East and Annandale and Eskdale health and social care partnership areas can benefit from extra help through a pilot project called HES Homecare. HES Homecare Energycarers visit people whose health makes them vulnerable to cold-related illness, and work with Care and Repair and Warmworks to make those homes easier – and cheaper – to heat. Contact HESHomecare@est.org.uk for more information.

To find out more about how Home Energy Scotland can support older people experiencing fuel poverty, you can visit their website, contact Mark Macleod, Stakeholder Relations Officer, on 0131 555 9151 or email HES_Partnerships@est.org.uk.

An update from Sandra Campbell

Sandra Campbell
Sandra Campbell, National Clinical Lead for Palliative and End of Life Care (Nursing)

My experiences

First of all I would like to say thank you to all the people who have got in touch with me in this new role as nursing national clinical lead for palliative care at Healthcare Improvement Scotland. Having conversations with like-minded colleagues is just great and, to me, the first step in working towards change and improvement. I am hoping that by engaging with as many teams as possible, I can learn about any particular issues and share best practice – please tell me about any good work going on, too! In providing palliative and end of life care we all have a common goal of getting it right for patients and those important to them at what can be a most difficult time, and we only get one chance to get it right.

In addition to working with six test sites in an advisory capacity, teams I have met to date include leads in NHS 24, Scottish Ambulance Service (SAS), Children’s Nurses, and Care Opinion, as well as teams within HIS and Scottish Government. All these conversations are about how we can ensure dignity at the end of life every time, such as through reducing the risk of inappropriate resuscitation attempts. Not surprisingly, it always comes back to the need for sensitive conversations earlier on in someone’s journey! It is essential that we support staff and teams to be able to have these conversations, which can be highly complex.

In July I attended a session at University College London Hospital recently on Talking DNACPR, and it was excellent. One thing I learned was the 5Ps model for sharing difficult information, based on work in St Christopher’s Hospice. Below is my adapted version:

P             Purpose               what is the purpose of this interaction?

P             People                  who should be there? The patient/family? Should I take a colleague?

P             Preparation        what do I need to know?

P             Process                how will I construct the conversation – should I use a model, e.g. SPIKES?

P             Product               what is the outcome I expect? E.g. a completed Anticipatory Care Plan or DNACPR form?

I think this could be used as a simple approach when teaching staff.  

Spotlight on the Four Principles

I mentioned the four principles from Caring for People in the Last Days and Hours of Life in my last blog post, and HIS have very kindly produced small cards that staff have can have in their pockets or use for teaching students, etc.

Please see below:

 

If you would like some, please contact: hcis.livingwell@nhs.net.

Compliance with these principles will also ensure excellent delivery of the fundamentals of nursing as advocated in the Nursing and Midwifery Council Code.

My Perspective on the SPPC Annual Conference

Paul and MichellePaul Baughan and Michelle Church, Improvement Advisor, with the Living Well in Communities poster at the conference

by Paul Baughan, GP and National Clinical Lead for Palliative and End of Life Care, Healthcare Improvement Scotland

For some people, the Scottish Partnership for Palliative Care conference is an annual pilgrimage, resembling a school reunion where people involved in palliative care can come together and catch up with one another (whilst secretly hoping that they have not aged as much as that colleague from the north or west of Scotland that they have not seen for a couple of years!). The informal sharing of experiences, pressures and local initiatives is every bit as important as the diverse programme.

My aims for the day

I attended this year’s conference with a specific question about how I could use the learning to support our six palliative care test sites.  As joint clinical lead for palliative and end of life care with Healthcare Improvement Scotland, I am working with six health and social care partnerships (HSCPs) to support local improvement work around the early identification of those with palliative care needs and the co-ordination of their care.

We had the opportunity at the conference to display and discuss our poster, which outlines the approach and process which the test sites will undertake during their improvement work. There was great interest from the delegates regarding this work, which made me even more determined to use and apply learning from the day.

The morning sessions

Professor Havi Cavel opened the conference via video link. She was able to introduce quite complex philosophical questions around the management of breathlessness through a remote presentation from Bristol. My thoughts turned to considering how we might use similar technology during our work with Eileanan Siar / Western Isles.

Next Jeremy Keen from Highland Hospice explored how specialists in palliative care can build partnerships and share experience and expertise with non-specialist colleagues dispersed across the health and social care system. One aspect I found challenging was Jeremy’s assertion that measuring things in palliative care can become a distraction to the care that is being provided.

Each of our six HSCP test sites will be measuring and collecting data related to their individual areas of improvement, and it is essential that they examine and record information and data that is appropriate and relevant. We need to ensure that this measurement does not become a distraction. Jeremy continued to discuss the ECHO project  that Highland Hospice is embarking on. This offers the opportunity for specialist advice and knowledge to be accessed more easily within the community, something which will be very relevant to the improvements in care co-ordination that our test sites will be developing.

Discussions on strategic commissioning

Diana slideThe biggest challenge of the morning fell to Diana Hekerem, as she was tasked with making the strategic commissioning of palliative care exciting. Having spoken with Diana before the conference, I knew this session would be anything but dull. The audience quickly realised that they would have to listen carefully as Diana had a series of questions lined up to test how well they were listening.

My ears pricked up when Diana asked the group which measure would they look at first when assessing success within palliative care. Perhaps the audience would heed Jeremy Keen’s caution about measuring things, and choose option 5 ‘something else’. Not so. A third of respondents suggested the Voices of the bereaved annual survey and another 30% thought the proportion of population with an anticipatory care plan (ACP) was important. The Living Well in Communities team have been developing a national approach to anticipatory care planning, and have recently launched an ACP toolkit, including an ACP app.

It was telling that only 2% thought that the number of people dying at home was the first thing that they would look at.

DianaDiana’s next question asked the audience to consider where they would spend more money. 82% thought it should either go to increasing nursing and healthcare support in the community, or to increased social care support. This was hugely reassuring as many of the six HSCP test sites are looking at how we might support community nursing and social care workers better within their tests of change.

Diana conveyed the powerful message that we all should be involved in the commissioning of palliative care services. Through 2018 and 2019, our programme of work will learn a great deal from six diverse areas in Scotland. It made me realise that the outcomes from our project should and must be used to influence local, regional and national commissioning of services.

Highlights from the afternoon

Unfortunately, it was not possible to attend all the breakout sessions in the afternoon. Of particular relevance to our work were the results from the Renfrewshire community project. Susanne Gray, Katie Clark, and Joyce Dunlop shared learning from this work, which developed ways to integrate supportive and palliative care approaches into mainstream community service provision. Their project can clearly inform our test sites, and Perth and Kinross HSCP has already been in contact with the Renfrewshire team to invite them to speak with their South Perthshire test site.

I listened with interest to Dr Georg Bollig as he spoke about the concept of Last Aid, whereby local groups receive information and training around how to care for members of their community as they approach the end of life. This approach fits with the wider community engagement work which is happening across the country, using the assets and skills of local volunteers.

Robbie Steel and Jo Bowden held parallel workshops. Fife HSCP are likely to use the learning from the excellent proactive best supportive care TCAT project as they develop their improvement work, but expanding the focus from lung cancer to other conditions.

Issues in advocacy

The hardest slot at the conference must surely go to the last speaker.  People are tired and thinking about travel plans, collecting kids, and what there is in the fridge for tea! Yet Prof Deborah Bowman pulled out a performance which would be worthy of a west end theatre. I stopped taking notes at this point and allowed her enthusiasm to wash over me.  She discussed the relationship between advocacy, marginalisation and the ethical professional. Her description of the ‘restricted view theatre seat’ helped me realise that we all have a restricted view of palliative care, as we are only seeing it from our own perspective.

Engaging with social care

So now I have shared my perspective of the SPPC conference in the knowledge that every other delegate will have picked up different highlights and learning points. It was good to catch up with long-standing colleagues and friends, and this is a huge attraction of this particular meeting.  Yet I also pondered an earlier poll which revealed that only 1% of conference delegates were from social care or the care home sector.

In our improvement work with the six HSCPs, we must do all that we can to engage with this important part of our workforce. They have an important voice which the wider palliative care community needs to listen to. And so next year, whilst I look forward to seeing the same familiar faces, I also hope to see many more unfamiliar faces. I’d like to move away from my restricted view seat, and listen and learn what palliative care is like from their perspective.

Testing the eFI in Scotland: focus on Midlock GP practice

 

Some members of the Living Well in Communities and Midlock teams at the NHSScotland event

The Living Well in Communities team is working with Health and Social Care Partnerships in Glasgow City, West Dunbartonshire and Midlothian to test the electronic frailty index (eFI) to identify people over 65 who are living with frailty in the community. The Living Well in Communities team have developed an assets-based approach to support evidence-based interventions that are tailored to the individual. This article looks at the work to date with Midlock GP practice in Glasgow.

The testing in Midlock GP practice

The eFI uses GP read codes to calculate an individual’s degree of frailty and stratifies them into fit, mildly frail, moderately frail and severely frail. The tool has been validated in England. The purpose of testing at Midlock GP practice was to determine if the tool was accurate in a Scottish context. We have been working with a GP and other members of Glasgow City HSCP, including housing and the voluntary sector. The testing involved stratification of the GP population for frailty and reviewing case scenarios to determine if the eFI tool fits with a Scottish population.

Following this process, there was broad consensus at Midlock GP practice that the eFI categories were accurate for their population. This prompted them to consider, how do we support people who are living with frailty? What does this mean for the individual? and how can we work collaboratively in the community to support them?

The case scenarios identified anticipatory care, crisis prevention and palliative and end of life care work as areas where the team could make a difference to support people to remain in their own home.

The team identified three stages of frailty to focus on initially:

  • people who are changing from mild to moderate frailty (anticipatory care),
  • people who are moderately frail with the biggest change in eFI score (crisis prevention), and
  • people who are severely frail with the biggest change in eFI score (palliative and end of life care).

Midlock GP practice has developed a virtual way of working within the multidisciplinary team and have used the Living Well in Communities falls and frailty intervention tool to guide the development of a falls and frailty collaborative working in the community. The team have found the tool beneficial to use during frailty case reviews, as it promotes holistic assessment across agencies and is a useful prompt that helps staff by signposting to partner agencies that could assist in care provision. Incorporating the tool in the case reviews highlighted five key interventions which should be implemented for every individual identified as frail (#Frailty5):

  • Frailty identification and coding on the GP system
  • Anticipatory Care Plans uploaded to eKIS
  • Key worker
  • Carer support and assessment
  • Falls & Frailty Conversation

These interventions had previously not been happening for every person, every time.

The impact so far

“The frailty tool is excellent guidance to follow and know where to signpost people.”

“There was a richness of information shared by the MDT and it’s amazing to know how many supports are there for people.”

All of the team at Midlock have made commitments to support the work. Community nurses are engaging more in anticipatory care planning conversations, and the third sector feel that they are an integral part of the work, and that their contribution is valued. The inclusion of housing options in the tool is valued by the team, and the tool has made them aware of all the supports that are available.

Supporting the Midlock team to test the efi and the falls and frailty interventions tool has helped the team to change the way that they work, with benefits for both staff and those who receive care.

Find out more about the Living Well in Communities frailty and falls work on the ihub website.

We also displayed a poster on our work at the NHSScotland event in June, which you can view here.

Updates from the Neighbourhood Care national partners meeting

On 27th June we held our latest national learning event on the neighbourhood care work being tested across the country.

With representation from Health and Social Care Partnerships and national organisations, the aim of the workshop was as much about exploring the challenges to developing this model of care as it was about sharing learning and increasing knowledge across Scotland.

After welcomes and introductions from Ruth Glassborow (Director of Improvement Support and ihub), Chris Bruce provided some background on how Scotland became involved in learning from the Buurtzorg model in the Netherlands, with an overview of the work so far.

buurtzorg onion model

All agencies and partners involved in developing local models – using the principles of Buurtzorg (and in the spirit of self-organisation) – have worked together to develop tests and start building a national learning community.

The testing principles in Scotland

  • Promote independence
  • Continuity of support and carer – reduce fragmentation
  • Self-organising, flexible teams, focused on people
  • Back office / organisation focused on staff and people
  • Opportunities – accelerate integration at point of care, empower nursing and social care workforce, change commissioning practice

Each of the eight neighbourhood care test sites (Borders, Dumfries & Galloway, Highland, Stirling and Clackmannanshire, Angus, Aberdeen City, Western Isles and Cornerstone) gave an update on what they hoped to achieve from the model, what their progress has been and what challenges they’ve faced so far.

Common themes

There were a number of common themes across the test sites when discussing developments: governance, communication, engagement, change management and recruitment.

Realistic Medicine Scotland

There was a feeling that some aspects of clinical and corporate governance were making testing more difficult than it needed to be. Should we take a risk proportionate approach, rather than risk averse? Do we have to be (more) brave?

Isn’t this the realistic approach to medicine?

The sites highlighted a need for regulations to be simple, straightforward, scaled-down, and to learn from the 3rd sector. Cornerstone rewrote and reduced their policies and procedures from more than a hundred to single digits.

The Cornerstone approach:

Start with nothing, then see what you actually need.

the workforce

There was agreement that for a lot of people working in the service there is strength to be drawn from the common goals of the neighbourhood care models.

It’s a way of working that empowers staff, promotes autonomy and self-management. It’s a model that can offer increased satisfaction for those working in it, leading to better recruitment, retention and less absence.

The importance of buy-in from all staff (including those in corporate and leadership roles) is hugely important to progress.

We are trying to introduce change in a complex environment. And for some this will lead to uncertainty, around themselves, their role, their workplace. Sharing success from the testing can help reassure people that this can work in Scotland.

Communication

Part of this will come from our internal and external communications, information sharing and engagement.

We will continue to develop the self-managing network for learning and sharing best practice across the test sites, as well as building a digital platform for updates and charting progress.

We’ll have key messages that can be use locally and nationally to help spread the word.

What ties all of this together is building trust between all the different agencies and people involved in health and social care.

Let’s talk about how we should co-operate together instead of competing; with other professionals, with informal carers and other organisations. How we make younger people enthusiastic for the profession and much more. 

Jos de Blok, Buurtzorg founder

We want people to see the successes from the test sites and for them to want to be a part of it.

We want to share people’s stories, share learning and promote success more widely.

So check back over the coming months when we’ll update you more regularly on the work of the individual test sites, hopefully looking at the practical aspects of the models as well as the broader themes and issues.

Intermediate Care & Reablement Atlas

atlas2.PNG

Chief Officers and their representatives from the 31 Health & Social Care Partnerships were invited to take part in Intermediate Care & Reablement scoping, comprised of an online survey and conversation about Intermediate Care & Reablement within their partnership area.

As part of the outputs from the scoping, the following Atlas provides information on the provision of Intermediate Care & Reablement across Scotland. It anticipated that this will be a live document that can be updated to reflect developments over time.

Download the atlas here or click the image above.

For further information, email Lianne McInallyYou can also follow Lianne on Twitter @LianneMcInally1

Anticipatory Care Planning Stories

We commissioned a series of films to introduce anticipatory care planning, how it can help to deliver person-centred care, and its benefits for people, families and their carers.

If you want to know more about anticipatory care planning or the making of these stories you can email Sheila Steel, Associate Improvement Advisor for ACP or follow her on twitter @SheilaSteel2.


A homeless person’s story – Duncan is 41 and has been in children’s homes, hostels, psychiatric care or homeless for most of his life.


A child’s story – Jack has a life-limiting condition. His parents have been told it is unlikely he’ll get to school age.


A carer’s story – Fiona was caring for her husband with cancer until he died. Now she is caring for her father alone.


An individuals story – Jim is in his fifties and is in the late stages of kidney failure caused by diabetes. His condition is terminal.


An ACP nurse’s story – Evelyn was admitted to hospital for the fourth time and diagnosed with Menieres diease. She is focussed on her illness rather than her recovery.

Find out more about Anticipatory Care Planning at myacp.scot