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.’

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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.

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.

Using a population screening tool to identify people with frailty in the community: the e-frailty index

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by Laura Dobie, Knowledge and Information Skills Specialist

The Challenge

A person with frailty can experience serious adverse outcomes following even a relatively minor illness. Timely identification of frailty can help to reduce the likelihood of a poor outcome following an intervention (or eliminate the need for an intervention entirely) and support the long-term management of people’s health needs.

If we can identify people with frailty in the community, we can offer preventative support that could improve their quality of life and reduce the risk of unscheduled admissions.

There are a number of tools which professionals can use to screen people for frailty (see the British Geriatric Society’s Fit for Frailty guidance). However, many of these tools are based on questionnaires that require practitioners to have direct contact with individuals and can only be used to assess people who are actively engaged with services.  It would be resource-intensive and challenging for services to screen large population groups for frailty using these individual assessments.

The risk stratification tool, Scottish Patients at Risk of Re-admissions or Admissions (SPARRA) identifies individuals within the whole population at risk of hospital admission based on nationally-collected data on acute admissions and community prescribing.  However, it does not discriminate frailty from other high-risk population groups and can only identify individuals who are known to services, as they have had recent acute admissions or have been prescribed high-risk medications.  Alternative population screening tools are needed to identify people with frailty living in the community. Continue reading “Using a population screening tool to identify people with frailty in the community: the e-frailty index”

How care homes in Argyll and Bute are working to reduce falls

By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland

On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.

PDSAs and data

Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.

The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.

The care home staff observed that people are increasingly coming in to care homes with more mobility problems and multiple conditions and co-morbidities. Sheila commented that everyone in the care home sector is at risk of falling and should have a multifactorial falls assessmentContinue reading “How care homes in Argyll and Bute are working to reduce falls”

Scottish Ambulance Service Falls and Frailty Pathways Action Group first meeting

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On 25th November 2016 the Living Well in Communities team from Healthcare Improvement Scotland’s Improvement Hub (ihub) supported the first meeting of the Active and Independent Living Improvement Programme (AILIP) and Scottish Ambulance Service Falls and Frailty Action Group. This Storify summarises the discussions from the day. Presentations and other resources can be accessed on the Falls and Bone Health Community site.

 

Risk Prediction: Using the Electronic Frailty Index in Scotland

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We’re all aware of how important an issue frailty is, particularly the effect it has on a person’s quality of life.

Supporting people in the early stages of frailty could help them maintain independence and live healthier lives in their communities, time that would otherwise have been spent in hospital.

One of the ways Living Well in Communities are doing this is by looking at risk prediction tools to identify people at risk of frailty in the community. We can use these tools to help explore the types of support that would most benefit people.

Electronic Frailty Index

Our workshop in December 2015, involving experts across health, social care and data analytics, looked at the available risk prediction tools. We had great dialogue around what’s important for predictive tools and decided to test the electronic Frailty Index (eFI) in Scotland.

Unlike other prediction tools, it uses information outside of acute care to evaluate someone’s condition. It’s based on the cumulative deficit model of frailty, and uses GP read codes to analyse the number of ‘deficits’ an individual has, to score whether a person is Fit, Mildly Frail, Moderately Frail, or Severely Frail. Continue reading “Risk Prediction: Using the Electronic Frailty Index in Scotland”

Preventing falls in Argyll and Bute: Cowal Befrienders’ exercise classes

Strength and Balance

In this article we look at a service which is aiming to prevent falls by supporting older people who have difficulty attending classes to take part in exercise.

Background

Exercise has an important role to play in reducing the risk of falls among older people in the community. A recent BMJ review has indicated that exercise-based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community, while a recently updated Care Inspectorate good practice resource, Managing Falls and Fractures in Care Homes for Older People has stressed the importance of keeping mobile, doing regular exercise and being physically active.

The Cowal Befrienders’ falls prevention exercise classes are working towards the overall aim that “Older people have a reduced risk of falls that may affect their ability to live independently in the community”.

The classes

Cowal Befrienders host two strength and balance exercise classes per week for older people who require some help to get to the Befrienders’ drop-in centre where the classes are held and support to participate in exercise classes.

Classes are co-ordinated and delivered by Otago-qualified staff employed by Cowal Befrienders (the Otago  exercise programme is designed to prevent falls). Referrals and assessments are managed by the NHS Highland physiotherapy team.

Clients are entitled to six free classes, and can continue to attend for a modest fee of £2.50 per session. There is a small charge for clients requesting transport to their classes to help offset the additional costs incurred to provide this service (£3 return for individuals living within Dunoon, and £5 return for those living outside of the town).

In addition to health and wellbeing benefits, such as increased strength, balance and mobility, and helping participants to feel more confident and independent, the classes also have a social aim: to help older people to expand their social networks and foster peer support, and to increase access to health-promoting information that meets their needs.

The social aspect of the classes has been particularly valued by participants, with 97% citing this as one of the things that they enjoyed most about the classes. Clients also particularly appreciated the encouragement that they were given by staff and volunteers, and the pace of the classes. Continue reading “Preventing falls in Argyll and Bute: Cowal Befrienders’ exercise classes”