I work in a residential care home and as much as we try our very best to individualise and personalise care plans, bedrooms, give freedom of choice wherever possible, the home still has barriers to full freedom and because of the shared living space, it can be difficult for the residents to have their own space. The decision to come into a residential care setting usually means that the resident needs that extra support and wants the extra company and reassurance that being in a care home gives. Person centred care is set to enable everyone to live as independently as possible, but the reality is, people need care. Residential care homes and sheltered living accommodation have improved greatly when we compare the institutions of many years ago, the asylums, where people with all sorts of disabilities were held together. There were numerous reports of abuse in such places, which led to them closing and a more community style care service was put in place.
Now there are many different options for the elderly, there is a lot of elderly people in Wales that are maintaining their independence at home, with a care package. Carers from an agency call several times throughout the day, night, depending on what the social services think they require, or what they can afford privately. As much as I think this is great, as it must be heartbreaking to give up your family home, it concerns me, as I hear horror stories of the elderly being left for several hours, maybe falling, sitting in their own urine or excrement and having limited choices throughout their day as to when they can get up out of bed, go to bed or even eat. The carers have allocated time slots each day and are allowed only a set time with each house visit, and then in-between they might be alone for long periods.
I know that such people can have a lifeline, which they can press to get assistance, the lifeline reaches a call centre and the call centre will then contact the named people on their list to go and see if all is well, or might send an ambulance if they feel the need. Lifelines are a great idea, if they are used correctly, I have heard of several who leave theirs at the side of the bed, they either cannot reach, or fall whilst visiting the toilet and are unable to get to it. I have also heard tales of people pressing their lifeline to get some response off someone, someone to talk to, some company, as they are lonely or even fretful during the lonely night hours. Sheltered accommodation is a great idea, each person has their own individual flat, often with a main front door with different door alarms on so they can call on the person they are visiting and go straight to see them.
These flats are contained, small, easy to get around and keep clean, they can have call leads in several rooms in case of an emergency, they can cook for themselves if they so require, make themselves tea, watch what they want on the television and live quite independently. There used to be a warden present 24 hours a day, well almost, a 9-5 day shift, and then sleep in, during the night to be available in case of an emergency. Of course now there are so many cutbacks that live in wardens have been stopped throughout Wales, possibly elsewhere.
There are now teams of 3 or 4 wardens that look after several establishments, they take turns to go around each unit, calling on the residents to ensure they are ok, they are usually there 9-1, half a day, then if the residents have any issues they must use their lifeline, or the emergency chord, which instead of being linked to the warden is now linked to a head office, who will contact relevant help for the resident.
A residential home, I can only speak of ours, I have worked in 2 other nursing homes as well as the residential home I currently work in. Our home is homely, not clinical, it has carpet, not laminate or tiled flooring and it has a beautiful garden and outlook, large communal areas, including a big conservatory and lounge space split into two sides. The home is decorated tastefully for the residents, with flowers and plants and pictures, homely but not cluttered, the residents bedrooms are personalised by themselves with their belongings and choice of décor. The home does its best to treat every resident in a person centred approach, but it can be difficult to meet all needs accordingly. There are set meal times, which can be flexible to a point, they are offered alternative menu choices, but it isn’t always convenient for residents to eat whenever they so chose to.
I must say that the residents are offered several snacks and drinks throughout the day so are very rarely hungry. The residents are able to come and go to their rooms as they wish, if they are safe to do so. The residents have a choice of communal area, or to go out and sit in the garden if they wish. Their meals are served in a communal dining room, but there are a few ladies that prefer to sit alone in the communal areas to eat their meal, which is fine. There are carers available 24 hours a day, to assist as little or as much as needed for each resident, they are assisted with personal care, if required, with meals and much more. Throughout the home there is a nurse call buzzer system, if a resident needs help they can just buzz the buzzer, which is linked to a panel that shows the care staff where the buzzer has gone off so they can go and assist in whatever way needed.
The home has a lift and a chair lift, aids in the bathrooms, toilets and showers, a laundry facility, a kitchen, domestic assistants, etc. I imagine many people compare the residential care setting to the hotel model of care, where residents come into care and do nothing much for themselves anymore. Maybe a lot of that is true, but not because they are not allowed to do anything for themselves, but because many chose not to, they are old, tired and have health complications and restrictions and want a rest. There are a few residents who like keeping busy and love to help with tasks around the home, laying tables, wiping tops, collecting cups, folding napkins, which is fantastic, but there are more that aren’t interested in any domestic chores.
Housing with care for later life, a review written for the Joseph Rowntree Foundation, suggests that there are so many different levels of housing facilities and choices available as a result of how care has developed in the UK over the last 20 years, with things changing to meet the needs of the tenants. Housing with some care is the most popular option that social and health care professionals like to choose for as many as possible, it seems to be the most popular as it is the most independent way of living for the elderly, with some level of support and security if needed.
Extra care housing, which are establishments that provide a meal, additional services , barrier free environments are also known as very sheltered housing, I know very little about or I don’t know of any in my area, but they sound great. (Oldsman 200, Baker 2002) have written about such housing. There isn’t much difference between them and residential care homes, except they have their own front doors and are called tenants or owners, they can go and mix with other tenants in communal areas if they wish and are provided with a meal and the use of communal facilities or assisted technologies if they want them.
It is important to consider an individual’s safety as well as their own choices, safety and security are as important as freedom of choice, as there are many elderly people that are extremely vulnerable and think that they are able to do much more than they can. Take for example Mrs H in our home; she loves to sit in her room alone for hours at a time. She is unable to walk, only transfer from chair to chair, to bed etc, she is a really bad epileptic and once she has a fit, it is difficult for ambulance staff, when called to bring her out of the fit, she usually requires hospital assistance as she has trouble breathing during her fit. She asks to go to her room all the time, but it is a huge risk and Mrs H has severe mental health issues after a brain bleed has been deemed to not have capacity to make safe decisions for herself.
Several times when she has fitted, the care staff have seen it start in the lounge as they pass by and have managed to get to her in time to put her in the recovery position and remove anything that might cause her more harm Mrs H doesn’t understand when trying to explain to her why she is unable to go and sit in her room for hours at a time, but does go up for shorter time periods. It is important that any care setting is tastefully decorated to suit the residents that live there, to look homely, welcoming, and familiar, kept clean, and refurbished whenever necessary. Residents will feel more positive if they are in a pleasant environment, with a nice outlook, with comfortable furniture to sit on, with accessible amenities they can use themselves, a TV, drinks machine, books, music equipment, suitable lighting etc.
Legal requirements have made a huge impact on care offered to the elderly today, when we look back at how things have changed, we have definitely come along way, but I would definitely not say we are there yet, as things are always changing, people change, and we need to also. Individualistic consumer led approach to care in the 80’s and 90’s led to the government looking at decreasing the dependency culture, to enable people to be as independent at they could. There have been many changes over the years with the financial support given to those with various needs, which enables them to choose their level of care and support and where they wish to live etc.
The 1989 Caring for People white paper led the way for care in the community, as well as the NHS Community Care Act 1990, which promoted independent living for people with a more flexible care service. In 200 the Care Standards Act came into place, they are basically in place to regulate all care facilities to ensure that everything within their power is being done to a satisfactory level. Along with the regulating, they also inspect care settings and have power to make big decisions and requirements for each place they visit, as a result of this Act we now have the National Minimum standards to adhere to.