Last November we launched a book with Dimensions called ‘Making it Personal for everyone – towards Individual Service Funds’. I handed a copy to the Department of Health’s Director General for Social Care, David Behan, when I saw him at a large conference last year. He asked me to describe what we had done, and then offered me a challenge:
“You have done it with six people living in residential care – come back to me when you have done it with 40 people.”
I took that challenge very seriously, and in partnership with Stockport Council and Borough Care, we are working to see how far we can go with personalising residential care for forty or more people living together.
Last week’s blog from Jaimee touched on person-centred practices with people living with dementia. This week, we want to share how we are trying to demonstrate this in a care home with forty-three people living with dementia.
We are trying to work at two levels:
1. That people living with dementia direct their own support on a day-to-day basis. We therefore need to know what matters to each person (what is important to them) and what good support looks like. We record this as a one-page profile.
We have started learning about this with Ellen who lives at Bruce Lodge and is 98. She has two sons, Stan and Roy who visit her. It is important to Ellen that she sits near the window or patio door where she can look out. She counts the planes which fly over and will tell you exactly how many have flown by. She loves watching the squirrels playing about in the garden. Ellen watches who is coming and going around the home and must always be supported to sit where she can keep an eye on what’s happening both inside and outdoors!
If you went to Bruce Lodge, you are also likely to hear Ellen singing. She is a wonderful singer and often sings Christmas carols in the Summer to raise a few smiles! She takes pride in her appearance and loves to have her hair tied up or plaited, with a bobble. A big Manchester United fan, Ellen also enjoys watching horse-racing.
Gill (From H S A who is supporting Borough Care) gathered this information with Ellen, and by talking to Stan, Roy and the staff who know Ellen. She also gathered detailed information about how to support Ellen well.
Here is what you would need to know if you were responsible for supporting Ellen:
- Ellen must be kept warm at all times.
- Always support Ellen to sit where she can look out of the window.
- Ellen loves birds – chat with her about the birds in the garden and when it is warm help her into the garden to feed the birds.
- Ellen must always be wrapped up well even if it feels warm outside – she is prone to chest infections & bouts of pneumonia.
- Know that Ellen will have lots of little naps during the day – she says there’s nothing wrong with that at 98!
- Know that Ellen will sometimes shout at you and say she wants to die. She will usually feel better after a cup of tea and a cream biscuit. Know that chatting to her about Stan and Roy or looking out at the birds and squirrels helps too.
- When Ellen is very vocal and upset, know that what works best for her is some time to herself.
Now our challenge is to make sure that all staff know this and act on it. When it came to ‘spending’ her two hours a month, Ellen said:
Lisa, the manager at Bruce Lodge, is now looking with Ellen at which staff member she wants to support her, and how to make this happen on the rota.
Is personalisation in care homes possible? Can we offer more personalised support to people who live in residential care, or should we, as some have suggested, be putting all efforts instead go into closing congregate living like this? Please share your thoughts.
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| Ellen's one page profile |
"No man is an island entire of itself" (Locke meditation 17). Compassion requires more than one person to be successful. Congregation in itself can affirm belonging and association; therefore be a neutral idea. If we make a deal with ourselves not to accept dehumanising processes and brutal distantiation in the lives of older people in residential support in return we will not to make the same mistaken policies insisting individuals did not congregate when the asylums were decomissioned.
ReplyDeleteit a brillant book and i find a great ref point to remind how tough this personlation journey is
ReplyDeleteI think that Ellen has all of two hours a MONTH to work with says everything we need to know about what her lived experience of this 'personalisation' will be.
ReplyDeleteHow much living can you fit into half an hour a week? Go for a cuppa? No way, that's not enough time to get into your wheelchair and put a jacket on, you'd be out of time before you got out the front door.
Obviously as this pitiful half-hour a week is unusable, it will have to be only an hour every fortnight instead. For someone with dementia, how much significance is that going to hold? Hush now dear, you went out for your cup of tea yesterday, it's only thirteen days until you can leave the building again.
I'd also like to know how Ellen's right to this two hours a month is recorded and protected - can the home management cancel it when someone's off sick or a new resident needs an extra pair of hands available? Will someone be able to tell themselves that she's "not up to it" and cancel that precious one hour when actually her behaviour has become more challenging BECAUSE she's desperate to get out and about?
Having lived in a mixed nursing home with many elderly residents with dementia, I can see exactly how this is going to go unless some very, very aggressive and dynamic measures are put in place to maintain it. As none such have been mentioned, it seems unlikely.