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Around 38,000 people live in Care homes in Scotland, however only a small amount of research is conducted in these settings and many studies specifically exclude Care Home Residents.  The ENRICH programme aims to support increasing the amount of research from its current levels in order to improve the quality of life and quality of care for all care home residents especially people with dementia.

The key reasons for conducting research and working with care homes:

• Residents in care homes are a vulnerable group, often lacking an effective voice due to dementia and other communication difficulties. There is therefore a risk that their health and social care rights are neglected.
• It provides evidence of what works best for the vulnerable population who live in care homes.
• We have relatively little research evidence from care homes
• It raises standards, the research evidence we have has been instrumental in helping raise the standards of care in care homes
• It can improve quality of life
• People in care homes and their families want to be involved in research to improve quality of life and quality of care.
• Research guides best practice
• Research provides an opportunity to develop the evidence base to guide best practice in care homes.

For further information/interest on ENRICH, and research in care homes please visit:

http://www.enrich.dendron.nihr.ac.uk

http://www.sdcrn.org.uk/resources/enrich-care-home-research

A podcast on Fit for the Future is now available on IRISS FM, with updates, lessons learned so far and more!

The Scottish Government recently published The Future of Residential Care  

This report and its accompanying recommendations, produced by the Scottish Government-led ‘Task Force for the Future of Residential Care for Older People in Scotland’, has now been published by the Scottish Government and can be accessed via the links above.

Interesting and relevant highlights from the recommendations section include:

On staffing:

“All of this is affected by perhaps the greatest single challenge for the delivery of a high- performing workforce into the future: terms and conditions. Care remains a low wage economy. There is no parity for the independent and third sectors in terms of pay or other terms and conditions with NHS or local authority equivalent jobs. Career progression in the sector remains challenging, making entry into the workforce a potentially unattractive career prospect. This also impacts on staff support and morale, as supervision of staff (if available), is often reported as being used as a management and performance tool rather than as a personal and professional development tool. All of this compounds the challenges we face in securing a sustainable and skilled workforce in this sector in coming years. New means of rewarding provision and the workforce need to be explored to address this, notwithstanding the current financial pressures. Levelling up the terms and conditions in the care sector to the Living Wage should be our goal. ”

A phrase we’ve been using a lot so far in this project is “I don’t know, let’s try it out!”

Rather than spending a lot of time modelling approaches on paper and agonising over approach and details, we’ve been testing things just to see how they work in practice and then working out the kinks.

I think there’s a lot of reasons why this approach (called prototyping) is appropriate in the Fit for the Future project:

1. Context matters – and differs. One size fits all can’t work in care.
2. It allows for collaboration and co-design – all people involved can be part of prototyping
3. It lets us see how something works in practice
4. It can be much more time efficient
5. It gives us evidence to share with others
6. It removes the ‘fear factor’ of something failing. By failing small and early, we can learn and move it. It’s a much more efficient way of failing, because we can understand why and improve.

In fact, the West Lothian Care Home Lab is a more formalised version of this overall approach. (for information on labs more generally see http://www.iriss.org.uk/project/social-services-lab)

But in North Lanarkshire, Falkirk and Argyll and Bute- we are starting small, testing, and learning. It’s a great way to build momentum and focus on doing.

At the recent Scottish Social Services Expo, Fit for the Future had a stand with sweets (always) and information for all the delegates.

The stand also asked a question: How do we engage with the independent sector?

We got some great responses which included:

• Move at a more strategic level
• Put something on the table – what’s in it for us?
• Give an opportunity locally

We didn’t have many people approach who were from the independent sector, and the ones that did, predictably, were already really engaged!

But what struck me was that some people mentioned ‘enforcement’ as a way to promote engagement. The idea being that collaboration may need to be forced

A theme that has arisen so far in Fit for the Future is that enforcement – through target-setting, inspection and regulation – has the opposite effect in many cases. A lot of the feedback I hear from providers is that when engagement is based on enforcement, it’s an unpleasant experience that doesn’t allow for positive, productive interaction.

I believe that the concept of target setting may also be part of this equation, which this recent report from Age Scotland (http://www.ageuk.org.uk/latest-news/dementia-targets-harm-patients/) suggests.

So are engagement and enforcement two different issues? Or are they part of the same process – collaboration, but two very different approaches?

I’m hoping to gather evidence over the course of the project as to what have been the most successful ways that we have engaged with the independent sector to think about how collaboration could look in the future.

 

The Fit for the Future team was delighted to have an opportunity to hold a workshop at the recent SSSE 2014 in Edinburgh.

We asked our workshop group to get creative with imaginary towns, lego services and real facilitators. 

We had great turnout (possibly too many!) and everyone engaged with the task really well. We just wished we had more time to explore some of the concepts in more depth.

A big thanks to our facilitators: Robert, Christine, John and Bill, who came from the Voice of Experience Forum and Grey Matters, two excellent representative groups for older people in Scotland. They were able to bring their experiences, and the experiences of people they know, to the table and really respond to the setting. They were highly praised in the feedback!

We managed to capture some feedback and comments throughout the session:

“Fantastic, creative, great fun, working together!”

“As a health care professional, I was initially reluctant but it was helpful to have a person as facilitator who could give lived experience”

“The use of the facilitators was great and a really fun interactive session. Thanks!”

 Here’s some of the comments we overheard during the session itself :

“Let’s have children involved- why can’t they come into care homes too?”

“I don’t want to have to fit into things -this town has to fit me!” – Facilitator

“The issue isn’t the service, it’s the access”

“We need to think about the full journey”

“Staff need to get to know the couple, together, even if they only see one of them at the end of their journey” – Facilitator

“We know all the problems – now we need to know the solutions” – Facilitator

“First question is: What would you change (directed at facilitator?)”

“We need to think about the full journey”

“How do we use the elements we already have?”

“I don’t want to have to fit into things -this town has to fit me!” – Facilitator

“We know all the problems – now we need to know the solutions” – Facilitator

“Staff need to get to know the couple, together, even if they only see one of them at the end of their journey” – Facilitator

The feedback also said that:

People felt they needed more time in the task to really get into the details, and we agree! If we run another of these sessions, we’ll give it much more time!

 

At the end of the session, we asked each group to feedback on what they had learned. The lessons were really telling of how important the role of the facilitators were.

• Listen to people themselves- they know the answers
• Intergenerational support is important
• Cooperation between people and planners
• Listening to people – letting them lead

 

If you came along – thank you very much! If you would be interested in exploring this idea further or using our materials, please be in touch!

The scoping phases of Fit for the Future are now over and we are into the in depth development stage! It’s really exciting but I’m taking a moment to reflect on progress so far.

I think work so far has been about harvesting good ideas. And what I’ve been thinking about lately is ‘where do good ideas come from?’. I’ve loosely categorised these into three  areas; People, Places, Spaces. The difference between place and space for me is that one is about the environment itself, and the other is more about the ‘feel’ of the environment and the ‘space’ that people are occupying.

People

• people who access support
• collaboration
• unexpected speakers – the quiet ones in the room
• new staff!

Places

• training days – away days
• in people’s homes – “on the job”
• at meetings (particularly multi disciplinary- but only when people feel at ease)
• online/in research

Spaces

• in groups where people feel comfortable and supported. This is somehow different from ‘people’ because, I think it’s about removing people from their typical mind frame into a new ‘space’. The best example for this would be that one of our project ideas came from a christmas party! It was the same staff team but in a more informal space, they were able to speak about something that might not have come up in day to day office conversation.
• in ‘electric spaces’ – for example, when staff travel together to training in a separate location, often the journey home after having an opportunity to meet new people and learn new things is ‘electric’ and an opportunity to think about different ideas.

 

Invitation for Older People and Carers 

Fit for the Future is a joint IRISS and Scottish Care project working to support the independent sector to deliver inspiring outcomes for older people.

We are hosting a workshop at the upcoming Social Service Expo and we are looking for older people and carers to help shape our sessions as a voice of experience. 

We would like you to shape the content of our workshop, and help out on the day as a representative for older people and their carers. This is an opportunity to share your knowledge and experience with a group of your peers and have some fun!

 

What is the event?

Fit for the Future: An independent sector project

An interactive workshop where participants will be given an opportunity to make real changes to imagined services to build a better future for older people in Scotland.

By the end of the session we hope that participants will:

·  Understand more about the opportunities presented by Reshaping Care for Older People

·  Experience the benefits of working with older people to design services

·  Share ideas and resources with your peers

·  Gain practical experience of the work being done by the joint IRISS and Scottish Care Fit for the Future project

·  Have created something that you are proud of!

Who are we looking for?

Any older person or carer who would like to have their voice heard and would feel comfortable working in a group. The sessions are designed to be fun and interactive!

 What would your commitment be?

• One day planning session (Monday March 10th in Glasgow, half day event Tuesday 18 March in Edinburgh) with lunch included
• Full compensation for travel

If you are interested in being part of Fit for the Future’s Expo session, please call Rhiann Mclean on 07545696162 or email rhiann.mclean@iriss.org.uk

As I spend more time in Argyll & Bute (specifically Cowal), trying to understand the landscape for older people, I’m learning that there isn’t so much an issue with filling in the gaps as there is connecting the dots.

There is a range of community support available- groups, clubs, befrienders and lunch clubs. There are also a range of paid-for supports in the area, offering different services in the home and community. But these services aren’t always delivering holistic outcomes for an older person -they may only be meeting specific basic needs. I think this may be because support (paid and unpaid) can be disconnected. This may be because of

• Transport
• Housing
• Information Sharing
• Access for older people with support needs

Isolation is a concern across Scotland, but can be even more so in rural areas like Cowal. Even more so for people who may have issues with mobility, may need support to leave the house and may not be able to use community transport. It is these people that services find it most difficult to reach. Paid care at home staff are often the only people to see some of these older people through the day. Their houses may be older, difficult to renovate and harder to reach.

The local befrienders charity, Cowal Elderly Befrienders, have adapted their service model to try to connect the dots. They try to act as facilitators for older people to get together with each other, giving them the support, opportunity and transport to do so. Rather than visit home to home, they try to bridge the gap between an individual and their community.

Distance is also an issue- I had the opportunity to sit in with the carers club at Crossroads Carers in Dunoon. The women in attendance were talking about lack of accessible venues meaning that even groups made to support people with long term conditions were not accessible to those people. There was also mention of travel, specifically to and from Inverclyde for hospital, which was seen as traumatic and unnecessary. It is in these cases that reducing unnecessary hospital admissions must be even more of a priority.

Work in Argyll and Bute will be centred on delivering support which addresses these issues as much as possible – and links with older people and the community to understand these barriers.

I’d also like to develop stronger relationships amongst partners in the areas- to try to connect the dots to deliver better outcomes for older people.