What matters to you matters to those living in care homes!

Edith MacintoshRehabilitation Consultant

Living life well in care homes

Arts in care coming soon!!

A bit of thinking and conversation!

What matters to you?

What’s living life well for you?

What do you need to do that?

Living life……….• Personal and unique.

• Gives us an identity.

• Empowers us.

• Indicates there is choice.

• Purpose and meaning to life – participation/ occupation

• Physical, emotional, mental and spiritual well being

• Provides a sense of dignity and self worth

• Joy, happiness and fun

Lets think about care homes - what is the Scottish picture?

Overall

Care homes for older people 866

Total registered capacity 37,657 places

Breakdown of providers of care homes (866 homes)

Private 626

Local Authority 121

Voluntary/not for profit 104

Health Board 15 (Highland) Highlands and islandsCare homes for older people – 79

Total registered capacity – 2233

Breakdown – Private 36, LA 17, Vol 11, Health 15. Lots of scope to develop networks to support and sustain improvement and support older

people to live well All figures as of 1st April 2016

Challenges - the same everywhere?• Cultural issues - doing to not with• Lack of infrastructure – not like the NHS!• Good leadership and mentorship

• Staff – turnover and capacity• Access to resources and training• Information sharing - across care sectors, health and social care. • Accessing local, wider health and social care services- low priority,

they’re ok! Challenges for living well! • Lack of involvement in local community/partnership planning.

• Lack of recognition that care homes are part of the community – rights and citizenship

However ……there is an appetite for improvement and vital networks of support are growing

Improvement programme

Health and well being (enablement, active living, falls prevention)

Rights, choice and citizenship(person centred care, contribution to community life)

Workforce development (inspire leaders, places of learning, developing capacity and capability care sector and CI.)

Good practice(self improvement resources, sharing and promoting good practice)

Go for Gold Challenge Improvement programme

Benefits of physical activity

• CHD and Stroke• Osteoporosis• Type II Diabetes• Hypertension• Improved sleep• Depression and anxiety• Obesity and overweight• Colon and other cancers• Reduction in accidental

injuries• Improved cognition

Prof Gerry Morris (1954)

Drivers 2.7

Civil servants 2.4

Conductors 1.9

Postmen 1.9

Age for age, drivers of double-decker buses — who sat for 90% of their shift — had substantially

more heart disease than the conductors, who would typically pound up and

down as many as 750 steps to and from the top deck

every working day.

Incidence of coronary heart disease per 1000 London Transport workers per year

Physical activity is it important? Well……

• Research evidence is incontrovertible in terms of benefits.• Specific benefits BUT huge impact on general health and well being.• Risks around extended periods of sedentary behaviour.• Falls prevention – 3 times more likely to fall in a care home.

Being active:• Increases engagement,• improves confidence, resilience and control,• reduces anxiety and depression as well as reducing symptoms of disease,• improves function and helps maintain independence. • And we age and live well.

Ageing population – people are living longer and there’s US!

• Activity declines throughout life• Benefits cannot be stored• Physical function starts to decline around 30 and

inactivity increases decline• Nursing home residents will spend 80% of their

time seated or lying• Following a week of bed rest it would take over a

year of regular exercise to regain lost bone density and up to 6 months to regain lost muscle strength and endurance.

• Recent research (Healy et al, 2011) shows that breaking long periods of sitting has a positive effect on health.

Human frailty

Time

DiseaseDisuse(Spirduso 1995)

The UK CMO guidelines on physical activity (2011)

• How much physical activity will bring health benefits?

• Apply to all older people (65+)• Interpret for use with frailer older people• Less sedentary behaviour• Some activity every day - some is better

than none!• Accumulating 150 mins moderate

activity per week in bouts of 10 mins

• Strength and balance – twice a week• Can apply to people living with dementia

GFG improvement story so far….• Began in 2012 – WCAA and Commonwealth Games

– Promote/celebrate participation in physical activity in the care sector.– Build capacity amongst staff through annual challenge events, piloting sporting ideas,

running learning events and developing resources.– Develop links - care sector and physical activity organisations.

• Annual challenges (walk, dance, events, triathlon, anything!) Incremental increase annually in numbers taking part

• Supported by a national network and reference group

• Learning events – 2/3 per yr• Linked into strategic plans with SG • Launch and implementation of self improvement tool - CAPA 2014• Evaluation 2015 – starting to change culture• GFG and CAPA implementation on going - 2016 and beyond

Some pics…

Show Dvd

GFG challenge 2016 - emphasis on walking…….Why?

Research clearly shows that the time and distance walked by older people declines with age……….

– Nearly 90% of over-50s walk, at a sufficient intensity or duration to benefit their health,

less than once a week. – Thirteen per cent of men and 15% of women aged over 70 are unable to walk for more

than 5 minutes on their own.– The ability to walk, measured in time and distance, declines with age and declines

more markedly among women– One quarter of men and women aged 70+ said they were unable to walk a quarter of a

mile on their own without stopping or feeling severe discomfort.– The UK National Travel Survey found that about 50% of men and 70% of women aged

over 80 years who were interviewed reported that they had physical problems that made walking outdoors difficult. (Source Skelton 1999)

In care homes activity levels are even lower! Look at - DH 2002. The Health Survey for England

Walking….

• Walking is a basic activity of daily living – functional fitness• Integrates the balance systems and improves the endurance

system through the performance of a natural and rhythmic use of arms and legs and both sides of the body

• Walking can range from assisted to self- directed to group activity. • Can be functional, recreational, competitive and sporting - from

gentle, through moderate to vigorous. • Walking styles and activities can be varied

Great opportunities for intergenerational practice

The Quiz!!!!!!!!!!!!

Ideas for action….

• Idea 1 - ‘Get up and go’

• Idea 2 - ‘Out and about’

• Idea 3 - ‘Walk with me’

• Idea 4 - Walking challenge events with mass activity participation

Ideas for action booklet!!

• To get good results from any of these ideas for action it requires

– Knowledge of those taking part

– Knowledge of local venues– Risk benefit analysis– Build on your achievements; explore how walking

can become a regular activity– Use a checklist – can be helpful

Care…about physical activity - self improvement tool

1. A booklet with:• an introduction to the resource, introduction to physical activity in care homes and

how to make improvements.

• the physical activity self assessment tool and guidance for its use

• a description of the three key principles to promote physical activity.

2. A DVD to support implementation of the resource pack.

3. Make Every Move Count – a pocket guide to active living.

4. A call to action poster.

5. Physical activity and self assessment tools.An app is available to download which will provide education and awareness and support the implementation of the resource from the app store.

The resource pack has been distributed to all care homes for older people in Scotland.

Implementation supported locally through established networks

Care About Physical Activity

Working towards the guidelines. The challenge

Sedentary

Meeting the guidelines

Increased physical activity

Increased benefits

Early feedback from evaluation…

• 91% - resource made staff more aware of the need to encourage physical activity• 87% - resource helped staff support residents to do more activity • 49% - impact had been ‘a lot’- staff supporting residents to do physical activity • 41% - staff are more aware of the need to encourage physical activity • 60% - positive impact on the amount of physical activity staff do themselves• 82% - resource had had a positive impact on both the number of residents

undertaking activity and the amount of activity residents were undertaking; in both cases, 30% or over reported that this impact was significant.

• The resource was reported to have had a positive impact on the emotional wellbeing of residents by 86% of respondents, while 78% reported a positive impact on reducing symptoms / managing existing physical or mental health problems.

(Lisa)

Make Every Move Count

• Designed to make something small but important happen on a regular basis

• Principles of Make Every Moment Count

• Ideas to enable the resident to have a voice and make a choice

• Realistic/achievable opportunities• The resident at the heart of the

process

Activity

Working in pairs ……

select one of the Key Messages and

look at how you could use this to support and older person to be active …………

What might you need to do to create opportunities for physical activity?

• Gentleman who couldn’t walk took part in Vitality classes and turned up at the office door a few weeks after starting!

• Lady who started swimming again now meets her old friends and swims locally.• Gentleman who was failing physically and mentally reignited his passion for

bowling, life has opened up and heading up the bowling in the care home and back at his local club.

• Dietetic student working with residents with dementia – ‘Rabbit Stew’ – had a huge impact on communication, socialisation and positive interactions.

• Highland care home who organised a games event with their residents – huge community involvement.

• Lady with dementia who began to communicate after many years because of enabling her to enjoy the outdoors and contribute to the life of the care home.

• Many stories of companionship and the impact of friendship on people’s lives.

Often doing what seems like something small can make a huge difference to lives

Atul Gawande, is a practicing surgeon, examines the ultimate limitations and failures – in his own practices as well as others’ – as life draws to a close. And he discovers how we can do better. He follows a hospice nurse on her rounds, a geriatrician in his clinic, and reformers turning nursing homes upside down. He finds people who show us how to have the hard conversations and how to ensure we never sacrifice what people really care about.

Phrases:Giving lives meaningSustenance of the soulAuthors of our own storyWe need people in the world who change imaginationsContinue to be who we areDebility and dependence does not rule out autonomySustaining the value of existence

(pages 140,146)

The challenge for us all - what can you do?

What one thing will you do differently (in your role) to support people in care homes to live well, live life and continue to be who they are?

Home is a place where a person feels deep within himself that this is a place where he can return to and be comforted and comfortable, a place where a person can feel physically secure because he is surrounded by positive uplifting things. There is also a spiritualness about home because home addresses every need we have even the ones we may not consciously be aware of.

Alex Haley 1986 (Author of Roots)Tennessee