Creating and maintaining a care plan shouldn’t just be paperwork. But pressures of time and resources can result in it becoming just another task with little meaning to either residents or staff.
Dan Lipscombe, Operations Manager for C&C which runs eight care homes in London, argues making each person in turn ‘Resident of the Day’ can transform their daily care and give satisfaction to staff.
There is little question that care home staff enact care plans for residents every day, assessing their needs, acting on them and planning care to maximise opportunity and minimise anxiety.
However, when it comes to documenting their actions and providing evidence, this can be more challenging because of time constraints, a lack of continuity of staff and the pressure to complete the task of care planning.
Person-centred care, as a concept, was introduced into the healthcare sector the 1970s, known then as the ‘Nursing Process’, which aimed to establish a holistic attitude to care and not just a medical approach.
This formally introduced the idea of looking at the range of factors influencing a person’s wellbeing and also gave a greater role to nursing staff, where previously doctors had been dominant.
Care planning is now a core element of nursing and residential care, and homes are offered a range of printed and digital templates to set up and maintain records for residents.
While these are undoubtedly useful, they can’t guarantee the information they contain is comprehensive or up to date. That’s down to the individual and the systems a provider has in place to meet the Care Quality Commission’s Regulation nine.
One key factor is when plans are updated, not just how.
Many homes will update care plans at the end of the month, setting aside a day to get through everyone’s health checks and care reviews. But how much attention does that afford each person? It can feel like a treadmill for staff, especially in larger homes, and the outcome is likely to be less than satisfactory for everyone involved.
At C&C we wanted to look at how efficient that was, both in terms of compliance and improving quality of life for our residents.
A little over a year ago we introduced ‘Resident of the Day’ in which care staff at each of our eight homes in and around London focus on one resident per day.
We felt a rolling programme would give more time and space to devote to each individual and turn what had been a ‘task’ into genuine insight into each person’s needs and desires.
This individual focus gives us a chance to celebrate, not just document, them and their preferences. Their room is deep cleaned and their photograph is displayed in the home as ‘Resident of the Day’. Each resident knows they matter.
It’s a low impact solution operationally as it removes the need to block out hours or a full day to go through every resident’s details.
While a one-to-one activity with every resident outside of the home could be difficult, requests are often very simple – kippers for breakfast, films of their choice with a glass of sherry or just the chance to do the washing up.
The important thing is that the ‘Day’ involves something that has meaning to that person. What we’ve learned is that comes down to two things, as it would for all of us - being given the chance to exercise choice and experiencing what brings them joy.
For example, one resident decided to visit the local supermarket on her ‘Day’ to choose her favourite foods, some of which she’d forgotten about because she didn’t shop anymore and didn’t see them. Not only did she revel in the freedom and control her ‘Day’ gave her, our staff learned she had a love of blue cheese which they wouldn’t have otherwise known.
Another woman had a lifelong love of horses. Having visited a local stable regularly, limits to her mobility meant she couldn’t make the journey anymore so staff arranged for a horse to visit her.
It was powerful reminiscence for this resident with dementia – the smell and the feel of the animal unlocked memories that staff had not previously heard, giving them new insight into who she was, and is. And the thrill of the visit stayed with her for many days afterwards, visibly reducing her levels of anxiety.
The benefits to residents have been clear but it has also had quite an impact on the homes and the staff.
We have seen real results in the standards of record-keeping, both in terms of how often they are updated and the quality of the information they contain.
As these examples show, staff now have a better understanding of individuals. There is more meaningful interaction between staff and residents and greater satisfaction among the care teams who have the opportunity to be creative, proactive and feel less ‘task’-focused.
Another of the key benefits of ‘Resident of the Day’ is that it puts residents at the heart of decision-making about their care. Being regularly asked about their needs and desires gives them a sense of control and enhances their feeling of personhood. And where health issues make communication difficult, families are closely involved which has led to stronger relationships with staff.
As with any new initiative, buy-in from home managers and staff teams is essential for success. Here are our key learnings:
- Be clear about the changes you’re making, their intended outcomes and what success looks like
- Establish a reporting process so home managers and clinical leads can monitor activity each week and make sure every resident has been involved
- Be clear on what triggers a red flag – it’s unlikely every resident wants to do the same thing or that one person wants to do a favoured activity each and every month
- Share success. Communicate inspiring examples internally to maintain motivation and share ideas - residents may need prompting because of their health or changes in mood.
Ultimately, ‘Resident of the Day’ is about creating an effective way of continuously updating our knowledge base about residents and improving their quality of life.
About Dan Lipscombe
Dan is Operations Manager for Care for C&C. He began his career as a care assistant in residential homes for adults with learning disabilities and progressed to be the manager of three such homes aged just 24 years old.
He joined C&C in 2014 as an area manager and was appointed to his current role in 2015.