On the 3rd of June 2015, we spent a fascinating day at the Person Centred Care; Barriers and Facilitators conference held at the Institute of Mental Health. It was an honour to be sponsor for the event and we were thrilled it was so well attended and so well received. The event aimed to work with delegates to explore the meaning of ‘person centred care’ and how the use of multi-sensory experiences such as music, reminiscence and shared reading might facilitate and overcome challenges to individualised care.
Programme of Presentations on the Day:
Welcome – Prof. Tom Denning, Director, Centre for Dementia, Institute of Mental Health
Research Partnerships with Providers – Dr. Adam Gordon
What is Person Centred Care – Dr. Tony Kelly
Training Barriers/Facilitators – Farai Pfende (JoCo)
Imagine Arts – Kate Duncan
Music & Person Centred Care – John Osborne (musicworks)
Evaluation of Museum Resources – Dr. Neil Chadborn
Knowledge-based Person Centred Activity (KuPA) – Dr. Mike Craven
Interdem – Research Partnerships across Europe – Prof. Martin Orrell, Director, Institute of Mental Health
Shared Reading – Dr. Kevin Harvey
Expert Panel – John Osborne (Chair), Anita Astle, Kate Fisher, Justine Tomlinson, Farai Pfende
Below are some of the photographs taken during the day and the questions put to the expert panel are included here for future reference.
Thank you for attending the day – we hope you enjoyed it and found it interesting and informative. We hope you will be interested in attending future events.
One question asked at the conference was “Are you using the Care Certificate Induction Standards?”. There was a real mixed bag of responses from care providers. JoCo will be holding a Care Certificate Assessor Workshop in the autumn. We want to share the right knowledge and skills so that you have the confidence to deliver consistent in-house induction and training. To express your interest and get more details please complete the form below:Submit your name and email address to receive information about JoCo Learning & Development's Care Certificate Workshop.
Expert Panel Questions
The Expert Panel was a favourite feature at the conference. We realise that they could have done with more time to answer queries and advise on Person Centred Care. We plan to keep in touch with all the experts and invite them to future events.
If you have any further questions or any comments to make on the questions or answers below, please submit them via the form at the bottom of the page. The page will be updated where relevant submissions are made.
A – Where does the money come from for social psychological person centred care? Is there funding anywhere?
First of all, what is ‘psycho-social person centred care’? Put simply it is working in a way that promotes mental well-being.
It is about approaching care with basic human values such as unconditional positive regard or treating someone as I would expect to be treated. None of this costs anything.
In order to achieve person centred care and to deliver psycho-social interventions with real impact it is important to focus on attitude, culture and behaviour – embedding it in every day practice. Every activity in the home should have that at its heart. It is the Manager’s responsibility to set the tone – it is not just something you can purchase and overlay on the top existing practice.
An investment in training to complement the above will help you to develop person centred approaches and culture can be a sound investment. This particular standard is now part of the National requirement for all healthcare and social care workers (Care Certificate) and so it is advisable to include training needs into the annual budget of the care home.
There are however some specialised interventions that were showcased at the conference for example, STML, Memory boxes, Reading, and Art These can be adopted by any care home at relatively low cost. Such groups often offer value for money and seek funding themselves to support their projects to reach care homes. You will be surprised what an afternoon visiting charity shops can yield when trying to create stimulating environments and reminiscence activities.
This may sound obvious but, do not be afraid to try things out, be creative and innovative or network with those who are doing things you admire.
B – How do we overcome negativity concerning dementia from other families and members of staff?
Confront the situation and speak to them about dementia. A care home’s responsibility to raise dementia awareness extends not just to staff but also to families and visitors to the home. It would be a good idea to host a Dementia Friends session and invite family so that they can be more aware and you can discuss matters of concern. When you create a dementia friendly care home with a person centred culture that has to include staff, family and friends.
Case study – Sir Ian Botham talking about the difficulty he had coping with his father’s dementia journey Click here for interview
Be understanding of the difficulties that families go through, the fear and the stigma… When Leslie became a resident in a care home, Sir Ian said he found the experience increasingly difficult and eventually decided to stop visiting his father.
He asked people not to judge him unless they have been in that situation.
If staff are being negative towards residents then this is wholly unacceptable. You would need to look at your people management policies and procedures. Do staff have knowledge, understanding and skill? Do they have the will to work in line with best practice and your own local policy?
Go back to the drawing board and review your Recruitment procedures. Recruitment should incorporate person centred values and aim to attract people who are caring and kind to begin with.
Some employers (for example one of the bigger homecare providers) intend to improve recruitment of the ‘right’ staff by a process of what is called ‘strength based recruitment’. Strengths-based recruitment helps employers to identify people based on their natural talents, by enabling them to assess the things that candidates not only do well but also love doing.
C – A resident admitted from a homeless organisation has dementia and no one knows his past and what his interests etc. are. How will we assess his needs and how do we develop his person centred care?
Gathering life history in these situations is not easy in these circumstances, but you have to be willing to do the hard work.
Follow the fact trail – Find out about the institutions and services they may have accessed to try and find out about them – Social worker (does the resident have a care manager who can help you)? Community support worker? GP? Hospital? Housing? Homeless charity? What were the circumstances of them accessing these services? Information sharing is not Healthcare/Social care’s strongest trait so go through the right channels to find information they need. GPs and Social workers are a good starting point.
Observation – how do they respond to particular stimuli? What do they talk about? What belongings have they brought with them? What clothing do they have? Do they have tattoos or jewellery? Do they have an accent? Does that tell you where they are from? All can give a clue to a person’s life experiences.
Environment – Have things around in the home that will stimulate – memorabilia from offices, factory, places of interest, music, film, art or animals so you can see what they respond to? Have conversations with them about them.
Person centred care is also about being relationship centred. Sometimes all you are left with is the relationships you build with the person and the information about a person’s present. It is then your responsibility to use time, skilled communication, good listening from interested staff to start building a life story about their present which they can take into their dementia journey.
D – How do you overcome a lack of support/no support from family for information gathering? How do we engage families more?
We cannot over-emphasise the need to come from a place of acceptance when it comes to family and friends of people with dementia.
When people move in to a care home – family carers enter a new chapter of their lives. It can be fraught with emotion – having to accept new challenges, guilt, a sense of failure, grief etc…
The process of admitting a person into residential care must take a whole family approach. You have to look after the family as well as the person. Have a clear strategy for how you build relationships with them. When you acknowledge their perspective, they will feel more inclined to work in partnership with you where they feel emotionally able. Again it’s about being relationship centred.
Relationship-centred care (National Care Forum, 2007), is about embracing the person with dementia, their family, care staff and other professionals, in a triangle of care. The approach appears most prominent in the care home setting (Woods et al, 2008), though it has great potency in home care too. The simple expedient of involving and informing the family carer in the person’s care has been shown to have beneficial effects (Oyebode, 2005; Raivio et al, 2007). Practical examples might include involving the family member in developing the person’s care plan, particularly in life history work, building a portfolio of memories that can be used to inform the delivery of person-centred care.
Wren Hall recently started the ‘Soundtrack to My Life’ project at their care home. They invited family to take part in the training workshops alongside care staff. This activity was well received and it is a way of involving family in the care home activities without directly placing demands on them to ‘give information’.
E – Is the provider the lone decision maker for his care?
No is the short answer. Embracing the idea of relationship-centred care suggests that other key decision makers are involved, working alongside the resident and their principal carer:
There must be partnership working as far as possible. Involve everyone from healthcare and social care (social worker, district nurse, GP, Mental Capacity advocate). This is not just those who pay for the person’s care but others who contribute to their wellbeing and have established good relationships. These are people who can be included in the person’s “relationship circles”.
The law also provides guidance on who can make decisions in the best interest of an individual.
Engage in training and refer to the Mental capacity act (2005) Code of practice
F – How do CQC and local authority measure success of person centred care? Are there no current standards?
There are CQC standards. Generally speaking, CQC inspectors assess services against five key questions:
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs
- Are they well-led?
Inevitably, the inspector’s professional judgement is involved (always the case that different inspectors will interpret things differently), supported by objective measures and evidence. The objective measures include a standard set of key lines of enquiry (KLOEs) that directly relate to the five key questions asked of all services. Objective evidence may, for example, include having an up to date plan of care, and staff who work in accordance with that plan of care – this is very easy for inspectors to test by reading the plan, and then by asking individual members of staff how they apply it (and by asking the resident, their relatives, professionals and staff if it is indeed applied). Inspectors will also tend to observe the actual practice taking place within the home (or person’s own home), noting for example if care staff apply the practice that is recorded in care plans, or apply the training that the manager has told them has taken place. If staff are not working in accordance with care plans and their training, what might this tell the inspector about the provider’s culture.
Ensuring that you deliver quality services that inspectors can observe might include some of the following measurable things that you have decided to put in place:
VIPS (University of Worcester)
V = Values people – Values and promotes the rights of the person
I = Individual’s needs – Provides individualised care according to needs
P = Perspective of service user – Understands care from the perspective of the person with dementia
S = Supportive social psychology – Social environment enables the person to remain in relationship
50 points of Dementia Care Matters
Care certificate will be a measure?
Stand up for yourself – you have the best interest of residents/service users. Have a robust criteria for self-assessing your service. Anyone’s assessment of your service should then find nothing wanting. General weakness is in lack of evidence and lack of visible, tangible culture.
Say what you do, do what you say, and prove it with appropriate documentation (care plans, training plans, relevant policies and procedures).
Points to consider
- The inspector’s experience of your home will have an impact. They evaluate your service from the moment they enter the home – creating the impression that showcases the culture and care delivered in your care home is important.
- Assessment by CQC etc. is in part subjective observation. You can explain certain things about your care home but they need to see it in action. Say what you do and do what you say!
- If it’s not written down it didn’t happen – no document no defence. Evidence and prove it in a way that is clear.
Please submit any comments or further questions here.
National care Forum (2007), Key principles of person-centred dementia care, Statement of Best Practice, at www.nationalcareforum.org.uk
Oyebode, J. (2005), Carers as partners in mental health services for older people, Advances in Psychiatric Treatment, 11: 297-304
Raivio, M., Eloniemi-Sulkava, U., Laakkonen, M. L., Saarenheimo, M., Pietilä, M., Tilvis, R., & Pitkälä, K. (2007). How do officially organized services meet the needs of elderly caregivers and their spouses with Alzheimer’s disease? American Journal of Alzheimer’s Disease and Other Dementias, 22(5), 360-368.
Woods, R., Keady, J. and Seddon, D. (2008), Involving Families in Care Homes: A Relationship-centred Approach to Dementia Care, London: Jessica Kingsley