My Home Life’s very own Professor Julienne Meyer was recently interviewed by Anna Melville James for The Elder Magazine about Best Practice in Care Environments: Seeing People in Later Life as Individuals, Not as Conditions.
Julienne is the executive director of My Home Life, she is passionate about best practice in care environments. Julienne spoke with Anna about the importance of relationships of all kinds in the care space – and the positive power of involving people in their own care decisions. Here what Julienne had to say…
What inspires you about working in the later life space?
I’m passionate about inequalities, and you’ll always find me working at the margins. I feel the need to champion older people’s issues because I think ageism is rife in our society.
It’s probably not surprising then that I’m working with frailty and dementia, in care homes and at the end of life – I’m always looking at the sorts of places where not everybody chooses to go.
I think increasingly people are recognising the ageing population is presenting challenges that we all need to be thinking about and addressing because it’s going to affect us all. It’s not a case of “them”. Ageing is actually about “us”.
In terms of inequality, is there a sense that older people don’t often have a voice, especially in the case of their care needs?
Yes, because we’re an ageist society, we tend not to see older people as individuals, and really listen to what their needs might be. There are many other contributing reasons too – one of those being that not everybody wants to engage with this, possibly because they fear their own ageing and frailty. I think sometimes people don’t want to think about it until it affects them personally.
A lot of my work is about awareness and helping to see people as individuals, rather than as conditions. I look at the importance of involving them in decision-making about finding out what they want and what matters to them.
“For person-centred care to be delivered, we’ve not only got to think about the needs of older people but also, the needs of relatives who visit and the staff who work there.”
What is the biggest area for improvement in care at the moment?
Well, we have to recognise the funding crisis, which is just massive. That has to be the biggest issue to be addressed and improved. But for me, improvement is also about what we can do in the situation in which we find ourselves now.
People talk about person-centred care, but I don’t think we’ll ever really get to that unless we pay attention to relationships between residents, relatives and staff. I do a lot of work in care homes, and I feel that for person-centred care to be delivered, we’ve got to not only think about the needs of older people but also, the needs of relatives who visit and the staff who work there.
If we don’t think about the needs of staff, how are they going to meet the needs of residents and relatives? We’ve got to value and respect the work that they do because often the care workforce is very marginalised and stereotyped.
We also need to think about the relationships between care homes and their local communities and help the public engage with care homes more. And we need to think about care homes and the broader health and social care system, and how we can better support care homes to deliver quality services for older people.
What are the principles of best practice for you?
I’m drawing on the work of My Home Life here because that’s been a big focus for the last ten years, but I’ve worked in all care environments, and I think best practice is a set of principles that can be applied across a whole range of settings and ages.
My Home Life draws on four conceptual frameworks, and one of those is about developing best practice together. We pulled together the evidence for best practice at the start, by asking ‘What do we know older people want and what works?’
“Everyone’s business should be connecting with the most vulnerable citizens in our society – and there’s lots that we can learn from doing so.”
Within these there are eight themes, three of which I’ve already mentioned – maintaining identity, sharing decision-making, and creating community. The others are about managing transitions, improving health and healthcare, and supporting good end of life. We also need to think about keeping the workforce fit for purpose and promoting positive cultures.
Another framework draws on Mike Nolan’s work, looking at how what individuals have to say matters to them. He themed it around the fact that intrinsically, we all – whether you’re a resident, a relative, staff member or visiting student nurse – have a need to feel a sense of security, belonging, continuity, purpose, achievement and significance.
So we use that framework and encourage care home managers to think about it in care planning, appraisals, or in their interaction with relatives.
A third conceptual framework is focused on appreciative inquiry – and pays a lot of attention to the use of language. In traditional problem-solving scenarios, instead of seeing things as problems, the conversation begins with what’s working well and asking how we support that to continue. We can then envision how we’d like things to be, and how to work with others to realise that vision.
The last framework is about having caring conversations, and I think this is the most important one because if we all did this, the other frameworks would probably fall into place.
This draw’s on Belinda Dewar’s work and places emphasis on celebrating what’s working well, connecting emotionally and asking people about feelings, because we often don’t. I think having caring conversations helps us not only to find out what individuals want but can guide how we work together to deliver that. We need to be more curious and less judgmental.
Our thanks goes to all those who were involved in the creation and publication of this article. Special thanks to Anna Melville James, Claire Bergins and The Elder magazine. Please see the original article for further details on The Elder magazine Best Practice in Care Environments: Seeing People in Later Life as Individuals, Not as Conditions
My Home Life spoke with a manager of a recently rated ‘Outstanding’ Dementia, Nursing, and residential care home, they kindly shared the key ingredients they needed to reach an ‘Outstanding’ rating.
“Thing’s in the home improved when I was out of my office, it made me visible to staff relatives and residents and most importantly, involved me in the home”.
Being out of the office allowed me time to get to know my residents and see first-hand what was happening in the home. Last year I attended a My Home Life Leadership Support Programme, it allowed me to focus on my personal development in becoming a healthy, confident coach and leader. The programme allowed me time out of the home to network with other care home managers, reflect on my leadership skills and learn new methods of communication with staff. All this has created a more open, empowered culture in the service. “It all begins and ends with quality Leadership”.
“Resident involvement in the daily running of the home was pivotal in creating a person centered environment “.
The manager said, to reach ‘Outstanding’ the care home moved towards providing consistent capture and feedback of relative, professional and resident comments regarding quality in care. I explained to MHL the need to always involve the resident’s in all aspects of care home life, from individual care planning, to events planning for the care home.
“Making time to listen to relatives, residents and staff members is extremely important to me”
I explained that using this time allows me the opportunity to feedback and meet or realign expectations which, overall improved the experiences of those living in, visiting and working in the care home.
“Just be yourselves, it’s enough”
I often speak to staff about the importance of maintaining a ‘normal’ day’s routine when being inspected. Every day I see my staff shine with talent and initiative, I want to ensure staff know an inspection day is no different to any other day. “The key is managers being confident in their staff’s abilities”, this comes from investment in quality training, and the development of a positive culture of openness and good relationships.
“Always support the questioning, challenge and reflection of why things are done in a certain way”
Reflective practice is the final key ingredient in reaching ‘Outstanding’. All people living, working, and visiting the care home are encouraged to feedback and question practice. The Manager explained that with questions, comes learning, with learning comes change, and then innovation. This is why we always want to develop our skills, share our knowledge and learn from positive and negative experiences.
“It’s not a job, it’s what we do here”, a statement of which truly embodies the positive values of caring for older people living in care homes.
My Home Life would like to extend its thanks to the manager who assist in the creation of this blog.
Our home held an older persons services information drop in afternoon in which we invited in local organisations and support groups to discuss services available to older people in the area and opened the event to members of the public.
We held the event in our home to provide a relaxed, comfortable space for people to come in and seek advice.
Representatives from the Alzheimer’s Society, Age UK, Care and Connect North Tyneside, Equal Arts, and the North Tyneside Carers Centre met with guests to discuss their services and the help, advice and support available in the area.
Why did you decide to hold the event?
We thought that this would be a great way to connect with organisations relevant to our residents and their families and friends, as well as provide the opportunity to showcase the works of Older Persons advice, support and social groups in the area and help inform local people of the resources and support available and equip them with the knowledge of where to go for help and further information. The open day also offered a networking opportunity for local older persons groups, as well as older people living in the area.
What was the impact on the professionals/residents and staff?
Following the event we received an email with some lovely comments about the event and the home from the Chairman of North Tyneside. The staff were very proud.
We also had some new visitors from a neighbouring sheltered accommodation complex who said they’d like to come along to our weekly coffee morning and future events which is great for our residents who like to make new friends.
What have you learnt about the power of community engagement?
As care homes we often think about how getting involved in the community can benefit our residents and our home but we also have so much to offer our communities too. As part of day-to-day life we form many close relationships and networks in our area, from our visiting healthcare professionals, to local suppliers, to our local authority, to community groups and churches involved in our activity provision.
We can use our connections and shared knowledge to help benefit people living locally and better our communities as a whole.
Thank you to Joanne Rossiter, Maria Mallaband & Countrywide Care Homes.
Imagine my concerns when during a monthly team meeting it became apparent that my team felt that their ideas and worries were not acted on.
The process we had in place to collect staff views was to feed them into the melting pot at staff meetings. But it became was clear to me only things that we had time to pick up or deemed as urgent were being actioned. On day two of the My Home Life Leadership Programme we learnt of the six sense framework, it made me think about how my team must have been feeling about their wishes and concerns not being acknowledged.
I said to myself, “Sarah, what does a deputy manager do?” I needed to give a clear structure to capturing staff comments and to have a team that knew who to report to and receive feedback from.
We have captured fantastic ideas such as care assistants with hobbies that can be transferred into activities and new ways of working to steer away from task orientated days. Another great aspect of this is that these lines of communication have become our supervision lines.
Overall this has allowed us to become more relationship centred as a home and united as a team, who are passionate, caring and devoted to the resident and service we provide! Creating a visual tool for colleagues to appreciate the structure and flow of our home and support system has helped everyone.
As a bonus it also acts as clear evidence that inspectors and support services look for when entering our residents home.
Many thanks to Sarah Clarke Deputy Home Manager, Buckinghamshire for sharing her experience with us.
Over the years we’ve had a relationship with different groups of young people in our care home but we had lost contact with them, so we decided to start to build the links up again. It wasn’t completely straightforward – when we first started to try to find groups to link with some of them said that they had other things going on and weren’t able to commit to visits, even not very often. But we’ve kept trying and now have a good relationship with our local Girl Guides and Scouts, and different age groups from schools, who all visit the home regularly.
One thing that’s worked really well has been coordinating with the school about what the children are working on and building in the care home visit opportunity. For example, our Activities Coordinator went in to visit the primary school children beforehand and read the group a story designed to help children understand people with dementia. Then they had a group activity drawing pictures of their grannies and grandads for a display in the front of the care home, which was waiting for them when they arrived. Continue Reading