Quality indicators for care homesIntroduction

My Home Life (MHL) (www.myhomelife.org.uk) is a UK-wide initiative aimed at promoting quality of life for those who are living, dying, visiting or working in care homes for older people. MHL is led by Age UK (Age Concern and Help the Aged) in partnership with City University London, Joseph Rowntree Foundation and is supported by the Relatives and Residents Association and all the national provider organisations that represent care homes across the UK1. MHL offers a vision for best practice that includes eight evidence-based themes that are evidence-based and relationship-centred i. Two of the themes (Transformation) are aimed at care home managers and are concerned with what they need to do to support their staff deliver the other six themes. Of the six themes for staff, three are concerned with the approach to care (Personalisation) and the remaining three with what they need to do to support residents and relatives/friends through the journey of care (Navigation). My Home Life provides a conceptual framework for promoting quality of life in care homes for older people and is underpinned by relationship centred care‐ 2 and the Senses Framework3. Based on empirical research in care homes asking older residents, relatives and staff what is important to them Nolan et al.3 suggest that the fulfilment of six senses (security, belonging, continuity, purpose, achievement and significance) is key to good relationships and quality of life in this context.

The MHL vision recently informed a European study ‘Quality management by result‐oriented indicators: Towards benchmarking in residential care for older people’ which was co financed by the European Commission, DG Employment, Social Affairs and Equal ‐Opportunities in the framework of the PROGRESS Programme. The project was coordinated by the European Centre for Social Welfare Policy and Research (Austria) and carried out with partners from Germany (the Institute of Gerontology at Technische Universitat Dortmund; the Ministry of Health, Equalities, Care and Ageing of the State of North Rhine Westphalia; ‐and the Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen – MDS), The Netherlands (Vilans) and England (City University London) as well as with E Qalin Ltd ‐representing partners from Austria, Germany, Italy, Luxembourg and Slovenia. Using existing quality management guidelines and frameworks from the countries represented inthe project (as well as the Minimum Dataset from the United States), the project team collected an initial list of performance indicators taking into account different perspectives, including those of residents, relatives, staff, management, and others working in the wider social and political context (for example, regulators and commissioners). These benchmarks 1 National Care Forum, English Community Care Association, National Care Association, Registered

Nursing Home Association, Care Forum Wales, Independent Health and Care Providers, Scottish Care

2 Tresolini, CP and the Pew-Fetzer Task Force. Health Professions Education and Relationship-centered Care. San Francisco, CA: Pew Health Professions Commission, 1994.3 Nolan, M., Brown, J., Davies, S., Nolan, J. and J. Keady. (2006). The Senses Framework: Improving care for older people through a relationship-centred approach. University of Sheffield. ISBN 1-902411-44-7.

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or quality standards were set in five domains (quality of care, quality of life, leadership, economic performance and context). An output from the project was a handbook for keystakeholders of care homes “Measuring Progress: Indicators for care homes” (http://www.euro.centre.org/data/progress/PROGRESS_ENGLISH.pdf), which contains the set of result-oriented indicators that were developed and agreed by the selected EU Member States. Interestingly, all the submitted MHL and SF indicators were accepted with the exception of some of the indicators for staff. Given that all the indicators for residents and relatives were accepted, it raises the question of whether the well-being of staff is recognised across Europe as being important to delivering quality of life in care homes for older people. The vision for MHL suggests that good relationships between residents, relatives and staff are key to quality of life in care homes and that the well-being of staff, as well as, residents and relatives needs to be kept in mind. Below is a list of all the MHL and SF indicators submitted to the EU project (including the six rejected indicators for staff). It is suggested that any quality improvement initiative in care homes considers using the rejected indicators for staff, in addition to the agreed EU indicators.

My Home Life (MHL) Indicators submitted to EU project

1. MHL Indicator (Personalisation): Maintaining identity

1.1 Resident % residents who feel staff know their life story

1.2 Relatives/friends % of relatives/friends who feel staff know who they are

1.3 Staff % of staff who feel their personal skills and abilities are recognised by colleagues

2. MHL Indicator (Personalisation): Sharing Decision-making

2.1 Resident % of residents who feel their own rights are acknowledged and acted on

2.2 Relatives/friends % of relatives/friends who feel involved in decision-making about their resident’s care

2.3 Staff % of staff who feel that they can take informed risks in caring for residents

3. MHL Indicator (Personalisation): Creating community

3.1 Resident % of residents who feel part of a special community

3.2 Relatives/friends % of relatives/friends who feel welcomed in the care home

3.3 Staff % of staff who feel the care home is part of their local community

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4. MHL Indicator (Navigation): Managing Transitions

4.1 Resident % of residents who feel emotionally supported in managing their sense of loss (e.g. moving from own home, reduced social networks, increasing frailty, end of life)

4.2 Relatives/friends % of relatives/friends who feel emotionally supported in managing their sense of guilt of putting their loved one into care

4.3 Staff % of staff who feel emotionally supported in dealing with constant loss and bereavement at work

5. MHL Indicator (Navigation): Improving Health & Healthcare

5.1 Resident % of residents who feel their health is promoted to optimise their quality of life

5.2 Relatives/friends % of relatives/friends who feel their resident has adequate access to healthcare services

5.3 Staff % of staff who feel their own health is valued

6. MHL Indicator (Navigation): Supporting Good End of Life

6.1 Resident % of residents who feel able to talk about death and dying with staff

6.2 Relatives/friends % of relatives/friends who have discussed with staff end-of-life care plans for their resident

6.3 Staff % of staff who feel emotionally supported when residents die

7. MHL Indicator (Transformation): Keeping Workforce Fit for Purpose

7.1 Resident % of residents who feel there are enough staff available to meet their needs

7.2 Relatives/friends % of relatives/friends who feel staff are competent to care for their resident

7.3 Staff % of staff who feel their training needs are met to care for residents

8. MHL Indicator (Transformation): Promoting a Positive Culture

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8.1 Resident % of residents who feel there is a positive atmosphere in the care home

8.2 Relatives/friends % of relatives/friends who feel their suggestions for improvement are welcomed by staff

8.3 Staff* % of staff who feel positive about changing practice

Senses Framework (SF) Indicators submitted to EU project

1. SF Indicator: Security

1.1 Resident % of residents who feel the care home protects them from intruders.

1.2 Relatives/friends % of relatives/friends who feel staff respond quickly when their relative asks for help.

1.3 Staff* % of staff who feel colleagues practice high standards of moving and handling.

2. SF Indicator: Belonging

2.1 Resident % of residents who feel staff are friendly to them

2.2 Relatives/friends % of relatives/friends who feel their resident seems happy in the home.

2.3 Staff* % of staff who feel colleagues work with them as part of a team.

3. SF Indicator: Continuity

3.1 Resident % of residents who feel they can have visitors whenever they like.

3.2 Relatives/friends % of relatives/friends who feel the home smells pleasant.

3.3 Staff* % of staff who feel colleagues keep records up-to-date.

4. SF Indicator: Purpose

4.1 Resident % of residents who feel staff encourage them to help themselves

4.2 Relatives/friends % of relatives/friends who feel they are involved in decisions about their resident’s care

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4.3 Staff* % of staff who feel colleagues share their goal to deliver high standards of care.

5. SF Indicator: Achievement

5.1 Resident % of residents who feel staff give them time to do things on their own.

5.2 Relatives/friends % of relatives/friends who feel staff appreciate their input to their resident’s care.

5.3 Staff % of staff who feel residents’ families appear to trust them.

6. SF Indicator: Significance

6.1 Resident Significance - % of residents who feel staff respect their personal belongings.

6.2 Relatives/friends % of relatives/friends who feel they are kept up-to-date with changes affecting their resident.

6.3 Staff* % of staff who feel all grades of staff are equally valued.

Staff indicators rejected by EU project

*All QoL indicators were accepted, except the following indicators for staff:

MHL Indicator: Promoting positive culture (8.3) - % of staff who feel positive about changing practice

SF Indicator: Security (1.3) – % of staff who feel colleagues practice high standards of moving and handling.

F Indicator: Belonging (2.3) - % of staff who feel colleagues work with them as part of a team.

SF Indicator: Continuity (3.3) - % of staff who feel colleagues keep records up-to-date.

SF Indicator: Purpose (4.3) - % of staff who feel colleagues share their goal to deliver high standards of care.

SF Indicator: Significance (6.3) - % of staff who feel all grades of staff are equally valued.

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i? NCHR&D Forum (2007) My Home Life: Promoting Quality of Life in Care homes. A Review of the Literature. London: Help the Aged (now AgeUK) (http://www.myhomelife.org.uk/resources)

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