PROFESSIONAL PRACTICE PAGE 4 MALE URINARY … · PROFESSIONAL PRACTICE PAGE 4 HOSPITAL ADMISSION ... INCONTINENCE LEARNING ZONE PAGE 6 PLANNING FUTURE SERVICES OPINION PAGE 10 Information,

NEWS UPDATE / COMPETITION / SELF-TEST QUESTIONS / DIARY DATES

PLUS

NUTRITIONAL CARE TOOL

PROFESSIONAL PRACTICE PAGE 4

HOSPITAL ADMISSION & DISCHARGE

WORK IN PRACTICE PAGE 8

MALE URINARY INCONTINENCE

LEARNING ZONE PAGE 6

PLANNING FUTURE SERVICES

OPINION PAGE 10

TENA Information, education and news for the care home team

WINTER 2016

CIG060 TT winter 2016 CS V4.indd 2 11/10/2016 15:43

This newsletter is the latest in a series helping you to excellence in caring for care home residents. We hope that the information we offer is useful. If you have any comments or suggestions for future content, please contact us: [email protected]

Welcome

This issue:02 WELCOME

Quality care

03 CARING CHALLENGES The Prosper project

04 PROFESSIONAL PRACTICE Good nutrition

06 LEARNING ZONE Male incontinence

08 WORK IN PRACTICE Hospital admission and discharge

10 OPINION What does integration look like?

11 DISCUSSION Advice and new ideas

12 UPDATE Health news review

edia coverage of the care home sector continues to be dominated by the ongoing

economic struggle the industry is facing. The impact of the increasing annual cost of running a care home – 5.2 per cent in the past year, according to recent figures – has been reflected in the significant rise in fees for residents. Prestige Nursing, one of the UK’s largest care agencies, reported recently that the average cost for a single room has now reached £30,000 a year.

However, it is important that, while we are acutely affected by the difficult financial climate, we also pay attention to the positivity generated by staff that underpins the quality of life for residents in the country’s care homes.

A recent study carried out by carehome.co.uk, one of the leading sites dedicated to the care home sector, showed that 82 per cent of residents and relatives gave UK care homes top rating for “dignity and staff”, with “care and support” a close second with 79 per cent.

There should be no doubt that, overwhelmingly, staff are appreciated for their efforts in maintaining morale and enthusiasm, regardless of the challenging environment in which they are working.

One area of the study that fared slightly worse in terms of rating was in response to a question about ensuring residents are stimulated through meaningful activities. Our most recent competition in the summer edition of TENATALK, where we asked for examples of outdoor activities, would suggest that, despite the low rating in the survey, there is a wealth of creativity in the minds of activity organisers in care homes all over the country.

Alongside the more traditional activities, such as tea parties, barbecues and summer fêtes, we learned of homes that indulge in slightly more “left-field” activities, such as abseiling, sailing, scarecrow building and having a dog display team to visit. We particularly liked the Pimm’s on the lawn and champagne barbecue options for getting everyone outdoors.

In this edition of TENATALK, we look in detail at some of the more routine, day-to-day challenges encountered in the home, such as the importance of providing nutritionally balanced meals and overcoming eating difficulties, and ensuring safety and reducing harm of vulnerable residents through staff skill development with programmes such as the Prosper project running in Essex.

Finally, congratulations to the winner of the TENATALK summer edition competition, Marcella Wilkinson from Westbourne House in Sheffield.

The TENA team

Quality care

02

WELCOME

MCare and support

Staff are appreciated for their efforts in maintaining morale and enthusiasm


Prosper (Promoting Safer Provision of care for Elderly Residents) involves Essex County Council and UCL Partners working in partnership with Essex residential care and nursing homes. It aims to improve safety and reduce harm for care home residents by developing the skills of care home staff through education, measurement and culture change. The project focuses on three main areas: pressure ulcers, falls and catheter infections/UTIs.

Ms Finch says her desire to take part in the initiative was mostly driven by the fact that carers would be encouraged to get involved in shaping new models of care, and that all trials would be properly evaluated via PDSAs (plan, do, study and act). “Encouraging carers to take ownership of the quality of care they are delivering helps to ensure its continuing development and improvement,” she says.

Ms Finch also welcomed the chance to enable her carer team by giving them additional knowledge and skills. Staff members undertook additional training for catheter care, glucose monitoring, preventive measures for UTIs, pressure ulcers and falls, wound care, medication administration, dementia, end of life

care, dental and mouth care, and dietary advice. As well as sessions outside the home, some training was done in the home. “One example of this was the popular 10-minute sessions held in the home so that all carers could participate, even if they were on shift. These sessions covered bone health, foot care, mobility and falls factors.”

In addition, Prosper champions were tasked with passing on the knowledge that they had gained from away days to their colleagues back at the home.

Says Ms Finch: “One of our carers, Eloise Biernat, said, ‘It was nice meeting carers from different homes and hearing how they have tackled the same problems that we all have in common. We have definitely all learnt from each other and found new and creative ways to resolve some of these problems.’”

Ms Finch says Marmora’s record keeping has improved and they are now collecting more data for analysis. Other changes include using “body maps” for anyone at risk of pressure ulcers and checking feet with special mirrors supplied by the Prosper team. “We have adopted many new systems, including the same safety crosses that are seen on hospital wards,”she says.

The residents have also been enjoying themselves. “They loved the nutrition and hydration open days and took part in the information

training sessions as well as tasting the different drinks and foods on offer,” she says. “They have been, of course, the ultimate winners due to improvements in our overall service.”

Marmora won a Prosper award earlier this year and the staff are rightly proud of their achievements. “All my staff work extremely hard,” says Ms Finch. “It was wonderful to see that a small home like ours can compete with the larger groups.”

Marmora has been able to reduce the number of UTIs and falls along with the time it takes to eliminate pressure ulcers.

“Although it is rare for one of our residents to get a pressure ulcer, we regularly receive residents from hospital or their own home with pressure ulcers,” says Ms Finch. “Our carers check the pressure areas of anyone who is at risk every day and they complete a body map to show that they have undertaken this check. We have found that this, in addition to the body map we complete whenever a resident returns to Marmora from a stay in hospital, means we are able to eliminate pressure ulcers quickly.

This training, alongside the completion of body maps, ensuring that pressure-relieving equipment is available as soon as required and that a turning regime is undertaken and recorded, has produced excellent results, says Ms Finch.

Extra training pays off

CARING CHALLENGES

03

ill Finch is manager of the Marmora Care Home in Clacton-on-Sea, Essex,

which has been part of the Prosper project since the end of 2014.

G

Case study

Conservatory areaClacton Pier

Marmora Care HomeClacton-on-SeaEssex


“All care homes will be able to register and use the NCT on a regular basis,” says Dr Ailsa Brotherton, chair of the quality and safety committee at BAPEN. “This will not only enable them to log a resident’s data and current nutritional needs, but to track their ongoing progress.”

While most care homes are doing some form of initial screening, Dr Brotherton says the way this is followed up varies enormously. “We would like to see homes making sure their care plan is tailored to an individual’s specific needs and using the tool to track nutrition outcomes and experience.”

EATING FOR HEALTHPart of this personalised approach is about changing the mindset of simply putting some food on a plate, says Dr Brotherton. “Eating for health can be very different from the concept of healthy eating, with high-protein, high-calorie intakes or oral nutritional supplements often being needed to get someone back on track,” she says.

It’s not just the absence of food that leads to malnutrition. “Perfectly good, nutritious meals can go untouched if an individual has trouble swallowing or using their cutlery, or simply cannot open packets, as is often the case with frail, elderly residents or patients with dementia,” says Dr Brotherton. “Then there’s the social aspect of eating. Sometimes people need to be encouraged, particularly if they’ve lost their appetite and interest in food or cannot recognise what is on the plate. This is where care staff can make a real difference and ensure that people begin to enjoy their meals again.”

FOOD, GLORIOUS FOODRemoving an untouched plate of food is never good enough,

04

PROFESSIONAL PRACTICE

Good nutrition on a plate

In June 2015, the British Association for Parenteral and Enteral

Nutrition (BAPEN), one of the UK’s leading health charities, launched its Nutritional Care Tool (NCT), a free screening aid that enables care providers to recognise and monitor a person’s nutritional requirements more easily.

according to Shaun Brennan, south-west divisional chef at Barchester Healthcare. Instead, he insists that people living in care homes should be gently encouraged into explaining why they did not eat.

“Not having an appetite on the odd occasion is perfectly understandable, but when it becomes a frequent occurrence, there’s an underlying reason that needs to be explored,” he says.

Barchester, which runs its own chef academy to ensure quality of training and nutrition excellence across its 200 care homes, completes a standard nutritional questionnaire when an individual moves into one of its homes. Residents (or their families) are asked about likes and dislikes, any allergies or special dietary requirements, as well as their preferences when it comes to portion sizes. Monthly nutrition meetings are also held to provide additional insights into weight loss or highlight any other nutritional issues that need to be addressed.

“We recognise that understanding an individual’s problem will only get us

With more than a third of people in care homes officially recognised as being malnourished or at high risk of malnutrition, the role of care givers in ensuring residents are properly fed and hydrated remains a key concern. Ph

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so far,” says Mr Brennan. “It’s how we act upon that information that will make the real difference.”

In addition to serving meals, Mr Brennan explains that he makes a point of dining with residents at the care homes in his division on a regular basis, with the aim of putting people at ease and gauging how well things are going.

“I will sit and eat a meal with residents at least once a week,” he says, “and I encourage the rest of the care home staff to do the same. You’d be amazed what information this can lead to. It gives me a really good steer on what people are enjoying about the food and what differences I should be making in order to accomplish this. I find that once they get to know me, people are more honest about their likes and dislikes and become confident enough to make requests or just ask for something smaller if they’re not that hungry, rather than simply going without.”

Finger foods have become a staple of Barchester’s nutrition programme, particularly with its Memory Lane communities for people living with dementia. Residents are supplied with a wide selection of finger foods and encouraged to help themselves throughout the day.

“People living with dementia often struggle with cutlery, so offering them tasty snacks that they can simply pick up is a great way of addressing their recommended nutritional needs,” he says. “We also place fruit platters throughout our homes to ensure everyone has access to good, wholesome food outside scheduled mealtimes.

It’s important to note, however, that food must be refreshed every two hours to ensure food safety.”

SERvING UP BEST PRACTICEKeep it colourful – use funky plates and vibrant vegetable colours to make dishes look as appetising as possible.

Turn the lights up – make sure people have their correct glasses and that the lighting is good enough for them to see clearly what is on their plate.

Show, don’t tell – give residents a more visual experience by showing them the food choices on offer.

Share meals – encourage your staff to sit and eat with residents. This contact really improves their confidence and generates great feedback.

Don’t rush things – make mealtimes more of a sociable experience by encouraging residents to take their time and linger over meals with each other.

Encourage requests – always keep an ear open for feedback and pass on any requests for a favourite dish.

Be flexible – work with residents as much as you can. If someone just fancies a sandwich, make sure they can have it.

Experiment – rather than simply reaching for the salt, use herbs and other flavourings (such as onions) to liven up meals.

Keep names simple – people love exotic dishes, so don’t be afraid to incorporate those. Just keep the names simple when catering for older residents.

Make it fun – if you need to fortify diets, come up with super-tasty milkshakes and quirky ideas that will put some joy into the experience.

Sweet lovers – serving sweet chutneys or sauces with savoury meals will increase their appeal for people with a sweet tooth.

Go the extra mile – don’t just add more butter for fortification, give things such as mash some real flavour with cheddar cheese or horseradish, for example.

RECIPE IDEASWinter warmers – homemade minestrone soup This wholesome soup is packed with nutritious vegetables.

Fortifying milkshake – mince pie smoothie With a festive taste to evoke Christmas, this high-fat smoothie also boasts lots of calcium.

Finger food – homemade pork and leek sausage rolls A tasty way to promote weight gain for people living with dementia.

Main – toad in the hole with onion and cider gravy With plenty of carbohydrates for energy, the protein in the milk, eggs and meat aid growth and repair.

Dessert – warm fudge brownies Crammed full of good fats essential for weight gain high calories.

All recipe ideas and tips supplied by Shaun Brennan, south-west divisional chef, Barchester Healthcare.

05

We would like to see homes making

sure their care plan is tailored to an individual’s

specific needs and using the tool to track

nutrition outcomes and experience

FURTHER USEFUL ADVICE

For more information on the Nutritional Care Tool, malnutrition and to access free training resources, visit bapen.org.uk

The National Association of Care Catering offers a range of free recipes and other training resources on its website, thenacc.co.uk

ANY NUTRITIONAL PLAN TO TREAT DISEASE-RELATED

MALNUTRITION SHOULD BE CO-ORDINATED IN CONJUNCTION WITH ADVICE FROM A QUALIFIED DIETICIAN AND/OR GP.

Training for care home staff

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After completing this training, you will:

• Understand the main causes of incontinence in men

• Know what signs to look out for that may indicate a man in your care may have a problem with urine leakage and what action to take

• Be aware of the products available to help manage incontinence in men.

Male urinary incontinence

LEARNING ZONE

ncontinence is a problem often associated with getting older and, although it is more common in women, it can also affect men. Men may be more

self-conscious about being incontinent and find it difficult to accept or talk about.I

Incontinence can be embarrassing for anyone, but older men in your care may find it distressing and not want to tell anyone. You may be the first to notice. Look out for:

• Bedding or clothing that is wet or soiled

• Urine stains in the bed

• Smell of urine

• Someone using pads or clothes for protection.

Always be sensitive. Talk to your supervisor if you think there may be a problem.

TIPS and

ADVICE

06

WHAT CAUSES INCONTINENCE?There are many factors that can cause incontinence, including:

• Getting older

• Certain medicines

• Infections of the urinary tract

• Being overweight

• Certain conditions, such as diabetes or neurological conditions (eg Alzheimer’s disease or Parkinson’s disease)

• An enlarged prostate gland (in men).

The prostate is a small gland about the size of a walnut that sits between the penis and the bladder. Only men have this gland – it is involved in the production of semen. It often becomes enlarged with age (often called BHP or benign prostatic hyperplasia), which can put pressure on the bladder and urethra. In many men, this does not cause a problem, but some get symptoms such as finding it difficult to start urinating; needing to go to the toilet more frequently, including during the night; and getting a sudden urge to urinate.

Tell your supervisor if a man in your care complains of any of these symptoms. BHP is not linked to prostate cancer, but it should be checked out. If it is affecting the man’s daily life, it may need to be treated with medication from the GP.

HOW DOES IT AFFECT qUALITY OF LIFE?If incontinence is not managed, it can affect a person’s quality of life. They may feel embarrassed or concerned they may leak or smell. It can stop them interacting with other people or taking part in social events. Look out for men who start staying in their room or sitting near the toilet as this may indicate they have a problem.

HOW CAN INCONTINENCE BE MANAGED IN MEN?The type of product used depends on how much urine leakage there is. There are pads and pants available that are discreet and designed to absorb the urine and control odour.

COMMON TYPES OF INCONTINENCE

Urge – where there is a sudden urge to urinate and the resident may not be able to get to the toilet in time. This can be linked to an enlarged prostate.

Stress – when urine passes unexpectedly during certain activities, such as coughing, laughing or sneezing.

Overflow – a constant or intermittent flow of urine caused by an obstruction to the flow of urine, which can be caused by an enlarged prostate in men.

After-dribble – where a few drops of urine are passed after urinating because the bladder is not fully emptied. This can caused by an enlarged prostate (in men) or weakened pelvic floor muscles.

Note: not all types of incontinence in men are caused by an enlarged prostate. Urine leakage can depend on many factors.



There are practical ways to help a man who has incontinence. The following may help some people:

• Take them to the toilet at regular intervals (for example, every two to four hours)

• Prompt them regularly by discreetly asking, “Do you need the toilet?”

• If they usually go at the same time every day, make sure you are available to help at these times

• If they are immobile and use a bell to attract attention, answer it as soon as possible to avoid accidents

• Don’t rush them when they are on the toilet. Make sure they have enough time to empty their bladder fully. If they have an enlarged prostate, this may take longer

• Keep the path to the toilet clear, and any walking aids they need nearby

• Consider if a urinal or commode would be useful.

Not every method works for every man. Talk to your supervisor about the best way to help each individual person. Always treat them with dignity and respect their privacy.

TIPS and

ADVICE

SELF-TEST QUESTIONS

You notice that Mr Jones, who is usually quite sociable, is withdrawn and is spending more time in his room. You ask him what the problem is. He tells you that he sometimes doesn’t get to the toilet quickly enough and drips into his trousers, and is quite embarrassed about it.

Think about how you could help Mr Jones and discuss this situation with your supervisor or manager.

07

ACTIVITY

1. The prostate gland is:

a. Only found in men b. Only found in women c. Found in men and women

2. An enlarged prostate can lead to:

a. Needing to go to the toilet more frequently b. Finding it difficult to start urinating c. Both of the above

3. Passing urine unexpectedly when coughing

is a sign of:

a. Urge incontinence b. Stress incontinence c. Overflow incontinence

4. A catheter is:

a. A sheath that goes over the penis to collect urine b. A hollow tube inserted into the bladder to collect urine c. A type of pad to collect urine

5. People with incontinence should be

encouraged to:

a. Drink more fluids b. Avoid constipation c. Both of the above

6. You notice that a man in your care has

urine-stained bedding. Should you:

a. Do nothing. Ignore it politely b. Change the bed quickly and tell him to be more careful c. Discreetly change the bed and alert your supervisor

Pads are generally used for lighter leakage and pants when a higher absorbency is required. There are also bed pads if there is a particular problem at night. Ask your supervisor to show you the different products available.

In severe cases, urinary sheaths may be used that go over the penis and are attached to a tube that passes the urine into a collection bag, or a catheter (a hollow tube that collects the urine) may be inserted into the bladder.

You should also ensure that people with incontinence drink plenty – at least six mugs or eight cups of fluid a day. You may find they want to reduce the amount they drink because they associate this with needing to go to the toilet, but if they don’t drink enough the urine can become more concentrated, which makes infections more likely.

Constipation can make the problem worse, so ensure they have a healthy, balanced diet and, if they do become constipated, alert your supervisor because they may need medication to help resolve the problem.


Whatever the reason for these hold-ups, there’s little doubt that any confusion or delay in transfer can prove distressing for both a patient and their loved ones. The NAO also claims that extended stays can have a noticeable effect on the body itself, with some patients at risk of losing five per cent of muscle strength for every day they spend in a hospital bed.

“A smooth and timely transition from hospital back to their home environment, whether that’s their

own home or a care home, has a positive effect on a person’s wellbeing and can speed up their recovery,” says Professor Gillian Leng, deputy chief executive and director of health and social care for the National Institute for Health and Care Excellence (NICE).

Experts warn, however, that too early a release can be just as costly, with patients who have yet to regain their health likely to become part of the so-called “revolving door”, where they wind up back in A&E within a few days or weeks.

HOW TO GET IT RIGHTSo, how do you co-ordinate safe and timely transfers to and from care homes?

In December 2015, NICE published new guidelines – Transition Between Inpatient Hospital Settings And Community Or Care Home Settings For Adults With Social Care Needs – in a bid to help care homes and other medical professionals develop a better approach.

It incorporates four main themes that are relevant to nursing and residential homes:

Person-centred care• Viewing everyone receiving

treatment as an individual and an equal partner who can make choices about their own care

• Identifying and supporting people at risk of less favourable treatment

• Involving families and carers in discussions about the care being given, or proposed, if the person gives their consent.

Communication and information sharing• For GPs and other relevant

practitioners who are responsible for transferring people to hospital (including care home managers) to share all appropriate information with the hospital when a person with social care needs is admitted

• Encouraging hospitals to bring together a team of multi-disciplinary professionals as soon as a person with social care needs is admitted to hospital

• Where health and social care practitioners record information about medicines, assessments and individual preferences in an electronic data system that is accessible to everyone who is providing care.

t’s a problem that costs the NHS a huge £820 million a

year, according to the National Audit Office (NAO). In a recent survey, entitled Discharging Older Patients From Hospital, it found that in 2014-15, 62 per cent of hospital bed days were occupied by older patients (aged 65 or over). Some 54 per cent of hospitals polled insisted that discharge planning did not start soon enough to minimise delays for most older patients. Some of these patients will be care home residents.

I

Best practice for hospital admission and discharge

08

WORK IN PRACTICE

Transferring care home residents to and from hospital for treatment can be complex. All too often, a lack of communication or an appropriate plan can delay a transfer and lead to delays.


Establishing a hospital-based multi-disciplinary teamNICE’s recommendation is the appointment of a discharge co-ordinator, who acts as a single port of call for a resident, their family and health practitioners.

This individual’s responsibilities would include:• Sharing updates on the person’s

health, including medicines information, with all appropriate practitioners

• Working with the hospital- and community-based teams to agree a discharge plan. This plan should then be distributed to the relevant individual, as well as all those involved with their care, including family members and carers

• Agreeing a plan for ongoing treatment and support with the community-based multi-disciplinary team who will be providing care

• Ensuring any specialist equipment and support are in place before the person is discharged from hospital.

Assessment and care planningHealth and social care practitioners should develop a care plan with adults who have identified social care needs and who are at risk of being admitted to hospital. This should include contingency planning for all aspects of the person’s life.

Care home managers are also asked to ensure the admitting team is given all available relevant information during admission. This may include:• advance care plans

• behavioural issues (triggers to certain behaviours)

• care plans

• communication needs

• communication passport

• current medicines

• hospital passport

• named carers and next of kin

• other profiles containing important information about the person’s needs and wishes.

For high-risk re-admission cases, it is recommended that a community-based nurse or GP calls or visits 24 to 72 hours after discharge.


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National Minimum Wage breachesThe largest list of employers to be named and shamed for failing to pay their workers the National Minimum Wage has been published, and 17 care homes have been identified underpaying their staff. The list notes some 197 employers who collectively owed £465,291 in arrears. Businesses or employees can find out more about the National Minimum Wage at acas.org.uk/nmw. Widening pay gap post-childbirthWomen, on average, are paid about 18 per cent less per hour than men, a report from the Institute for Fiscal Studies has revealed. For women, the pay gap widens “consistently” for 12 years after their first child is born, by which point women receive 33 per cent less pay per hour than men. This has led some to refer to a “motherhood pay penalty”. It was found that women who work part time miss out on subsequent wage progression, as do women who take time out of paid work and then return to work.

Manager’s bulletin

INTRODUCING THE RED BAG SCHEMESutton Homes of Care has launched an innovative new scheme designed to apply NICE’s recommendations for best practice into a workable and highly effective solution.

Whenever a resident travels to hospital, they are furnished with a red bag, which stays with them at all times. The initiative has been developed in partnership with Epsom and St Helier hospitals, Sutton and Merton Community Services, London Ambulance Service and representatives of Sutton care homes.

It aims to improve the experience of hospital admissions by making it easy for all parties to work together and facilitate early discharge, so residents don’t stay in hospital longer than is required for clinical care.

Contents include:

• An alert that the patient comes from a care home

• Standard documentation that enables quicker understanding of the clinical situation and the resident’s health, current medication, wellbeing needs and wishes

• A resident’s personal belongings (clothes, glasses, hearing aids, dentures, etc), together with documentation.

A copy of the patient’s discharge summary (which details every aspect of the care a patient received in hospital) is placed in the red bag when the patient is ready to go back to their care home.

Kim Kerwood, manager at Eothen Home in Sutton, the first care facility to use the red bag, says: “It’s still early days, but the communication around residents’ hospital transfer process has been excellent, with all parties working together. It is a great step forward in the care we provide for our residents.”

It is reported that the average number of calls from hospital to care home during a resident’s stay has reduced from between six and eight to just one as a result of the project.

For more information on NICE’s recommendations for hospital transfers, visit nice.org.uk


Integration is on the lips of every politician and senior officer in health and social care.

Integration should set a new direction for health and social care and, if done properly, it clearly puts the user at the centre of the system. In order to deliver integrated care, we have to challenge the way we deliver services, and challenge the power relationships between user, commissioner and provider.

There is a need for independent advocacy that will enable users to make informed choices, and there is a pressing need to clearly separate the role of assessment from that of provision. The past history of purchaser/provider split within health and social care is not a good one, and if we are going to have real independence and accountability in the system, we need to separate clearly the role of assessment and commissioning. We also need to ensure that services are planned on the basis of citizens’ needs, wants and aspirations, not on the needs of services or institutions. My ideal approach would be to move towards citizen-led assessment and citizen-controlled commissioning.

What we need is a new approach to individual commissioning, and advocacy and regulation that ensure the commissioner responds directly to the user, and is accountable to the user for fulfilling their needs. This would lead to a situation where users got the support they wanted, rather than having to fit into an existing service. For example, many people are forced to have home care and not given the choice of residential care. In future, it would be for commissioners to respond to need, not to political dogma. In this new approach, we would hope to see some creative thinking and commissioners purchasing a range of services, some of which would not just be health and social care.

The problem with the current system is that social workers tend to think only in terms of health and social care services, so, for example, if a person is identified as being depressed, the usual response is to buy in a mental health service. For some users, the answer to this may be totally different – a trip to see their family, for example, could relieve depression and isolation.

We need commissioners who can think laterally and creatively, and we need a system that is independent from the assessing authority. If this service develops, we will also need to ensure that it is both qualitative and accountable, and it is for this reason that it should be regulated. And we need to put in place some clear measures of success.

I would work to three macro measures of success. The first would be citizen experience. We would measure how people experience services and ensure they were satisfied with both the service and how it was being delivered.

The next measure would be about clinical and care outcomes, and whether the person’s wellbeing had been improved.

The final measure would be the effective and efficient use of resources, and it is my assertion that if we could measure every service on this basis, we would be getting more out of the health and social care system.

All too often systems get tied up with process, and they do not connect well with outcomes. I think this is true of continence issues, where we see a focus on the cost of continence products, and we do not see the impact of continence issues on people’s lives. I believe that if the service user were in control of which services were delivered to them, issues such as continence care, which has a low priority in the current system, would be raised much higher up the priorities list by individuals. After all, if you are not being supported to be continent, your confidence suffers, your engagement with society diminishes and your wellbeing is reduced.

We are a long way from the vision that I would like to see for integrated health and social care services. The answer to the question – what does good integration look like? – is simple: it is completely invisible to the service user. In an ideal world, all people would experience a good quality of life, and the services that help them achieve it would be like a raft lifting them across the river, rather than a minefield that they have to navigate.

10

OPINION by Professor Martin Green

We have to challenge the way we deliver services, and challenge the power relationships between user, commissioner and provider

Integration: what should it look like?

Professor Martin Green is chief executive of Care England


TENA NEWS

11

We’d love to hear your news and views by email or letterWe will give space to your letters, emails or information to share in every edition of TENATALK. Email the editor at [email protected] with any subject relevant to care homes (about 150 words is ideal) and we will publish a selection of your comments.

q How can we support those living with dementia to engage with the surrounding world?

A Dementia can be distressing for the individual, family and friends, and supporting individuals to maintain interests and relationships is essential to helping someone with dementia feel happy and motivated.

Focusing on the activities that he or she used to enjoy will evoke memories: helping them to reduce the anxiety and irritability that dementia causes.

Take time to understand what activities he or she previously enjoyed, such as gardening, knitting, puzzles or keeping a house. Support someone to tend a garden, to fold towels in the laundry or encourage baking or arts and crafts, to promote a sense of achievement and purpose and help the person to feel connected to normal life.

In the later stages of dementia people may have difficulty with processing information or communicating verbally, but they will still have some or all of their senses. There are various things you can do to stimulate these:

• Encourage the person to touch or stroke pieces of fabric, dolls or cuddly toys. A twiddle muff, for restless hands, provides visual, tactile and sensory stimulation

• Hand massage can be soothing

• Take time to sit and talk or read to the person

• Provide a calm environment with a regular change of scenery: enjoying the garden and getting some fresh air or sitting by a window with a nice view

• The smell of fresh flowers can be pleasant

• Use memory boxes, containing pictures and special items

• Play music – this boosts brain activity, can stimulate memories and evoke emotion, unlocking areas of the brain unaffected by dementia.

Centre activities on the individual’s interests and abilities – in general, small and manageable works best. Here are some tips:

• Be patient, praise and encourage

• Remember the end result is not important

• Assist only when necessary, to promote independence and achievement

• Prompt involvement using short sentences

• Guide – non-verbal communication is important to demonstrate what to do

• Be tactful – treat the individual as you would like to be treated

• Make doing things together a part of the daily routine.

TENA is a market-leading supplier to care homes. For information about the TENA product range or to contact the team:

www.tena.co.uk

[email protected]

Ask the TENA team

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New TENA Men are specially engineered for a man’s body, with the discreet cup shape creating a snug and secure fit for comfort and protection against leakage. The secure absorbent core effectively locks in anything from leaks to larger surges of urine, and the Unique Odour Control prevents any unwanted odour.

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For more information about TENA Men, please contact [email protected].


BETTER DENTAL CARE NEEDED IN CARE HOMES

More than half of older adults in care homes have tooth decay, compared with 40 per cent of over-75s and 33 per cent of over-85s who do not live in care homes. NICE’s guidance, “Oral health for adults in care homes”, calls for oral health and access

to dental treatments to be given the same priority as general health for all adults in care homes.

Recommendations focus on improving and maintaining residents’ day-to-day oral healthcare, ensuring staff are properly trained to confidently look after the oral health needs of residents, and that there is adequate access to dental services when needed. The guidance recommends all residents have an oral health assessment when they enter a care home, with the results, including any treatment needs, being entered into their personal care plan.

“Everyone should be able to speak, smile and eat comfortably, but all too often this is jeopardised by poor oral health, which can have a significant negative effect on a person’s wellbeing and quality of life,” said Professor Elizabeth Kay, foundation dean of Peninsula Dental School, Plymouth University and professor and consultant in dental public health.

nice.org.uk

CHANGES IN SENSE OF SMELL MAY BE FIRST SIGN OF ALZHEIMER’SResearch from Canada suggests that changes in the ability to identify smells could be an early sign of dementia. The findings, which came from two separate studies, compared established characteristics of dementia with an impaired sense of smell in older people without dementia. They also took brain scans.

“These studies add to growing evidence that sense of smell can be affected in the early stages of dementia,” said Dr Doug Brown, director of research and development at Alzheimer’s Society. “Most people experience some sensory loss as they age, so anyone with an impaired sense of smell shouldn’t be immediately worried about dementia, but if you have noticed changes to your sense of smell at any age, it’s advisable to speak to your GP.”

alzheimers.org.uk

A TREATMENT FOR SUPERBUGS?Researchers at the University of Sheffield are developing a treatment for antibiotic-resistant bacteria such as MRSA. The research, funded by Age UK, is designed to help prevent bacterial skin infections, thereby preventing ulcers and bed sores from becoming infected.

Bacterial skin infections are a major issue for older people in residential homes, especially those who have long-term health conditions. Infected wounds take longer to heal, which is painful and distressing and costly to treat.

Dr Pete Monk from the university’s Department of Infection, Immunity and Cardiovascular Disease, who led the study, said the research might reach clinical trials in the next three to five years.

ageuk.org.uk

NEW ACCESSIBILITY STANDARD TO HELP DEAF-BLIND PEOPLEA report published by the national deaf-blind charity Sense has revealed the barriers faced by deaf-blind people accessing healthcare in England. The report made it clear that health and social care providers across the UK, including providers of social care, need to be able to offer more accessibility to patients with sensory loss.

More than half of deaf-blind people reported leaving an appointment with their GP without understanding what had been said, and many relied on family or friends to ask and answer questions for them. Sarah White, policy manager at Sense, said the Accessible Information Standard provided a once-in-a-generation opportunity to “change the culture and practice of the healthcare services deaf-blind people receive”.

There are many steps that care providers can take to make services accessible, such as including better communication, assessing the physical environment and even making documents accessible for deaf-blind people.

The Accessible Information Standard must now be carried out by all providers of NHS and publicly funded adult social care. Visit the NHS England website for more information and advice.

england.nhs.uk; sense.org.uk

No part of this publication may be reproduced without the written permission of the publishers, SCA in association with Communications International Group Ltd. © 2016 Communications International Group Ltd, Linen Hall, 162-168 Regent Street, London W1B 5TB. 020 7434 1530. TENA TALK is distributed three times a year. If you have questions or suggestions for content, please call the editor on 020 7534 7212.

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