Social Care Training Barbara Gregg Training Services Barbaragregg1@Hotmail.co.uk

Session plan Understanding Person- centred care and support Understanding Reablement and how to deliver Reabling support to service users – challenges and benefits Documentation – Importance of good recording and how to record Reablement interventions

PERSON CENTRED CARE

Learning Objectives Explain what Person Centred care is Explore and understand different aspects of personalisation Describe how you can put it into practice within your role Reflect on different examples of good and poor practice Consider how person centred care is an ongoing process

What does the term “person centred care” mean? “Valuing the persons life experience and history” “Respecting the persons experience of their health problems and concerns” “Valuing and respecting someone’s dignity” “Helping the person make well-informed decisions and empowering them to do so” “Being compassionate and empathising with the person in your care” “Looking for non-verbal cues to help determine how the person is doing or feeling”

Person centred thinking Historically, services have just focused on what is important for them to keep people healthy and safe. Working in a person-centred way requires that we see the person first – what matters to them, not just …..what the matter is with them. We need to learn both what is important to the person and what is important for them, and find the balance that works for them

Examples of good and poor practice Good person centred care: Engage with the person – value and appreciate their point of view Respect how the persons health problems and concerns effect their day to day life Establish rapport – open-ended questions, prompting the person to talk, using good eye contact, pick up on non verbal cues Respect time with the person – try to avoid interruptions Provide information , guidance, instruction, prompting Good listening Be yourself - aim to establish a relationship and build up mutual trust. Poor Person centred care ignores or dismisses a persons understanding or opinions about their needs.

What are the benefits to our service users by working in a Person Centred way Service users feel listened to They feel their experiences, opinions and needs matter They are more likely to engage with treatment or care plans if they are part of the decision making process They are able to establish a relationship with health and social care practitioners and build up mutual trust They have “continuing care” rather than a series of ad-hoc appointments and referrals Giving individuals control in their own decisions

What could hamper good person centred care? When you are unsure of our role Short staffed Not enough time Not listening Not enough information on the care plan Rushed or stressed Tired ?

Use of “person centred profiles” Helpful to give structure to questions Capture important information Informs care and support plans At a glance way to know what is Important to a person Examples: Helen Sanderson – person centred practice OR Alzheimer's organisation

How can profiles help support people better? It captures important information about a person, what people appreciate about them and how they want to be supported Helping us build better relationships by truly understanding what really matters to the person in their life and the way they are supported to live it Providing a record that can move with the person as they transition from service to service or use multiple services Being regularly updated to reflect people’s changing circumstances and aspirations

Consider the following statements and answer “never, occasionally, sometimes or always” I take time to know the people I care for – I have a profile for each person I treat people in my care as individuals who have their own unique history, preferences and health I empathise well with the people in my care and try to see the world from their perspective I establish a relationship with the people in my care I aim to empower the people in my care to make informed decisions about health and well being I value the opinions and views of the people in my care in relation to their past experiences of health and social care I am honest and direct without being disrespectful or uncaring.

Reablement

Learning Objectives Understand Reablement – benefits and challenges Consider importance of maintaining mobility Learn how to adopt a reabling ethos in daily living tasks

What is Reablement? The reablement ethos is a person-centred approach which is about promoting and maximising independence to allow people to remain in their own home as long as possible. The reablement service is a planned short term service which provides support to a person in their own home. It is designed to enable people to gain or regain their confidence, ability, and necessary skills to remain independent, after having experienced a health or social care crisis, such as an illness or injury. The aim NI is to help people perform their usual daily living skills such as personal care, walking, and preparing meals, so that they can remain independent within their own home. “Reablement will help you to do things for yourself rather than having to rely on others.”

What are the benefits of a reabling ethos for Service users?

What are the benefits of a reabling ethos for Service Users? Improving quality of life for service user Keeping and regaining skills, especially those people who have potential to live independently Regaining or increasing confidence Improving health and well-being Increasing people’s choice and autonomy Person centered practice Enabling people to be able to continue living at home Reducing the need for ongoing care and support Packages available for others who require support

What are the benefits for staff Great job satisfaction Doing something worthwhile Learning and developing new skills Motivating Supporting people to stay longer in their own home ‘Seeing the client complete a task on their own for the first time is very rewarding, however small that task may be.’ Support Worker

What are the challenges for staff ? Care plans may not be specific enough Time needed to deliver a “hands off approach” Need for Occupational therapy direction/equipment Long-standing packages hard to change Expectation of service user/families Handy!

The Role of the Occupational Therapist To assess Activities of Daily Living (ADLs) Determine problems that interfere with independence Determine treatment objectives Remove or reduce physical, cognitive, social and emotional barriers that interfere with performance Provide training Provide equipment to increase independence

Adverse effects of hospitalisation deconditioning Impact of bed rest in the first 7 days Impact of bed rest in the first 24 hours Reduced muscle power 2 – 5% Reduced circulatory volume by up to 5% Acute frailty network UK Reduced circulatory volume by up to 25% Reduced muscle power 5-10% Reduced skin integrity Reduced dignity, quality of life, confidence , independence and choice

Mobility – importance for older people Mobility is the ability of a person to be able to move freely and easily from one place to another Independent Purposeful transfers Walking on flat/uneven surfaces Ascending/descending steps or stairs Negotiating doorways, around furniture

What are the benefits of movement? Keeps muscles and bones strong Prevents joint stiffness Improves circulation Prevents weight gain Reduces risk of osteoporosis

Benefits of Movement cont. Helps prevent/manage risk of Diabetes and some Cancers Reduces Cholesterol levels Manages blood pressure symptoms Reduces risk of heart disease Improves lung function, helps breathing

Benefits of Movement cont. Increases energy levels Increases confidence Increases self-esteem Maintains Independence Maintains quality of life – opportunities to get out and about

Warning Signs to note Always be aware of any of the following Patient complains of increasing pain Skin colour changes e.g. pale/flushed Patient feels faint Patient feeling dizzy Shortness of breath Nausea

Preparation for mobilising and transfers Is the path clear of clutter Is floor dry, smooth and not sticky Is person dressed correctly with appropriate footwear What assistance/prompts are needed Remove all obstacles Can person sit down/stand up safely Can person turn safely Where are you going/ what task is to be completed What (if any) aids or equipment are needed

Prior to starting to carry out any tasks always think how to….… Prepare yourself/colleague Prepare the environment Prepare the Service user

Prepare yourself…… Always read the care plan Know exactly what help you are going to provide prior to commencing task Apron/ gloves Hand washing – protects clients and staff Follow Moving and Handling guidelines Do not undertake tasks not documented in care plan Encourage independence

Prepare the environment Ensure adequate space as possible Ensure aids/items for task are to hand Ensure an obstacle free passage and work area Ensure equipment is checked and safe for use

Prepare the Service user Introduce self, explain reason for visit and gain consent from client to commence task Check client is feeling well and able to participate in task Glasses/ hearing aids/footwear/equipment etc.

How can you deliver a reabling ethos ? Personal care Meals management and medication Dressing/undressing

Principles of good practice for all Activities of Daily living Clear and simple instructions Respect and privacy for the client Warmth Do not rush (a challenge for us all!) Observe clients attempt; give them a try Encourage to do for themselves – involve the client – give choice If struggling suggest an alternative – sit, use stool Help if necessary

Reabling activity Assistance: means hands on help Supervision: means no physical hands on help but you don’t think they are at a point of being left to manage the task without someone there. Verbal prompts: Encouraging client to help themselves but not physically assisting Set-Up: Items placed within easy reach Independent: means you would be happy for them to complete the task without you or anyone else in the home

Things to consider for Medication management Definitions Administer Supervise Prompt Check Call Intervention Subtly check if meds have been taken Allow opportunity to administer independently Prompt only if needed Physical help if needed Record level of assistance/independence with task

Things to consider for meal preparation Hygiene awareness Fatigue levels Concentration – problem solving ability Safety awareness – using gas, cooker kettle etc Planning and organisational skills Sequencing Use of equipment – e.g. trolley, perching stool Selecting appropriate items Functional mobility in confined area Fatigue management

Things to consider for dressing & undressing Undress- only top half, full body Choose clothes- put on in right order Dress upper body Fastenings Dress lower body- pants, pad, socks, trousers, shoes Sitting balance Fatigue

Things to consider for personal care Transfer from bed, on/off WC, mobility Set up - basin, toiletries Shower or body wash – use of equipment Drying self Wash upper body/ lower body Grooming, teeth, deodorant, shaving, make-up Sitting balance, fatigue, range of movement

Barbara Gregg Training Services For further information contact: barbaragregg1@hotmail.co.uk