Places to Flourish Transforming Practice, Place and Policy for long term care settings Ann Coyle National Planning Specialist for Older People Health Service Executive

Rita  Has been in residential care for three years  Makes sure the dog is let out  Takes her time getting up after breakfast in bed  Sorts out the seeds for the garden  Visits Kathleen  94, wheelchair bound, in pain, several cancers  Flourishing

Mick  Dense stroke, mostly bed bound  Worked on the building site-early riser  Politics and sport  Nothing to do except ‘ate and drink’  Connectivity through care routines  Alone in a busy place  Companionship  Languishing

 Flourishing  Connected  Challenged  Important  Languishing  Lonely  Bored  helpless

Residential care policy context  Workhouses, County Homes, Geriatric hospitals, Community Nursing Units, Private Nursing Homes.  Shift from public to private  Introduction of NHSS and Regulation  Quality initiatives

Challenges  Challenges in public system  Infrastructure  Staffing  Growth of private sector curtailed by banking crisis  Demographics

Ideological challenges  Medical model,  Hierarchical models,  Segregation  Regulatory models

Opportunity  Begin a new dialogue  What do you want?  What do we as a community want?  What do older people want?  What is possible?

International Context  Move to new models of care  More hopeful- Flourishing  Smaller Scale- Domestic  Care based on relationships/Companionship  More involvement of residents and families  Greater connection to local communities

Models  Irish models  Housing with Care  Creating communities within our communities

Learning from Irish Models  Strong explicit and lived value system  Dependency of resident is not a barrier  Does not require more staff  Staff enthusiastic about the changes  Hard work  Environment still a barrier

Scale  Economic view 50 beds  Emerging Evidence  More direct care with the same number of staff  Food and Medication savings  Less turnover

Housing with Care  Many examples internationally  Shifts the emphasis from hospital to housing  More emphasis on autonomy  Dementia care

Creating Communities within Communities  Sheridan Wyoming  Not Public, Not Private  Developed by a not for profit group of volunteers  Building developed through combination of state grants, philanthropy and fund raising  Cost paid through state funding system  Small scale living, stand alone- domestic design 

Where to?  Dialogue about policy  Culture shift from care and protection to growth and flourishing  Share experiences and learn from each other and elsewhere  Involve everyone  Goodwill

Places to Flourish  A space to develop and share thinking and knowledge  Evidence of good practice-  netwell centre  Collaborations  Embrace diversity  Communicate 