The recent spell of hot weather brought the familiar debate over whether my shorts and T-shirts had shrunk over the winter months, or it was time to recommence my annual and largely unsuccessful fight against flab. It is a familiar story for many of us, with fears about obesity and the associated health risks dominating.
Unfortunately, while being overweight is clearly a health issue, which receives much prominence in the press, at the other end of the spectrum we have those suffering with malnourishment. This is often forgotten, yet recent researched shows that in 2015 there were around three million people in the UK that were malnourished or at risk of being malnourished. A million of these being over the age of 65. Elderly people living at home on their own may have a tendency not to eat wisely or drink enough
. Our appetites appear to diminish as we get older. Some of our customers have said the lack of sociability of eating alone and the effort of preparing a balanced meal for one person sometimes makes them lose their appetite. One of my lovely lady customers always tells me “Why worry? It’s not like I’m at the size I was when I was a young woman.” For others it can be a reduced sense of taste or smell or the recognition that they’re doing less exercise. There has also been research that suggests malnutrition can be linked to poor mobility, where older people are unable to stand or reach meaning they cannot use their kitchen safely. Furthermore, those living which dementia frequently miss meals due to their lack of memory. Meanwhile, doctors tell me that as we grow older, our kidneys become less effective. Our older bodies are not as good at hydrating and then conserving water making it easier for us to become dehydrated.
Why should we worry about good eating and drinking habits for the elderly? Statistically, malnourished older people visit their GP twice as often, experience more hospital admissions and have longer lengths of stay. People that don’t eat and drink well also have an increased risk of infection and urinary tract infections and have longer recovery times from illness. In short, the easiest way to avoid regular periods of hospital confinement is to eat well and take on sufficient fluids. So, if we can save on the number of visits to hospital we may yet save the NHS!
When considering eating and drinking well Halcyon carers are trained to follow these “rules” and I recommend you adopt when dealing with an elderly loved one.
1. Present a meal which is appetising. Don’t forget the setting of the table or tray and think like you’re serving to a customer in a restaurant.
2. Consider whether by joining someone at the table while they eat may result in more food and nourishment being taken in. It can be lonely eating alone but don’t make yourself an unwanted guest!
3. Let’s provide appropriate sized meals. Many older people came from a generation where leaving something on a plate was socially scorned. So let’s encourage people to have the satisfaction of finishing their meals and agree to abandon the “no clean plate, no dessert rule”.
4. Serve a drink with every meal and leave a drink within easy reach when you go.
5. We strongly believe as in all elderly care that there is a principal of “Use it … or lose it”. So, please do encourage safe participation in preparing the meal.
6. Variety is good for diet and appetite. Let’s abolish the mandatory cheese sandwich for lunch and offer imaginative alternative suggestions.
7. Don’t accept “ I ate earlier” without searching for evidence that some eating took place, for example, dirty dishes and foods still left out.
8. If someone really isn’t hungry make a “deal” to leave something out but agree you’re going to check it’s been eaten when you come back!
9. If you have suspicions about fluid intake levels use a jug that has a measure down the side to fill glasses and celebrate when it gets emptied.
10. If snacks are a normal part of a diet try and avoid products with too much sugar or salt.
Last week’s papers brought us the story of the NHS introducing a system of warning letters to try and stop ‘bed-blocking’ by medically fit elderly patients. Other recent reports have shown that over 220,000 days of hospital delays are being caused annually due to elderly patients not moving through and out of the hospital system quickly enough; an increase of 25% in the last two years with numbers still rising.
According to reports, some NHS managers have decided to threaten families of elderly patients with legal proceedings, if they do not move out of the hospital within 3 weeks of being declared medically fit. This particular report clearly blames the families, as it concludes the problem of ‘bed blocking’ is significantly reduced if the elderly person resides in a care home or receives home care funded by their Local Authority. This is contrasted with the higher number of elderly people remaining in hospital who are classified as ‘self-funded’. These ‘self funders’ and their families are apparently taking too long to find a suitable provider and need the encouragement of the threat of legal proceedings to make their decision. Toby Lewis, the CEO of Sandwell and West Birmingham said that the warnings helped to ensure families get their heads around the ‘responsibility to pay’ for care before making a decision about where relatives should live.
While some campaigners responded with concerns about the quality and availability of care, to Mr Lewis the key issue is getting families to the point where they accept that the responsibility to pay for care will fall to them if after financial assessment they are considered ‘self funding’. What a situation! People that have made savings over their working lives and are of little burden on the State (and probably still paying taxes) are now open targets for name calling, legal action and it’s all their own fault!
In our experience, being informed you are a ‘self funder’ is a key and often very difficult moment for the care recipient and their families. We receive calls from individuals recently informed that their relatives need care in Maidenhead in order to be released from hospital, but with no idea of what is required. In many cases the only assistance offered has been a list from the Local Authority with ours and every other care provider’s contact details …. And a deadline. Furthermore, the social worker will have inevitably said that it’s policy that they’re not allowed to recommend a care provider, despite their obvious experience in dealing with care providers. So that’s really helpful! The family is left to differentiate between providers, with no guidance on how to determine who will be best for their loved one’s needs; They are fearful of the costs; stressed at the responsibility; and equally fearful of the concept of strangers regularly coming into their home and giving personal care.
None of us have had any preparation for this situation. We have been misled to believe the NHS is ‘from the cradle to the grave’, and the pensions industry only encourages retirement savings with pictures of Round the World cruises. Where are the adverts preparing us for possible care provision costs. It’s not helped by a cultural belief that it is our role to ‘pass on’ our savings to our survivors and guilt that we may be eating away at their inheritance.
It’s so clear that we need an urgent and honest discussion to discuss how families are meant to cope with caring for ourselves in old age. Let’s expose the big secret that those in the know, like Mr Lewis, are already expecting us to “get our heads around the responsibility to pay” and are impatient that we haven’t already done so.
Why wouldn’t someone in Government think this is a simple strategy to implement and it is their responsibility to provide thought leadership on? Because that would mean them having to admit the inadequacy of the current arrangements that have gone on for too long? Whatever reasons, it’s time for a change. We need to stop sleep walking into this family crisis and then having our loved ones labelled as bed-blockers.
Returning from a short spell in South Africa I am in awe of the number of older people ignoring the current perceptions that try to define them by their number of years on Earth.
As I wilted in the heat of a queue for the Table Mountain cable car, tired from the overnight flight and simply trying to stay on my feet in the ferocious wind at the top, I was comforted by the grace and good humour of my fellow traveller. Many were well past the flush of early retirement in their late 80s but their capacity to withstand the ardour of an 8 hour wine tasting trip was impressive. If the heat, sun or coach travel didn’t “get you”, then our inability to only “taste” the gorgeous wine in preference for finishing each glass might have been considered punishing for adults of any age. They was no difference in capacity, although jokes about toilet stops suggested more personal management issues.
By any tabloid headline these people should have been blocking beds in hospitals, slowing down queues at busy ATMs or hogging their 6 minutes allocated with GPs, preventing doctors from serving the needy in the community. Instead, I found them very interesting and entertaining, hearing their ambitions for the trip (and the next one after this), while also learning of their families and their own slices of history. These were fabulous people to spend time with!
I accept that most elderly with ailments and financial resourcing issues could not afford either the rigours or the fare from the UK to Cape Town but those that do state quite clearly that we should only ever define someone by their capabilities. In the land still inspired by Mandela this truth rings particularly true to the ear.
But on returning, slumped in a chair in front of the television, the message was amplified as I watched Prunella Scales with her husband Timothy West. Despite acknowledging she was suffering from Alzheimer’s disease, Prunella went ahead with filming a TV series Great Canal Journeys, in which her illness is often addressed with humour between the couple who have been married for over 50 years. Although Alzheimer’s develops at different rates for each individual, and is clearly an individual journey for each person affected, her willingness to share her enjoyment of life and how they manage the increasing impact on her capabilities was a reminder to care and enjoy older people for what they bring and can do.
So, as an alternative to the usual warnings about NHS bed management failings and politicians pointing out scapegoats for their failure to manage and prepare our society for the demographic and health advancements predictions of over 50 years ago, let’s celebrate our older superstars for what they bring to our society.
This week I saw the final touches of our latest Halcyon staff recruitment video.
Katie and Tracy who produced the material say they are looking to attract people that want to make a difference to the lives of elderly people in Maidenhead. Their belief is that there are people out there with a great capacity to care, but are worried that it’s going to be too much regulation or formal nursing. They’re hoping this video explains that Halcyon will provide and cover all the things a carer needs. This means our carers are able focus on meeting the needs of the customer they are visiting.
They chose for the video to follow Katie as she described a typical care visit and how we approach organising this care. This was to show the working environment at Halcyon, which allows for carers to interact with customers in an individual manner whilst having also having a full support team at the office if things get difficult. We want a carer to do things properly but with her own personality.
The key to being a good carer is undoubtedly expressing interest and empathy towards each of our customers as an individual person with a life-time of experiences and stories. It is that empathy and interest that lead the people we recruit as carers to respect and value each customer. It is why each of the Care Plans that Tracy produces for a customer are defined by the unique components of that individuals personal needs, home environment and other available support from friends and family.
At interview we don’t ask applicants to describe how to shower an elderly person in a bathroom of limited size, prepare a breakfast or whether they’ve changed a continence pad. We know we can train almost everyone to do those tasks. Instead we question if you would be happy spending time with our customers just exchanging ordinary pleasantries and chatting about life, the world or the weather! In reality, we can’t teach someone to care if they aren’t interested in or do not value the elderly in our community. While the practical skills are necessary, it is about building a relationship with the customer by being friendly and a good listener.
A caring job may be at times stressful, unglamorous or messy but it matters! It really matters! Almost all our customers would agree that what our carers do for them matters in their lives. Ultimately, what job could be more rewarding?
400+ homecare hours a week, 25 staff — and growing
Thanks to our great reputation we’ve had a recent expansion in customer numbers. We’ve smashed through our 400 care hours a week target and that is set to rise even further in the coming months. Our growth has been phenomenal – 35% growth over last year in terms of care time and 35% growth in staff numbers. And what’s more – it’s only March!
Our massive growth surge is thanks to the quality and reputation of our carers. Our recent CQC inspection report findings support this: “A very reliable, efficient and caring service” and “a very high standard of care based on regular and consistent staff who understood the needs of their customers.” Our own customers support it too, saying things like: “Staff are really lovely and go beyond the scope of what they need to do.”
We’re delighted – of course! But we need urgently to get more people of the same calibre on board. So we are recruiting right now. Our staff are what make us special. At Halcyon we place utmost importance on the quality of our care – our carers are with us because they really care about what they do. The most important aspect of care is Communication. We want carers who genuinely want to listen and talk to our customers, to get to understand them and their needs. We offer great training for everything else – but you can’t teach dedication.
We also offer good remuneration and we believe strongly in supporting our staff and rewarding them for outstanding work. If you think you have the right qualities to be a Halcyon carer – please give us a ring on 01628 298262
Good management of a domiciliary care agency takes more than just ticking boxes
The CQC inspectors have just returned our annual inspection report and we are delighted to announce that a great CQC report coincides with the news that we have just exceeded 400 care hours per week, and now employ 25 people — a significant milestone we set out to achieve and are now surpassing.
We’d like to share some of the CQC findings with you. It just goes to show once again that boxes can be ticked, but to really come up to scratch you have to see the evidence in the comments behind the boxes. So we are happy to report that not only are we meeting all the standards, but have surpassed expectations in certain areas.
We were found to have met the standard for Respecting and Involving people, Care and Welfare of people, Safeguarding people from abuse, Supporting workers, Assessing and monitoring the quality of service provision — and we would expect nothing less. What really matters is what both our customers and their relatives, and our carers and their managers, told the CQC about us.
Here’s a summary of what they found:
From our customers:
“People were wholly complimentary about the quality of the service they received with one person describing staff as ‘really lovely’ and said staff went ‘beyond the scope of what they need to do.’
Other people described staff as ‘respectful’ and ‘very well trained.’
One person said the manager was ‘very particular about the staff they employed.’”
This is exactly one of our top priorities and it’s good to know it’s being noticed.
From our staff:
“Staff felt supported and one, who was new in the post, found the support helpful in making them feel comfortable in their role. Staff were also motivated and said they enjoyed their work.”
And here are some first-hand remarks that support our top priorities — the report highlights that we keep our promises.
Involving people in their care plan, giving them control and respect: “We saw there was a clear schedule of support the person had planned with staff and the times this was to be delivered. The schedule was supported by detailed individualised care plans. People we spoke with said they had been involved in their care planning and were able to request changes and we saw these requests were acted upon.”
Treating people with dignity: “Staff spoke with confidence about how they ensured people were treated with respect and dignity and gave examples of how they did this when supporting people with their personal care needs. People using the service, and relatives, said staff were always respectful and showed regard for people’s dignity and independence.”
Keeping people safe from abuse: People who used the service told us they felt safe with the care staff allocated to provide their support. Staff told us they were up to date with their safeguarding training and we saw records of certificates, in staff files, to confirm this. The information provided, together with our observations demonstrated that people were protected against the risk of abuse.”
Regular vetting and training of staff: “We saw that staff were regularly assessed. Managers carried out regular checks to assess staff performance and also to offer support and guidance to staff. Staff said they had enough time to carry out their duties effectively and we saw that staff always stayed at a person’s home for the allocated time to ensure they were providing the most effective care they could.”
It’s great when a homecare agency can be upfront about its operations; none should have anything to hide.
Our social followers will have noticed we’ve popped up a few posts this week reminding people that the elderly may have a particularly tough time in this dreadful weather. Whether it is the distress or flooding or power interruptions, storm damage or simply the temperature drop, we are always keen to encourage people to keep a weather eye out on elderly neighbours and relatives.
However, they aren’t the only ones affected by these problems. Home carers such as our own team must continue to deliver their care, come hail or come shine. This past two weeks, the flooding in Berkshire has created immense problems with road closures and jams as cars squeeze into alternative routes, to avoid road closures. All of that makes it immensely harder for our ladies to reach their charges.
We are proud to say that we haven’t dropped a single call and are committed to continuing this record throughout what promises to be a very challenging few weeks.
It truly puts in to perspective some of the recent media speculation and debate around the cost of home care, and the ever-tighter funding. This squeeze on resources is driving councils to insist on ridiculously short care visits, and is driving a focus on price of care, when it is quality of care which is so much more important. We will be talking more about this in the coming weeks. For now, we want to highlight the fact that when carers cannot be paid for their travelling time between calls, and face issues like the current travel delays and challenges, it is those carers who are paying a heavy price. As a nation we are beginning to depend on the goodwill of underpaid carers to prop up the social care delivery to the elderly – and that is neither fair nor sustainable.
At Halcyon we do all we can to support our carers, always paying above the minimum, and refusing the very short flying visits that we are asked to make. We fight for quality of care and respect for the elderly, above all. I am deeply proud of the continuity and quality of the care that our care team has provided, and will continue to provide, throughout this dreadful weather period.