The National Institute for Health and Clinical Excellence (NICE) has long been the standard bearer for evidence based best practice guidance for the National Health Service (NHS). Last year it also became the bastion for producing and benchmarking good practice for the social care sector.
NICE quality standards are a set of statements designed to improve and measure improvements within a particular area of care. It should come as no surprise that in response to government and media portrayal of the care home sector and as a result of the Darzi review of the NHS, the Winterbourne report and the subsequent calls for wide ranging changes following the Francis Mid Staffs NHS review and 290 recommendations, some of the first new guidance for good practice and outcome change has come for care home provision.
Wellbeing of Service Users and staff should be the goal of every care establishment
Quality Standards, QS50 – Issued: December 2013 -This quality standard covers the mental wellbeing of older people (65 years and over) receiving care in all care home settings, including residential and nursing accommodation, day care and respite care. The standard uses a broad definition of mental wellbeing, and includes elements that are key to optimum functioning and independence, such as life satisfaction, optimism, self-esteem, feeling in control, having a purpose in life, and a sense of belonging and support.
For those of you who may be as yet unfamiliar with the quality standards (my blogs will soon familiarise you so have no worries) these come with attendant pathways and the pathways themselves present an overview of the topic and lead to a wealth of supporting material and specifically for your purposes; guidelines on implementing good practice. Visit the NICE Pathway: mental wellbeing and older people.
You will see that much of the suggested pathway involves the use of activities and occupations. In future blogs we will look very closely at why being physically and mentally active improves wellbeing – and we will also look at why a lack of physical and mental stimulation achieves the opposite outcome. You will come to know that I believe strongly in the power of care homes and the dedicated care teams working in these establishments to create, foster and nurture a therapeutic relationship.
Building blocks to foster the therapeutic relationship
It is vital that older people feel worthwhile, that they have a sense of self- importance and control and that they feel they can contribute and hold influence over their own lives. Living with a dementia does not rob someone of these needs: it increases their importance.
If we look closely at those people living with us, and then assess which areas of their daily contribution to the life and running of the care home we could enhance to meet the above needs, without a doubt it is the level and degree of activities and occupation.
Activities need to be designed to meet the basic need for inclusion and involvement, and each person individually needs to be meaningfully occupied. Activities should not be childlike, nor should they outpace someone physically, psychologically or emotionally. They should be performed in groups and individually, and each group and individual plan of care should be created around a strengths- based model. Everyone should have a meaningful assessment of their abilities to respond to and participate within an activity and occupation programme. This programme then should be tailored to the person’s specific needs.
My next blog looks at what it means to have an individual, meaningful activity and occupation programme. I look forward to ‘speaking to you soon’.
Paul Smith – Dementia Care Expert
