This is the story of a care home which wanted to invite the community into the home in order to enhance the lives of isolated older people living in Argyll and Bute. Over the course of 2014, Ardenlee care home worked with Iriss and Scottish Care to develop the Sunday Lunch Club by building a business case, engaging with the local community and getting buy-in from the Care Inspectorate. These are the lessons we learned from the journey.
What is the role of the care home in communities?
Scotland’s shift towards delivering more support for older people in a community setting has led to lengthy debate and discussion on the future role of residential care. There has been a national push to ensure that care homes don’t become ‘islands of the old’, but are seen as community assets integrated in daily life. Initiatives such as the National Care Home Open Day are designed to invite the community to spend time in residential settings, dispelling common myths about ‘old folks homes’ and supporting better relationships. A recently published report The Future of Residential Care also highlighted the importance of community involvement to encourage more volunteering in care homes. The report also highlights the importance of flexibility from the Care Inspectorate when it comes to registered care homes adding services to their functions to provide an outreach service to non-residents in the local community.
Why Cowal and Bute?
Cowal and Bute has one of the highest populations of older people in Scotland. The rural geography of the region means that many older people are unable to socialise with others or access local services in the area. A recent consultation with older people in Argyll and Bute found that their top two priorities were transport and activities. The report also highlighted a need for more groups and activities to be available over the weekend.
Initial scoping of the community surrounding Ardenlee Care Home showed that the local rural community was lacking in accessible buildings and public spaces. When visiting the local carers centre, I heard the story of two women whose father was recovering from a stroke. They found a local stroke group for him to attend but the club was held in a building with stairs. The women were open about the indignity of carrying their father up the stairs and having to support him to use a bathroom which wasn’t wheelchair accessible. The club, which they had hoped would boost his confidence, let him down because it simply wasn’t suited to his needs.
Who are Ardenlee Care Home?
Ardenlee is a care home with 32 beds in Dunoon that has beautiful views of the Clyde. At the time of the project, Ardenlee were experiencing lower occupancy, which was motivating them to think about their role in the future. The management understood that the landscape of care was changing, and wanted to start exploring other ways they could be using the space they had available.
The idea was simple: invite isolated older people in the community to attend a Sunday lunch and afternoon of activities.
What were the proposed outcomes?
- Dispel some of the myths associated with care homes: that they were just places people went to die
- Support older isolated people in the community to access social/peer support in a safe setting
- Raise the profile of Ardenlee’s respite service amongst the community as a place where people can maintain their independence
- Explore alternative uses of long term residential care homes to begin to plan for the future
Ardenlee chose to develop an eligibility criteria for the Sunday lunch club to make sure that they were able to meet the outcomes of guests without compromising the quality of care for their residents. They chose to allow attendance to the club when:
- The person will benefit from the club in a way that is meaningful to them
- The person will have a positive impact on the residents, and will not cause distress or harm
- The person is either independent in eating, continence and medication or will be bringing their own support
The manager meets all people who want to attend to assess their needs and outcomes before their first visit. This helps the home understand what they can do for the person (for example, their favourite food or activities) as well as what adjustments they will need to make (for example, staff support in and out of a dining chair to decrease chance of a fall).
What are the outcomes for the guests and residents?
There has been a high interest in the club across Cowal. The home has received referrals from social work, the carers centre and people themselves. These are the initial experiences of Sunday lunch guests and residents in the home.
Sandy is 102 years old and lives on her own in rural Cowal. She is in good health, but has a visual impairment which means she struggles to get around and feels quite vulnerable alone at night. She has a visit from care at home once a day on weekdays to help her wash and cream her feet. Other than this, she can go for long periods without seeing anyone and the weekends were the most difficult for her. Coming to the Sunday Lunch Club, everything changed. Sandy met some people she knew from the community, had a big home cooked roast and participated in the afternoon activities. Sandy’s daughter remarked that her mum was really keen on the club, and she was talking about how happy she was to have won one of the games. Sandy’s daughter is worried that her mum isn’t coping as well on her own but feels like if the time comes when her mum needs respite or 24 hour support, it won’t be such a scary experience. In the meantime, Sandy will keep on coming to Sunday lunch. When asked about how she would describe the club she said: “fun afternoon, friendly people, food was great”.
Mags and Jean:
Mags and Jean both live in a sheltered housing complex. When they moved in, there were lots of evening activities but budget cuts mean they’ve lost the support they used to rely on. They say that now it’s “just a house” and that they can feel quite isolated with nothing to do, especially on the weekends. Mags and Jean saw the poster for Sunday lunch and decided to go together. Jean knows absolutely everybody, so she caught up with her old friends and colleagues at the home. Both Jean and Mags say they can’t wait for Sundays now, because they have a chance to meet new people and have a blether. Mags says that she used to think of care homes as places old people go to vegetate and do nothing, but now they’re part of the community and they’re a place you can go to socialise and learn new things.
John was referred to the Sunday Lunch by social work. John is living with dementia and doesn’t have much company at the weekend. John really enjoyed the drive on the bus as the driver took the scenic route so they could enjoy the views. John happily enjoyed his lunch at the home. But in the afternoon, staff noticed that John was becoming agitated and upset. John wasn’t sure why he was at the club, and wanted to leave. Staff worked really hard to help John to feel safe but they were worried that the experience had been negative for him. Since his first visit, the manager at Ardenlee has worked with social work to try the club again, now that John knows the routine and has new medications that they hope will ease his anxiety. The staff think that once they get to know John, they can help him feel at home. Ardenlee plans to learn as they go, but are also aware that the club needs be meaningful to John, and needs to meet residents’ outcomes too. They want to make sure they give everyone a chance to take part, but it’s a learning experience for everyone!
Marnie lives in Ardenlee care home and is usually very withdrawn. She likes to keep to herself and spends most of her days sitting on her own and doesn’t like to joint in with any of the planned activities in the home. On the third week of the Sunday lunch club, Marnie noticed Jean outside and seemed to recognise her. It seems that Jean and Marnie knew each other when they were younger. Marnie asked to go and sit with Jean and Mags and ate her meal with them. This is a big change for Marnie, who usually prefers to eat alone. She was a lot brighter and more engaged and seemed to really like Jean’s company. Staff hope that Marnie might come out of her shell more now that she has a friend coming to visit regularly.
- Engaging early with residents, families and staff about the idea to understand their hopes and fears as well as give them some ownership of the process.
- Engaging with the community (including the befrienders, Crossroad Carers and various care at home providers) to understand what was available and where the gaps were.
- Building a robust business case with associated risk assessments. This included looking at all the policies in the home and considering how they may be impacted by the lunch club. This supported the case for the Care Inspectorate and helped management understand impact.
- Identifying a geographical catchment which was enough to include some very rural areas, but still manageable in terms of transport.
- Meeting with the local care inspector to pitch the idea and work together to make sure the service could work in a way that meets care standards.
What were the challenges?
- Balancing the needs and outcomes of residents and guests. As the group of people living in the home changes over time, this is an ongoing process.
- The local care inspector made himself available to discuss the idea and how the home could do more for the community, but in the same visit also inspected the service. The provider may have benefitted from the opportunity to discuss innovation and change outwith the inspection process
- The small test of change for the Sunday lunch had to be signed off by the Care Inspectorate registration team. This process took five months.
Three Lessons Learned
- The process was lengthy due to delays in registration, and would have benefitted from a mechanism for approval of small tests of change outwith the process of registration
- Understanding the future users of the service was key to delivery. Establishing an eligibility criteria meant the home could keep their own residents as a focus, and could plan the right supports in advance.
- The process was lengthy due to delays in registration, and would have benefitted from a mechanism for approval of small tests of change.
Are you interested in opening up more to the community?
Below are a series of questions that we hope will guide other care homes to consider how to be more involved with their communities.
Community and Demand
- What are the needs of your community?
- What are the gaps?
- What are the experiences of older people in the area?
Public and Private Space
- Is the space fully accessible?
- Is there space to spare? Would any visitors be encroaching on residents’ space?
- Will there be access to shared areas only? How will residents own private space be protected?
- How will you engage residents in decision making and evaluation?
- How will you involve families in decision making and evaluation?
- How will you involve senior management in the planning of the service and get their buy-in?
- How will the Care Inspectorate be involved? How might this impact your registration?
- Who will be eligible to attend the home?
- Will this be a ‘drop-in’ service?
- Who will take responsibility in assessing people before they arrive?
- What level of needs can the care home cater to? (ie. dementia, physical disability)
- How might this impact on staffing levels? Will any additional training be needed?
- Consider what times of day/days of the week you will open the home. Is public transport available at this time? Will this link in with local bus/train schedules?
- Do you have your own transport available? How will you journey plan to make the best use of time and resources?
- Will using the transport reduce opportunities for your residents?
- Will you offer the service free of charge?
- Will you charge for food/transport?
- What charging structure will you put in place if attendance means extra staff are needed?
- How will opening up your care home impact on both the residents and the people visiting the home?
- How will you have a focussed discussion with residents and their families about how this new service may impact on their outcomes?
- How will you understand and measures the outcomes for the residents and the guests of the new service over time?
It may be useful to map these outcomes with: Framework of Outcomes Important to People Living in Care Homes
Argyll and Bute Partnership (2014) Long, Healthy, Active and Happy Lives
Task Force for the Future of Residential Care in Scotland (2014) Recommendations for the Future of Residential Care for Older People in Scotland