Introduction

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. This quality 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[1]. For more information see the mental wellbeing of older people in care homes overview.

Why this quality standard is needed

The average age of the UK population is increasing. The proportion of people aged 65 and over in the UK population increased from 15% in 1985 to 17% in 2010, an increase of 1.7 million people. It is projected that by 2035 people aged 65 and over will account for 23% of the total population[2]. It is estimated that in England there are more than 400,000 older people living in care homes[3]. This includes people receiving care in residential and nursing accommodation funded by Councils with Adult Social Services Responsibilities and people who either partially or fully fund their own care.

Evidence from the Institute for Public Policy Research suggests that many older people are dissatisfied, lonely and depressed, and many are living with low levels of life satisfaction and wellbeing. These problems are widespread in older people living in care homes.[4] Research by the Alzheimer's Society has shown that many care homes are still not providing person-centred care for older people.[5] One of the major problems identified was that older people in care homes do not have access to enough activities or ways to occupy their time.[5] It has also been reported that many care home residents have problems accessing NHS primary and secondary healthcare services.[6] A lack of activity and limited access to essential healthcare services can have a detrimental impact on a person's mental wellbeing.

Older people in care homes should be treated with dignity and as individuals who have choice and control over how they live their lives and the care they receive. Empowering older people in care homes to be involved in all decisions about their lifestyle and care is fundamental to their mental wellbeing.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2013–14

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life*

Outcome measures

People manage their own support as much as they wish, so that are in control of what, how and when support is delivered to match their needs.

1B Proportion of people who use services who have control over their daily life

Carers can balance their caring roles and maintain their desired quality of life.

1C Proportion of people using social care who receive self‑directed support, and those receiving direct payments

1D Carer‑reported quality of life*

People are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation.

New measure for 2013/14:1I. Proportion of people who use services and their carers, who reported that they had as much social contact as they would like.

2 Delaying and reducing the need for care and support

Overarching measures

2A Permanent admissions to residential and nursing care homes per 1000 population

Outcome measures

Everybody has the opportunity to have the best health and wellbeing throughout their life, and can access support and information to help them manage their care needs.

Earlier diagnosis, intervention and re-ablement mean that people and their carers are less dependent on intensive services.

2B Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services**

New placeholder 2F Dementia – a measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life**

3 Ensuring that people have a positive experience of care and support

Overarching measure

People who use social care and their carers are satisfied with their experience of care and support services.

3A Overall satisfaction of people who use services with their care and support

3B Overall satisfaction of carers with social services

New placeholder 3E Improving people's experience of integrated care**

Outcome measures

Carers feel that they are respected as equal partners throughout the care process.

3C The proportion of carers who report that they have been included or consulted in discussions about the person they care for

People know what choices are available to them locally, what they are entitled to, and who to contact when they need help.

3D The proportion of people who use services and carers who find it easy to find information about support

People, including those involved in making decisions on social care, respect the dignity of the individual and ensure support is sensitive to the circumstances of each individual.

This information can be taken from the Adult Social Care Survey and used for analysis at the local level

4 Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm

Overarching measure

4A The proportion of people who use services who feel safe*

Outcome measures

Everyone enjoys physical safety and feels secure.

People are free from physical and emotional abuse, harassment, neglect and self-harm.

People are protected as far as possible from avoidable harm, disease and injuries.

People are supported to plan ahead and have the freedom to manage risks the way that they wish.

4B The proportion of people who use services who say that those services have made them feel safe and secure

New placeholder 4C Proportion of completed safeguarding referrals where people report they feel safe

Aligning across the health and care system

* Indicator complementary

** Indicator shared

Table 2 NHS Outcomes Framework 2013/14

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

Improvement areas

Reducing premature death in people with serious mental illness

1.5 Excess under 75 mortality rate in adults with serious mental illness*

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

Health-related quality of life for people with long-term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

Enhancing quality of life for carers

2.4 Health-related quality of life for carers**

Enhancing quality of life for people with dementia

2.6i Estimated diagnosis rate for people with dementia*

ii A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life***

4 Ensuring that people have a positive experience of care

Improvement areas

Improving access to primary care services

4.4 Access to

i GP services

Improving experience of healthcare for people with mental illness

4.7 Patient experience of community mental health services

Improving people's experience of integrated care

4.9 An indicator is under development***

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

*** Indicator shared with Adult Social Care Outcomes Framework

Table 3 Public health outcomes framework for England, 2013-2016

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.6 Adults with a learning disability/in contact with secondary mental health services who live in stable and appropriate accommodation

1.16 Utilisation of outdoor space for exercise/health reasons

1.18 Social isolation

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.23 Self-reported wellbeing

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.9 Excess under 75 mortality rate in adults with serious mental illness

4.12 Preventable sight loss

4.13 Health-related quality of life for older people (Placeholder)

4.16 Estimated diagnosis rate for people with dementia

Coordinated services

The quality standard for the mental wellbeing of older people in care homes specifies that services should be commissioned from and coordinated across all relevant agencies encompassing all of the person's needs and their whole care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to older people in care homes.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for older people in care homes are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals and social care practitioners involved in assessing and caring for older people in care homes should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Healthcare professionals and social care practitioners should be aware of the Code of Conduct and National Minimum Training Standards for healthcare support workers and adult social care workers (Skills for Care, 2013).

Role of family and carers

Quality standards recognise the important role family and carers have in supporting older people in care homes. If appropriate, healthcare professionals and social care practitioners should ensure family and carers are involved in the decision-making process about all aspects of their care.



[2] Office for National Statistics (2012) Census 2011

[4] Institute for Public Policy Research (2008) Older people and wellbeing

[5] Alzheimers Society (2007) Home from home

[6] British Geriatrics Society (2011) Quest for Quality