Making a choice about when to move into a dementia care home can be a challenging, frustrating and frightening prospect for many older people. Opening our care home up to the community for lunch club assisting with dispelling myths of care homes, helping with a smooth dignified transition into care.
Lunch club enables all above quality standards to flow, supporting a resident before one decides to move into a care home. Making sure that a quality pre-assessment of ones holistic needs can be met on admission. Lunch club supports one with developing new relationships prior to moving in, so a less anxious time for the resident plus their family/friends.
This example was originally submitted to demonstrate implementation of NICE QS30. This has now been replaced by NICE Quality Standard 184. The experience descriobed in this example continues to demonstrate how statement 5: activities to promote wellbeing, in practice.
- Dementia (QS184)
Aims and objectives
- To make a transition into care dignified and respectful.
- To empower people by giving them an opportunity to visit care homes and develop new relationships before making a final decision about their future.
- To fully involve family and friends in this process, 'getting to know' everyone.
Reasons for implementing your project
Beforehand residents would visit once, but would forget by the time one moved in, distressing times as could not relate to ones new environment. Extra staff would be put into place to nurture and support families and resident, but even this approach was still very emotional as too much was happening for the resident to take in and understand. The old way of admission just wasn't working for people with dementia, no time for adjustment, planning and understanding of ones rights and choices or for building up new relationships.
In terms of identifying problems with the exisiting admissions system, It was about natural observations and time incurred with the previous admission process. The old system is still effective for those residents who don't have a diagnoses of dementia, as they are able to retain plus understand the next stages making an informed choice. As a residential care home back then but moving towards dementia care we gradually witnessed changes since 2008 where more and more residents applying to Browns Field House had already been diagnosed with dementia. One or two visits to our care home just wasn't enough time to establish and empower the resident to make a formal decision, plus to really get to know ones interests, life history. Lunch club gradually over time would allow the resident to establish relationships with other residents - joining in activities whilst recording this in picture format - acting as a dignified prompt reminder that one had visited previously by viewing pictures in a scrap book. This process of time was very empowering for families as often feeling guilty about placing a loved one into care, so this transition into care benefited everyone.
There are a larger number of people being diagnosed with dementia in the local area meaning that are services are in greater demand however as we only have a limited number of residential places it is only possible for us to successfully work with those who will become residents. It is a way of working that will be possible for other residential homes to copy to help their new residents to settle into their homes.
Within Cambridge this was easily achieved with staff collecting residents and within wider Cambridgeshire, families would often drive relatives or they would pay for staff to collect via taxi.
How did you implement the project
One of the key benefits of attending lunch club is that it promotes feelings of safety in the transition period and will reduce issues of abandonment and disorientation:
- Families also feel more supported in the knowledge that time has been spent listening to their relative and that personal preferences have been recognised and will be respected.
- A total life history should also be completed prior to each resident moving in, giving the carers a more personal view of who the individual is and what is important to them.
- The lunch club gives time for a full pre-assessment to be carried out in a calm and dignified manner and allows residents needs to be assessed through a naturalistic observational mapping process over many visits to the care home.
- Lunch club now supports many residents on the waiting list during the week.
I set up the lunch club in 2009 - which is still running. Its impact has been evidently good with every admission - previously families and the resident when moving in would be a highly stressful time - due to so much information gathering which would have been acquired within a snap shot. Before lunch club upon admission, I would place an extra carer on duty to buddy up with the new residents, such a cost which had not been previously budgeted for, so 1-2-1 time could be spent with everyone to welcome and settle everyone in. Lunch club elevated this extra cost as the family knew most staff and their way around the home when moving in day arrived. Staff really knew who was moving into the care home as a robust getting to know you file had been completed with the resident and family. For the resident lunch club provided a dignified approach/transition into the next chapter of their life, after spending many days at the care home prior to admission residents moving were less anxious plus confused than previously on admission. Plus staffs really got to know the person first moving in and then their dementia.
This addresses the main issues that were found with the old admissions system as it does not put the new resident into their new home with little prior knowledge of the building, other residents or staff but instead gives a gradual introduction to the home meaning that it is a familiar place when the new resident moves in.We didn't anticipate or have any concerns but felt saddened when lunch club became so popular that we couldn't accommodate more than one extra resident per day to our home.
Families were much more prepared when their love one attended lunch club, they could see how their relative was adjusting to the new environment, robust assessments with everyone was complete before admission so we really knew the residents choices and preferences.
The free 'lunch club' service can be offered to everyone on waiting lists. Each potential resident visits the home once or twice a week and should be accompanied by a friend or family member on the first few visits. They may also choose to join in afternoon activities, giving them time to acclimatise to the environment and meet new people. This is also a great way for families to observe what happens on a daily basis in the home.
Photos can be taken during the visits and kept to use as visual prompts when the individual finally moves into the home prompting them in a dignified manner through visual aids that they had visited and been part of the home.
Approximately 28 residents and families have benefited. Feedback was gained through annual surveys or care plan reviews or relatives meetings.
The view from the family of one resident was:"'Moving our dad into a care home was our families biggest worry, as we didn't know how Dad would cope leaving his home, the care home staff supported us all with making the right decision. They took real time to see our Dad first by collecting a life history file - involving us all within our Dads care. The day our Dad moved in was so successful and smooth we couldn't have wished for anything else, we even stayed for lunch that day to welcome and settle Dad into his new home".
Key learning points
Some care managers may feel that this approach could be very time consuming but having one additional resident for a day isn't as taxing as it may seem. Additional work beforehand also means that furniture and room layout have already been discussed, allowing the entire transition is conducted in a holistic, stress-free way, plus without the need of placing an extra staff member on duty on move in day. But ultimately a smooth transition into care for that resident which alleviates anxiety.