Care Plans

This post is slightly out of sequence. Apologies, but a lot has been happening recently.

When Rosemarie first went to the Care Home their paperwork included a Care Plan that basically transferred her statement of needs from pieces of paper sent by the hospital to different pieces of paper used by the Care Home.

This is all very well but I have a lot of experience of systems where actions and commitments are transferred from one piece of paper to another but there is no actual follow up or controls put in place. It's like those impressive Mission Statements that companies come out with and then forget. 

I voiced my concerns at the two-week review I pushed for and at the formal three month review, and have spoken to the Care Home Manager on many occasions.

As so often happens, the problem reduced itself to one of vocabulary and interpretation.

The structure of the Care Home is that there is a Care Home Manager responsible for everything including administration, and a Care Manager responsible for the medical and care side of things. Each floor has a qualified nurse responsible for the care of the patients on that floor, and anything from two to five care workers to do the actual caring.  Some residents are effectively bed bound and some are mobile and pretty independent. Quite a few, however, are wheeled or gently led to one of the two lounges and parked there or seated in comfortable chairs. There should always be at least one care worker in the lounge at all times.

Now to me one-to-one care means that there is somebody dedicated to looking after Rosemarie's needs at all times. Not just keeping an eye on her and protecting her from falling when she stands up, but trying to stimulate her and dealing with agitation and distress. Moving her somewhere quiet if it is too noisy. Making sure she eats well and hydrates properly - even if this means taking her somewhere quieter at meal times. This is a full time job.

It became apparent to friends and family that in practice (regardless of the management commitment) one-to-one care was interpreted at the workface as a requirement that the person sitting in the lounge would sit next to or near Rosemarie. That's it.

There are two dedicated staff who run activities for all residents, usually on the ground floor, every afternoon. A friend took Rosemarie to one of these and was told that it was wonderful she had brought her down because usually she missed out because she was on one-to-one care. Eh? I appreciate that there will be times when due to sickness or emergency they are short staffed but that should be the rare exception not the rule.

The CCG approved funding for twelve hours of care a day in December. I was expecting this to solve all the problems because that was effectively funding individual care for every minute Rosemarie was out of bed. There were staff shortages over Christmas and New Year due to holidays and sickness, but I expected everything to be in place by the end of January.

The Community Mental Health Team had a meeting scheduled at the Care Home for a couple of weeks ago and I thought that would be a good time to draw everything together and invite the Care Home Manager to review the Care Plan with us. I think she felt a bit ambushed but the CMH Team (as representatives of the CCG) carries more weight than I do and I wanted to get this clarified.

I was very happy with the result. The Care Home Manager agreed with everything we proposed and it was apparent very quickly where the problem was. Either the care workers did not know that this is what was expected of them or the nurse in charge of the floor was being tempted to dilute the role of the designated one-to-one carer to cover inadequate staffing levels. Either way it is a management issue. The CCG is paying for a care worker to look after Rosemarie, not contributing to general running costs.

There are no villains in this piece. There are a couple of workers I don't have a very high opinion of but in general the staff are excellent and committed. I hope the awareness of outside scrutiny will focus attention where it is needed.

With the movement resulting from the recent medication review, I feel that we are starting to get some traction at last.