Measuring Dignity in Care Homes

1

• Measuring Dignity in Care Homes
• Taking the Dignity Campaign Forward in Brighton
  and Hove
• Sara Fulford
• Sara.fulford_at_brighton-hove.gov.uk
• Tel.[phone]

2
Measure Dignity????!
3
Dignity

• Not being funny but do we really have to do it
  I mean Is it a Performance Indicator or
  Something?

4
Competing Priorities?

• Budgets The Big Squeeze Economies of Scale,
  Time and Motion Studies,Value for Money,
  Efficiency Savings
• Expediting Hospital Discharge
• Independence,
• SDS,
• Infection Control
• Performance Indicators, Targets Throughput,
  Turnover, Occupancy,Efficiency

5
Competing Priorities?
6
Contradictions?Pressures?Tensions?Compromises
or Challenges?How do we keep personalised
services that afford dignity?
7
Measure Dignity??

• ??!

Designed tools to measure the Challenges
8
MethodsSources of evidence collated to
contribute to the evaluation

• Service user and informal carer dignity surveys
  -guided interviews focussed on the Challenges
• Info. from regularly administered questionnaires
• Anonymous carer/visitor surveys during
  consultation week

9
Methods (cont)

• Staff consultation Session
• Staff anonymous surveys focussed on Dignity.
• Stakeholder surveys e.g. to G.P.s, D/Ns,
  therapists hairdressers and other regular
  visitors to the home.

10
Methods (cont)

• Extended Regulation 26 visits to the home
  focussed on Dignity observations, met with the
  manager and staff, and examined documentation
  and records
• Evidence from past years quality assurance
  visits and CQC reports. 

11
Common ThemesPositives

• Very high levels of satisfaction expressed with
  staff attitude, patience and treatment of service
  users .
• Nearly everyone reported they had been treated
  with dignity and respect , very well, all of
  the time.

12

• very caring and always find time for you,
• Mum always comments that she is treated with
  kindness
• All appear, sincere, polite and helpful I feel
  well understood by staff, They are wonderful
  friends to me
• We have always felt able to say what is
  important to mum

13

• Difficult to improve something so perfect.
• Staff said we try to make people feel special
  while they are with us

14

• High levels of respectful interactions between
  staff and residents observed. Offering choices.
  Negotiating care timing.
• People using the services reported being made to
  feel very welcome when they arrived.
• Several services had strong multi- disciplinary
  support within ICS service to assist
  rehabilitation and independence. Care staff have
  also been trained in assisting independence.

15

• Flexibility re routines observed in practice-
  including where and when to eat. (Try to adapt
  round individual).Service user comments included,
  Staff work with you, rather than making you fit
  in with them.
• Generally high standard of dignified décor and
  environment- most areas, addressed promptly
  where lacking.
•  Recording detailed, respectful and non-
  judgemental.

16

• Comprehensive staff training reported to help in
  meeting peoples needs.
•  Robust staff safeguarding training.
• Welcome of Diversity statement is advertised well
  in posters some services.
• Visitors and Carers are welcomed well

17
Dignity Audit Brighton and Hove City Council
Older Peoples ServicesCommon Development Themes

• 1.Greater attention to monitor pain control.
•  
• 2. Opportunity for activities/ engagement need to
  be developed further .
• 3. Furniture and general equipment should be
  reviewed by OTs/Sensory team to maximise
  independence.
•  

18

• 4. Statements of rights and welcoming diversity.
• 5.Translation of brochures information, and
  different formats.
• 6.Choice of male/ female staff for personal care.
•  

19

• 7.Culture of recording low level complaints
  officially as complaints/ comments. 
• 8. Waiting for an answer to knock before entry.
• 9. Service users tend to feel that use of
  kitchenettes is a staff domain
•  

20

•  
• 10. Service users tend to feel that use of
  kitchenettes is a staff domain
• 11 Service users tend to report that care plans,
  and how their needs will be met, are decided by
  staff rather than themselves.

21

• 12. Approximately 30 of all people admitted in
  night clothes or hospital gowns, and without
  their own possessions with them.
• 12. Further develop some holistic, person
  centred, care planning

22
Examples of Improvements

• Knocked doors being answered,
• Pain management
• Activities programmes,
• Staff photo boards , name badges
• Admissions to our services in own clothes - get
  possessions.
• Better recording of low level comments and
  complaints

23

• Revision of service user information to achieve
  more accessible formats,
• Re vamped rights statements,
• Care support plans to ensure they give a better
  sense of the person and their life history and
  preferences.
• Encourage more use of Kitchenettes

24
Is it a Performance Indicator or
Something?The SAS wants to know

• What have Brighton and Hove Been Doing About
  Dignity??
•  
•  

25

• Nominated Adult Social Care Lead Dignity
  Champions
•  Corporate Lead Dignity Champion
•  USED OTHER PEOPLES IDEAS AND METHODS
• eg Sarah Restall, Catherine Mullins, Warwick,
  Health Champion colleagues, Used Website

26
KEEPING THE DIGNITY IN CARE AGENDA LIVE 

• Dignity Updates
• Part of Personalisation briefings
• Dignity Challenges are advertised in posters
• Dignity workshops at yearly Safeguarding
  Conferences
• Dignity Workshop as part of a Senior Managers
  Forum

27
SPECIFIC DIGNITY MEETINGS 

• Dignity Champions forums
• High Level overarching Dignity Meetings
•         Director / Lead Councillor Chairs
• Joint meetings with the health trust lead
  champions
• Joint meetings with Independent Providers

28
What else do we do?

• Dignity Audits 2007-Action plans - still live and
  Monitored
• Dignity and Empowerment Training
•  Continuous quality monitoring,
• Care Home quality assurors meet
• Robust restrictive practices procedures
•  

29
What do our Contracts Dept Do?

•     Home Care - tendering process Contract,
  Service Specification
•    Incentive payments for continuity of care
•    Evaluation Surveys/interviews

30

• Fairer Contracting initiative
• Dignity in care is implicitly tested in all
  quality monitoring.

31
Rewarding Dignity in Care??

• RR
• Incentives
• Publicising Good Practice
• FEEDBACK - PRIDE

32
Not being funny but do we really have to do it?

• Front Line Staff do Small Things that make
  Dignity all the Time
• The Right Quality Measures and PIs audit Dignity
  and ensure improvement
• Yes, We Really Have to (and already do a lot of
  the time).