Monthly Archives: May 2015

What does success look like in care in the home for Dumfries and Galloway?

During the election I saw a tweet that suggested that the public don’t really think about social care provision until they or someone they know and care about have a need for it. I’m not sure who said this or if it’s entirely accurate. However, I have to admit that I only really felt the need to get immersed in in personalising home care when it became something that directly affected my family.

My Aunty Edie was 96 and still living in the same 2 up 2 down terraced house that she had been born in. She was a kind, independent and proud person who had always had a role caring for others. She supported her husband Jimmy who’s years in the coal mine had lead to problems with his lungs and mobility and her elderly sisters (including my Nana) who all lived to a ripe age, but who needed her practical help and support (I hope I take after this side of the family).

Aunty Edie had always remarked that the only way she would ever leave her home would be in a wooden box! When ill health and a fall resulted in her needing homecare she was grateful for the fact that this prevented her from going into residential care. She was incredibly appreciative of “the girls” as she called them and often said that they couldn’t do enough for her. However, when family members visited we could see that not everything was going well. This wasn’t because the carers didn’t care, they did! I think it was because they didn’t really know what mattered to her or how to support her in a way that made sense to my Aunty.

Developing her one-page profile was a logical solution and provided much more information that the care plan did. As a result, the care and support that Aunty Edie received improved.

In Dumfries and Galloway, several homecare providers are taking part in the Care at Home pilot and are currently practicing developing one-page profiles for both customers like my Aunty Edie and for their colleagues, using specific person-centred thinking tools to further personalise the customer experience and to focus on building resilient, person-centred teams.

I’ve been working with the leadership team who meet after each stage of the programme to analyse progress, celebrate and build on successes and problem solve anything that is getting in the way. I’ve been struck by the motivation of the homecare managers and am impressed by their practical, no nonsense approach to implementation. Despite the daily challenges experienced by the homecare staff, they have managed to not only deliver on the goals and targets that they set themselves, but have exceeded them. One of the things that I think has helped with this was developing a shared one-page strategy right at the start of the work. This showed what success looked like from these four different perspectives:

People using the services (customers) Staff and managers The provider organisations The commissioner

It identified how this would be delivered and how it would be measured. Each provider was asked to set their own targets; ones that felt realistic to them given their knowledge of their services.  These are the success statements that all 6 providers and the commissioner have co created and are working towards. In Steven Covey’s book ‘The Habits of Highly Effective People” habit 2 is Begin with the end in mind, which helps us to focus on what and where we want to be and do in order to be successful. I think early indications suggest that this was a great place to start.

Please click on the image for a larger version.

Success

Michelle Livesley

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One-page profiles and their use in providing personalised care in the home

In our work together with homecare providers in Dumfries and Galloway we have been paying a lot of attention to one-page profiles as a core tool in personalising support for people who are cared for in their homes. One-page profiles are a person-centred thinking tool that supports the transition from people using services being passive recipients of care to enhancing the amount of choice and control they have over how their supports are delivered. At our last two training days the participants heard Hilda’s story.

Hilda

Hilda’s Story

When Hilda needed home care support at the first meeting there were conversations about what made a good day & what made a bad day for her, What was Working (WW) & What was Not Working (WNW) for Hilda and also from her families perspective. Looking at Hilda’s good days and bad days provided rich, detailed information about what was important to her, and clues about what support she wanted and needed.. Asking different questions led to different conversations that led to a thorough understanding about what matters to Hilda and how she wants to be supported. This in depth information about what is important to someone is what we need to ensure a person’s support is tailored to their needs and aspirations – the very bedrock of personalisation. Family members are a mine of rich information about their loved one and it is vital that they, and other people who know the person well, are involved in sharing this for their ‘top tips’ around providing great support. If you were to meet Hilda through her care plan, you would learn about what she struggles with and needs help with. You rarely read in care plans the positive, valued characteristics of the person, the rich detail of who they are – their important relationships and connections, passions, hobbies and interests – in so much detail that you know which newspaper matters, or what their culture or faith means to them, other than a tick box about which religion they follow. Looking at Hilda’s one-page profile, you get a real essence of who she is.  We can do this with everybody regardless of whether people use words to speak or communicate typically –  because we listen more carefully to what people are telling us in other ways & also the rich contribution family have to make.

What we are learning about in Dumfries and Galloway

Historically we know that services pay great attention to what is important for people focusing on what it takes to keep people healthy safe, whilst what is important to someone is often seen as something we do if we have enough time or enough staff. Personalisation brings this back into balance – people are the experts in their own lives and we must know and pay attention to what matters to people and deliver support in the context of how people want to live their lives.

D&G3 1

The homecare providers in Dumfries and Galloway have spent a good deal of time working on developing their skills to have the different kinds of conversations needed to develop one-page Profiles. The focus of the last two days has been on one-Page Profiles for the people they support. We also spent time thinking about how the initial conversation with a new customer might happen and this led to a penny dropping moment for some of the participants. They told us that until they had practiced developing a one-page Profile with someone they had never met, they always had the service already offered at the back of their minds. The new kind of conversation they were practicing started from the person not the service!

D&G3 2

Because participants have been able to learn skills across a number of weeks, with time to reflect in between, they are really starting to think about every conversation being an opportunity to gather rich information for a person’s one-page profile. Another participant said that as she’s talking to someone she is making mental notes about what’s important to them and what best support would look like.  The other thing that was very clear over the last two days spent with our homecare providers is the level of detail and clarity in the information they are capturing on their one-page profiles. This new way of thinking, talking and sharing information is going to make such a difference to the staff and people who they support.

D&G3 3

One-page profiles are fundamental to the planning process and they help us ensure that people, like in Hilda’s story, are consistently supported in a way that makes sense to each of them, truly enhancing their choice and control on a day-to-day basis because those supporting follow the one-page profile. We can’t decide on outcomes to be achieved without thinking about then in the context of what is important to the person and knowing how best to support them from their perspective.  Without this information, people are likely to be treated as a clinical condition and their disabilities will always be seen first. One-page Profiles get us moving away from those care plan boxes that often focus only on a person’s physical needs without also paying good attention to learning what matters to people – our quality of life is determined by the presence or the absence of those things which are important to us and so we have to take this into account when providing support.

Gill Bailey, Emily McArdle