We are working with the Commissioning and Contract teams in Flintshire County Council, in a programme to transform their home care from time and task to what matters and wellbeing.
Here Nicki Kenealy and Lyn Morris, from the contracts team, describe how this is progressing and we share an example that illustrates the process we are using:
“We want to tell you about the work that Flintshire Social Services is undertaking in partnership with Helen Sanderson Associates and all of Flintshire’s domiciliary care providers. This was day 3 of an exciting programme of change that we are implementing in readiness for the Social Services & Well-being Act that will come into force in April 2016.
Today we have been working with our Providers on some real life examples of the practical implications of changing our approach away from ‘task and time’ to delivering “what matters most” for people and achieving personal outcomes. We have to tell you this morning we were all quite apprehensive about how we could manage things differently but by the end of the day we know that it can be done and we have a model to help us look at individuals situations differently. We found that this new approach really is about working in a person centred way and unlocking each individual’s circumstances rather than apply a “one size fits all” approach.
Providers told us that this approach was creative and inspiring and that they could see how their staff would also benefit and enjoy greater satisfaction, a win – win!
This is only the beginning in Flintshire but we will continue to tell you about our success and our pain as we move forward, through these blogs.”
On the day that Nicki and Lyn mention, we worked with eight provider managers looking at how we could offer a very different service, with different outcomes, but using the same amount of time. One of the examples we worked through to explore this was Connie (a real person, but her name has been changed).
Connie is in her eighties and lives in Flintshire. She has homecare support from a local agency for 21 hours a week. Typically she has four visits a day: one for breakfast; a second at lunchtime; a third for her evening meal; and the fourth to help her go to bed in the evening. Connie’s outcomes are that she lives safely at home; that she is physically healthy, and that she is clean and well-dressed. We had permission to roll up her hours to a weekly or monthly amount, that could be used creatively to achieve the same outcomes. This is how we approached it:
We started by looking at what matters to Connie.
We know that music is important to her, and she has the radio on most of the time. It’s also really important to her to look well-dressed and wear her jewellery. We know that Connie enjoys her garden, lilac is her favourite colour, and she loves to dance. She used to love poetry as a child, and still quotes quite a lot of poetry now.She’s a bit unsteady on her legs, and walks with a frame so making sure things are out of the way so she doesn’t trip or fall is important to support her well.
We started the process by looking at what matters to Connie, and then started thinking about her relationships and community connections. When we completed her relationship circle, we saw that she has a daughter, who lives two miles away, and grandchildren. She doesn’t know any of her neighbours very well but recently one of the neighbours was having some work done to the house and popped a letter into her letter box addressed to Diane, her daughter, to say he hoped it wouldn’t be of any inconvenience so there is a small amount of contact.
When we looked at Connie’s community map, she used to go to a day centre quite a long time ago before she went into hospital, but that isn’t happening anymore. Other than going to her daughter’s twice a month for Sunday lunch, she doesn’t leave the house at any other time.
Now that we understood a bit more about Connie, we wanted to see if we could use her 14 hours differently, so still achieve her outcomes, but more towards increasing her well-being by thinking about relationships, community connections and contribution. Could we help Connie in the 5 ways to Well-being – through opportunities to stay active, keep learning, connect, give or take notice?
We started by looking at how the family contribute and if there is anything that can be changed? Her daughter, Diane see’s Connie on alternate Sundays when she comes home for Sunday lunch but also pops in twice a week during the afternoon for an hour to chat with Connie. The first possibility was to have a different conversation with Diane. At the moment Diane cooks all the food for Connie and leaves it frozen, then carers get it out and reheat it, and sit with Connie as she eats. Connie finds it really quite difficult to stay focused on eating so the 45 minutes they spend with her at lunchtime are spent encouraging her to eat and chatting.
Firstly, we wondered if we could talk to Diane about how she used her time, and ask her that rather than popping in in the afternoon whether she could possibly come and eat with Connie twice a week. Because if Diane could do that, that would free up about 45 minutes to an hour in Connie’s ‘budget’ (her hours) for her to use differently.
The second possibility is with her grandchildren and great-grandchildren are in contact with her, and pop round to see her. We wondered whether it was possible to arrange for them to have tea together once a week, which again would free up about 30 to 45 minutes of time we could use differently.
Having both Diane and her grandchildren go round to see her would help Connie achieve her outcome of being physically healthy and eating at lunchtime, and taking her medication. It would also mean that some of that time could be used more flexibly.
We also wondered if we could extend the two visits that Connie has at her house on Sundays to include tea as well, which would save about an hour and 15 minutes of budgeted support twice a month – time which could then be used more flexibly.
Just by making small changes, we would have freed up about 2 hours and 20 minutes to use differently with Connie to help her achieve her outcomes. Here were some of our ideas about how this time could be used to build connections and contribute – as part of focusing on her well-being as well as her outcomes.
We looked at what we could do to strengthen and build Connie’s relationships with her neighbours, hoping that we could support that to become something that felt reciprocal. This helps with ‘connect’ from 5 Ways to Wellbeing.
One of Connie’s carers said that it was almost as if the neighbours wanted to be in touch with Connie, but didn’t quite know how to do it. The neighbours would have seen lots of carers coming in and out of the house, and the carer’s worried that the neighbours thought that they might not want to interfere. So we looked at ways Connie could make the first overture, or start to connect with her neighbours. One possibility is that because Connie does spend so much time in the house, one contribution she could make would be to take in any parcels or letters that would come for her neighbours.
Because Connie isn’t able to cook herself, we explored how cooking could be much more of a sensory and supported experience for Connie. We wondered if Connie could help to ice the cakes the carers might make with her, and then offering those to her neighbours as well. We were looking at ways that Connie could make contribution rather than just being the person who was cared for as well as potentially connecting further with her neighbours.
Knowing that Connie loves her garden so much, and that it is important to her, we thought a carer could go with Connie to a garden centre to have lunch there. One of Connie’s mealtime visits has a little extra time and so we thought that we could use that time to facilitate her trips to the garden centre. We also thought that it might be possible to set up a herb garden with Connie, maybe on her window ledge, so she could grow herbs to share with her daughter, or even with her neighbour as well.Once we looked at potential contributions, it is clear that Connie could be a great neighbour and connect with her neighbours in a different way.
Then we looked at community, and what opportunities there might be for her to go out and feel more part of a community and follow her interests.
We know that Connie used to love to dance, and now she sways happily to music with her frame. We explored whether there was any possibility of Connie using some of her time to go out for a light meal in the evening and then go to a tea dance. The freed up hours from the slight changes to the family visits would provide for this support.
So within the community we are focusing on Connie’s love of gardening, her enjoyment of dance, and if there might be a luncheon club Connie could be part of.
Finally, we looked at how we could get the best fit between staff and Connie.The first thing we did was look at the staff that live in or know Connie’s area, and who could do a better job of connecting Connie locally. Most importantly, local staff would decrease the amount of travel time involved in supporting Connie and her visits. Then we thought about the kind of personality that would get on with Connie. So we looked at what kind of people Connie gets on with, and where we have people with similar personalities who would give Connie the best support (from our best guess). We looked at whether we had any staff with shared interests — particularly people who like gardening, poetry or dance — so Connie would have her own team of people she could really get to know.
Based on Connie’s outcomes and what matters to her, we have been looking at using the time that Connie has for her support in a more effective way, that will continue to provide the same amount of support but to a greater benefit. Specifically, we are looking at trying to extend the number of people in Connie’s relationship circle, potentially with her neighbours. and she would also be able to meet people if she was able to go to a tea dance regularly.
By thinking differently, by rolling up hours to have a budget that could be spent flexibly to meet Connie’s outcomes, and by her family making the same time contribution they’re already making but in different ways means that Connie could get a lot more out of her 21 hours.
This is an illustration of what could be possible. Next month we are using this process with two older people supported by two home care organisations in Flintshire, with the person, their family, the manager an the councils Reviewing officer. As Nicki and Lyn say at the beginning, we will keep sharing what we are trying and learning, and whether we can move from these ideas to delivering them in practice.