Personalising homecare: A breath of fresh air for Rhona
24 August 2016
By Michelle Livesley
Recently I've been working in Dumfries and Galloway in Scotland, exploring how to achieve more personalised outcomes for older people who have been receiving home care.
We’ve been doing this through Scottish Self Directed Support (SDS) scheme, particularly looking at Option 2. I’m really excited to say that we’ve been able to make a real difference through the pilot project, improving people’s quality of life without adding any extra impact on resources.
Like many places, Dumfries & Galloway is facing considerable challenges in finding ways to improve outcomes for older people, within a wider context of increasing need and reducing financial resources and workforce. This meant that achieving sustainable improvements within existing resources was a key requirement.
We’ve done this by being structured and consistent in the way that we get to know what really matters to people, by using person-centred thinking tools. In a time where we’re looking at a system under real strain, it’s encouraging to know that there are ways to make budgets stretch further. You can read more in the intro we wrote to this project here.
Rhona is a lady in her eighties who lives in a sheltered housing complex in Stranraer, although she is originally from Tyne and Wear. She’s one of the people who has taken part in our SDS Option 2 pilot. This is what we achieved.
Rhona's old support plan
Rhona was getting homecare support for 15 hours and 45mins, split into four visits a day including:
- a morning visit of forty-five minutes to assist with washing/dressing and food preparation;
- a lunch visit of thirty minutes to prepare her main meal of the day;
- a tea visit of thirty minutes to prepare a light meal;
- and a bed time visit of thirty minutes to assist with undressing and supper preparation.
Her existing outcomes included:
- that her mobility is maintained and use of mobility aids are safely promoted;
- health and safety are upheld within her home environment;
- she is supported as necessary with personal care and dressing;
- she is supported as necessary to maintain a healthy well balanced diet; and her daily routine is respected.
Rhona has angina, which can cause her to experience breathlessness as well as high blood pressure and spells of dizziness. Her arthritis means that her knees cause her much pain and discomfort, and her mobility has significantly declined meaning that she uses a Zimmer frame at all times in her home. Rhona requires support to use a wheelchair when she goes out.
We received permission from Rhona and from management at Dumfries & Galloway Council to creatively utilise Rhona’s hours and effectively achieve Rhona’s outcomes in a personalised manner in partnership with her support provider Rainbow Services.
Making the most of Rhona's support time
We started by using person-centred approaches and tools to look at what really matters to Rhona.
We learnt that most of the time Rhona is very comfortable with her own company and particularly enjoys crosswords and reading. She is happy and content with her routine, and her only request was to be able to get out. When Rhona was younger she led a very active life and walked just about everywhere “if you wanted to get there you had to walk it, the nearest bus stop was at least one mile walk away.” Rhona always enjoyed “getting out and about out in the fresh air”. However, since a decline in Rhona’s health and mobility she very rarely goes out these days. Rhona expressed “I would love a walk along the front to Broadstone or Agnew Park or for a look in Morrisons.” We also learnt that Rhona has a fondness and appreciation of home-cooked foods, and told us that she misses going to the shops in town to see for herself the variety and the bargains, as well as for inspiration.
Next we considered her relationships and community connections.
Rhona’s relationship circle includes her son. He lives locally but she feels he is busy with his own life due to very long hours at work. He currently assists with some shopping and occasionally takes his mum out for a walk when time and weather permits, visiting once a week. Rhona said that she did not wish to put any further pressure or demands on her son.
Rhona enjoys the company of other residents at the complex where she lives and usually attends the dayroom at least twice a week for activities, including bingo. She also has a hairdresser and a cleaner who both visit her at home once a week.
Now that we understood a bit more about Rhona, we discussed with her if we could use her support hours differently, in order to still achieve her outcomes, but also to move towards delivering what really matters to her and achieve her personal outcomes.
Small adjustments, big difference
We discussed with Rhona the possibility of reducing the bedtime visit from thirty minutes to twenty minutes each day. We then discussed this with social work, who advised that the visit time would need to be reduced to fifteen minutes. When we had initially discussed this with Rhona she had expressed that twenty minutes would be much better and she felt more comfortable with this time frame. We therefore had to go back to Rhona to ask if she would be agreeable to a fifteen minute bed time visit.
A fifteen-minute saving each day would potentially save one hour and thirty minutes each week of budgeted support. This extra time could then be used flexibly to support Rhona to go a walk along the front to Broadstone or Agnew Park, go to the shops, or even be supported to make a home-cooked meal.
By listening to what really matters to Rhona, we have looked at using the time she receives for her support in a more effective and efficient way. This will continue to provide the same amount of support but to a greater benefit. By thinking differently and making a small change, Rhona could get a lot more out of her current time, make significant difference to her quality of life and help her get back out in the fresh air that she so misses.
I’m really excited to see the other stories coming out of this pilot!
If you’d like to know more about using person-centred tools to make support time more efficient and effective, e-mail me at firstname.lastname@example.org. I’d love to hear from you.
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