Opinion
A place to call home? Getty
Sarah Rochira hopes her review can reboot the care home system in Wales and make it truly person centred
IN NOVEMBER, I published the findings of my review into the quality of life and care of older people living in residential and nursing care homes; the biggest piece of work of its kind ever undertaken in Wales. While my review found many examples of outstanding care and good practice, there are significant variations that mean that too many older people have an unacceptable quality of life. Too many older people living in care homes are unable to do the things that matter to them, lose meaningful choice and control over their lives, have their emotional needs neglected and do not have their basic rights upheld. Too often, there is an acceptance of an overall level of care that is simply not good enough, where care delivered without neglect or abuse is considered to be good care. Through my review, I want to ‘reboot’ the care home system in Wales to ensure that quality of life sits at its heart, shifting from a culture of task-based care to care delivery that is truly person-centred. My review report – A Place to Call Home? – sets out the action required to make this a reality and deliver the change that older people, their families, care and 12 March 2015 | Volume 27 | Number 2
nursing staff, managers and care home owners have told me they want and need to see. I have called for change across all levels of our residential and nursing care systems, including the need to ensure that we have the right number of care and nursing staff, and with the right skills. And as care home demographics continue to change, with a growing number of older people needing highlevel support and a rapidly growing number of residents living with dementia, it is more important than ever that we have a well-trained, well-supported and well-motivated workforce. Barriers identified However, the evidence submitted to my review by the RCN identified a number of barriers faced by nurses working in care homes that must be addressed to ensure that they can deliver the best possible care. The first, an issue for nurses working across the whole of our healthcare system, is staffing levels and workforce planning. Understaffing is a significant issue in our care homes, placing additional pressure on nurses whose
roles are already emotionally, mentally and physically demanding. Understaffing necessitates a task-based approach to care delivery as there simply is not time to develop the relationships needed with residents for a more person-centred approach. This issue is exacerbated by workforce planning that does not reflect the staff needs of care homes, thereby creating issues around recruitment, particularly for nurses working in dementia settings. My review also found that nurses working in care homes may face additional pressure due to a lack of clinical supervision and peer support, as well as lack of support from the wider NHS. This occurs because they tend to work in more isolated environments, resulting in nurses having to make decisions on their own. Similarly, the isolated nature of many care homes, coupled with issues around understaffing, can restrict opportunities for professional development, which is essential to build the knowledge, skills and confidence that can equip nurses to deal with the challenges they may face in their role. My review has been welcomed by all of the bodies subject to the requirements for action and there seems to be the desire to address the issues identified. This is essential as we all have a responsibility to ensure that the best care is delivered to older people, who are not a separate group, but are our family and friends. These are the people who raised and taught us and who still have much to contribute so they should be seen as important members of our communities. To satisfy this responsibility, it is fundamental that nurses and other care staff receive the right support so that they have sufficient time and can meet their full potential to deliver the outstanding care we all want to see. Sarah Rochira is older people’s commissioner for Wales
See Careers, page 42 Reference Older People’s Commissioner for Wales (2014) A Place to Call Home? A Review into the Quality of Life and Care of Older People Living in Care Homes in Wales. tinyurl.com/q9xleo8 (Last accessed: January 27 2015.)
NURSING OLDER PEOPLE
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18/02/2015 11:36
A place to call home? Getty
Sarah Rochira hopes her review can reboot the care home system in Wales and make it truly person centred
IN NOVEMBER, I published the findings of my review into the quality of life and care of older people living in residential and nursing care homes; the biggest piece of work of its kind ever undertaken in Wales. While my review found many examples of outstanding care and good practice, there are significant variations that mean that too many older people have an unacceptable quality of life. Too many older people living in care homes are unable to do the things that matter to them, lose meaningful choice and control over their lives, have their emotional needs neglected and do not have their basic rights upheld. Too often, there is an acceptance of an overall level of care that is simply not good enough, where care delivered without neglect or abuse is considered to be good care. Through my review, I want to ‘reboot’ the care home system in Wales to ensure that quality of life sits at its heart, shifting from a culture of task-based care to care delivery that is truly person-centred. My review report – A Place to Call Home? – sets out the action required to make this a reality and deliver the change that older people, their families, care and 12 March 2015 | Volume 27 | Number 2
nursing staff, managers and care home owners have told me they want and need to see. I have called for change across all levels of our residential and nursing care systems, including the need to ensure that we have the right number of care and nursing staff, and with the right skills. And as care home demographics continue to change, with a growing number of older people needing highlevel support and a rapidly growing number of residents living with dementia, it is more important than ever that we have a well-trained, well-supported and well-motivated workforce. Barriers identified However, the evidence submitted to my review by the RCN identified a number of barriers faced by nurses working in care homes that must be addressed to ensure that they can deliver the best possible care. The first, an issue for nurses working across the whole of our healthcare system, is staffing levels and workforce planning. Understaffing is a significant issue in our care homes, placing additional pressure on nurses whose
roles are already emotionally, mentally and physically demanding. Understaffing necessitates a task-based approach to care delivery as there simply is not time to develop the relationships needed with residents for a more person-centred approach. This issue is exacerbated by workforce planning that does not reflect the staff needs of care homes, thereby creating issues around recruitment, particularly for nurses working in dementia settings. My review also found that nurses working in care homes may face additional pressure due to a lack of clinical supervision and peer support, as well as lack of support from the wider NHS. This occurs because they tend to work in more isolated environments, resulting in nurses having to make decisions on their own. Similarly, the isolated nature of many care homes, coupled with issues around understaffing, can restrict opportunities for professional development, which is essential to build the knowledge, skills and confidence that can equip nurses to deal with the challenges they may face in their role. My review has been welcomed by all of the bodies subject to the requirements for action and there seems to be the desire to address the issues identified. This is essential as we all have a responsibility to ensure that the best care is delivered to older people, who are not a separate group, but are our family and friends. These are the people who raised and taught us and who still have much to contribute so they should be seen as important members of our communities. To satisfy this responsibility, it is fundamental that nurses and other care staff receive the right support so that they have sufficient time and can meet their full potential to deliver the outstanding care we all want to see. Sarah Rochira is older people’s commissioner for Wales
See Careers, page 42 Reference Older People’s Commissioner for Wales (2014) A Place to Call Home? A Review into the Quality of Life and Care of Older People Living in Care Homes in Wales. tinyurl.com/q9xleo8 (Last accessed: January 27 2015.)
NURSING OLDER PEOPLE
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18/02/2015 11:36
