My Health, My Care, My Home - healthcare framework for adults living in care homes: annual progress report September 2023

Prevention

A preventative approach to healthcare has sometimes been seen as a clinical intervention but it is the everyday things we do to keep ourselves healthy and well, which help prevent the onset or delay of health conditions.

There are a number of groups which are in place to come together to consider how best help and support people living in care homes. The Allied Health Professional (AHP) care homes network have met on a regular basis to share challenges, solutions and good practice. They are in the process of developing a document “AHPs in care homes, supporting health and wellbeing” which will highlight a shared vision and ideas to support people to live well and help prevent the onset or decline of conditions associated with long term conditions and aging.

Initiated before the covid pandemic, Fullerton Care Home in Irvine took a new approach to mealtimes which enabled people to be more independent, increase confidence and better fluid and nutritional intake, all of which are vital for preventative healthcare. Something similar is being adopted in St Ronan’s care home in the Borders. When we visited, they shared that they are moving back to giving people the option to enjoy their meal in the communal dining room. Residents are now able to contribute by setting the table, preparing aspects of meals, tidying up, putting water on the table and more.

Targeted meaningful activities for an individual, such as an intergenerational reading group, can help prevent cognitive or mental health decline. Other examples can be found at Age Scotland’s website where they have a multitude of resources, which includes fun active games for strength and balance and free advice guides for increasing physical activity.

A large proportion of our focus in the past year has centred around falls reduction and associated harm.

Hawkhill House care home have created a “Happy Feet” programme which centres around a visual prompt for staff in the care home to check-in with residents who are deemed to be at a higher risk of falling.

A poster of feet is displayed on the resident’s door to increase awareness of the risks and encourage collective responsibility. When we spoke with the care home manager we were advised of the success of this simple, yet very effective, programme which significantly reduced the number of falls in the care home and was having a cultural impact across all staff, with maintenance and kitchen staff also taking responsibility to engage and check-in on residents.

We were delighted to be invited to join the Scottish sub group of the Four Nations Falls Forum. The group provides the opportunity to discuss developing approaches and facilitates the sharing of good practice, new initiatives and concerns regarding falls. In the most recent meeting, the group agreed on removing the term “prevention” from falls work and replacing it with “falls reduction”.

We are also participating in conversations which are taking place to look at the definition of a fall and fall with harm, which will enable better data collection and subsequent improvement opportunities.

More widely, we have had conversations with a range of stakeholders, including the Care Inspectorate, regarding how best to collect data around falls in a meaningful way. While these conversations are ongoing, we are hopeful this will be incorporated into their data collection moving forward. Having this data will help maintain an awareness of the multiple risks associated with falls and provide a focus towards the quality and outcomes of care. It will also reduce data requests, increase data sharing, and provide a stepping stone to standardised data as recommended in the Care Home data review.

At a local level we have also been invited to NHS Lothian’s Falls Forum which builds on a lot of great work they did pre-pandemic which yielded significant reductions in falls. Lothian are currently consulting on a suite of documents which will enable improved awareness, assessment and response for people who are likely to fall.

Between May and June this year, we carried out a case study with care homes in Borders and Fife to raise their awareness on activities that contribute towards falls reduction and gathering examples that happen within care homes:

Supporting people to continue with their hobbies and activities can really contribute to falls reduction. A care home manager in the Borders shared with us some examples of this, including daily household activities, moving indoors and outdoors for socialisation, musical bingo, air hockey, and much more, which lead to improved strength and balance.

In addition, having a lovely garden encourages many more outdoor activities which lead to more stability and confidence. The residents help to cut the grass, water plants and plant items in the greenhouse.

In one care home in Fife, small trolleys are provided for residents to uplift their daily essentials from the worktop where there is a collection of teapots and baskets of snacks available.

When it was discovered that one resident, who struggled with socialising, had a talent for soup making, staff worked with her to develop recipes and prepare soup which everyone was able to enjoy together.

In another home, over 65s are encouraged to carry out as many daily living activities themselves as possible. They enjoy collecting the lunch trolley to share with others and being supported to make tea.