My Health, My Care, My Home - healthcare framework for adults living in care homes: summary

1. Nurturing Environment

The health and wellbeing of someone is greatly influenced by the immediate environment, activities, and those providing day to day care.

Health and healthcare is much more than medicines and clinical diagnoses. Provision of a safe, homely and stimulating environment with meaningful activities, good nutrition and social connection are essential and fundamental components of good healthcare that also support positive wellbeing. Health and wellbeing is represented by the largest section of the diagram below (figure 2) as it is greatly influenced by families and friends, the local environment, the community living in the care home, and professional carers. It is often through routine daily contacts that families and social care staff are able to detect that 'something is not quite right'. This comes from knowing the person in the care home well, recognising different patterns of behaviour and spotting changes that are indicative of illness.

It is essential that the important role of care home staff in improving health and wellbeing is both recognised and valued in our society. The care home team should continue to play the leading role in the healthcare of people living in care homes, with a keyworker who co-ordinates the day-to-day care of the individual

Contact and engagement with families and friends greatly enhances health and wellbeing. Based on feedback from stakeholders and families, the Scottish Government considers that Anne's Law should provide people who live in adult care homes with the right to see and spend time with a named visitor or visitors at all times.

Other healthcare provision can be categorised as general, complex and specialist; and it is important to ensure that people are able to access the help they need from the right person at the right time.

The requirement for someone to be living in a care home indicates a level of complexity in their care. However, some people have very specific and highly complex healthcare needs which may have previously required inpatient hospital care, or specialist input within a community hospital or a complex care ward. These individuals must be able to access appropriate specialist assessment and regular specialist review when living in a care home where that is required.

Recommendations

1.1 We must recognise and value the important role of all staff working in the care home in improving health and wellbeing of people living in care homes.

1.2 The care home team should continue to play a leading role in the healthcare of people living in care homes, alongside a keyworker who co-ordinates the day-to-day care of the individual.

1.3 Health and social care professionals must work together to address any healthcare needs within the nurturing environment of the care home and ensure that people living in care homes are not over-medicalised.

1.4 Everyone living in a care home should have access to nursing care. These nurses may either be employed by the care home, or, if employed externally, should have expertise in care homes.