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

1. Nurturing Environment

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

During the COVID-19 pandemic, restrictions were imposed on many of the activities that people living in care homes were allowed to participate in. This had a significant and detrimental impact on their health and wellbeing, and also that of their friends and families.

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.

There should be daily opportunities to do things that are important or meaningful to the individual; such as connecting with families and friends, music, art, exercise, gardening, animal therapy and spiritual time.

As such, health and wellbeing is represented by the largest section of the diagram below (figure 2) as it is greatly influenced by the local environment, the community living in the care home, professional carers, families and friends.

As we come through the pandemic, the importance of day-to-day activities and social interactions has never been clearer and we rely on our skilled and dedicated care home staff to enable this to happen. It is often through these routine daily contacts that 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. They will have the same access rights to care homes as staff, while following infection, prevention and control procedures. Anne's Law will be incorporated into primary legislation in the National Care Service Bill, due to be introduced by the end of this parliamentary year.

The Health and Social Care Standards set out what people should expect when receiving health and social care in Scotland. Two new standards were introduced in March 2022 to ensure that people living in care homes have their right to maintain contact with people important to them in their care and support upheld.

Other healthcare provision (as outlined in figure 2) can be categorised as general, complex and specialist. However, health and wellbeing must not become over-medicalised as care homes are where people live and call home, they are not, and should not become clinical wards. Health and social care professionals must work together to address these healthcare needs within the nurturing environment of the care home.

Nurses working in care homes play a leading role in supporting people living in care homes to live the best life possible. They also lead many aspects of 'general healthcare' such as managing minor illness and infections supporting the more complex care needs that people have.

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. It is important that there is also responsive access to wider community and specialist nursing, allied health professionals and advanced practitioners for healthcare.

The General Practitioner, as the 'expert medical generalist', has a particularly important role within the multi-disciplinary community team in managing people with complex and multiple medical problems and making sense of 'undifferentiated presentations'. This is illustrated in the 'complex healthcare' section of figure 2.

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.