Care home staff be trained in screening the elderly for malnutrition.


In January 2018 a report by the All-Party Parliamentary Group on Hunger an influential cross-party group of MPs called for care home staff to be trained in screening the elderly for malnutrition. The recommendation follows on from evidence given to the group by Managing Adult Malnutrition in the Community who estimate that 35% of people recently admitted to care homes are malnourished. This chimed with the oral evidence given to the MPs by the Hertfordshire Independent Living Service, which found that approximately 40% of people referred on to its books are malnourished.

The evidence received suggests that malnutrition is most likely to arise amongst older people following an accumulation of setbacks – bereavement, illness, a loss of community transport services, and a nearby shop closing, for example – which leave them unable easily to access food. Over and above these cumulative setbacks.

What is malnutrition?

Malnutrition arises when a person’s body does not gain the nutrients it needs to function properly. Older people are particularly at risk of becoming malnourished, due to a range of unique medical, physical, and social reasons.

The World Health Organisation defines malnutrition as: ‘deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

On the most recent estimate, the report claims that 1.3m older people were malnourished or at risk of malnutrition at a cost of £11.9bn to health and social care services.

The cross-party group estimates this figure will rise to £13bn by 2020 and £15.7bn by 2030.

Prevention

The report calls on Secretary of State for Health and Social Care Jeremy Hunt to ensure that care staff are trained to use the Malnutrition Universal Screening Tool, or an equivalent mechanism, to identify older people who are at risk of malnutrition and ensure they receive appropriate food and support to improve their condition.

The report recommends social care providers are given the duty and appropriate funding to ensure elderly people at risk of malnutrition receive at least one hot meal a day with nutritional supplements if necessary.

Care providers should also be given responsibility to ensure older people receive the necessary help to prepare meals and undertake any other activities that can help keep malnutrition at bay.

On a practical level care services should carry out a nutritional assessment as part of the assessment process or when there are concerns about a person’s loss of weight or lack of appetite. This is advocated in the Bettal Quality Management System.

Costs

The Report goes into some detail about the outcome of savings through the introduction of screening for malnutrition. It does not take into account the cost of carrying the process out. That would involve: undertaking the screening, documenting evidence on appropriate decisions on how to pursue the diagnosis underlying any malnutrition or risk of malnutrition, intervention plans to combat the malnutrition and timelines for review and or re measurement.

Criticism of the report

Margaret Wilcox, President of ADASS, was critical of the report’s findings, arguing it was the “wrong approach” to impose a further duty on social care providers.

“The way forward is to deliver more personalised care, and that requires more resources, not more rules,” she said.

“Placing more duties on already-pressured social care staff to tackle one issue, rather than providing the funding needed to address the underlying care crisis, will hinder rather than help.

“If new duties are imposed, then as a bare minimum social care providers must be given adequate funding to ensure they are effectively carried out, otherwise sorting out one human tragedy will create another, as resources are pushed from pillar to post.”

Summary

All-Party Parliamentary Group on Hunger highlights the growing problem of malnutrition. It is a shocking indictment of our society that according to Managing Adult Malnutrition in the Community 35% and the Hertfordshire Independent Living Service who estimate that approximately 40% of people admitted to care homes suffer from malnutrition.

It is good practice to carry out an assessment of a person’s nutritional needs on being admitted to a care service, including with their consent measuring height and weight.

However, we must also take into account the costs of carrying out the process and staff training. With or without extra funding social care services have a duty to care, and must embrace the full meaning of safeguarding to ensure that people who use their services do not go undernourished.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Is the new Government cash injection for social care just another stop gap measure?


Local Authority Councils have welcomed the government’s decision to give them an extra £150m in funding for social care over the next financial year, but warned it was a temporary measure that would not alleviate wider pressures.

The cash injection was announced by Sajid Javid, the community’s secretary, in a written ministerial statement outlining the local government finance settlement for 2018-19.

After “listening to representations”, Javid said, he was committing an extra £150m over the year for social care, to be allocated on the basis of relative needs. The money will come from an expected underspend elsewhere in his department.

It is hard not to see the money as a response to the actions that are now being taken by Councils that in order to provide social care they are having to massively control their spending on other services.

It follows the decision last week by the Conservative-run Northamptonshire county council to signal it as near to effective bankruptcy after admitting “severe financial challenges”, particularly over social care.

The council issued a section 114 notice imposing financial controls and banning spending on all services except statutory obligations to safeguard vulnerable people.

The government has also faced pressure from some of its MPs to boost funding. The Shrewsbury and Atcham MP, Daniel Kawczynski, tweeted on Monday that he was having “difficult discussions” over the local government finance settlement.

The new cash means the government has given councils £9.4bn in dedicated funding for adult social care over three years, the statement said. The wider issue of social care needed “a sustainable settlement for the future”, Javid said, adding that a long-planned green paper on the subject due this summer would set out further plans.

Responding to the settlement, Gary Porter, the Conservative peer who chairs the Local Government Association (LGA), said the £150m “is recognition of the LGA’s warning about the urgent need for the government to further try and help councils tackle some of the immediate social care pressures they face”.

The money was, however, “a temporary measure and needs to be compared against an annual social care funding gap of £2.3bn by 2020”, Lord Porter said.

He added: “Core central government funding to councils will be further reduced by half over the next two years and almost phased out completely by the end of the decade.

“We have warned that councils also face an unprecedented surge in demand for children’s services and homelessness support. This is leaving increasingly less money for councils to fund other services, like fixing potholes, cleaning streets and running leisure centers and libraries.”

This financial year, Porter said, some councils were “perilously close to the financial edge”, even with the possibility of raising some extra council tax revenue.

Paul Carter, the leader of Conservative-run Kent council, and chair of the County Councils Network, said his organisation welcomed the extra money in the funding settlement.

He said: “While this funding provides some new resource for this coming financial year we must continue to work with ministers, who understand the enormity of the financial challenges facing counties, to deliver a long-term sustainable and fair funding solution to meet the estimated £2.54bn funding gap for counties.”

Councils have repeatedly warned that they face an increasing financial crisis caused by a combination of a significant reduction since 2010 of their support from central government and an increase in their statutory obligations, notably on providing social care to an ageing population.

Longer-term plans to tackle the crisis over funding social care were delayed after Theresa May swiftly ditched an election manifesto proposal to increase the amount people would have to contribute themselves.

In November, it was announced that the green paper outlining plans for the sector would be published this summer.

Summary

The cash injection of £150 million although given a cautious welcome by councils does little to address the funding gap in Local Authority funding. It can be seen more or less as a response to prevent some councils from declaring themselves bankrupt and unable to provide services for vulnerable people. It is one of a number of stop gap measures introduced by the Government to give it time to prepare the green paper outlining plans for the social care sector due to be published this summer. In the meantime, the rationing of social care will continue.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Validation Therapy for people with dementia


All staff who care for people with dementia, particularly advanced dementia, are very aware that it can be a particularly difficult challenge. With the progression of the condition service users withdraw into themselves more and more, they don’t let anyone come near them and they no longer remember recent events.

However, in order to meet people’s needs, staff must have some means of communicating with the person – either verbally or non-verbally. Dementia Support suggest there is another method that can help those who care for people with dementia to make a positive connection with them. This method, developed by Naomi Feil in the 1980s, is known as Validation Therapy, and it enables staff to react effectively in response to a service user’s behavior.

By using the Validation method, staff can reduce tension between themselves and those in their care, and begin to develop a closer relationship with them. One critical element of validation, for example, is that it shows that you have respect for who they are and that you accept their current feelings and expression of their emotions.

The central belief and goal of Validation Therapy is that people with dementia should always be taken seriously – no matter what they say, feel or how they act.

Objectives and goals of validation therapy

Whenever you use the Validation method, you are making a connection with the feelings of those in your care. Knowing their Life History, therefore, plays an important role in providing this advanced level of care.

The objectives of Validation Therapy will give staff an understanding of what the approach is trying to achieve:

Cognitive Goals: Improves the persons capabilities
Physical Goals: Improves their wellbeing
Emotional and Personal Goals: Resolves any past conflicts
Social Goals: prevents social isolation of the person

In order to achieve these goals staff should aim to meet the following intermediate goals:

Convey the persons esteem
Reinforce their identity and self-respect
Maintain dignity
Reduce stress
Improve wellbeing
Revive past emotions
Establish effective communication
Communicate at the emotional level.

The aim of Dementia Care & Support, is always to give managers practical, step-by-step advice so that they and their staff can learn quickly and effectively how to apply advanced care techniques in their daily work. Rather than offering unnecessary theory, here are their fast-track tips for implementing the Validation Method in your care service:

First, observe the person in your care

Within a short period of time, you’ll notice certain behavioural patterns that recur time and again. You’ll then be able to draw on these later.

Convey to them a feeling of their own esteem

Esteem is a prerequisite for gaining their confidence. You can express your esteem for them by:

• Giving them your full attention
• Showing them that “I have time for you”
• Adopting and reflecting back to them their manner of expressing themselves and their body language
• Being tactile and being close to them.

But don’t overdo it and be sure to express only genuine feelings. Even if people with dementia often give the impression of being confused and disoriented, they’re still exceptionally sensitive to feelings and moods. They will pick up on the exact tone of your voice and the intention behind it.

When using Validation Therapy, there are a set of rules of communication that you can follow that are especially appropriate to the feelings and behavior traits of people with dementia. Dementia: Care & Support have put together the following checklist for you to use in your care home.

Validation therapy also encourages carers not to contradict the person with dementia and to instead enter their world, rather than trying to bring them (usually unsuccessfully) into your own.

‘Validation is about being in the moment with the person,’ explains Julia Pitkin, one of the first validation practitioners in the UK. ‘Being corrected can make a person feel devalued.’ Whether you call it special care or validation therapy, both approaches recommend using distraction techniques rather than lying.

So, for example, if a service user keeps asking where her husband is, instead of reminding her he died five years ago, you could say, ‘it sounds like you’re really missing him, how did you meet? Can I see some wedding photos?’

Empathy and respect are what matters, say supporters of both approaches. Feeling listened to and supported, they argue, helps people with dementia regain their dignity and feel a greater sense of calmness and peace.

Summary

Managers and staff are always on the lookout for new approaches to engaging and communicating with people who suffer from dementia. Validation Therapy is not new, but the benefits of this approach are now being recognized. There is a great deal of literature available on this topic if managers are interested. Including: Dementia Care and Support for Care Home Personnel.

There is also a video by Naomi Feil available on YouTube here.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director