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Benefits of using arts in care homes

Registered managers of care homes are always on the lookout for person centred activities that will involve service users. The Social Care Institute for Excellence (SCIE), are promoting the benefits and the importance of art in care homes by bringing together a range of resources that allows managers to tap into and improve the quality of life for service users.

The following are links to general information produced by SCIE about the importance on arts in care homes and the resources available:

Creative Homes: how the arts can contribute to quality of life in residential care

This joint publication with NCF (the National Care Forum – the umbrella body for not-for-profit care providers) and NAPA (the National Association for Providers of Activities for Older People celebrates existing good practice in the use of the arts in residential care and demonstrates the value of art to improving the quality of life for people in care settings. (Baring Foundation).

Creative and credible: evaluation resources

This web-based resource provides information to help evaluate the impact of art and health projects. Sections providing information to help understand why you might need to evaluate, what approaches might be appropriate, and how to plan and implement evaluation for a project. (Willis Newson).

Local authorities + Older people + Arts = A creative combination

This publication describes the unique combination of roles and interests by local authorities which make them the ideal champions for arts and older people. These are: health and wellbeing; arts and cultural services; older people’s services and social care; social inclusion and leadership and coordination. These are illustrated by six case studies. (Baring Foundation).

Technically older: an update on digital arts and creative ageing

This report revisits and updates the work done for the 2012 publication Digital Arts and Older People. It explores developments since 2012 in the field of artists working with older people using creative technology. New and additional benefits of using digital tools with older people are considered and 10 new case studies of practice are presented. (Some of which are used in our topic areas.) (Baring Foundation).

Arts and dementia: bringing professional arts practice into care home settings

This report reviews evidence relating to the benefits of arts participation for people with dementia. It draws on research spanning the fields of health, dementia care and participatory arts. This is one of a series of publications around arts and dementia that have grown out of Live and Learn. (Collective Encounters).

Arts and dementia: Pocket guide for carers 2nd edition

All available evidence indicates that imaginative mental exercises have a direct, positive impact on the health of individuals living with dementia. Arts-based activities such as the ones featured in this guide have been shown to help people with dementia to manage their symptoms, significantly enhancing their quality of life in the process. This guide is the result of three years of research in Merseyside with the carers of people living with dementia (Creative Encounters).

Growing the Creative Ageing Movement: International lessons for the UK

This report highlights imaginative programmes that have been developed in communities across the UK by Churchill Fellows, following their global travels to witness inspiring practice in other countries. Projects, which have particularly concentrated on work around art and dementia have taken place under five topics: art form; day care; training for care staff; artists in care settings and evaluating impact. (Baring Foundation).

Creativity in care homes: evaluation report

The programme was delivered in 2012 by City Arts for Nottingham City Council. Events were held to stimulate interest in the project and provide practical support to staff from residential care settings. An artist in residence worked with a care home to trial different approaches to improve wellbeing of residents and to enable Activity Co-ordinators to continue the work beyond the project. (City Arts).

An evidence review of the impact of participatory arts on older people

This review is the first synthesis of the evidence base for the effects of participating in artist-led creative projects on older people. It concludes that ‘it is evident that engaging with participatory art can improve the wellbeing of older people and mediate against the negative effects of becoming older’. These impacts are explored in terms of mental and physical wellbeing at the individual, community and societal levels. (Mental Health Foundation).

The participative arts for people living with dementia: a critical review

This review of academic and grey literature contextualises the participatory arts for people living with dementia and provides an overview of some of the art forms that are most widely used. Looks at the benefits of using participatory arts and highlights some of the current gaps in the knowledge base. (International Journal of Ageing).

Arts in care homes resource pack

This online resource pack brings together a collection resources to help promote the importance of arts and creative activities for older residents in care homes. It aims to support care staff to plan and run creative arts sessions and help then work with professional artists. (Care Inspectorate).

Learning for older people in care settings: a guide for activity coordinators and care staff

This guide is for activity coordinators and other members of care staff involved with, or interested in, supporting older people to take part in learning activities. (National Institute of Adult Continuing Education).

Summary

The Social Care Institute for Excellence and their partners should be commended for bringing together this resource pack that promotes the importance of the arts in care homes. This can be seen as a valuable tool for managers and an essential means of improving the quality of life for service users.

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

The postcode lottery in the provision of quality care in nursing homes

People reading the recent article by Claire Ellicott political correspondent of the Daily Mail on 27th December 2017, based upon the Care Quality Commission findings into inadequate quality of care in nursing homes will be alarmed.

CQC figures in their report reveal that in some parts of the country three quarters of nursing homes are failing.

  • Nearly one in three (30.1 per cent) of all nursing homes ‘require improvement’ or are ‘inadequate’, according to Care Quality Commission reports.
  • And most regions have experienced care problems, with 93 per cent of areas having homes that need improvement.
  • In Kensington and Chelsea 75% of homes were rated as requiring improvement.
  • Of the 5,300 homes inspected this year, 2,000 were found to be inadequate or in need of improvement

The figures highlight the postcode lottery in the provision of quality local care across the country.

More than a third of nursing homes in the North and a quarter in the South either needed improvement or were deemed inadequate.

The issue is particularly acute in central London, where Westminster has a 50 per cent rate of failing homes, despite being under the nose of MPs at the Houses of Parliament.

In the Royal Borough of Kensington and Chelsea in London, where Grenfell Tower is situated, 75 per cent of nursing homes were rated as requiring improvement.

In Salford, 64.3 per cent or more of nursing homes were rated as ‘requiring improvement’ or ‘inadequate’, while Coventry had 60 per cent and North Tyneside 62.6 per cent.

In Wakefield, 52.6 per cent, are rated as ‘requiring improvement’ or ‘inadequate’ while the figure in Wolverhampton is 58.3 per cent.

Elsewhere, half of nursing homes in Hull, Newham, Telford and Wrekin, the Wirral and Derby were found to be failing.

According to the Daily Mail the stark survey underlines the extent of the crisis facing England’s broken care system, which is providing substandard care despite sky-high prices.

Earlier this year, the Daily Mail revealed social care was struggling so much that four in ten care homes were failing inspections.

Of the 5,300 homes inspected this year, 2,000 were found to be inadequate or in need of improvement.

Currently, rules mean care home residents have to use their assets to pay the full costs of their care until they are reduced to their last £23,500.

The cost of their care is taken off the value of their home after they die, denying thousands of children their inheritance.

David Cameron pledged to introduce a cap of £75,000 on care costs two years ago, but this has now been shelved until after 2020.

Theresa May announced a plan for families to keep £100,000 of their assets but with no upper cap on costs during the election.

However, the pledge was abandoned after critics dubbed it the ‘dementia tax’.

The new figures were provided directly to the Labour Party by the CQC and are based on the watchdog’s most recent investigations.

Barbara Keeley, Labour’s social care spokesman, said a lack of nurse training places and bursaries had affected staffing levels.

‘Nursing care providers are struggling to recruit and retain staff because of a lack of registered nurses but similar trends are present across the care sector because of the impact of cuts on pay and conditions for other care staff,’ she said.

Last month, analysis by Which? found that more than half of all elderly care places in England are in failing care homes.

In six local authority areas, more than 50 per cent of the beds available were rated as inadequate or needing improvement.

The council in Kensington and Chelsea said its poor ratings were the result of having relatively few homes.

A spokesman said the borough was home to only around ten privately-run care homes and the small number ‘skewed’ the figures.

A report on care homes in Kensington and Chelsea from May revealed it had problems attracting low-paid staff to the most expensive area of the country.

This is another report that casts nursing homes in poor light. It is to CQC credit that they continue to bring to the attention of people, politicians and decision makers the shortfalls in quality care. However, what is surprising is the that those who represent nursing homes are not bringing more into the spotlight, the difficulties in recruiting and retaining nursing staff.

It would be wrong to criticise the efforts of providers in attempting to address the situation, when registered nurses are just not available because lack of funding for nurse training.

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

The unfair practice of self-funding residents subsidising residents supported by local authorities

The published report of the Competition and Markets Authority’s market study into residential and nursing care homes for older people makes interesting reading for those working in this sector.

The study found that public expenditure on adult social care of all types (including non-elderly care and care outside care homes) has been under pressure. For example, aggregate expenditure has declined in real terms by 8% between 2009/10 and 2015/16 in England.

The sector has reported facing challenges to its sustainability, due primarily to the low fee rates being paid for state-funded residents – those challenges being exacerbated by increased cost pressures due largely to wage costs. In its annual assessment of the quality of health and adult social care in England (October 2016), the Care Quality Commission (CQC) said that the sustainability of the adult social care market is approaching a tipping point.

The Competition and Markets Authority have undertaken an extensive profitability analysis of the sector using information provided directly by care homes and taken from company accounts. It is understood to be the most complete study of profitability in the sector in recent years.

In their assessment, they found that the average fees paid by Las are below the full costs involved in serving these residents. Our financial analysis of the sector shows that, looked at as a whole, the sector is just able to cover its operating costs and cover its cost of capital. However, this is not the case for those providers that are primarily serving state-funded residents.

Many care homes, particularly those that are most reliant on LA-funded residents, are not currently in a sustainable position. Our analysis shows that while many can cover their day-to-day operating costs, they are not able to cover any additional investment costs. This means that while they might be able to stay in business in the near term, they will not be able to maintain and modernise facilities, and eventually will find themselves having to close, or move away from the LA-funded segment of the market.

This shows that the fees currently being paid by Las are not sufficient to sustain the current levels of care under the current funding model. The implication is that public funding needs to increase if the current model of funding is to continue, or alternatively, if current levels of funding do not increase, the funding model for care will need to be changed.

Our analysis suggests that about a quarter of care homes have more than 75% of their residents LA-funded, and that these are the ones most at risk of failure or exit because of a funding shortfall. We estimate that LA-fees are currently, on average, as much as 10% below total cost for these homes, equivalent to around a £200 to £300 million shortfall in funding across the UK. This finding is based on an average result – there will already be a proportion of operators that are struggling and at risk of closure.

The large majority of care homes offer places to self-funded as well as LA-funded residents. Many care homes are relying on higher prices charged to self-funders to remain viable, even when providing the same services. Self-funded residents in mixed homes are meeting a much greater proportion of homes’ fixed costs. Without this, the public funding shortfall would have a substantially larger impact than it currently has.

Our assessment based on larger providers is that self-pay fees are now, on average, 41% higher than those paid by Las in the same homes. This represents an average differential of £236 a week (over £12,000 a year). We understand that fee differentials for smaller providers are slightly lower but still significant.

This difference between self-funded and LA prices for the same service is understandably perceived by many as unfair. The large majority of self-funders are not wealthy; the current thresholds for support are currently drawn so that practically anyone who owns their property will be ineligible for state funding, regardless of income. Moreover, there is very poor visibility of the size of these fee differences so the public is generally unaware and Las do not have to justify their approach to the fees they pay to care homes.

In addition to this, however, the situation may not be sustainable. Where LA rates are below total cost, those care homes that can attract self-funders are likely to move away from serving a mix of residents. We already observe that nearly all new care homes being built are in areas where they can focus on self-funders. While we would expect that many mixed homes with differential pricing could continue to operate for some time, there will be a need for additional funding to support further care homes that would not be sustainable without the benefits of this price differential.

Our assessment is that if Las were to pay the full cost of care for all residents they fund, the additional cost to them of these higher fees would be £0.9 to £1.1 billion a year (UK wide, and assuming this money is directed specifically to those homes where LAs pay fee rates below total costs).

Summary

The Competition and Markets Authority’s market study into residential and nursing care homes for older people, confirms what we have known for some time a seriously underfunded social care sector. However, what is interesting from their analysis is how the care home sector is propping up their services. To remain viable it is asking self-funded residents to pay the real cost of care and thereby subsidising local authority sponsored residents who are paying much less for the same care. This is grossly unfair. It is time for Local authorities to pay the real cost of care. Equaity should mean equality.

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

 

It that time of year again – Looking back over 2017

Looking back over the year 2017 I have tried to bring to your attention articles and blogs that you might find interesting in the world of social care. I have covered topics ranging from the crises in social care funding to the use of yoga in care homes.

The central purpose of my blogs is to keep you informed of innovative practice that may improve the quality of life of people who use social care services. In addition, I also include new requirements placed on providers by the Care Quality Commission.

Overall the year 2017 in social care is ending as it began. Social care is still in crises because of underfunding, and has reached a tipping point. A number of care homes have decided to call it a day, and some domiciliary care providers have even handed back their contacts to local authorities because they are uneconomically viable.

Looking forward positively, we are promised a Green Paper on social care funding in the summer of 2018. On the one hand, this may be seen as a method of kicking the problem in the long grass, and further delaying tactics. Alternatively, it may at last be recognised as a problem, where the solution can only be found outside the cut and thrust of party politics and consensus on way forward is agreed by all parties.

All the best to you and yours for 2018.

Happy Christmas!

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

 

Community Mental Healthcare Sees No Improvements, Report Reveals

People’s experiences of community mental healthcare services across England have not improved over the last couple of years – and in fact, in some cases they’ve even got worse.

This is according to new research from the Care Quality Commission (CQC), revealing that while 64 per cent of those asked rated their experiences as seven out of ten or above, this is not an improvement on what was seen in 2014 where 65 per cent said the same.

In addition, it seems that fewer people than ever are happy with the quality of care and support they receive when they do make contact with a healthcare professional. Some 26 per cent admitted that they didn’t feel they got the help they required from crisis care, compared to 21 per cent three years ago.

Deputy chief inspector of hospitals (lead for mental health) at the CQC Dr Paul Lelliott said: “The finding that a higher proportion of people who sought help in a crisis were dissatisfied with the help provided is a particular concern.

“We expect providers to review their results very carefully. We will continue to use these findings to plan our inspections and will be looking carefully at the action plans that providers have developed in response to their local survey results.”

Back in October, the CQC also published its initial review of mental health services for children and young people, finding that although the majority of specialist services do provide good quality care too many young people are struggling to access services. As such, they’re not receiving the care they need as and when they need it.

For help with your CQC compliance system, get in touch with us today.