My Health – My Care – My Home
The Scottish Government recently published its healthcare framework for adults living in care homes, - My Health – My Care – My Home. According to the Scottish Government, providing high-quality, personalised care that is consistent, safe, and meaningful, is the top priority for health and social care services.
Aim of the framework
The framework aims to provide direction and vision that will maximise the health and wellbeing of people living in care homes and examine how the health and healthcare of people living there should be optimised, and supported. The framework will also enhance the assessment, monitoring and response to the forever-changing health and healthcare needs of people who live in care homes.
Core elements of the framework
In developing the framework, the wider determinants of health and wellbeing of people living in care homes were examined and explored. This, coupled with an extensive programme of engagement, helped to centre the framework around six core elements:
1. nurturing environment 2. the multi-disciplinary team 3. prevention 4. anticipatory care, supporting self-management and early intervention 5. urgent and emergency care 6. palliative and end of life care
Key enablers
Importantly, the core elements are underpinned by both ‘a sustainable and skilled workforce’ and effective use of ‘data, digital and technology’. These areas are seen as key enablers that will help the sector to implement the recommendations within this framework. Other enablers are realistic medicine and ethical commissioning.
Significant long term medical condition
There is recognition that the majority of people in care homes are living with more than one significant long term medical condition which may not improve and will often be progressive. Therefore, by providing a consistent and enhanced approach to care will enable people to remain as healthy as possible encouraging them to live their best life.
To achieve the framework it requires professionals, services and systems to work effectively providing seamless, personalised care at all times.
It challenges professionals, services and systems to work effectively to support this, and provide seamless, personalised care at all times. With this in mind, a key element of the framework is to ensure a proactive focus on the fundamental components of what we need to live well. For example, by ensuring that a person’s fundamental needs of fluid, nutrition and movement are met, we can reduce or delay the need for wound care. Similarly, by ensuring a person has the opportunity and support to connect, engage and express their needs, can alleviate distress and anxiety.
Emphasis on healthcare needs
Although the framework makes clear that a person’s health is enabled by both ‘social care’ and the ‘healthcare’ workforce. Therefore, throughout the document, the term healthcare refers to the health needs of the individual in their broadest sense. I feel however that the framework does not emphasise sufficiently the resident’s quality of life and the strategies rewired to maintain it. By placing so much emphasis on a resident’s healthcare needs there is a danger that the resident’s quality of life. That is the activities they enjoy in addition to their healthcare needs may get overlooked.
Wheel of wellbeing
What is needed is a holistic approach to the provision of care that includes the needs identified in the ‘Wheel Of Wellbeing ’namely:
Environmental Needs – Safety Shelter Resources Biological Needs – Heath Food and Water Social Needs - Meaning Belief Achievement: Belonging Community Connection Psychological Needs – Attachment Love Security
Summary
The long-awaited Healthcare framework for adults living in care homes in Scotland has been published following extensive consultation with the main stakeholders. The aim of the framework is to provide direction and vision that will maximise the health and wellbeing of people living in care homes.
The framework goes to great lengths to emphasise the health care needs of residents, identifying many who will have progressive medical conditions. While this is undoubtedly correct, and the health needs of residents should remain at the forefront of care, it would be remiss to move the focus away from quality of life.
The contents of the wheel of wellbeing offers the promise of a holistic approach to life in care homes, but this will need to be supported by well trained staff who are up to the challenge and the all-important resources being made available to achieve the aim of the framework.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy