What care homes can do to improve life for their residents

It’s official: size matters. In the Care Quality Commission’s latest state of adult social care services report (pdf), 89% of smaller care providers were rated good or outstanding, compared with 65% of larger nursing homes. The figures are similar for domiciliary care.

The CQC praised these services for looking “beyond people’s medical conditions” and encouraging people to “be themselves”. This is the crux of the matter: smaller services are dedicated to person-centred care.

How do smaller services provide personalised care and can this be mirrored in larger settings?

Personalisation is about having choice and control; person-centred care is something that, in theory, any service can achieve. It is about being sensitive to individual needs and desires: the way a person wishes to be referred to, when and where someone wants to eat, what they love and hate … Delivering person-centred care means knowing who a person was, is and wants to be. There are several ways to make this attitude part of their care.

Get the care plan right

The CQC report observes that good person-centred care means people are “fully involved in all areas of their care, such as writing care plans”. At Manor Community, we are developing software to help people make updates and changes to their care plans directly. It is a major step towards promoting direct involvement.

For those who are not internet savvy, we have found reverse mentoring fantastic. Our apprentices mentor managers and the people we support about using Skype, laptops, iPads and social media safely.

Care plans often stipulate a goal towards finding employment, but one of the main obstacles for people we support can be getting work experience. So we ran a workshop recently as part of Remploy’s experts by experience initiative, where people who use services help with CQC inspections. It’s a great way of helping people to get paid work experience.

Act on feedback

Encouraging feedback from service users is important. We support someone with autism who said he felt staff did not understand his experiences. So we arranged training for staff, families and other local providers, and involved that person in setting the agenda. User involvement truly does work.

Larger providers could mirror this approach by, for example, setting up family and service user improvement forums. These could be used to communicate what improvements are planned as a result of their feedback and then seek comments on the success of those improvements once implemented.

Co-production is key

Another buzzword, but it’s an important one. Designing services around the person flips the “doctor-patient” relationship on its head. Everyone should be consulted on the decisions that affect them, from décor and activities to recruitment and training.

This is easier to do than you might think. A simple questionnaire when people enter a service helps reveal their preferences. Changing the layout of a room can help people feel at home and is cost neutral. Having a survey of preferred activities or asking people to feed back on recent activities helps inform management decisions on future investment. We have invited people to sit in on interview panels and give feedback to management following staff trial days. All of this helps people be directly involved in the running of the service.

Create a homely environment

One of our inspection reports highlighted that the service created a sense of “living together as an extended family”. The CQC state of care report, meanwhile, stipulated that homelike environments, such as those created by Shared Lives schemes, create a supportive family environment. Larger homes must endeavour to feel homely: the smell of home baking, the choice of eating out – such as offering pub quiz evenings in small groups – or simply having a Netflix night. Developers should consider designing larger services in a way that mimics the feel of a smaller service.

Staff with time to care is also important here. One of the questions I would love to see on a feedback questionnaire is: “Do you feel the love in this service?” I refrain from asking it as it doesn’t quite seem professional, but I’m talking about mindful compassion. This is where people feel understood, loved, heard and valued as part of a social group, where kinship, caring and secure relationships help people to thrive. This matters in person-centred care but is difficult to deliver when staff are rushed or distracted.

Size does matter, but involving people in their own care matters more. Big or small, this can be achieved by all providers and it will make all care outstanding.

Sophie Chester-Glyn is director at Manor Community and is starting a PhD on person-centred care planning

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