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Care of the Older Person – Unit 4 5N2706

Care of the Older Person

5N2706

Unit Four - Care Settings

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Care of the Older Person – Unit 4 5N2706

Following this Unit, the learner will gain understanding of:

➢ The care settings available for older people

➢ Members of the healthcare team

➢ Specific services that are available for older people in the following:

o Education

o Lifelong learning

o Leisure

➢ Current approaches towards developing quality in the provision of services

for older people and their families to include standards and quality

assurance.

Care of the Older Person – Unit 4 5N2706

Contents

CARE SETTINGS AVAILABLE ................................................................................... 3

Respite care ............................................................................................................................... 3

Sheltered living .......................................................................................................................... 4

Long-term residential care ........................................................................................................ 4

THE HEALTHCARE TEAM ........................................................................................ 5

KEY MEMEBERS .................................................................................................... 5

FACTORS THAT PROMOTE A MULTIDISCIPLINARY APPROACH: .............................. 5

IT’S IMPORTANCE ................................................................................................. 6

SPECIFIC SERVICES AVAILABLE ............................................................................. 13

PROVISION OF QUALITY STANDARDS .................................................................. 18

National Standards: Residential Care Settings for Older People............................................. 18

Standards and Criteria ............................................................................................................. 19

Care of the Older Person – Unit 4 5N2706

CARE SETTINGS AVAILABLE

Vernon (2008) informs us that the aim of any of the services for the older person is

to maintain the client’s independence for as long as possible and to remain in their

own homes or sheltered housing in the community. Facilitating a person to remain in

their own home encourages independence, self-esteem for the person and is

financially more beneficial to the government. Each community/locality will have a

number of different services available to the older person in the community.

The first service available to the elderly is their general practitioner (doctor). Other

services within the community include the public health nurses, healthcare

assistants and home helps. Other facilities that play an important part in supporting

people to remain in their own homes include day centres, day hospitals, respite care

and meals on wheels.

The day care centres and day hospitals provide support for the older person. They

offer an opportunity to socialise, be involved in reminiscence therapy, physical

activity and other activities. There is a nurse available at these centres who can

monitor health issues and advise the person, and or their family, if they feel that the

person should see their GP or other relevant person.

Respite care

Some long stay units and nursing homes provide respite beds for families to have a

break from caring. This is essential if the family are to continue caring for the person

on a long term basis. It also provides an opportunity for the person to have their

health reviewed.

Meals on wheels provide dinners for older people living in the community.

Care of the Older Person – Unit 4 5N2706

This is a valuable support to older people as it ensures that they are eating a

nutritious diet, which is important in maintaining health and thus keeping them in

their own homes and community.

Sheltered living

Sheltered housing offers the opportunity for the older person to live in a community,

where they have their own private accommodation, but communal dinning and

recreational facilities if needed. There is also a qualified nurse and carer available on

call if they need assistance. Unfortunately, this service is not available in all areas of

Ireland. Very often when a person can no longer live in their own home it is a matter

of researching what is available in their community and making the choice from that

availability.

Long-term residential care

Long-term residential care is provided in district and community hospitals. Nursing

homes also provide long-term care. The Nursing Homes Support Scheme, also known

as the “Fair Deal”, provides financial support to people who need long-term nursing

home care. The scheme is operated by the Health Service Executive (HSE) and

replaces the Nursing Home Subvention from 27th October 2009.

The Nursing Homes Support Scheme, A Fair Deal, began on the 27th October 2009.

The purpose of the Scheme is to provide financial support for people assessed as

needing long-term nursing home care. The scheme is founded on the core principles

that long-term care should be affordable and that a person should receive the same

level of State support whether they choose a public, voluntary or private nursing

home. Since the 27th October 2009, the Nursing Homes Support Scheme is the

single funded means of accessing long-term nursing home care for all new entrants.

Care of the Older Person – Unit 4 5N2706

THE HEALTHCARE TEAM

Multidisciplinary working refers more readily to a group of people who come from

different health and social care professions, but who do not necessarily interact

(Petrie, 1976). Care is a collaborative approach to treatment, planning, and on-going

care throughout the treatment pathway. Multidisciplinary care aims to ensure that

members of the treatment and care team can discuss all relevant aspects of patients'

physical and psychosocial needs along with other factors impacting upon the

patient’s care.

KEY MEMEBERS

❖ Doctors

❖ Nurses

❖ Physiotherapist

❖ Occupational therapist

❖ Speech therapist

❖ Dietician

❖ Social workers.

Multidisciplinary care encompasses focus on continuity of care, development of

pathways and protocols for treatment and care, development of appropriate referral

networks, including appropriate referral pathways to meet psychosocial needs and

development of multidisciplinary team meeting audit mechanisms.

FACTORS THAT PROMOTE A MULTIDISCIPLINARY APPROACH:

❖ Good communication

❖ Understanding of each discipline's role

Care of the Older Person – Unit 4 5N2706

❖ Mutual respect

❖ Team approach

❖ Trust

❖ Non-hierarchical relationship

❖ Involvement of patient and family in decision-making process.

IT’S IMPORTANCE

Allows information to be shared

Increases knowledge

Skills and resources can be effectively used

Patient is the central focus.

To ensure optimum functioning of the team and effective patient outcomes, the

roles of the multidisciplinary team members in care planning and delivery must be

clearly negotiated and defined (Mitchell et al 2008). This will require consideration

of:

Respect and trust between team members

The best use of the skill mix within the team

What clinical governance structures need to be in place and how

communication and interaction will occur between team members

Team Members

A general practitioner or GP: is a medical practitioner who provides primary care

and specialises in family medicine. A general practitioner treats acute and chronic

illnesses and provides preventive care and health education for all ages. The GP is

the gatekeeper to all health care services; a patient must have a referral from their

GP to be seen by a specialist/consultant.

Care of the Older Person – Unit 4 5N2706

The GP is a member of the primary healthcare team and works alongside public

health nurses, pharmacists, and physiotherapists etc to provide holistic care to

patients. GPs also prescribe and review medication.

Medical Doctor: practices medicine, which is concerned with maintaining or

restoring human health through the study, diagnosis, and treatment of disease or

injury.

The doctor oversees the medical care of the patient's biological needs

Prescribes medication

Gives information and reassurance to patient

Builds up trust

Works with other members of team to ensure quality care.

Public Health Nurses: in Ireland are employed by Health Service Executive (HSE) to

provide a range of healthcare services in the community. They are usually based in

your local health centre and are assigned to cover specific geographical areas. They

provide services in schools, in health centres, in day care and other community

centres and in people's homes. Public health nursing teams provide basic nursing

care as well as advice and assistance to their patients.

They provide planned essential weekend nursing and, in some cases, twilight nursing

(this is the service for terminally ill patients). Public health nurses also act as an

important point of access for other community care services. Public health nurses

and community registered general nurses liaise with family doctors (GPs), practice

nurses, hospitals, hospices and other health service providers to ensure that the

needs of the patient are met by the overall health service.

Public health nurses sometimes visit newborn infants and their mothers in their

homes and are also involved in the arrangement of school health services.

Care of the Older Person – Unit 4 5N2706

In some areas, public health nurses keep a register of older people and visit them as

a matter of course. Sometimes, the same service is also provided for people with

disabilities. The main groups of people to whom public health nurses and their teams

provide services are:

Older people who live at home

People who are chronically or acutely ill at home and people who are dying

at home

Children - infant welfare services, child health services and school health

services

Expectant mothers and mothers who have recently given birth

People with disabilities

People suffering social deprivation

Travellers

Those who have contracted Hepatitis C directly or indirectly from the use of

human immunoglobulin-anti-D or from the receipt within Ireland of any

blood product or a blood transfusion and who hold a Health Amendment

Act Card.

Healthcare Assistants: are valued members of multidisciplinary teams and work

under the supervision and direction of a registered nurse.

Roles and Responsibilities of a Healthcare Assistant:

Ensure the highest possible levels of care are maintained by

supporting/assisting clients when required with personal hygiene and all

other aspects of daily living encouraging independence at all times.

Provide care under the supervision of a registered nurse and report any

problems encountered to the nurse.

Follow instructions/guidelines from care plans from any member of the

multidisciplinary team.

Care of the Older Person – Unit 4 5N2706

Assisting clients in all aspects of care needs e.g. physical, emotional and

spiritual.

Assist clients with limited mobility or physical difficulties making best use of

aids provided.

Closely monitor clients who may have challenging/behavioural problems.

Observe care planning needs and complete any documentation.

Assist with social activities by interacting with clients and helping continue

with hobbies and activities.

Liaise with other members of healthcare team, including relatives, family

and friends.

Be aware of your role in relation to local policies and procedures.

The HCA can work in many different areas, in the community as a home help, in the

hospitals, intellectual disability services, in day services etc. Their duties will be

defined by the area they are in and will be outlined in their job description.

Registered Nurse: Nursing encompasses autonomous and collaborative care of

individuals of all ages, families, groups and communities, sick or well and in all

settings. Nursing includes the promotion of health, prevention of illness, and the

care of ill, disabled and dying people. Advocacy, promotion of a safe environment,

research, participation in shaping health policy and in patient and health systems

management, and education are also key nursing roles. Role of the nurse:

Oversees nursing care of patient.

Involved in assessment, planning, evaluation and implementation of care.

Works in a supervisory capacity as well as hands-on.

Liaises with other members of multidisciplinary team.

Documentation, communication, teamwork.

Care of the Older Person – Unit 4 5N2706

Physiotherapist: works with patients to help them regain mobility, independence

and well-being. They do so by hands-on therapy, such as manipulation and massage,

designing and supervising exercise programmes, and by applying electro-therapies,

such as ultrasound and laser treatments. Role of physiotherapist includes:

Assessing patients.

Assessing patients' equipment.

Providing physiotherapy for patients.

Developing programmes that can be carried out by the nurses and care

assistants.

Liaises with the other members of the team.

Occupational Therapist: is a therapist who is trained in the practice of occupational

therapy. The role of an occupational therapist is to work with a client to help them

achieve a fulfilled and satisfied state in life through the use of purposeful activity or

interventions designed to achieve functional outcomes which promote health,

prevent injury or disability and which develop, improve, sustain or restore the

highest possible level of independence. Role of occupational therapist includes:

Assisting patients to achieve independence through a variety of means.

Assessing needs.

Assisting with the use of equipment.

Adapting homes.

Liaising with other members of the multidisciplinary team.

Speech therapist: The role of a speech and language therapist (SLT) is to assess and

treat speech, language and communication problems in people of all ages to enable

them to communicate to the best of their ability. They may also work with people

who have eating and swallowing problems. Other roles include:

Assessing patients.

Care of the Older Person – Unit 4 5N2706

Developing communication programmes for nurses and care assistants to

carry out.

Working with patients who have swallowing difficulties.

Implementing programmes for these patients.

Liaising with other members of the team.

Dietician: Dietetics is the interpretation and communication of the science of

nutrition to enable people to make informed and practical choices about food and

lifestyle, in both health and disease. A dietician will have trained in both hospital and

community settings as part of their course. Dieticians can work in a variety of areas;

many of these are in the HSE within hospitals or in the community as dieticians,

health educators or as managers. Both hospital and community dieticians educate

people who need special diets as part of their medical treatment.

Social worker: is part of a profession and a social science committed to the pursuit

of social justice, to quality of life, and to the development of the full potential of

each individual, group and community in a society. Social workers draw on the social

sciences to solve social problems. Their role includes:

Offering support for patients

Counselling

Social welfare advice

Assistance with social welfare and other issues

Liaising with other members of the team

Other people may involve:

The catering staff

Orderlies

Domestic staff

Bus drivers

Care of the Older Person – Unit 4 5N2706

Volunteers

Chaplins.

Any person who the patient/client has contact with can have a negative or positive

influence on the patient. For example, a cheerful member of the catering

staff/domestic can lift the spirits of a patient by chatting to them as they go about

their work.

Care of the Older Person – Unit 4 5N2706

SPECIFIC SERVICES AVAILABLE

As people spend more of their active life in retirement, many organisations have

been set up to support retired people in their pursuit of hobbies, leisure activities

and education. There is a wide range of older retired people’s organisations and

most of them fall into one of the following categories:

❖ Activities

❖ Campaigning

❖ Support, including carers’ organisations

Activity-based groups include active retirement associations, sports, arts and culture

groups. Some of them are largely concerned with providing a social outlet, others

organise all sorts of activities including traditional leisure activities and education

and training. A number of groups advocate for the rights of older persons and others

offer support and information to older persons and their families.

Active Retirement Ireland (ARI): A national network of local active retirement

associations whose purpose is to enable retired people to enjoy a full and active life

and to advocate for them. You can contact ARI to find your local active retirement

association or to get information on how to set up a new group.

Age and Opportunity: Age and Opportunity works to promote opportunities for

greater participation by older people in society in a range of areas from the arts and

physical activity, to promoting age equality.

Older & Bolder: Alliance of non-governmental organisations that champions the

rights of all older people and is working towards the attainment of an age- friendly

society.

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Older Women’s Network: National network that links individuals and groups of

women aged over 55. The network provides a forum for older women to meet

together to share their experiences and discuss issues of concern. It works to bring

about positive change and the social inclusion of older women. Membership of OWN

is open to women who support its aims and who live in Ireland.

Irish Senior Citizens Parliament: The organisation represents the interests of senior

citizens to government and other public bodies on issues affecting older people such

as income, health or housing.

National Federation of Pensioners’ Associations: As a representative body for

pensioners’ organisations the Federation aims to protect and promote the interests

of pensioners and retired people with regard to social welfare, health,

superannuation and tax.

Age Action Ireland: Age Action Ireland is a national advocacy body for ageing and

older people. The organisation aims to achieve fundamental change in the lives of all

older people by empowering them to live full lives as actively engaged citizens and to

secure their rights to comprehensive high-quality services according to their

changing needs.

ALONE: supports vulnerable older people providing temporary or permanent

housing and combating isolation and loneliness in society. Volunteers and staff work

with older people in ALONE’s dedicated housing projects and in the community.

Friends of the Elderly: Friends of the Elderly is an Irish charity that brings friendship

and social opportunities to the elderly, especially those who live alone. Its volunteers

visit the elderly in their homes in the Greater Dublin area.

Carers Association: The Carers Association aims to support family members who

provide care for frail older persons.

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The organisation lobbies and advocates on behalf of family carers in the home who

lack services, such as in-home respite, which are essential to family carers. It has a

network of carers’ resource centres.

Caring for Carers Ireland: Caring for Carers Ireland works to promote the health,

well-being and quality of life of all family carers and those for whom they care. The

organisation focuses on the areas of recognition, provision of information on

benefits and entitlements, respite, training, research and advocacy to promote social

inclusion.

Alzheimer’s Society is the leading dementia specific service provider in Ireland. The

Society was founded in 1982 by a small group of people who were caring for a family

member with Alzheimer's disease or a related dementia. Today, it is a national

voluntary organisation with an extensive national network of branches, regional

offices and services that aims to provide people with all forms of dementia, their

families and carers, with the necessary support to maximise their quality of life.

Education/lifelong learning

Professor Tom Collins (cited in) ANTOS, The National Adult Learning Organisation in

their submission to the positive ageing strategy 2009 stated:

‘If we think about the quality of life in a community, adult education can enrich it

by providing new ways of gaining physical and mental aliveness and alertness by

maintaining the health of an ageing population. In fact, I would think that an

educational approach to health and wellbeing for older people would be far more

beneficial and cost effective than any way we know. The possibilities of adult

learning include the way which it can promote and sustain independence.

Care of the Older Person – Unit 4 5N2706

Sustaining independence, for as long as a person’s life ultimately represents a

phenomenal savings to the state, because otherwise that person literally becomes

an encumbrance on the state.

So, managing a life that is full, that is life giving, that is physically, socially,

intellectually and emotionally alive and enriched – this is what adult education

offers and, in its absence, the alternatives include medication, long term care, a

reliance on an overstretched healthcare system and a gradual decline into

dependency.’

From the above statement we can see how important ongoing lifelong learning and

education is for all people. Lifelong learning is noted in the points under the 5 UN

Principles for Older People:

❖ Independence: Older persons should have access to appropriate

educational and training programmes.

❖ Participation: Older persons should remain integrated in society, participate

actively in the formulation and implementation of policies that directly

affect their well-being and share their knowledge and skills with younger

generations.

❖ Self-fulfilment: Older persons should be able to pursue opportunities for

the full development of their potential. Older persons should have access to

the educational, cultural, spiritual and recreational resources of society.

Lifelong learning/education

Many initiatives that focus on this area have been introduced successfully, from the

Age Action initiative ‘Getting Started’ to local courses run by the VECs across the

country, to FAS and local community groups.

Getting Started is a training programme for older people to encourage and help

them to use computers, the Internet and mobile phones.

Care of the Older Person – Unit 4 5N2706

Classes are run by volunteer tutors with small groups of learners, in local, non-formal

learning settings. This training can open the door to many other courses for the

older person, as computer skills are an essential part of many courses.

Care of the Older Person – Unit 4 5N2706

PROVISION OF QUALITY STANDARDS

National Standards: Residential Care Settings for Older People

Health Act 2007 requires

All “designated centres” are inspected and registered whether run by the HSE,

private providers or voluntary organisations.

HIQA Statement:

'For the first time, all residential care settings for older people run by private

and voluntary providers and the Health Service Executive will be inspected by

an independent Authority. Once the necessary regulations, set by the Minister

for Health and Children, are in place, the Social Services Inspectorate of the

Authority will register and inspect all these residential care settings to ensure

that they are delivering care in accordance with the new quality standards.'

Dr. Marion Whitton Chief Inspector/Social Services @HIQA stated:

‘At the heart of the new standards is a deeper focus on the individual needs of

residents. Each resident must now receive a contract setting out what they can

expect regarding accommodation, care and services. Residents’ independence

should be preserved and they should be able to enjoy a flexible daily routine

which can be varied to suit their needs.

Where appropriate, their lives in the residential care setting should reflect as

far as possible the lives they lived before they entered their new home. The

emphasis will be on evidence that residents are being looked after and that

individual needs are being met.’

Care of the Older Person – Unit 4 5N2706

The advent of the Residential Care Standards of care for Older People compel

services to become person focused, and to organise and manage care which is based

on assessed health, personal and social needs, with the detail of care to be set out in

a care plan.

Standards and Criteria

The standards are made up of standard statements and criteria.

The standard statement sets out what is expected in terms of the service

provided to the resident.

The criteria are the supporting statements that set out how a service can be

judged to meet the standard or not.

In 2009, HIQA published the National Quality Standards for Residential Care Settings

for Older People in Ireland. The Standards reflect relevant legislation and are

informed by existing standards and guidelines, research findings and best practice.

They are set out below.

Section 1. Rights:

Standard 1: Information: Each resident has access to information, in an

accessible format, appropriate to his/her individual needs, to assist in

decision making.

Standard 2: Consultation and Participation: Each resident’s rights to

consultation and participation in the organisation of the residential care

setting, and his/her life within it, are reflected in all policies and practices.

Standard 3: Consent: Each resident’s consent to treatment and care is

obtained in accordance with legislation and current best practice guidelines.

Standard 4: Privacy and Dignity: Each resident’s right to privacy and dignity

is respected.

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Standard 5: Civil, Political and Religious Rights: Each resident is facilitated to

exercise his/her civil, political and religious rights in accordance with his/her

wishes.

Standard 6: Complaints: The complaints of each resident, his/her family,

advocate or representative, and visitors are listened to and acted upon and

there is an effective appeals procedure.

Standard 7: Contract/Statement of Terms and Conditions: Each resident has

a written contract/statement of terms and conditions with the registered

provider of the residential care setting.

Section 2 protection:

Section 2: Protection

Standard 8: Protection: Each resident is protected from all forms of abuse.

Standard 9: The Resident’s Finances: Each resident’s finances are

safeguarded.

Section 3 Health and Social Needs:

Standard 10: Assessment: Each resident has his/her needs assessed prior to

moving into the residential care setting, a full assessment upon admission,

and subsequently as required, to reflect changes in need and circumstances

during his/her period in residence.

Standard 11: The Resident’s Care Plan: The arrangements to meet each

resident’s assessed needs are set out in an individual care plan, developed

and agreed with each resident, or in the case of a resident with cognitive

impairment with his/her representative.

Standard 12: Health Promotion: Each resident benefit from policies and

practices that promote his/her health, rehabilitation and wellbeing.

Standard 13: Healthcare: Each resident’s assessed health needs are

reviewed and met on an ongoing basis in consultation with the resident.

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Standard 14: Medication Management: Each resident is protected by the

residential care setting’s policies and procedures for medication

management and, where appropriate, is responsible for his/her own

medication.

Standard 15: Medication Monitoring and Review: Each resident benefits

from his/her medication to increase the quality or duration of his/her life.

He/she does not suffer unnecessarily from illness caused by the excessive,

inappropriate or inadequate consumption of medicines.

Standard 16: End of Life Care: Each resident continues to receive care at the

end of his/her life which meets his/her physical, emotional, social and

spiritual needs and respects his/her dignity and autonomy.

Section 4. Quality of life:

Standard 17: Autonomy and Independence: Each resident can exercise

choice and control over his/her life and is encouraged and enabled to

maximise independence in accordance with his/her wishes.

Standard 18: Routines and Expectations: Each resident has a lifestyle in the

residential care setting that is consistent with his/her previous routines,

expectations and preferences, and satisfies his/her social, cultural,

language, religious, and recreational interests and needs.

Standard 19: Meals and Mealtimes: Each resident receives a nutritious and

varied diet in pleasant surroundings at times convenient to them.

Standard 20: Social Contacts: Each resident maintains contact with his/her

family, friends, representatives and the local community according to

his/her wishes.

Standard 21: Responding to Behaviour that is Challenging: The needs of

each resident with behaviour that is challenging, including behaviour that

poses a high risk to him/herself or others, are managed and responded to

effectively in an environment that promotes wellbeing and has the least

restrictions.

Care of the Older Person – Unit 4 5N2706

Section 5. Staffing:

Standard 22: Recruitment: Staff are recruited in accordance with best

human resource management practices.

Standard 23: Staffing Levels and Qualifications: There are appropriately

skilled and qualified staff sufficient to ensure that services are delivered in

accordance with these Standards and the needs of the residents.

Standard 24: Training and Supervision: Staff receive induction and

continued professional development and appropriate supervision.

Section 6. Care Environment:

Standard 25: Physical Environment: The location, design and layout of the

residential care setting are suitable for its stated purpose. It is accessible,

safe, hygienic, spacious and well maintained and meets residents’ individual

and collective needs in a comfortable and homely way.

Standard 26: Health and Safety: The health and safety of the resident, staff

and visitor to the residential care setting is promoted and protected.

Section 7. Governance and Management:

Standard 27: Operational Management: The residential care setting is

managed by a suitably qualified and experienced nurse with authority,

accountability and responsibility for the provision of the service.

Standard 28: Purpose and Function: There is a written statement of purpose

and function that accurately describes the service that is provided in the

residential care setting and the manner in which it is provided.

Implementation of the statement of purpose and function is clearly

demonstrated.

Standard 29: Management Systems: Effective management systems are in

place that support and promote the delivery of quality care services.

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Standard 30: Quality Assurance and Continuous Improvement: The quality

of care and experience of the residents are monitored and developed on an

ongoing basis.

Standard 31: Financial Procedures: The continued viability of the residential

care setting is assured through suitable accounting and financial

procedures.

Standard 32: Register and Residents’ Records: Each resident is safeguarded

by the residential care setting’s recordkeeping policies and procedures.

While there are 32 standards which are broken into 7 sections, it is important to

know that each standard has a number of criteria attached to it. These criteria are

clearly outlined in the publication the National Quality Standards for Residential Care

Settings for Older People in Ireland which is available on the HIQA website

www.hiqa.ie. All staff involved in caring for the older person in residential settings

should read this publication.

This Concludes Unit 4 and your Course. Please commence with

your Assessments.

Care of the Older Person – Unit 4 5N2706

NOTES: