Managing and Enhancing Care Homes in the Digital Age

Professor Malcolm JohnsonCentre for Death and Society

Department of Social and Policy SciencesUniversity of Bath

M.L.Johnson@bath.ac.uk

R C PA A N N UA L S E M I N A RS O M E R S E T C O U N T Y C R I C K E T C LU B , TA U N T O N

N O V E M B E R 2 0 T H 2 0 1 3

Managers are the Key to Quality Care

Good Care Homes need: Well designed buildings, appropriate and trained staff, good

food, keeping residents safe, personal space, dignity, well controlled and administered medication, skills in dementia care, stable staff group, person centred care, end of life care……..

But most of all they need good management.

GOOD MANAGER - GOOD HOME

POOR MANAGER - POOR HOME

Skilling Care Home Managers

JOSEPH ROWNTREE FOUNDATION

A study by Malcolm Johnson, Lesley Cullen and Demi Patsios of Bristol University’s International Institute on Health and Ageing explored the range of views within the sector on what makes a good manager, and what form training should take to improve managers’ performance.

“They conclude that real net gains in the quality of long-term care can best be achieved through improving the effectiveness and skills of staff by training their managers.”

Research commissioned by the Joseph Rowntree Foundation, book published 1999.

Who are the good Managers

Well trained and experienced practitioners, who have also learned to manage people and resources and their own time and emotions.

Professionals who genuinely care for the wellbeing of frail older people.

Excellent managers and motivators of staff Role models for staff. Individuals who can work to budgets. Caring and articulate representatives of the Home to residents,

families, CQC, Commissioners and the various agencies of the NHS.

Leaders who are up to date with all that goes on in their Home. Leaders who are up to date with current best practice and the

regulatory requirements.

Increased complexity

A care Home with 50 beds has a staff of around 80. In some it would be more.

Such a Home would typically have a Deputy Manager/Head of Care; plus a range of ‘Seniors’ present on all shifts.

Increasingly the Proprietor, the Service Manager/Head Office, and the Regulator require regular detailed information about:

Falls. Medications. Dependency levels. Deaths. Staff sickness absences. Use of Agency staff. Spend on food per person / day.Ratio of Staff cost to Income. Rates of Induction training in the first 3 months. Staff turnover. Complaints ……. and more

Key Records are on paper

In the vast majority of care homes the key records are the Care Plans. They are hand written by staff and are kept in residents’ rooms.

Care Plans are typically collections of long used assessment tools (such as Waterlow and Mini-Mental State) plus daily ‘observations’. Often the tools are modified or replaced by ones staff have used in other places.

‘Hand-knitted’ Care Plans are not good care plans!

AND HOW DOES THE MANAGER GET THE DATA IN ORDER TO MAKE THE MONTHLY REPORTS? with difficulty; much time and effort

Becoming digital

How many computers in a typical care home?

Two or three: The Manager The AdministratorBut it is now cheaper and easier than ever to have Care Plans recorded on well designed software,using Tablets.

For some years I researched and evaluated the use of the US Assessment and Care Planning tool MDS ……… but gave up.

But now the world around us is computer based.

Are care staff able to use computers?

Ah but my staff wouldn’t be able to use computers in their work

So how many computers are there really in your care home?

Almost every member of staff brings one to work every day. They phone, text, e-mail, Facebook, use the internet– whilst they are at work.

What are the benefits of computerised records?

A good Care Plan, Assessment and Review tool is an essential aid

to being a good Manager. It should make available to you all you need to know about the

health and care profile of your residents and what your staff are doing to care for them.

It should also allow you, at the press of a button, to produce all that data that others require and you need to keep an eye on all that is going on.

It should also allow you to track and review whether agreed plans are being carried out – and whether the plans need adusting.

Electronic records should save staff time and money as well as providing essential management information on a continuing basis.

Social Media Technologies Older people – the excluded sector

In the last decade, an array of technologies has changed the way many of us interact. Internet communication systems such as email and social networking sites like Facebook and Twitter have revolutionised personal communication for younger people. …..Many people are enjoying faster, easier access to public services through digital means.

Not the over-65s, though: studies show that they have been largely excluded from this revolution and the benefits it brings. A startling 70% report that they have never used the internet.”

“Only half of people aged 60-69 have access to the internet at home, but this falls to 17% among the over-70s.”Older people, technology and community, Calouste Gulbenkian Foundation, UK, 2010

But the average age of people in care homes is almost 90

Listening before doing

My current research based in care homeswith Dr Rachid Hourizi, Department of Computer Science, University of Bath

Initiatives and research to date have focused on trialing established technologies (internet, e-mail, skype)

Remarkably, there has been no substantial research (we know of) which has investigated what older people in care homes wish to know or do, where IT might deliver what they want.

Our research design rests heavily on LISTENING first

Not questioning and interrogating

and using what we learn (after validating with those who talked to us) to fashion IT solutions that genuinely meet the needs and wishes of older people

Conclusions

Managers are the keystone of the care home arch.

They need to be equipped for the increasing complexity of their responsibilities, by high quality information about everything that is going on in their Home.

Moving into the digital age, more fully, should make them better informed with less effort. It should save their time whilst making them more effective

And residents deserve to be able to breach the walls of the Home and reconnect with the world they have lost