Applying social work skills in practice
Applying social work skills in practice

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Applying social work skills in practice

3.1 Moving on

It is useful to think about moving into residential care as a transition. As you discovered in the previous section, transitions are significant events in a person’s life, which mark one ‘stage’ or period of life from another: starting or leaving school is one example, becoming a new parent is another. These are major changes that can affect how the person sees themselves. Life changes and transitions can be experienced both positively and negatively, and often bring with them a mixture of gains and losses. Moving home at any age can have an emotional impact, especially when people feel a strong attachment to where they live. The first activity will help you to start thinking about this.

Activity 8 Losing your home

Allow about 15 minutes

Imagine that you suddenly have to leave your home without knowing if or when you’ll be able to return. You will be moving into temporary shared accommodation, with limited space. Add your responses to the questions in the diagram below.

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You may have found it difficult to imagine how you would feel in this situation. You might have mentioned feelings of loss, fear, anxiety, anger or sadness. There would be a loss of familiar routines. You might lose contact with friends and neighbours, and miss seeing familiar faces in shops, at bus stops or just going about your day-to-day life. Change is not just about loss, however: perhaps you also identified positive emotions associated with meeting new people or moving on from unsupportive situations.

What would you take with you? Apart from essential items, you probably mentioned small reminders of home, practical things that make you feel comfortable, or keepsakes that summon up happy memories. In other words, you might take things that reflect your identity.

In the next activity, you focus on the lives of three people who have moved into Drummond Grange, a care home that provides residential nursing care and support for both younger and older adults with physical disabilities, or long-term health conditions, such as multiple sclerosis. The activity is split into two parts: the first focuses on the experiences of people moving into a care home, and the second invites you to think about your response to what you have seen and heard.

Activity 9 Supporting people with transitions

Allow about 1 hour

In Part 1 of this activity, you will consider the impact of moving into residential care on service users and their families. You will also think about how professionals can provide support.

In Part 2, you reflect on your own feelings when hearing about the experiences of residents and their families.

Part 1

Allow about 45 minutes for this part of the activity

Watch Video 6 featuring Maria Hutchison, the manager of Drummond Grange Care Home, in which she talks about the transitions people go through when moving from their homes into residential care.

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Transcript: Video 6 Maria Hutchison: supporting people through transitions

Moving from their own home into long-term residential care is a transition that many people find hard to make. The process involves both physical and psychological upheaval.
When a new resident comes to the home, there are a range of different experiences that they go through. It’s one of the biggest and most difficult decisions that most people have to make in their life. They’ve gone through their life, most of them never expecting to have to make a decision like that, and it’s really quite frightening.
A smooth transition is generally the result of a good match between an individual’s needs and what the home has to offer.
We would never accept a resident to the home without carrying out an assessment of need. Although it may be a very long-winded process, the two essential functions are, does the home suit the needs of the person who is looking for the care? Would they be happy there? Do they think they would settle? Is it close enough for family to visit, et cetera? The other side of the coin is, can we meet the needs both physical, social, spiritually, that the resident may have in coming in?
I know that I have visited over a period of years slightly older friends who were in a home and one thinks, well, I hope I never need to do the same, but I’ve never regretted coming here. And everyone has their own little routine of when they go out and meet other people in the place and when they stay in their room. We all have different interests because we all have different background. And we just bring with us as much as we can of the old routine we had at home.
I really think that’s lovely.
So, that’s a record …
Elizabeth and her family had looked at more than a dozen homes before deciding that Drummond Grange best met their needs.
But everybody’s so pleased with that one.
The staff I thought did awfully well.
For others, the choice was more immediately obvious.
I have a friend in here who we came to see, and very quickly I decided when we came here, I hadn’t known the place was here, I decided that this would be where I would want to come because it had everything that I was looking for. Nice wide corridors. Self-contained units and it looked very comfortable to me.
I’d heard about this home mainly through people that I knew from Liberton Hospital, where we used to meet in respite, who’d already come here, and to try it out, the rest of the family were going as a summer abroad. So I came in here for 12 days to try it out. And at the time, just about everything that could go wrong did go wrong. But even so, I decided this was still the place that I wanted to come, and I actually came the next year, the next May, in ’99, and I didn’t even bother to look at any other homes as such.
At Drummond Grange, existing residents play an important role in helping newcomers adapt to their change in situation.
We try as hard as we can, all of us who are here and settled, when somebody new comes in, to help them over the first 48 hours. And it’s amazing to see people coming in thinking this is the end of the world, and within perhaps two or three weeks, living quite a normal life and working out their own interests and making their own relationships with other people.
It’s the difference between them being able to settle very quickly and taking a very long time, or thinking that it’s maybe not right for them as well. The more that they can be involved and the more that other residents, without prompting, are involved the better, and we are very, very lucky here in that we have a group of residents who are extremely good at it.
End transcript: Video 6 Maria Hutchison: supporting people through transitions
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Now listen to Audio 1 featuring Maria Hutchison and Rose Guthrie (the home’s counsellor), where they talk about some of the feelings and anxieties of residents and their families. (We apologise for the background noise on this recording.)

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Transcript: Audio 1 Supporting people with transitions

I’m Rose Guthrie, and I work as a charge nurse in the dementia unit, but I am also the counsellor for the home.
The counselling role involves working with clients or residents who have come into the home, perhaps young disabled people who are just admitted to the home, and it’s about working with also relatives and maybe staff as well.
People coming into the home, that’s a big change in lifestyle, it’s a lot of change in life, so I’d be working with the resident or the client, the adaption to change, it’s adapting to losing independence, especially in the young disabled unit. It might be working with sexuality, because that’s a very important part of the person. We are all sexual people, so therefore it’s important that they’re able to express what their feelings are. It’s about how they can cope with that, what we can do to make it as much as possible still part of their life. And I’m there to support and help them through that.
Quite often family do not want their relative, their mother or their father, to actually be in the care home. It’s because of circumstances that they are unable to cope with in their own home. They feel very guilty about putting their loved one into a home. And it’s working through those kinds of issues. Or you might have a family where the brother is for the nursing home and perhaps the daughter is saying, ‘I would really like to have mum at home’. So there’s lots of issues that come up for family in that way.
Someone who’s been admitted to the home, there would be observation as to how they’re settling in, and some people do settle in very well because they’ve had preparation to think, ‘I would like to go into a nursing home’. That is their decision. But there’s other people who come into our home feeling a bit reticent that they’re here, that they haven’t got family to look after them, and it’s like working with a person who has just lost a home. It’s loss of many, many angles, their whole lifestyle changes, and so it’s helping them look at those issues and being able to voice it to someone who is not emotionally connected, where it’s very difficult with family to explain that.
I do work with other agencies. I work closely with a GP that comes into the home. I would also be working with a psychiatrist, or a couple of them, and I could be working with staff. And if there are issues come up, perhaps for an adolescent in the family, then I would be referring to someone who would be working with adolescents. So I am linking up with other networks there and other agencies to provide support.
It’s not just like choosing a new house because in that instance you would have all of your own family round about you, and they don’t have their own family round about them twenty four hours a day, so the staff play a very, very key role. Sometimes that’s very minor in just making sure that they’re the ones who make all the extra frequent visits, that they get to know all the same faces over and over again, that they’ve maybe met their key worker before they were admitted, out in the community, they’ve got a face that they already know when they come into the home. Other times it can be more than that. They can need more.
Very often, especially if they still have a spouse, it can be a very emotional issue and it can be a situation where they’re not very sure if their marriage is actually going to survive the point that it’s reached, meaning that the level of dependency and strain that’s put on both parties before the person’s admitted to the home, because sometimes within the community they can reach a very high level of dependence and feeling guilty about how they feel about each other, etc., before they do come into the home.
Sometimes the spouse feels very guilty, that there’s a sense of relief that, ‘Oh my goodness, you know, this won’t happen again at one o’clock in the morning and I won’t be rushing to the hospital in an ambulance three hours later, and I know that they will be looked after and people will be looking out for them twenty four hours a day and I feel like I can finally have a whole night’s sleep’ and then, ‘Oh, I shouldn’t be thinking like that’. But it is, it’s very human nature. So often the support on admission is as much for the relatives as it is for the new resident. Sometimes the new resident is actually more accepting of it and has already worked these issues through in their mind, and the family haven’t or the close friends haven’t, and that can be very, very stressful for them.
One of the ways in which some of the stress can be taken out of being a new admission is trying to maintain some of the links and the interests that the person had before they were admitted. Now sometimes they can’t do that to full capacity. Perhaps they raced homing pigeons, but that doesn’t mean to say that they probably couldn’t go to the local pigeon society and join in with their weekly meetings or their monthly meetings, and still be involved in the news and who’s rearing the best birds and things like that. That just because they can’t actually physically do exactly what they were doing before, they can still be very involved in different things.
After admission we try to gauge how successful that’s been. Very initially after the first six weeks of admission, we ask the resident or the nearest relative to complete a short questionnaire where they can actually say, did they find that their admission to the home was helpful and what things did they like? Did they feel that they understood what they were coming in to? Did the staff understand their needs? Were the staff polite? Did they have all the information they needed to make the decision, etc?
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Finally, complete the following table.

The issues to consider when working with people moving into residential care
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The losses that individuals may experience when they enter residential care
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Positive aspects that residents may experience as a result of the transition
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The feelings that a new resident’s family may have about the move
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Identify two learning points for your social work practice
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Responses to transitions vary, so it is important to listen to residents and carers. Counselling may help residents and their families to cope with change. Support from other residents can also help people to adjust to a new environment. Maintaining links and interests supports self-worth and a positive sense of identity.

The losses that a resident may experience when they move into care include:

  • lifestyle
  • home
  • independence
  • family support
  • a relationship with a spouse
  • sexual contact.

Transition isn’t all about loss: Bill appreciated the enabling design of Drummond Grange; and Elizabeth embraced the sense of community that she discovered there.

Close family members and friends may experience feelings of guilt on the move to a care home. Many feel relief when the decision to enter care has been made. Residents may find it easier to accept their situation than the family members who have previously cared for them.

Here are some points that a social work practitioner would need to consider:

  • offering support to a new resident can ease the difficulty of the transition
  • it is important to be alert to the mixture of feelings aroused for both residents and those in their support network (family, friends and carers)
  • there will be variation in what residential homes can offer, and Drummond Grange’s resources may not be available everywhere.

Part 2

Allow about 15 minutes for this part of the activity

Write a few notes about your own feelings on hearing the experiences of residents and their families.

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The audio and video clips may have evoked powerful feelings if you have experience of your own relatives moving into residential care. Or you may have thought about your own ageing and future needs. This kind of social work can stir up strong personal emotions in the practitioner, and it may be helpful to discuss this with a trusted colleague or member of your close network.

There is no doubt that, for the Drummond Grange residents, moving into a care home was a significant life event to which they had to adjust. This can apply to people of any age – in the audio clip, you heard Rose Guthrie refer to transitions for younger disabled adults. Drummond Grange provides an example of very high quality residential care, but in any setting it is helpful when the staff understand that entering a care home is a time of transition.


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