Ageing and disability: Transitions into residential care
Ageing and disability: Transitions into residential care

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Ageing and disability: Transitions into residential care

2 Care environments

2.1 Design and organisation of the care environment

The way a care environment is designed and organised can have a profound impact on the residents' lives, and careful consideration of factors such as the physical environment and the care home's values can have positive effects on their quality of life. For example, Philpot (2005) reported on the design of a building that illustrates the kinds of things that make life easier for people with dementia.

Box 1: Design for dementia

The open plan of [Stirling University's Dementia Services Development Centre's] Iris Murdoch Building is a dementia design principle – everything and everybody can be seen. The building is light and non-reflective, there are no shadows and high-quality acoustic tiles on the ceiling combat any echoes. There is a glass-fronted fridge and the cabinets, drawers and doors have glass panels. Carpets are blue, not patterned as these can cause confusion. Different textured carpeting indicates where you are.

As people with dementia can have problems with three-dimensionality, each stair has a different coloured nosing, the skirting is stair-shaped, and the banister is pillar-box red. Different colours distinguish the seat, pan and back of the toilets, the whereabouts of which are indicated by door signs combining symbols, words and pictures. Light switches are in vividly contrasting colours to the plain walls.

(Philpot, 2005, p.36)
Figure 2
Dementia Services Development Centre ©
Dementia Services Development Centre
Figure 2: Transparency in dementia design

Mary Marshall, who influenced the design of the Iris Murdoch Building, argues that appropriate design principles make daily living easier for people with dementia, or other cognitive impairments such as autism, learning difficulties or high levels of stress (Philpot, 2005). Research also shows that careful consideration of living arrangements for children in residential homes is important (Whitaker et al., 1998).

Activity 3 asks you to consider care environments further through reading about some research. This article was first published in 1993 and refers to observations made in the 1970s. Since then much has changed in residential care homes. Standards have been raised by the introduction of Codes of Practice for social care workers and employers. Staff are usually better qualified and provision is more responsive to service users' needs than it was. However, the article usefully offers an illustration of how different philosophies of care and organisational arrangements can produce different qualities of care, irrespective of resources.

Activity 3: Encouraging autonomy in care environments

1 hour 0 minutes

Read the article, ‘Does group living work? [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ’ by Julia Johnson, where two different environments for residential living for older people are described. As you read:

  1. Consider the features of each care environment. Make two lists:

    • the factors that promoted residents' autonomy

    • the factors that restricted residents' autonomy.

  2. Consider any other contexts of care for older people, residential or non-residential, that you know about. What has changed (or has remained unchanged) in recent years?

Discussion

1 Your lists may have included some of points listed below.

Factors that promoted residents' autonomy

  • Short distances between communal and personal living areas.

  • Strategies to promote residents' physical independence.

  • Promotion of self-reliance by encouraging participation in normal daily tasks and activities, which also increases social interaction among residents.

  • Mixed-need groups, providing opportunities for more able residents to support those who were less able.

Factors that restricted residents' autonomy

  • Communal and personal living areas not located near each other.

  • Staff discouraging residents from using their rooms.

  • Lack of control over getting-up times, bedtimes and mealtimes.

  • No attempt to reduce residents' reliance on walking aids.

  • Residents dependent on staff for moving around the building.

  • Lack of opportunity to engage in daily care tasks.

2 The author of the article told me in a recent interview that her current research into residential care homes for older people shows that provision intended to enhance residents' lives still varies in quality:

My current research is already demonstrating that some homes are almost paralysed by bureaucracy – health and safety regulations, care standards, and individual risk assessments, which make these kind of enabling environments almost impossible to create. It's depressing that these kinds of developments provide the excuse for why residents are deemed not capable of doing this, that or the other. However, our research is also showing that there is huge diversity in residential care provision which suggests that there may be scope for creativity nonetheless (this I think depends very much on the person in charge of the home).

In terms of providing opportunities for enhancing residents' autonomy, Arden House and Parkview appear to be at opposite ends of a spectrum. Arden House represents a progressive service user-centred approach, while Parkview takes a more traditional service-centred approach, with more features of institutionalised living. Drummond Grange has elements of both care environments. The use of the building's space has more similarities with Parkview, but without a tendency to impair the independent movement of residents. Eric, Bill and Elizabeth, as wheelchair users, welcome the wide corridors and easy access created for them to move about independently. While many of the residents at Drummond Grange are highly dependent on staff to assist them with daily care and living tasks, great emphasis is placed on sustaining interests and enabling residents to engage in activities that interest them. They are also encouraged to personalise individual rooms to create their own space.

Care environments that constrain autonomy can have negative psychological effects that contribute to depression (Boyle, 2005). In Activity 4 you will consider how the dominant values promoted in residential homes can affect residents.

Activity 4: Care home values

0 hours 15 minutes

In this activity you will consider how the dominant values promoted in a residential home can affect the daily living experiences of the residents.

Listen to the audio clip below as Maria Hutchinson talks about the ‘philosophy’ of Drummond Grange and delivering ‘quality care’. Make notes on what Maria believes to be the guiding principles.

Click to listen to the audio clip (3 min 44 sec)

Download this audio clip.
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Transcript: Philosophy and quality care

Maria
My name’s Maria Hutchinson. I’m general manager here at Drummond Grange. We have a hundred and eleven beds and a number of different specialities. The home’s quite different to a lot of the other nursing homes in that it’s not all care of the elderly, which really adds quite a bit to the community style of living that we have in the home, just the way you would in your own street. We have young, physically disabled adults aged between 18 and 65, we have frail care of the elderly and we also have a very specialist unit for our dementia care, using the memory lane concept. So at the moment our youngest resident is 23 and our oldest is 102!
I think your philosophy has to be something that belongs to the staff and the residents. It has to be a serious belief that unless they have ownership of it, it won’t happen. Drummond’s philosophy does centre around the home and the staff that are part of the home. It’s about delivering and predominantly about quality, respect of privacy, the level of care that’s really expected within it, and the fact that it’s really promoted to be their home, as opposed to being like an institution or a hospital. And it’ll never be their own house, but hopefully it will be the closest thing that you can come to that. Every resident has a copy of the philosophy as well, so that should there ever be anything that they come up with they can come back on that one too.
One of the ways that we encourage residents to be part of the decision making within the home is that we do have a residents’ committee. We used to have a set-up where all the residents came but that became very difficult to actually get a focus on how to take it forward. So the committee is now representatives from all of the different areas within the home. They all come with their own issues and they’re extremely good, the ones that do come, at taking back those issues to the other residents, or bringing other people’s issues forward to it. We print it up as minutes and we always review them at the following meeting to make sure that the action has been taken and how we’re going to go forward with it or why it hasn’t been taken.
And from the staff side of things, quite often the staff are the residents’ advocates and therefore on a monthly basis they all have their own unit or department meetings and can bring forward anything from a resident that has become an issue and feed that back up and down the ladder in the home to make sure that everything’s addressed and nothing’s missed. We value the contribution that the residents make to daily life of the actual home. It’s not just for them, it’s about them, it’s by them, it’s with them and they can be very, very supportive to new people who are being admitted to the home and that’s extremely important. It’s not just about staff being mannerly or approaching with dignity and respecting privacy. It really is about how they would be accepted by the peer group that they are actually going to be living with as well.
Sometimes the home has to look at ways of bringing other people into the home because of the disability of the person and being able to go out that they don’t quite have the ability to do something like that. One of the things that Drummond does is that we have the Parkinson’s Disease Society section for Midlothian and we actually host their meetings. So once a month we have lots of people from the Midlothian region, or anyone who can’t manage to go to the Edinburgh meeting is free to come to one of the other region meetings, and they actually meet within the home.
A lot of relatives, when the resident still has a degree of ability, are very, very good at coming and taking them out, which means the time they do have with them is much more quality because they don’t then have the stress of thinking, ‘I may not sleep all night tonight’ so the time they do have becomes very, very valuable to them.
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Discussion

The principles underpinning National Care Standards mean that care home providers should meet the diverse needs of residents. The Standards describe what people can expect from service providers and focus on the quality of life service users should experience. For care providers, this entails making provision for the range of physical, emotional, spiritual and cultural needs and preferences of the people who come to live there. Homes should take account of service users' cultural preferences when, for example, planning menus or activities and should ensure that residents can practise their religious beliefs. This may mean establishing links with organisations outside the care home, and creating networks to provide relevant services to meet these diverse needs. Careful assessment of needs, competences and abilities enables staff to provide for service users' needs and preferences. Staff working in residential care environments can help to preserve and increase service users' control by recognising and promoting their interests and abilities.

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