NEWS NHI News published by: Nursing Homes Ireland, Unit A5, Centrepoint Business Park, Oak Road, Dublin 12. Tel: 01 4292570 | Fax: 01 4291845 | E-mail: firstname.lastname@example.org | Web: www.nhi.ie
SUM M E R
2 0 1 3
NHI NATIONAL CAMPAIGN
HSE LONG STAY CARE
DEFICIT OF LONG STAY BEDS
THE INADEQUACIES OF FAIR DEAL
TRANSFORMING THE CARE ENVIRONMENT
NHI’s unprecedented Public Affairs Campaign: bringing to national attention critical issues requiring action ‘Too many reports, too much talk, not enough action’.
Tadhg Daly, Chief Executive Officer, Nursing Homes Ireland
ast month, we embarked upon a national public affairs campaign to bring to policy, stakeholder and public attention the urgent requirement for the establishment of a ‘Forum on Long Term Residential Care’. Our frustration at the Government’s failure to plan accordingly for the significant growth in numbers of persons requiring nursing home care has prompted NHI’s national campaign and mobilisation of our members across the country.
As a Society we have a responsibility to plan services for our ageing population and the private and voluntary nursing home sector has a key role to play with the services provided by our members an integral part of the solution. Our members, as key healthcare providers and major employers in communities across the country, have been visiting elected representatives in their local communities to advise on the key issues and the requirement for the establishment of a Department of Health led forum. This campaign is unprecedented. It is the first large-scale campaign by the private and voluntary nursing home sector and includes advertising, postcards and letters targeted at politicians, key stakeholders and the wider public setting out the inordinate challenges in the delivery of nursing home care. Issues of immediate concern being highlighted and negatively impacting upon the provision of long-term residential care and require urgent addressing include: P The disconnect between HIQA and the NTPF, with the NTPF’s narrow definition of long term care services failing to take into consideration private and voluntary nursing homes statutory responsibility under the national quality standards. The consequence of the unsustainable price squeeze under the Fair Deal will negatively impact upon the high standards of care provided by the homes. P The urgent requirement for a transparent framework for fee negotiations under the Fair Deal that acknowledges the costs of providing high quality care and to also support investment to meet significant increase in demand for long term residential care. P The necessity to introduce an independent appeals process to enhance the regulatory framework that has created greater
01 — NHI NEWS
confidence within the nursing home sector. Nursing Homes must be afforded opportunity to address HIQA’s public judgements and conclusions. Such a development can enhance the regulatory environment by providing greater transparency and balance. For some time, we have consistently warned Government that it cannot afford to ‘bury its head in the sand’ in respect of the future requirements for long term residential care. We once again highlight that failure to act leaves the sector, our health services and wider society facing into a crisis in respect of the provision of long-term residential care. We cannot keep dodging the issues as a society or we will cause major stress to older people and put the livelihoods of over 22,000 private and voluntary nursing home employees in jeopardy. We need real and meaningful action from Government now or there will be significant consequences for employment, for our residential care capacity and most importantly, for our ageing population. P The Centre for Ageing Research and Development in Ireland projecting growth in demand for nursing home care will rise by 12,270 (59%) from 2006 to 2021 – an average growth of over 800 persons a year.“Even with greater emphasis on care at home and more resources provided to realise it, demand for residential care is going to increase significantly in the next decade.”1 P The ESRI projecting additional requirement for 888 long-term residential care places per annum to 20212 P More than 31,000 persons in Ireland will require long-term residential care in 2016, according to the World Health Organisation.3 P The CSO projecting our very old population (aged 85+) will rise by 135% to 2031.4 P The number of people diagnosed with dementia is set to rise from an estimated 41,447 in 2006 to between 67,000 and 70,000 in 2021.5 The consequence of Government failure to deliver a framework that supports the complex care requirements of persons requiring nursing home care and meet the true cost of provision of such care is now manifesting. The HSE National Operational Plan 2013 (as reported in this issue) is projecting “a significant national deficit of long stay beds by 2016”. The HSE Dublin North East Regional Service Plan states long-term bed capacity within the region “is not adequate to meet the needs of the elderly population” and adds, “The majority of beds (public and private) are designated to long term care and this capacity and service provision, in its current format, is not adequate for the increasing number of older people with specialised care needs, eg dementia and challenging behaviour.” As evidenced above, the crisis has begun and will escalate. Failure to support our sector to meet the significant growth in demand for nursing home care will have serious consequences for older persons and our health services. In April, the HSE introduced an emergency measure over a three week period to pause the Fair Deal chronological placement listing, due to problems of overcrowding within acute hospitals in Dublin and Cork. The ESRI reported recently6 40% of beds ‘occupied’ within the acute hospital sector are by persons aged 65+. The establishment of a ‘Forum on Long-Term Residential Care’, central to our campaign, is an absolute necessity to address the growing healthcare demands of our ageing population and to plan accordingly. There has been too many reports, too much talk and not enough action. The Department of Health must bring those who play a role in the provision of long-term residential care and older people’s representatives around the table to map out the future of nursing home care. There is an obligation on all stakeholders to ensure that we plan now to meet the challenge of growing and funding the best
CONTENTS NHI NEWS News from Nursing Homes Ireland, the representative organisation for the private and voluntary nursing home sector. NHI MEMBERS SEMINAR 2013 Challenges in the provision of dementia care and in the future financing of the private and voluntary nursing home sector were outlined at the NHI Members Seminar 2013.
READ ALL ABOUT US Reminiscence in Co Waterford, a Kilkenny nursing home elects its first citizen, a loving home is found for Shirley in Co Dublin, and discussion surrounding the use of antibiotics: news from NHI Member Homes featured this month.
NHI CARE AWARDS 2013 It’s time once again to honour your local nursing home, its staff and its residents!
NEWS UPDATES Dáil Éireann is warned of the significant challenges facing nursing home care, HSE spend on older persons services is outlined, an update on the Fair Deal review, admin burdens affecting nursing homes, and threat to gerontological nursing; stories in our News Updates section.
HSE LONG STAY CARE 2013 A significant national deficit of long-stay beds in 2016 is forewarned by the HSE as it reports an under supply of beds in urban centres.
BEST PRACTICE A Co Monaghan centre has undertaken significant infrastructural, staffing and cultural changes to provide greater levels of independence for residents.
REHAB CARE The Fair Deal scheme is inadequate to meet the complex high dependency needs of young people with disorders of consciousness and the specialised care requirements of such persons must be acknowledged and given legislative recognition, inter-disciplinary team of the National Rehabilitation Hospital writes.
DEMENTIA CARE Person-centred dementia care leadership involves valuing and empowering front-line staff; leaders are responsible for developing a climate of empathy and respect, writes Buz Loveday, Director and Lead Trainer of DementiaTrainers, UK.
HIQA TRAINING Marie-Kehoe O’Sullivan, Director of Safety and Quality Improvement at HIQA, outlines training it is providing on quality improvement and patient safety to nursing homes to help them improve patients safety and the quality of services they provide to residents.
END OF LIFE CARE Irish Hospice Foundation workshops training workshops help make people aware of the power they have to make a difference when people are coming to the end of their lives.
BEALTAINE 2013 115 nursing homes participated in Bealtaine 2013 Thanks to all supporters of NHI, many of whom are featured in this newsletter. Please note, NHI is not responsible for third party services advertised in this publication. Inclusion in this newsletter does not endorse, recommend or imply any approval of the suppliers listed in this publication.
possible residential care services for our older people. Otherwise, we are going to be catapulted into a crisis in residential care. There is a real concern the serious issues pertaining to the delivery of long-term residential care are not being given the urgent attention they require. This HSE’s National Service Plan 2013 states “in the absence of the allocation of additional funding for the NHSS [Nursing Home Support Scheme – Fair Deal] in 2013, that there will be challenges in responding to the need for residential care and a placement list will be in operation and new places offered under the NHSS as funding becomes available in line with the legislation”. “The impact of potential insufficient capacity of the NHSS” is one of 11 potential risks cited in respect of delivery of the plan. At the 23rd May Oireachtas Health Committee meeting, attended by Health Ministers and Senior HSE Officials, the pressures and stresses being brought to bear upon the Fair Deal scheme and major challenges in meeting the long-stay residential care requirements of the ageing population were brought to the attention of those in attendance. HSE CEO Designate Tony O’Brien informed the Committee the challenge of providing the right resources in the right place, in particular for the increasing cohort of older people, is enormous. “We will have to face up to it in the coming years,” he added. We are again concerned that this is again being put on the long finger. We need to act immediately and not in “the coming years” as suggested by Mr O’Brien. The investment required together with the lead in time for new capacity means that we cannot ignore this issue any longer. The number of older people in Ireland is going to rise dramatically in the years ahead yet there has been no meaningful engagement to put in place the infrastructure to adequately address this. Our campaign is bringing the very serious issues surrounding the provision of nursing home care to the fore. They must be highlighted and acknowledged. Our reasonable actions to support care delivery and job creation must be supported. Failure to act now leaves us facing into a crisis.
Tadhg Daly, NHI CEO
1. Future demand for Long-Term Care in Ireland, CARDI, October 2012 2. Projecting the Impact of Demographic Change on the Demand for Delivery of Health Care in Ireland, ESRI, 2009 3. Health System Responses to Financial Pressures in Ireland: Polity Options in an International Context, November 2012 4. Population and Labour Force Projections, 2011-2046, CSO 2013 5. Creating Excellence in Dementia Care – A Review of Ireland’s National Dementia Strategy, 2012 6. Activity in Acute Public Hospitals in Ireland Annual Report 2011, ESRI, November 2012
NHI NEWS — 02
NHI UPDATES Committed to excellence in care www.nhi.ie
Age Action benefits from NHI care awards
ge Action Ireland CEO Robin Webster, left, accepts a cheque for €1,856, kindly contributed by NHI to the charity that promotes positive ageing and better policies and services for older people. NHI members generously made contributions to the charity at the NHI Care Awards 2012, when it was selected as the chosen charity that would be supported at the event. Presenting the cheque to Mr Webster is Tadhg Daly, NHI CEO.
Tadhg Daly, NHI CEO, presenting the cheque to Age Action Ireland CEO Robin Webster
Five Nations Gathering Issuessurroundingtheregulationoflong-termresidentialcarewerethe primaryfocusatthemostrecentmeetingoftheFiveNationsCareForum, whichtookplace15th&16thApril2013.TheForumisanallianceof professionalassociationsrepresentingthecaresectoracrossIrelandandthe UK.JoiningNHIontheForumarerepresentativeorganisationsfromNorthern Ireland(IndependentHealth&CareProviders),England(EnglishCommunity CareAssociation),Scotland(ScottishCare),Wales(CareForumWales),and theUK(UKHomeCareAssociationandtheNationalCareForum).
Pictured at the most recent meeting are: back, from left, DesKelly,NationalCare Forum;MikePadgham,UKHomecareAssociation;HughMills,IndependentHealth& CareProviders;MartinGreen,EnglishCommunityCareAssociation,AsifAziz,Boots; RanaldMair,ScottishCare;NigelNewman,Boots. Pictured front row, from left, BridgetWarr,UKHomeCareAssociation;Christine Thomson,IndependentHealth&CareProviders;GeraldLee,NationalCareForum; TadhgDaly,NHI;SharonBlackburn,NationalCareForum;RobinSidebottom,Scottish Care;MarioKreft,CareForumWales;OwenMcGartoll,NHI.
03 — NHI NEWS
Valuation Bill will erode independence & transparency The Valuation Amendment Bill will lead to signiﬁcant erosion of the independence and necessary transparency imperative for the valuation process. NHI has issued that warning in its submission to the Department of Expenditure and Reform in respect of the Bill, informing of its impact if enacted as published upon private and voluntary nursing homes as care providers and lead employers in communities across Ireland. The Bill proposes the removal of the appeals process to the Commissioner and NHI informs this will amount to a signiﬁcant erosion of the independence and necessary transparency that is an imperative requirement for the valuation process and its relationship with Ireland’s business community. The submission states: “We have very serious concerns that if passed this Bill could further impact on ratepayers, with much of its content being unfair, inequitable and negating against a good business environment that is required to sustain and create jobs. NHI is also warning in its present form the Bill will impact upon the ability of our Members to enhance and extend their care facilities and meet the continued increased growth in demand for nursing home services.” NHI’s submission is available for Members to view on the Members section of the NHI website, www.nhi.ie.
NHI campaign for Government forum to address issues surrounding long-term residential care requirements NHImembersacrossIrelandhavebeenvisitingpoliticianstohighlighttheimperativerequirementfor theDepartmentofHealthtoestablishaForumonLongTermResidentialCaretosupportthesectorin meetingrequirementsfornursinghomecare. ThevisitstoTDs,SenatorsandCouncillorsarepartofanationalcampaignNHIhaslaunchedtoalert keystakeholderssuchaspoliticiansandthewiderpublicabouttheveryseriousissuesfacingthe provisionofprivateandvoluntarynursinghomecareandreasonableactionsrequiredtomeetongoing andfuturecareprovisionrequirements. ThenationalmovementhasinvolvedthemobilisationofNHImembersacrossthecountry.Members andNHIexecutiverepresentationsaresettingouttheinordinatechallengesincaredeliveryforlongtermresidentialcareandtheurgentrequirementtoaddresssectorrequirementstomeetescalating growthindemandforsuchcare. ThemainaimofthecampaignistosecuretheestablishmentofaDepartmentofHealth-led‘Forum onLong-TermResidentialCare’whichwouldbringtogetheralloftherelevantstakeholdersinvolved intheprovisionofsuchcareforolderpeople. TadhgDaly,CEOofNursingHomesIreland,saysthatthisForumisavitalrequirementbecauseof theincreasingdemandforlongtermresidentialcareandalsothethreattothesustainabilityofthe nursinghomesector:“TheForumonLong-TermResidentialCareisanabsolutenecessitytoaddress thegrowinghealthcaredemandsofourageingpopulationandtoplanaccordingly.Therehasbeentoo manyreports,toomuchtalkandnotenoughaction.” “TheDepartmentofHealthmustbringthosewhoplayaroleintheprovisionoflong-termresidential careandolderpeople’srepresentativesaroundthetabletomapoutthefutureofnursinghomecare andimplementanappropriateframeworktomeetthesigniﬁcantgrowingrequirementforit.Thereis anobligationonallstakeholderstoensurethatweplannowtomeetthechallengeofgrowingand fundingthebestpossibleresidentialcareservicesforourolderpeople.Otherwise,wearegoingtobe catapultedintoacrisisincare.” “Wecannotkeepdodgingtheissuesasasocietyorwewillcausemajorstresstoolderpeople andputthelivelihoodsofover22,000privateandvoluntarynursinghomeemployeesinjeopardy.We needrealandmeaningfulactionfromGovernmentnowortherewillbesigniﬁcantconsequencesfor employment,forourresidentialcarecapacityandmostimportantly,forourageingpopulation.” “ThenumberofolderpeopleinIrelandisgoingtorisedramaticallyintheyearsahead.Yet,there hasbeennomeaningfulengagementtoputinplacetheinfrastructuretodealwiththis.Privateand voluntarynursinghomesmustbeprovidedwiththeframeworktoenablethemmeetthesigniﬁcant pressuresbeingplaceduponthemarisingfromapopulationthatislivinglongerandbringingwithit increaseddemandforspecialisedcare.” Thecampaignoutlinesthecriticallyimportantroleprivateandvoluntarynursinghomesfulﬁlwithin thehealthsectorandinmeetingourpopulation’shealthcarerequirements.Italsoinformsofthe importanceofprivateandvoluntarynursinghomesinjobfacilitation,theimportanceofprotectingjobs andrealopportunityforjobcreationwithinthesector.
CSO projection further evidence of urgent requirement to plan Recent CSO projections that the very old population is to rise dramatically in the coming years prompted NHI to warn the Government once again “failure to plan now leaves us facing into a crisis”. The CSO report Population and Labour Force Projections 2016 – 2046, published April, said the very old population – those aged 80 years and over – is to rise dramatically, increasing from 128,000 in 2011 to between 484,000 and 470,000 in 2046, depending on the scenario chosen. NHI publicly stated the projections further strengthen its call for for a Government-led forum on long-term care to be established as a matter of priority. “Failure to plan now leaves us facing into a crisis,” Tadhg Daly, NHI CEO warned. “This further strengthens NHI’s call for a Government-led forum on longterm care to be established as a matter of priority. Private and voluntary nursing homes must be supported and enabled to meet the signiﬁcant pressures being placed upon them arising from a population that is living longer and bringing with it increased demand for specialised care.” NHI’s comments were reported upon in the Irish Independent, Irish Examiner and on Morning Ireland.
PAC discusses issues surrounding Fair Deal ‘pause’ NHI briefed Public Accounts Committee members to advise of the HSE’s emergency measure to pause Fair Deal’s chronological placement listing for a period of three weeks commencing 15th April. Members were briefed in advance of a Committee meeting on 25th April with senior HSE oﬃcials. Committee members at the meeting sought further information in respect of the measure. Deputy Paul Connaughton, Fine Gael, asked if the scheme was suspended and was informed by Tony O’Brien, HSE Director General Designate, “one aspect of its administration has been paused, that is the chronological list basis.” Deputy Connaughton stated: “The problem at the moment is that if one is in hospital long term, one stands a better chance of getting a bed through the Fair Deal scheme than someone who went through the normal procedures”. Mr O’Brien said to counter this in March the HSE released 400 more Fair Deal places. Deputy Connaughton told the hearing he was aware of a constituent who was waiting beyond four weeks for Fair Deal payment. “That person’s position is not disadvantaged with respect to what it would have been,” Mr O’Brien responded. He said the chronological listing was paused for a three-week period, with applications being approved being conﬁned to persons in acute hospitals awaiting Fair Deal, and in cases of hardship for persons in the community they would be examined with view to approval. Explaining why the measure was undertaken, Mr O’Brien said the late ﬂu season and a higher proportion of persons attending accident and emergency created a risk for elderly persons in the acute sector. Deputy John McGuinness, Fianna Fáil, Chairman of the Committee, concluded the debate by stating persons awaiting Fair Deal payment have been approved 24/7 care and families are anxious they get that. “I hope when the third week is up the HSE will turn its attention to the people who are waiting and under pressure,” he concluded.
Tales from a Nursing Home The news section of the NHI website, www.nhi.ie, features ‘Tales from a Nursing Home’, a feature broadcast on Tom Dunne on Newstalk that brought residents into a Co Dublin Nursing Home, Belmont House.
NHI NEWS — 04
TV launch for NHI Care Awards 2013
The NHI Care Awards 2013 were launched with an insight into nursing home life on TV3’s The Morning Show, broadcast 7th May. The show spoke with staﬀ , residents and visitors to Ashford House Nursing Home, Dun Laoghaire, Co Dublin, to coincide with the launch of the 2013 Awards. Among those featured and interviewed was Terry Tiernan, Catering & Nutrition Award Winner 2012, who demonstrated his culinary skills during the feature. TV3 Presenter Sybil Mulcahy, who will co-host the NHI Care Awards 2013 with fellow TV3 presenter Martin King, visited the home to gain an insight into nursing home life. The Annual Awards will once again honour outstanding care and excellence in NHI member homes across Ireland. Closing date for nominations is Friday 19th July and you can find out more about the Awards and nominate at www.nhicareawards.ie.
Resident Catherine McGilligan speaks with TV3 presenter Sybil Mulcahy
O N H
NHI Board of Directors The NHI AGM 2013 took place in Kilkenny, 24th April. The NHI Board of Directors to server for the coming year is as follows: P
Owen McGartoll (Chairman)
Gearóid Brennan (South East)
David Corboy (Midlands)
Stephen Eustace (Dublin North)
Robert Fagan (Dublin Wicklow) (Newly elected)
Denis Fitzpatrick (North West)
Valerie Joy (Dublin Kildare)
Aidan McGrath (West)
Helena Moore (Nursing Committee)
Frances Neilan (Midwest)
Diarmuid Ó’Dálaigh (South) (Newly elected)
Keith Robinson (North East) (Newly elected)
Thanks were extended to the outgoing Board and in particular to the three retiring directors Pat Durcan (Dublin Wicklow), Michael McCoy (North West), and Rodney Murray (South) who served with great distinction.
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05 — NHI NEWS
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NHI MEMBERS SEMINAR 2013
Care & lending challenges outlined to NHI Members Lack of training within the acute hospital sector is resulting in persons with Dementia being sent home without planning necessary for their future social care requirements, a speaker the NHI Members Seminar that was held in April told delegates. Professor Eamon O’Shea, NUI Galway, also spoke of the need for the views of nursing home sector to be heard in respect of care and quality of life for persons with dementia. Challenges facing the private and voluntary nursing home sector were also outlined by a banking representative, and the significant growth in requirement for nursing home care was outlined by a Professor of Health. P rofessor O’Shea, of NUI ’s Department of Economics, informed NHI members that he would like to see greater exibility in respect of the care nursing homes can provide for persons with dementia in the future. He said ideally the nursing home sector should complement care for persons with dementia in the community. He said there has been great desire amongst the nursing homes he has visited to increase their knowledge in respect of care delivery for persons with dementia and to challenge the means by which they provide care. In respect of ‘mobilising intellectual resources’ to respond to the care challenges for persons with dementia and plan the provision of such care going forward, nursing homes have a “critical role” to play in improving the quality of life of residents. “Up to two-thirds of your residents have dementia – we need to hear your views on quality of care and quality of life and the resources needed to provide optimal care for these people,” he stated. While public knowledge of dementia is improving, attitudes remain pessimistic around the disease, Prof O’Shea said. Citing current realities, he said there is a lack of focus on prevention of the disease, diagnosis is poor with most persons unaware they have the disease, while community care remains fragmented and incomplete. The signicant growth in numbers growing older will have serious implications for care services in respect of care delivery for persons with dementia. It was his view that the provision of dementia care is the most important challenge in the ageing sector. Diagnosis is an issue of critical importance, he told delegates. He cited lack of training within the acute hospital sector to identify the disease, sometimes resulting in people not being identied as having dementia and being sent home without the planning necessary for their future social care requirements. The new National Strategy, expected later this year, will, according to Prof O’Shea, focus attention on the needs of people with dementia and be a big addition to the policy landscape. Given the current economic climate it would be unrealistic to expect much by way of new additional resources for dementia, although
been utilised for expanding homes and for new greeneld locations. The book growth for the private and voluntary sectors has grown by more than €300m in the last ve years, he stated. Commenting on the Bank’s recent experience in engaging with the sector, he said average occupancy is 90% plus, with good demand for beds, particularly in the East of the country. Mr Bergin outlined a number of challenges that the Bank foresees for the private and voluntary nursing home sector:
Prof Eamon O’Shea: “The significant growth in numbers growing older will have serious implications for care services”
such resources would be very welcome. The reality is that we will continue to have to make hard choices and prioritise where best to spend current and future allocations, he added. Denis Bergin, Regional Business Manager at Bank of Ireland Business Banking, told delegates the Bank is optimistic about the future of the nursing home sector, with projected demographics and increases in life expectancy providing condence that the outlook is bright. He said the sector continues to provide attractive opportunities for investment and there is active interest from overseas home operators who view the Irish nursing home sector as “attractive”. “The main investor concern is around the fragmented nature of the nursing home sector,” he said. “Many groups/homes are in tax based structures with different owners so it’s hard to build scale. The Irish nursing home sector is attractive to external investors due to underlying demographics and the future growth opportunities.” Investors are typically interested in 1,000 plus beds so scale is a key requirement, he added. Mr Bergin said greeneld sites are options being assessed, however most want a mix of acquiring existing and building greeneld locations. He advised that Bank of Ireland launched two separate nursing home funds totalling €250m over a ve year period which have
Current uncertainty surrounding the Fair Deal scheme.
Tougher National Treatment Purchase Fund negotiations with the nursing homes, seeking to reduce payment to homes for costs associated with the provision of complex care and longer contracts being requested
Demand for higher HIQA and care standards leading to signicant cost challenges for operators
The potential requirement to reduce staff costs as a percentage of nursing home income – historically high at circa 60%
Increased availability of home care packages.
Professor Charles Normand, Health Policy & Management, Trinity College Dublin, outlined the main ndings of the Centre for Ageing Research in Ireland research Future Needs for Long Term Care in Ireland, a project he led. Prof Normand outlined the forecasted increase in the ageing of the Irish population, with those aged 75+ anticipated to grow by 61% from 2006 – 2021 (56,452 increase), 80 – 84 year olds by 53% (34,326 increase), 85+ by 120% (57,830 increase). Population ageing will mean greater need for care in all settings, he said. Key questions we face include how and where to meet need, how to design our systems and how do we fund care. Outlining the projected increase in demand for longterm residential care services, it is anticipated the annual average increase will be between 550 and 756 places per annum P Members can download conference presentations at the Members section of the NHI website, www.nhi.ie
NHI NEWS — 06
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READ ALL ABOUT US! What activities are taking place in your home? How are residents fullling their lives? What celebrations are taking place? Read all about us! oﬀers NHI Nursing Homes the opportunity to publicise the wide-ranging activities that are taking place in homes across the country. It provides an excellent opportunity to publicise nursing home life in the positive light it should be seen in and members are encouraged to make us aware of what is going on. You can send any articles or pictures of interest to firstname.lastname@example.org.
Reminiscence brings farm life to Killure Bridge The spring reminiscence session in Killure Bridge Nursing Home brought farm life to the Co. Waterford home, writes Mary Burke, Director of Care. Reminiscence therapy is defined as "the use of life histories - written, oral, or both - to improve psychological well-being”. This form of therapeutic intervention respects the life and experiences of the individual with the aim being to help the resident maintain good mental health. In Killure Bridge Nursing Home Eileen Power, a retired nurse, facilitates a weekly reminiscence session. Eileen has a theme for each session but allows the residents dictate the session; she may start talking about shops in Waterford and end up recalling streets names or different characters from the city. Recently Eileen facilitated a butter making session using a table churn. The residents joined in churning the butter and eventually enjoyed eating the butter on some homemade brown bread. Eileen has a collection of old items which she uses to initiate the session, for example recently she had an old telegram which got the session started. Residents recalled what happened when we had no phones and telegrams were the only form of communication. Residents recalled the feelings they felt when the telegram man called, as it was always good or bad news.
Another day Eileen was discussing weddings and relatives brought in their wedding photos and they had great enjoyment recalling their wedding day. Memories are stimulated for residents by discussing past times like school days and how the residents travelled to school, what they had for lunch, where they got their clothes, the memories they have of their friends, where they played, what games they played and what they used to have for dinner. Reminiscence enables residents with dementia to recall events and have a discussion with other residents. The lived experiences of our residents are valuable and when they share their stories they have a great feeling of wellbeing. Reminiscence encourages sociability with relatives and help confirm a sense of identity and encourage feelings of self-worth. The spring reminiscence session involved one of our relatives bringing in two lambs; one three days old and another 10 days old. The residents really enjoyed feeding the lambs and talking about life on the farm. Another relative brought in duck eggs which initiated a conversation regarding chickens, ducks and hens. Killure Bridge recently purchased six hens and a hen house and the residents love going out to gather the eggs in the morning.
Above: The residents recently enjoyed churning butter and then enjoyed it on homemade brown bread Left: The spring lambs who were visitors to Co Waterford Nursing Home. Left: Nelly Farrell churning the butter.
09 — NHI NEWS
Rational use of antibiotics discussed at TLC lecture
Shirley finds her temple in Rush Nursing Home
TLC City West recently hosted a consultants lecture on ‘rational use of antibiotics in Nursing Home settings’. Imelda Burke, Director of Nursing, reports upon the successful event.
Shirley was a very worried four year old Collie taken into Dogs Trust’s rehoming centre in Finglas at the beginning of January but has found herself a temple of joy in a Co. Dublin Nursing Home, Catriona Birt, Dogs Trust Centre Manager writes.
On a lovely spring evening 25th April, TLC City West hosted a highly successful consultant’s talk on rational use of antibiotics in nursing home settings. The topic was chosen because the TLC Group recognised the escalation of antibiotic resistance microorganism in the care of older persons. There was a time when antibiotics were given to cure an infection but now the antibiotic, in some cases, can cause more harm that the original infection. We have to ensure that we do everything in our power to prevent the use of antibiotics and when deemed necessary there is a need to choose carefully which one we use. In preparing for the evening it was decided to get experts from urology, gerontology and microbiology to bring diverse group perspectives on how we can prevent these resistances escalating. Excellent presentations were provided by: P Dr. Tara Coughlin: Consultant Geriatrician and Stroke Physician, Age-Related Health Care and Stroke Service,The Adelaide & Meath Hospital, Dublin P Mr. Ted McDermott Consultant Urologist, The Adelaide & Meath Hospital, Dublin P Dr. Jerome Fennell, Lecturer in Clinical Microbiology Trinity College, Head of Department of Clinical Microbiology The Adelaide & Meath Hospital.
When Shirley first came into Dogs Trust, she was a very worried little dog with a heavily matted coat causing her a lot of pain. She was clipped, washed and given loads of TLC and a little princess emerged. We discovered her favourite thing in the whole world was to chase after a ball. After paying Dogs Trust a visit, Heather Carter, Manager of Rush Nursing Home in Co. Dublin instantly fell in love with the adorable pooch. “Shirley is absolutely beautiful with an amazing soul, the perfect temperament for our Nursing Home,” Heather explains. “I can honestly say she brightens up our day, as well as providing endless benefits for our residents. Adopting her from Dogs Trust was the best thing we ever did.” With 50 residents currently in the home, Shirley is never short of someone to throw the ball for her to chase or to give her a cuddle and with landscaped gardens on her doorstep, as well a choice of leisure rooms, Shirley really has found her temple. P
For more information about the benefits of owning a dog please see ‘Canine Charter for Human Health’ on www.dogstrust.ie.
Dr.Coughlin spoke about the ethics of using antibiotics in chronic disease management. The question asked is why older people get diseases or why are they susceptible to infections. Antibiotics account for 40% of medication use in older people. Her talk was informative and thought provoking. Mr. Mc Dermott spoke about the function of the urinary tract and the reasons for susceptibility in an aging population. He went into detail with regards to catheterization and offered advice that hydration is one of the most important things in deferring urinary tract infections (UTI). Mr. Mc Dermott’s knowledge and expertise in this area was evident in his delivery. Dr. Fennell spoke about hand hygiene and the appropriate use of personal protective equipment and the management of waste. He went into some detail on Extended-spectrum beta-lactamase and Carbapenem Resistant Enterobacteriaceae Healthcare Associated Infections in Long Term Care statistics were discussed. The questions that should be asked prior to prescribing antibiotics for UTI are: P What were the past organisms that caused previous infections? P What antibiotics were used in the past to treat UTI? P What allergies dose the clients have? Dr Fennell’s talk definitely would make you look at alternatives prior to prescribing antibiotics and the need to make evidence based decisions is a priority. Questions and answers followed with a good debate on individual points of view, questions were discussed and in each case answers were clarified thoroughly. The evening was chaired by Dr. Liam Lacey CEO of TLC whose presence added an additional element of expertise. Thank you to the team in City West and Fresenius Kabi for sponsoring the speakers. P
Above: Shirley’s now never short of someone to throw the ball for her Right: Shirley has found happiness and a loving home in Rush Nursing Home
NHI NEWS — 10
Brookhaven elects its first citizen In all of our endeavours here at Brookhaven Nursing Home, promoting and maintaining a sense of community between staff, residents and their families, is always high on our agenda, writes Angela Lynch, Activities Coordinator at the Co Kilkenny nursing home. As with any community, therefore, it is important that people feel empowered to take charge and make changes to the environment around them. Here at Brookhaven our residents have not only embraced this sense of community, but have taken steps to harness the power that it brings by electing their very first Mayor. After initial discussions at their monthly meeting, our residents voted in favour of electing a Mayor for the nursing home and put forward five candidates for election. The voting papers were drawn up and the campaign began. As in all elections, it is important to have the right people for the right job and our Director of Care Bernadette Fennelly was selected by the residents to take on the role of elections officer to approach each of our residents individually for their vote. After preliminary voting had taken place, it looked as if we had a tie breaker. However, when all votes had been cast, one clear winner emerged, beating the other candidates by a small margin. Once the inauguration date was set by the residents for the 14th February, all systems were go. The posters were printed and posted around the nursing home inviting staff, residents and their families to this special evening. Our arts and crafts class set to work on making the decorations and our chef set to work planning the food. The evening was upon us and our local Cathaoirleach from Kilkenny County Council, Councillor Maurice Shortall kindly donated his time and presented the chains of office to our newly elected Mayor, Mr William Hughes. Surrounded by our community of staff, residents, families and friends, our local newspaper photographed William taking on board the power of office P
First Citizens: Brookhaven resident & newly elected Mayor William Hughes is congratulated by Kilkenny County Council Cathaoirleach Councillor Maurice Shortall
DATES FOR YOUR DIARY Upcoming events of interest November
NHI Care Awards 2013 (closing date for nominations 19th July) The fourth annual Nursing Homes Ireland Care Awards will once again celebrate excellent care provided in NHI Member homes across the country. Nominees are invited to recognise outstanding care delivered by nurses, carers, catering and ancillary staﬀ. Awards also allow you to recognise innovative care delivered by nursing homes, their interaction with local communities, and the resident achievement award recognises outstanding contribution of a resident to their home. Closing date for nominations is 19th July and visit www.nhicareawards.ie to nominate. Citywest Hotel, Co Dublin, is the venue. NHI Annual Conference 2013 The NHI Annual Conference is a key date on the health sector calendar. An excellent line-up of speakers will discuss issues pertaining to the delivery of long-term residential care and healthcare delivery. The full line-up of speakers, conference theme and event schedule will be announced in the coming weeks. Keep an eye on www.nhi.ie for the announcement. The venue is Citywest Hotel, Co Dublin.
NHI will run a series of Member education days around the country informing of issues surrounding care delivery in respect of incontinence. Members will be informed of details in the near future.
Sonas APC workshop Spiritual Care for Older People - Do we know what good practice is? A set of three master classes delivered by Professor Elizabeth MacKinlay on Friday 12th July 2013, Milltown Park Conference Centre, Dublin 6. Visit www.sonasapc.ie for further information.
1st & 2nd October
1st & 2nd 11 — NHI NEWS
National Wound Management Conference The conference will be held in the Rochestown Park Hotel, Co Cork, 1st & 2nd October. It will examine various aspects of Wound Management. Visit www.wmai.ie to read more. National Council of the Forum on End of Life 2013 Forum The event will take place at Dublin Castle, with the theme being Length of Days – Quality of Life. Visit www.hospicefoundation.ie for further information.
NHI Care Awards: Terry Tiernan, Catering & Nutrition Award winner 2012, is pictured at the launch of the 2013 Awards with staff of Ashford House, Co. Dublin.
Honour your local nursing home, its staďŹ€ and residents! www.nhicareawards.ie NHI CARE AWARDS 2013 - THURSDAY 7th NOVEMBER, CITYWEST HOTEL | NOMINATION CLOSING DATE: FRIDAY 19th JULY
Award Categories Director of Nursing/Person in Charge Award Registered Nurse of the Year Award Carer of the Year Award Social and Recreational Programme Award Catering and Nutrition Award Ancillary Worker Award Community Initiative Award Innovations in Dementia Care Award Resident Achievement Award
Nursing Homes Ireland Care Awards 2013 in association with Homecare Medical Supplies Celebrating Excellence in Care! Nominate now!
THE LATEST HAPPENINGS IN THE CARE SECTO R
Minister outlines CNU spend & challenges HSE capital spend on infrastructure to support services for older people, including the development of Community Nursing Units, was €508 million between the years 2006 – 2012, the Minister for Older People recently informed the Dáil. Minister Kathleen Lynch advised of the spend 14th May in responding to questions from Deputy Bernard Durkan who asked the Minister for Health “the degree to which he will continue to support public sector nursing homes and hospitals caring for older persons”. Deputy Durkan referred to “piecemeal stripping out of elements of service” within public homes. Responding on Minister Reilly’s behalf, Minister Lynch said challenges for public nursing units include stafﬁng, funding and their age and structure. She commented: “Between 2006 and 2012 approximately €508 million capital funding was invested in infrastructure, including CNUs [Community Nursing Units] which supports the delivery of Services for Older People. In order to comply on an ongoing basis with regulatory requirements, the HSE is now concentrating on the refurbishment and upgrade of existing accommodation.” Minister Lynch further informed the Department is working with the HSE to develop an overall plan regarding future provision, which “will reﬂect regional need and have regard to the current severe ﬁnancial constraints, restrictions on public sector stafﬁng and recruitment and the ongoing need to meet service and safety standards; all of which poses challenges for community nursing units across the country”.
HIQA Annual Report 2012 The Health Information and Quality Authority published its 2012 Annual Report 9th May. Points of interest pertaining to the nursing home sector include: P Of the 568 active centres operating on 30th June 2013, 562 were registered. The six remaining were in the ﬁnal stages of the process P 73% of registered long-stay residential care centres are private; 21% are public; 6% are voluntary P 838 inspections were undertaken in respect of 561 designated centres P Two thirds of the centres inspected (69%) were subject to one inspection visit. A further 22% were subject to two P 14 nursing homes closed over the three year period to June 30th 2012 because of regulatory action – 27 closures were voluntarily P Five closures were brought about last year because of regulatory action P 17 new nursing homes opened 2009 – June 2012
Lack of transparency re public nursing home costs queried in Dáil The Minister for Health has been asked when updated cost of care ﬁgures for public nursing homes will be published. The last published costings date to March 2011 while the cost for private and voluntary homes are regularly updated, the most recent being May 2013. Fianna Fáil health spokesperson Deputy Billy Kelleher asked in Dáil Éireann 16th April for a speciﬁc timeframe to inform of the publication of such costings and the reason for the lack of transparency in respect of public nursing home costs. Minister Lynch, answering on behalf of the Department of Health, informed the Nursing Home Support Schemes Act 2009 requires the Minister to lay details of goods and services which constitute long-term residential care services before the Houses of the Oireachtas and revised public costings would be published “shortly”.
Removal of ﬁnancial barriers will lead to increased demand for health services TILDA warns Removing ﬁnancial barriers to health services is likely to increase demand for hospital inpatient and outpatient care, a report by The Irish Longitudinal Study on Ageing has advised. The report published March and titled Patterns and Determinants of Healthcare Utilisation in Ireland states age is not strongly associated with use of outpatient services or the likelihood of being admitted to hospital, but older people have longer hospital stays. Having a medical card increases the number of days in hospitals as does having medical insurance, it states. “Age in itself is not a signiﬁcant driver of service use,” the report states. “While strongly correlated with age, use of GP services is driven by need factors (three or more chronic diseases, poor self-rated health), enabling factors (especially having a medical card, as those with medical cards, on average, make two additional visits per year) and to some extent levels of disability.”
Incoming ICGP chair expresses concern re possible nursing home closures The incoming chair of the Irish College of General Practitioners has expressed concern nursing homes could be closed down based on a technicality related to the fabric rather than the quality of care. “There is concern that the letter of the law on building regulations may mean that homes could be closed down based on a technicality related to the fabric rather than the quality of care,” Mary Sheehan, incoming chairperson of the ICGP is quoted as stating in 7th May edition of Forum, the journal of the ICGP. Ms Sheehan is quoted: “I think HIQA has been good and the quality of care has improved with more recognition of quality. If your parents are in a nursing home you want to feel that quality is important. At the same time however, not every building is purpose built. There is concern that the letter of the law on building regulations may mean that homes could be closed down based on a technicality related to the fabric rather than the quality of care. Does a building have to be 100% perfect? It’s a difﬁcult area.”
Dáil Éireann NHI representation re planning for nursing home care HSE warning of a signiﬁcant national deﬁcit of long-stay beds by 2016 has been raised in Dáil Éireann by Fianna Fáil health spokesperson Billy Kelleher. Deputy Kelleher also raised with the Minister for Health the Centre for Ageing Research and Development in Ireland warning that the number of persons requiring long-term residential care will rise by 12,270 or 59% by 2016. The HSE warned of a “signiﬁcant national deﬁcit of long stay beds by 2016” in its Operational Plan 2013. Deputy Kelleher referred to NHI warnings Fair Deal is not providing the private and voluntary nursing home sector with the necessary framework to meet ongoing and future requirements for nursing home care, against a backdrop of signiﬁcant reduction of public capacity. Responding on the Minister for Health’s behalf, Minister Kathleen Lynch acknowledged demand for such services will continue to grow, pointing to the 14.4% growth in the number of persons aged 65+ revealed by Census 2011. She advised the Department is working with the HSE to develop an overall plan for public nursing home provision and the review of Fair Deal is expected to be complete in 2013. Right: Deputy Billy Kelleher raised in Dáil Éireann HSE warning of signiﬁcant national deﬁcit of long-stay beds
15 — NHI NEWS
Gerontological nursing ‘under threat’ The speciﬁc skills of older people’s nursing have never been so much in demand and yet so much under threat, a new report undertaken by leading nursing organisation AIGNA has claimed. Professor Brendan McCormack, President of the All-Ireland Gerontological Nurses Association (AIGNA), has warned that efforts to undermine the profession will leave the country unable to cope with the realities of an ageing population. Approximately 572 predominantly full-time nursing vacancies at all grades exist in the private and voluntary nursing home sector, and this is expected to expand to 867 over the next year, according to NHI research. Professor McCormack was speaking at the launch of AIGNA’s research report Exploring Nursing Expertise in Residential Care For Older People in Ireland in February. AIGNA represents the older people’s nursing sector throughout Ireland and promotes healthy ageing and wellbeing through the advancement of excellence in the sector. The extensive research, compiled in conjunction with NHI, UCD and University of Ulster, is the ﬁrst to document and articulate the precise experience of registered nurses in residential settings in Ireland. It was launched by Dr Maura Pidgeon, Chief Executive, Nursing and Midwifery Board of Ireland (An Bord Altranais).
“Registered nurses make a critical contribution to the lives of older people in residential care settings, yet we ﬁnd they feel undervalued and constantly under threat,” said Prof McCormack. “Decision makers and educators in the nursing ﬁeld need to recognise the unique skill set that applies in this growing sector for nurses. Nurses feel that the discipline is being continuously eroded by such moves as the Government’s removal of the requirement for 24-hour qualiﬁed nursing care in certain residential settings. The AIGNA report shows the dual role that registered gerontological nurses play in the new reality of person-centred care in our ageing society. “The report also shows how undervalued these specialist skills are in relation to other branches of nursing which are considered more challenging. It is the job of policy makers and managers alike to ensure that gerontological nursing is viewed as a challenging and healthy career choice, and one with a bright and rewarding future.” Tadhg Daly, CEO of Nursing Homes Ireland, praised the real-life experience of the comprehensive report, stating the research challenges misconceptions and dispels the perception that nursing in residential care is unchallenging and of poor status. “Workforce planning must address the challenges of attracting and retaining a high-quality workforce to care for older persons,” he added.
Below - Professor Brendan McCormack, AIGNA President, pictured at the publication of the report Exploring Nursing Expertise in Residential Care For Older People in Ireland
Initiative to improve care of older persons, INECMA conference hears Older persons in Irish hospitals care quality and outcome will be improved and delivered in a coordinated, focussed and cost effective manner under a new joint initiative between the Directorate of Clinical Strategy and Programmes (CSP) of the HSE and the RCPI, the 2nd annual conference of the Irish National Extended Care Medicine Association (INECMA) was told. Dr Diarmuid O’Shea, Clinical Lead for the National Clinical Programme for Older People, spoke at the conference titled Optimising Health and Wellbeing in the Nursing Home Resident: A Partnership Approach that took place in Kildare in April. Speaking ahead of his presentation, Dr O’Shea said: “We want to build on the existing excellence and innovation being delivered by healthcare professionals looking after older people around the country. This way of delivering geriatric services will mean the older person is less likely to have an extended hospital stay. The initiative of the National Clinical Care Programme for Older Persons will not just improve the quality and outcome for the older person, it is also cost effective and designed to ensure the needs of the older person are assessed when they are admitted to hospital and their care delivered in a coordinated and focused manner.” The primary objective of INECMA is to promote clinical care standards for Nursing Home residents, many of whom have complex medical needs, through education and increased collaboration between healthcare professionals.
Empty public nursing home to be private run
Brian McEnery appointed HIQA Chairperson Minister for Health James Reilly has announced the appointment of Mr Brian McEnery as the new Chairperson of the Health Information and Quality Authority (HIQA). Mr McEnery will succeed outgoing chairman Pat McGrath. Mr McEnery, a qualiﬁed accountant, is currently a lead Partner with the healthcare consulting arm of BDO Consulting, in particular dealing with older person, primary and acute care. He is a Member of the Board of NAMA and Chair of its Audit Committee.
A Community Nursing Unit in Inchicore, Dublin, that has been built two years but remains closed is expected to open within six months under a public private partnership initiative. Speaking with regard to Hollybrook Community Nursing Unit, HSE Chief Operating Officer Laverne McGuinness told the Oireachtas Health Committee 23rd May: “The reason it has taken time [to open] is because there is a question about whether the service will delivered by HSE staff, which would require new staff, or through a public-private partnership initiative.” “Our plan is that it is done through a public private partnership initiative. A specification is currently being concluded and we hope that will happen within a four week period. Under the public service agreement we also have to engage in an extensive consultation process with unions. That will be concluded in the next six to eight weeks. Thereafter, we hope to open the unit within six months.”
NHI NEWS — 16
THE LATEST HAPPENINGS IN THE CARE SECTO R
Minister Lynch: Fair Deal review to be completed late 2013/early 2014 The Department of Health will shortly be seeking tenders through public procurement for external input in respect of the review of the Fair Deal scheme. Minister Kathleen Lynch provided Pat Deering, Fine Gael, with an update in respect of the scheme in Dáil Éireann on 28th May. Deputy Deering asked if the Minister for Health will introduce an independent appeals mechanism to address failure to agree necessary fee for nursing home care. In response, Minister Lynch advised of the commitment to review the Fair Deal scheme. “Work will continue on the review in the coming months and the Department will shortly be seeking tenders through the public procurement process for external input to this review,” she said. “It is envisaged that the review will be completed by end 2013 – early 2014.” Right: Deputy Pat Deering: Asked Minister for Health if he will introduce independent appeals mechanism re nursing home fees
Health Committee concerns re nursing home pressures Health ministers and senior HSE officials were informed of major concerns in respect of pressure and stress being brought to bear upon the Fair Deal scheme and the provision of beds for nursing home care at a recent meeting of the Oireachtas Health Committee. Speaking at the meeting on 23rd May, Deputy Billy Kelleher, Fianna Fáil Health spokesperson stated: “There are major concerns that the Fair Deal system and the provision of beds for people in long-stay facilities is under major pressure and stress. It must be dealt with in the short term and the medium term. Looking at the demographic profile and the ageing population, it will be a major challenge in the years ahead.” Senator Colm Burke, Fine Gael, spoke of contact from NHI “on several occasions” in respect of the organisation’s call for the
establishment of a ‘Forum on Long-Term Residential Care’ to address issues surrounding the significant growth in requirement for such care. He advised NHI is seeking a coherent approach to ensure a structured programme to support the delivery of nursing home care. Speaking at the meeting Tony O’Brien, HSE Director General Designate stated: “If we break the demographic profile down between immediate and longer-term issues, Deputy Kelleher was correct to say that the changing demographic profile presents a longterm challenge for the entirety of the spectrum of health and social care services. The needs and intensity of our population will change. The challenge of providing the right resources in the right place, in particular for the increasing cohort of older people, is enormous. We will have to face up to it in the coming years.”
Nursing Home admin burdens highlighted in Government report
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www.diamonddesigns.ie 17 — NHI NEWS
A Government commissioned SIRA Consulting report focusing upon the administrative burdens within the health sector and those of the the nursing home sector is now available to view via the Nursing Homes Ireland website (www.nhi.ie – publications – other publications). The report recommends the following actions in the short term to reduce administrative burdens upon nursing homes: P
HIQA should assign a unique registration number to each designated centre and associate that number with the information provided about that centre that remains constant.
Use online forms. It would be convenient if software or online templates would be available for more standard documentation.
If HIQA would accept some documentation in electronic format it would considerably reduce expenses in terms of ink and paper.
The report informs HIQA has stated that it would be open to suggestions in relation to operational matters and is prepared to consider options such as the possibility of accepting declarations to the effect that information previously supplied has not changed in the interim. It also states much of the information provided to the NTPF for Nursing Home Support Scheme (Fair Deal) is also requested by the HIQA. If this information could be shared between Government agencies, the AB [administrative burden] on operators would be reduced because it wouldn’t be necessary to provide the information to both bodies separately. NHI made representations to the Department of Enterprise High Level Group on Business Regulation that committed to examine the issue of administrative burdens on nursing homes, with Tadhg Daly, NHI CEO, presenting to the Subgroup to outline unnecessary admin burdens being imposed upon NHI members.
HSE LONG STAY CARE 2013
HSE warns of ‘significant deficit’ of nursing home beds as challenges for care provision outlined Areas are already experiencing an undersupply of long-stay beds as HSE Operational Plan warns of signicant national decit come 2016 and outlines key challenges for public units in meeting care requirements of persons requiring nursing home care. The HSE is projecting “a signiﬁcant national deﬁcit of long stay beds by 2016” and has stated there are currently areas with an undersupply of beds for nursing home care. The HSE National Operational Plan 2013 – Implementing the National Service Plan 2013 provided the Executive’s warning and it outlined key priorities to address issues pertaining to long stay residential care for the year ahead. The Plan states: “At the end of July 2012, there were approx 25,500 long stay beds in the country. From a national perspective it would appear there is sufﬁcient long stay bed stock to meet the needs of the growing elderly population for the next two years. However, as there is not an even geographical spread, there are areas currently that have an under supply of beds, particularly Dublin and other urban centres, and also areas where there is an oversupply of beds so this national picture is distorted. Based on population projections, there will be a signiﬁcant national deﬁcit of long stay beds by 2016 based on the HSE’s target of 4% of older persons in long stay care.” It describes the provision of adequate residential care beds for older people as a “key challenge and will continue to be going into the future”. The composition of units and number of long stay care beds have changed signiﬁcantly in the last number of years, the plan states, predominantly due to ﬁnancial constraints, reduction in capital funding, introduction of HIQA standards, public service staff moratorium and legislative changes, including the implementation of the Nursing Home Support Scheme Act 2009 (Fair Deal). “In order to meet increasing population need and deliver sustainable services within available resources, innovative models of care are required to further advance the development of equitable integrated care for older people across community-based services, intermediate care options and quality long term residential care services (supported by a robust and well-funded scheme presently the NHSS),” it states. Speciﬁc emphasis will be placed upon the provision of transitional / intermediate care to
address the issue of unnecessary admissions to acute hospitals and the requirements for long stay care, it adds. Signiﬁcant challenges for public provision of nursing home care are identiﬁed within the 2013 HSE Regional Service Plans. The Dublin North East Plan warns: “Bed Capacity in DNE is not adequate to the needs of the elderly population. The Dublin North and Dublin North City areas have a deﬁcit of both long and short term beds. Cavan/Monaghan and Louth/Meath have a deﬁcit of short stay beds.” It adds: “The majority of beds (public and private) are designated to long term care and this capacity and service provision, in its current format, is not adequate for the increasing number of older people with specialised care needs, e.g. dementia and challenging behaviour. In that context, reconﬁguration of bed capacity will be part of an overall plan to provide supportive responses for older people and their families in accessing respite care, also the appropriate long term residential care placement when required.” It states there is a “dearth of respite and rehabilitation beds”. “Availability of nursing home beds is critical in relation to moving existing clients from long stay wards and deploying staff from long stay services to other areas,” it adds. By the end of 2013 HSE Dublin North East will have 55 fewer public long term care beds, the plan informs. HSE Dublin Mid-Leinster says a key priority in 2013 will be to address the major challenges in relation to future viability of the public residential units due to ﬁnancial constraints, reduction in capital funding, HIQA infrastructural requirements and staff moratorium. HSE South is developing a sustainability programme for public residential facilities in preparation for HIQA 2015 deadline and identifying key issues that need to be addressed. “The community hospitals and units delivering long-stay care across HSE South will be required to implement a range of initiatives around reorganisation of rosters and skillmix, elimination of unsustainable levels of agency and overtime, as well as reorganising existing work and redeployment of staff to ensure that we bring the cost of care in all our public
facilities to sustainable levels and to maximise occupancy levels, which ensure that the appropriate level of funding is received from the national NHSS,” it states. A HSE West priority for 2013 is the reorganisation of residential units where appropriate into groups in geographical areas in order to maximise efﬁciencies. It is also carrying out an audit of absenteeism in community hospitals and nursing units to implement appropriate plans to reduce absenteeism where required. Key priorities in respect of long stay residential care outlined by the HSE within its Service Plan for 2013 include: P Reconﬁguration of public residential facilities P Review of short term bed requirements P Devising efﬁciency measures including review of skill mix, human resource deployment and viability measures P Progression of the Single Assessment Tool “to ensure robust equitable standardised care needs assessment nationally”.
Key actions for 2013 include: Support of 22,761 clients by Fair Deal P The development of a plan for future provision of public long stay residential care facilities in each region for 2014 – 2015 P The review and determination of short term bed requirements for rehabilitation – less than 12 month stay – including respite, short stay, step up/step down and assessment beds P Identiﬁcation within public bed stock number of beds that can be converted to meet short term bed requirement P “Examine and review alternative models of long stay care with a view to ﬁnding alternative and more efﬁcient solutions for the shortage of long stay beds which will occur over the next 4 years based on population projections and identiﬁed need.” P
NHI NEWS — 18
Innovative model of care puts resident independence at heart of care Castleross in Co. Monaghan has adopted a model that has incorporated physical building design and culture changes required to take ‘the hospital model’ out of the nursing home, while maintaining excellent standards of care and clinical practice, writes Paul McCoy, Castleross CEO. astleross Nursing and Convalescent Centre were constructed in 2002 as a 46 bed traditional nursing home sited outside the thriving market town of Carrickmacross in Co. Monaghan. Demand for extra beds remained constant over the following years, particularly around dementia specific services, so in 2008 we added a 19 bed dementia care unit and extra nursing care beds bringing capacity to 70 beds.
The constant demands of running a large facility consumed most of our day; however unease around how we were doing things remained. We were unsure what exactly we needed to change but we knew that the person in our care deserved and wanted more. Many families and staff said ‘if it’s not broken don’t fix it’. The regulation visits found us to be fully compliant with minimum standards, yet we felt some of the control, choice and independence lost upon move to nursing home care needed to be given back to the person.
Household Model The design and layout of the Centre was traditional in nature, with main reception, nurse’s offices, long corridors, large sitting rooms, and centralised dining areas that lay empty for most of the day. Important times during the day centred on rising, dining, staff breaks, staff shifts and bed time, which is a normal part of all our days. However, in our nursing home these critical activities dictated to the person rather than including them in decision making and allowing some element of independence. Many of my colleagues who provide great care in other facilities thought we were ‘crazy’ as we ‘ran a great facility’ and our waiting list was always growing. The results we now see every day far out-way the risk we took. At the same time my brother Michael, who runs a similar facility, was asking the same questions so we started looking for alternatives together. To help get answers we started to research different models of care around Europe and America and found a lot of the answers in a facility in Manhattan Kansas in Midwest America. Kansas is famous for the Wizard of Oz and it became the centre of learning for us for the next number of years. Here we found a model of care called the “Household Model,” which addressed our needs perfectly as it offered
19 — NHI NEWS
solutions for the physical building design and culture changes needed to take ‘the hospital model’ out of our nursing home, while maintaining a high standard of care and clinical practice. Following consultation with staff, families and the people living in Castleross, a programme of physical and cultural change commenced. One of the two pillars for this model is the physical environment changes that are needed to create living and private spaces similar to what we have in our homes, for example a locked front door, homely kitchen, dining/sitting rooms and private bedroom areas. We retrofitted the existing 70 bed nursing home, creating three distinct houses each having their own front doors, kitchens and other features. We also built a fourth house for 28 people bringing our total capacity to 98 beds.
Culture Changes The second pillar of the Household Model is staffing and culture changes. We created new roles like that of “homemaker”. This person works in a house kitchen serving meals at a time that suits the person living in the house. This role is critical to this model, as just like home the mother is at the heart of the kitchen and knows everything about all who live in the house. Now when a daughter is visiting her mother she is welcomed with a friendly offer of a cup of tea or a chance for a chat. This may help with emotions families sometimes feel when visiting a loved one. Household coordinator is another new role which enables a significant amount of non- clinical responsibilities to shift from nurse to a senior carer, for example responsibilities surrounding staff rosters, enquires around clothes, room layouts, ordering of house supplies. This role allows the nurse to spend more time on clinical and healthcare issues like auditing, while empowering the staff to make decisions normally. To share the workload of the person in charge, each house also has a clinical coordinator (Nurse Leader) who shares the governance of their house. This person supervises a number of clinical staff while working very closely with the household coordinator in their house. Normally a senior nurse fills this role, however sometimes we have promoted very capable nurses who thrive on the opportunity.
Breakthroughs The hardest part of the change process was changing the way we think and do things. Very caring staff had to trust the process and be willing to move out of their comfort zone, which is where most of us feel safe. We had to look at every role in place and redesign them to fit a new way of caring and organising our day. People were asked or volunteered to change roles, do things completely different than ever before, give up offices and work in the houses, come out of the main kitchen and become a homemaker etc. The final nugget of change was the removal of all uniforms. This created huge anxiety and confusion, as exampled by some of the following comments and concerns raised: “We won’t know who is who”,“How will I know the Nurse,” “Staff will look like visitors,”“Residents will be confused”. Now we have nurses more empowered not by the colour of their uniform but by what they do. The people who live here when looking for help call ‘Mary’ or ‘Liam’, not ‘nurse,’ as people know each other better than ever before. One of the most significant breakthroughs came from the “learning circle,” a group discussion of representatives from all walks of life in Castleross. Our maintenance man Pat suggested we refer to residents as “the people who live here” and staff “the people who work”. For many it took a long time to understand what he meant but now we know. We have 98 people who live in Castleross and 120 staff who assist them living here. This simple change in how we view the person has enabled a shift in power from the giver to the receiver. Each of our four houses now have their own dedicated staff, shift patterns, meal times and ways of doing things driven by the specific needs of the people living there. So for example Mary at 89 years of age can get up in the morning at 11 am if she wishes, have her breakfast prepared by the
Clockwise from left: ...
Homemaker present in Castleross Household Kitchen The village centre in Castleross, with Rev David Cole pictured. Castleross Garden in Dementia care Household
homemaker and because of this have a light lunch and dinner in the evening. This is all because the systems and culture allows this to happen. Mary now has control and independence at a level she is comfortable with. Many people in nursing homes when asked have struggled with loss of independence. Mary is now living in Castleross, rather than a resident of an ‘institution’ called Castleross Nursing and Convalescent Centre. We now simply refer to Castleross Nursing & Convalescent centre as Castleross.
Best Practice is a feature in NHI News that focusses on best and innovative practices in nursing homes. Nursing Homes are invited to make us aware of practices the wider public should be aware of and can contact email@example.com if interested in contributing an article P NHI NEWS — 20
Caring for Chronic Disorders of Consciousness The Fair Deal scheme is inadequate to meet the complex high dependency needs of young people with disorders of consciousness and the specialised care requirements of such persons must be be acknowledged and given legislative recognition, an inter-disciplinary team of the National Rehabilitation Hospital write. Conscious awareness is a complex phenomenon that can be signiﬁcantly alteredordiminishedfollowingseverebraininjury.TheNationalRehabilitation Hospital(NRH)providesadedicatedservicefortheassessmentandtreatment ofpatientswithDisordersofConsciousness(DOC)followingtraumaticornontraumaticbraininjury.Advancesinemergencyandintensivecarehaveresulted inmorepeoplesurvivingwithveryseriousbraininjuries.Patientswhodonot recoverfullyremaininadisorderofconsciousness.Theywillhavespenttime incomafollowingtheirinjuryorillnessandhaveemergedintothevegetative state(VS),minimallyconsciousstate(MCS)orastateoffunctioninghigherthan theminimallyconsciousstate(emergingMCS). Prevalencedataforthenumberslivingwithadisorderofconsciousness inIrelandarelimited.Sinceourservicecommencedin2001wehaveincreased our Disorder of Consciousness Service and have had 77 DOC admissions, currentlyaveragingat10patientsperyear. Excluding one patient that died whilst an inpatient in the NRH programme, 42 (55.26%)ofthesepatientsweredischarged toalongtermcarefacilitydirectlyfromtheir NRHrehabilitationprogramand34(44.74%) weredischargedtoanacutehospital.Ofthe patients discharged to a long term care facility 24 (57.15%) were discharged to nursing homes and the remaining 18 (42.85%) to long term care in community hospital facilities, Cheshire Homes and PeamountHospital.Itisaregrettablereality that so many are transferred back to the acute hospital. This reﬂects the dearth of suitableonwardcarefacilitiesforadultswith adisorderofconsciousness. Theaverageageofthefortytwopatients whoweretransferredfromtheDisordersof ConsciousnessServiceattheNRHtoalong termcarefacilitywasthirtyeightyearsoldat timeofinjury(Range:17-65years).
disorderofconsciousnessconditionchangesorﬂuctuates. Featuresofeﬀectivecollaborationwithfamiliesincludes: 1. Identifyingfamilies’currentknowledge,understandingofthecondition,and their readiness to receive further information about the rehabilitation processandtheprognosis; 2.Teammembers’sensitivitytotheemotionalnatureofdiscussionsabout levelsofcare; 3. Respectforpatient,andfamilymembers; 4. Comprehensive family meetings involving senior staﬀ to provide opportunitiesforfamilymemberstoaskquestionsandexpressdoubtsand concerns; 5. Signiﬁcantsupporttofacilitatedischarge,whichisanemotionallycomplex process as well as fraught with diﬃculties due to lack of funding and anomalieswiththeFairDealsystem. Informationonappropriatelongtermcareunits isanidentiﬁedneedforfamilieswhoareliving alloverthecountry.AtNRH,weareawareof some excellent nursing homes that provide specialisedbedsorunitsforyoungpeoplewith acquiredbraininjuryandchronicillness.Weare also aware that services for patients with disordersofconsciousnessareinshortsupply andpoorlycoordinated.Itisregrettablethat thereisnonationallistavailablewhichwould assist families and professionals in making important decisions about continuing care management for patients with disorder ofconsciousness.
“The Fair Deal scheme is currently being reviewed and like others who have made submissions on behalf of young people with acquired brain injury, we hope that their specialised needs will be acknowledged and given legislative recognition.”
Impact on Family The personal impact of a disorder of consciousness on family life can be profound and devastating. No family member is ever prepared for the magnitude of loss and change that enters their life. The losses for family membersaremultiplebutbecausetheirlovedoneisalivetheirgriefisoftenleft unrecognised.Whenarelativeisinavegetativestatethefamilymustalso strugglewithtwoopposingrealitiesinthattheirrelativeisphysicallypresentbut psychologicallyabsent.Aswellasthiscomplicatedgriefprocess,familiesalso experience a range of stressors and worries with the potential to create signiﬁcantdistressandeconomichardshipunlessthereisappropriatesocial, practical, and emotional support available to them. Frequent challenges experiencedbyfamilymembersincludeadjustingtochangedroles,forexample retiredparentsresumingparentingresponsibilityfortheiradultchildwitha disorderofconsciousness,diﬃcultyaccessingappropriatecareandnegotiating complexhealthandsocialwelfaresystems;reducedlivingstandardssuchas thelossofaparent’sincome,andincreasedresponsibilitiesforchildcareand generalhouseholdmanagement. Importance of Information & Support Experience of working with families indicates that consistent reliable informationandsupportisasigniﬁcantneedforfamilieswhoaretryingtocope withthelackofcertaintyandmanagethefeelingsofhopeanddespairasthe
21 — NHI NEWS
Managing Long Term Care Needs Due to extent of the physical disability experiencedbypeoplesurvivingwithachronic disorder of consciousness, they normally require maximum assistance from two care staﬀ for most personal care activities. Patients will require percutaneous endoscopicgastrostomyfeeding(tubefeeding)fornutritionandhydration.Most patientswithdisorderofconsciousnessaredoublyincontinentandrequire assistancefromtwocarestaﬀorcaregiverswithcontinencecare.Theywill require24hourposturalmanagementwhichshouldincludeaperiodoftime sittingoutdailyinappropriateseating. Asnoted,theintensityofcareisnormallyveryhigh,withpatientsrequiring twoormorecarestaﬀtocompletemostaspectsofthecareroutine.Ideally, patientsinavegetativeandminimallyconsciousstateshouldbecaredforina singleroom.Thishasmanybeneﬁts,includingthepromotionofprivacyanddignity incareandanopportunityforfamiliestocreateahomelyenvironmentforthe patient.Further,thenormalattentionalﬁlteringsystemthathelpsusallﬁlterout irrelevantbackgroundnoiseandsensorystimulationisoftendamagedinpeople whohaveadisorderofconsciousness.Asaresult‘sensoryoverload’through visual, auditory, tactile, and olfactory stimuli can lead to increased levels of drowsiness,agitation,autonomicproblems,dysautonomicreﬂexia,increasedtone, grimacingandmoaning,whicharenaturallydistressingforfamiliesandcarers. Providingasensoryregulatedenvironmentisveryimportanttopromotealertness and opportunity for awareness and engagement. Simple strategies such as reducingdirectsunlightinthepersonscareenvironmentorprovidingperiodsof timeduringthedayforquietresttimecanhelptopromotepositiveresponsiveness. Optimising Physical & Mental Wellbeing Duetotheirlevelofdisability,thisgroupofpatientsareatriskofdeveloping
many secondary complications. Examples include: respiratory and urinary tract infections, skin breakdown, contractures and deformities, pain, Deep Vein Thrombosis, Weight loss and dehydrationetc. Carestaﬀshouldhavetheappropriatetrainingtominimise the risk of these patients developing the acute and chronic complicationswhichmustbepartofthelongtermmanagement plan to meet ongoing complex needs. The NRH strongly encouragesallcarefacilitieswhoareduetotakeovercareofan NRHpatientwithdisorderofconsciousnesstoattendtheNRHfor training speciﬁc to that individual patient needs prior to their discharge.CarestaﬀwhohaveattendedtheNRHforindividualised braininjurytraininghavereportedhigherlevelsofcompetenceand conﬁdence in managing the complex needs of these patients. UnfortunatelytheNRHisunabletoprovideroutinecomprehensive outpatientreviewsbutwilladviseoncareissuesasrequested. Following discharge from the NRH it is recommended that all patientsshouldaccessalliedhealthcareservicesintheCommunity. Weacknowledgethatcurrently,manylongtermcarefacilitiesdo nothaveaccesstoCommunityCareServicesasavailabilityand fundingoftheseservicesvariesacrossthecountry. Patient Centred Deal Themajorityofpatientswithdisordersofconsciousnessrequire specialisedlongtermnursingcarewhichalsoinvolvestheneedfor maintenancetherapysuchasphysiotherapytopreventcontractures andmaintainmuscletone.Decisionsaboutlongtermcaremustbe made in the patient’s best interest in conjunction with the family.Howevertherecentconstraintsonfundingandprovisionof services are a huge barrier in the care pathway. The Fair Deal schemeisinadequatetomeetthecomplexhighdependencyneeds ofyoungpeoplewithdisordersofconsciousness.Insomeinstances patientsapprovedfortheFairDealcannotmoveontolongterm care after their rehabilitation phase is completed. This means patients must return to acute hospitals to wait indeﬁnitely for additionalfundingknownas“topups”fromtheDisabilitySector, tocoverthecostoftherapiesandintensivenursingcare.Thisdelay causes immense stress for families. It also impacts on the rehabilitationteamwhohaveinvestedmuchtimeandexpertise providingtherapyandnursingcare.Directtransferstoappropriate longtermcareunitswherepatientscanbeclosetotheirfamilies areinthepatient’sbestinterestandthesedelayshavethepotential toerodethegainsachievedfromweeksofintensiverehabilitation. TheFairDealschemeiscurrentlybeingreviewedandlike otherswhohavemadesubmissionsonbehalfofyoungpeoplewith acquiredbraininjury,wehopethattheirspecialisedneedswillbe acknowledgedandgivenlegislativerecognition.Wealsohopethat fundingwillbeallocatedonthebasisofindividualisedtreatment andcareneeds,ratherthanthecurrentmodelofaﬁxedpricefor eachpatientirrespectiveoflevelofrequiredneed.
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“The recent constraints on funding and provision of services are a huge barrier in the care pathway. The Fair Deal scheme is inadequate to meet the complex high dependency needs of young people with disorders of consciousness.” NHI NEWS — 22
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23 — NHI NEWS
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Role models can help meet key expectations of person-centred care Person-centred dementia care leadership involves valuing and empowering frontline staff; leaders are responsible for developing a climate of empathy and respect, writes Buz Loveday, Director and Lead Trainer of DementiaTrainers, UK. As a trainer working with dementia care services for over 20 years, I am in no doubt that person-centred dementia care does not exist without person-centred leadership. Without good leadership, staff lack clear priorities, goals and motivation, and the needs of people with dementia can easily go unmet. Thankfully, many dementia care services nowadays provide training that equips staff with an understanding of the psychological needs of people with dementia. But however useful a formal staff training course has been, whether or not its outcomes are sustained lies primarily in the hands of the managers. They have a fundamental role to play in embedding new learning, motivating and inspiring the staff team. They also need to be able to promote day-to-day learning within the care setting, supporting staff to reﬂect on their practice, to listen, observe, enquire and learn about the individuals for whom they are providing care. A powerful example was given to me in a case study written by Jacqui Harper, a care home manager who attended one of my training courses, the Dementia Care Leadership Programme. In seeking to support staff to develop their practices, she focused on Tess, a resident with dementia who staff had been ﬁnding particularly challenging, particularly when they were trying to give personal care. Tess had assaulted staff on a number of occasions and, as a result, many staff were avoiding talking to or making eye contact with her. Jacqui spent time with Tess, listening to her and observing her reactions and interactions. She tried to tune in to Tess’s reality and understand why Tess was ﬁnding personal care to be such an upsetting experience. She came to realise that Tess felt highly vulnerable and mistrustful, and the reluctance of staff to engage with Tess was, in itself, contributing signiﬁcantly to this feeling of alienation. Jacqui led a reﬂective discussion about Tess at a staff meeting; she talked with the team about how Tess could be feeling, reminding them of certain aspects of Tess’s personal history that could be contributing to her state of mind. She also explored how staff were feeling, giving time for them to express their frustrations and fears. Through the discussion, Jacqui helped the team recognise that a key objective was to help Tess develop a sense of safety, and she identiﬁed three staff members who were prepared to work at building strong, trusting relationships with Tess. These staff would also serve as role models to others who were still wary of Tess. Over the next few weeks, Jacqui regularly spent one-to-one time with each of these staff members to give them the opportunity to talk through their progress and the speciﬁcs of what was working and what wasn’t. She also ensured that there would be sufﬁcient time for them to spend with Tess without feeling rushed. The results provided a valuable learning experience. Three weeks later, Jacqui wrote: “We could not have anticipated the improvement to this resident’s well-being. Our interventions as a team have transformed Tess from an anxious, unhappy woman spending perhaps 10% of her day in well-being to spending about 75% of her day in well-being. Tess is now
continent again, taking herself to the toilet both day and night. We have had no assaults on staff for 10 days…This real team effort has had a positive effect on staff morale as well. We have concluded that the more information we have about an individual the more we can put ourselves in their shoes and have a better understanding on what they may be experiencing. We have also concluded that our resident with the most challenging behaviour was trying to communicate to us how frightened, unhappy and misunderstood she was feeling.” Staff learn much from what they hear from their managers and, even more importantly, what they see their managers do. Person-centred leaders need to be involved in the day-to-day lives of people with dementia living in their care homes. Jacqui’s example illustrates how, through a hands-on approach, leaders can both role model good practice and also develop their own understanding of the perspectives, feelings and needs of people with dementia and the issues and challenges facing front-line staff. Person-centred dementia care leadership involves valuing and empowering front-line staff; leaders are responsible for developing a climate of empathy and respect. Delegates at the Sonas 5th international conference on dementia provided some valuable thoughts on how dementia care leaders can be role models. The importance of managers spending time communicating with residents was highlighted as a key priority – having conversations, spending time with residents who are upset, providing explanations whenever they are needed, and even just engaging in brief exchanges to help raise a person’s mood. When managers are seen doing this, not only are they role modeling, but they are helping to clarify one of the key expectations of a person-centred care service: that of the central importance of communication. My work over recent years has focused more and more on leadership development. Through two of my accredited training programmes in particular – the Dementia Care Leadership Programme mentioned above, and the Dementia Care Trainers’ Programme, which equips senior staff within care homes and other dementia care services not only to lead good practice but also to train their own teams, I have met many committed and inspirational dementia care leaders. They have afﬁrmed my conviction that quality of leadership has a huge inﬂuence on the culture of care. As Tom Kitwoodii wrote, an empowering, cooperative and supportive management style will play a key part in creating these same qualities in staff interactions with people with dementia. Equipping current and future leaders is therefore a priority for dementia care in the 21st century.
Buz Loveday was a keynote speaker at Sonas apc’s 5th international Dementia Care Conference at the RDS in April. Sonas apc will run an international master class on Spiritual Care for Older People in Dublin on 12th July. Further information at www.sonasacp.ie.
NHI NEWS — 24
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The Minimum Effective Dose of Oral Nutritional Supplements = 400kcals per day 1
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t 1 Patient, 1 Bottle, 1 Day t GMS Approved www.fresenius-kabi.com Date Dat eo off Preparation: Preparation: Feb Feb 2013. 2013. EN/2kcal/002.13 EN/ 2kcal/002.13 References: 1. Raynaud-Simon References: Raynaud-Simon A: Clinic Clinical al pr practice actice guideline guideliness fr from om the F French rench He Health alth High A Authority: uthority: nutritional suppor supportt strategy strategy in pr protein-energy otein-energy malnutrition in the elderly. elderly. Clin Nutr 2011, 2 011, 3 30:321-319. 0:321-319. 2. Hubb Hubbard ard GP. GP. A ssystematic ystematic rreview eview o off c compliance ompliance tto o or oral al nutritional supplemen supplements. ts. Clin Nutr 2 2012,31:293-312. 012,31:293-312.
Nursing Homes Registration Renewals - Summary of Findings In late 2012 HIQA began the first registration renewal inspections for Nursing Homes. Health Care Informed (HCI) has compiled a report on the HIQA findings from a sample of ten nursing homes inspected for renewal of registration during the first quarter of 2013. The HCI report was completed against the six core domains of the Health Act, 2007; the following provides a summary of three of these domains. Governance Risk Management, and Health and Safety continued to raise concern in four out of the ten centres: x Deficiencies reported were in relation to controls to ensure the security of the premises in reducing the risks associated with residents wandering, and lack of identification of all risks in the centres including smoking and floor coverings in laundry rooms not being non-slip. Quality of Service The most frequently breached areas were Complaints Regulations, and General Welfare and Protection: x Inadequate Policies and Procedures in General Welfare and Protection of Residents was found in three centres, with the most common deficits in relation to lack of assessments in resident restraint in accordance with national guidelines, and staff being unclear on the Policy and Procedure for reporting alleged incidence of abuse. x Within Complaints Procedures, three centres lacked clarity in Policies and Procedures resulting in confusion in the operation of independent appeals and not outlining the independent appeals process. Health and Care Needs Assessment and Care Planning, and Ordering, Prescribing, Storing and Administration of Medication, were both breached in five of the ten centres inspected: x Three Centres were cited for insufficient application of the Assessment and Care Plan regulation, this incorporated resident needs not being set out in care plans and inadequate evidence of residents and/or their relatives being involved in the development and review of care plans. x Ordering, Prescribing, Storing and Administration of Medicines Regulation continued to cause concern for HIQA, with a lack of information being provided on prescription sheets ďǇ'W͛Ɛ, and Policies and Procedures incorrectly reflecting the transcribing and PRN medication practices. The registration renewal inspections have shown improvements in the care and welfare of residents. All nursing homes displayed areas of good practice in the following Regulations: Visits, Clothing, Communication, Person in Charge, and Training and Staff Development. The HCI report highlights the continuing trends in HIQA findings in relation to achieving the Health Act and HIQA standards. For a full copy of the report contact Health Care Informed (HCI) on 093 36126 or email firstname.lastname@example.org
NHI NEWS — 28
Pictured at the launch of the training programme earlier this year is Marie Kehoe-O’Sullivan (seated on the right), Director of Safety and Quality Improvement in HIQA, along with training participants from Tara Winthrop private clinic nursing home.
HIQA programme focusses on service improvement Marie Kehoe-O’Sullivan, Director of Safety and Quality Improvement at the Health Information and Quality Authority (HIQA), outlines how HIQA is providing training on quality improvement and patient safety to nursing homes in Ireland to help them improve patient safety and the quality of services that they provide to residents.
he ultimate goal of the training is to make patients safer. This programme will provide participants with the skills needed to implement all the National Standards that we have developed to promote safer health care in all settings. The Authority is providing the training in collaboration with the Institute for Healthcare Improvement (IHI), the expert open school for healthcare professionals worldwide. HIQA is the hub for the IHI Open School here in Ireland. Staff and residents in nursing homes will really beneﬁt from the training. Staff will learn new skills, tools and methodologies that will help them to continually improve the quality of services that they provide to residents. They will be taught how to identify areas that need improvement, how to make those improvements, how to measure what they have done and how to sustain the improvement.
29 — NHI NEWS
Residents will beneﬁt as well from the improvements that are put in place because training allows the learner to view improvements through the eyes of the resident. HIQA is building capacity across the country; for phase one of the programme we have selected one acute hospital in each of the four HSE Regions and community hospitals or nursing homes which directly transfer patients to those acute hospitals. The locations we selected ensure that the country is fairly represented geographically and that different types of health settings – large and small, rural and urban – are participating. In turn each site has identiﬁed a multidisciplinary team who are involved in the training, made up of ten health professionals such as nurses, pharmacists, GPs, paramedics, speech and language therapists, etc.
The main advantage of training is its ﬂexibility; it consists of 18 modules that are taken online and can be taken at the learners own pace, as long as they complete them by the end of this year. Learners can complete two modules every month and factor in a six week break over the summer period. We provide participants with ongoing support; we talk weekly with the leads in each team to discuss the learning and challenges. We also visit each site monthly to provide further support on each of the modules. To ensure that the education is not just ‘theory’, we have added an action learning component to the online training programme. Following discussions with the lead pharmacists in the Department of Health and the HSE, medication safety and in particular medication reconciliation has been identiﬁed as the ‘action learning’ priority for this year. We have plenty of evidence that this was a priority area in need of improvement given our ﬁndings from the ﬁrst three-year cycle of regulation, inspection of the nursing home sector, the evidence from international literature on preventable harm events, and the fact that this area has been identiﬁed as one of the priorities for the EU patient safety initiatives for this year. In May ten sites will receive their training on the medication reconciliation programme and to consolidate their learning, they will be asked to implement this programme as part of the education and training programme. The programme will be evaluated early next year to see if it has met its objectives and if there are improvements that can be made. Following on from this, we plan to roll out the programme to further sites in the acute and community sectors over the next three years.
Embracing the course – participant testimony “The team at Tara Winthrop commenced the programme in February. We were delighted to be chosen as a pilot site. We all attended a meeting at the HIQA offices and the take home message for me from the session was that the Safety Quality Improvement Directive (SQID) team are there to support practitioners to achieve a better standard of care for our residents/patients. The Authority pointed out that the regulatory framework applied over the past number of years did not assist those who were struggling to meet the standards and SQID is now operating to address this issue. This is a phenomenal change which in time will prove itself in setting a safer better healthcare for all in this country. The clinic has a multidisciplinary team of ten people enrolled with IHI and progressing through the modules which are accredited. Marie Kehoe O Sullivan and Peter Culhane visit the clinic on a monthly basis to support the team with the ongoing learning process. The team at the clinic have embraced the course and are truly uplifted with this new way of learning and from the support of Marie and Peter. The team are enjoying our weekly meetings on-site and there is no doubt education is an empowering tool to equip the workforce with.”
Catherine Dunleavy, Director of Nursing, Tara Winthrop Private Clinic, Co. Dublin.
NHI NEWS — 30
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Prescribing Information (IRL) (Please refer to the full Summary of Product Characteristics before prescribing.) RESOLOR® (prucalopride). Selective serotonin (5-HT4) receptor agonist, enterokinetic agent, available as 1 mg and 2 mg film-coated tablets for oral administration, once daily, with or without food, at any time of the day. Indication: Resolor is indicated for symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief. Dose: Women: 2 mg once daily, elderly (> 65 years): Start with 1 mg once daily and increase to 2 mg once daily if necessary. Patients with severe renal impairment (GFR < 30 ml/min/1.73m2): 1 mg once daily. Patients with severe hepatic impairment (Child-Pugh class C) start with 1 mg once daily which may be increased to 2 mg if required to improve efficacy and if the 1 mg dose is well tolerated. No dose adjustment required in patients with mild to moderate renal or hepatic impairment. Men, children and adolescents <18 years: not recommended until further data become available. Contraindications: Hypersensitivity to prucalopride or any of the excipients. Renal impairment requiring dialysis. Intestinal perforation or obstruction due to structural or functional disorder of the gut wall, obstructive ileus, severe inflammatory conditions of the intestinal tract, such as Crohn’s disease, and ulcerative colitis and toxic megacolon/ megarectum. Precautions: Caution should be exercised when prescribing Resolor to patients with severe hepatic impairment (Child-Pugh class C) due to limited data in patients with severe hepatic impairment. Patients with severe and clinically unstable concomitant disease (e.g. cardiovascular or lung disease, neurological or psychiatric disorders, cancer or AIDS and other endocrine disorders) have not been studied. Caution should be exercised when prescribing Resolor to patients with these conditions. In particular Resolor should be used with caution in patients with a history of arrhythmias or ischaemic cardiovascular disease. In case of severe diarrhoea the efficacy of oral contraceptives may be reduced and an additional contraceptive method is recommended. Contains lactose monohydrate. Patients with galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption must not take Resolor. Interactions: Prucalopride has a low pharmacokinetic interaction potential. Studies in healthy subjects did not show a clinically relevant effect of prucalopride on the pharmacokinetics of warfarin, digoxin, alcohol, paroxetine or oral contraceptives. A 30% increase in plasma concentrations of erythromycin was found during prucalopride co-administration. The mechanism for this interaction was not clear. Ketoconazole increased the systemic exposure to prucalopride by 40%. This effect is too small to be clinically relevant. Therapeutic doses of probenecid, cimetidine, erythromycin and paroxetine did not affect the pharmacokinetics of prucalopride. Pregnancy: Animal studies did not indicate harm. Experience of Resolor during human pregnancy is limited. Cases of spontaneous abortion have been observed in human clinical studies although, in the presence of other risk factors, the relationship to Resolor is unknown. Resolor is not recommended during pregnancy. Women of childbearing potential should use effective contraception during treatment with Resolor. Lactation: Prucalopride is excreted in breast milk, however at therapeutic doses no effects are anticipated on the breastfed newborn/ infant. In the absence of human data Resolor is not recommended during breastfeeding. Effects on ability to drive and use machines: No studies have been performed. Resolor has been associated with dizziness and fatigue, particularly on the first day of treatment, which may affect driving or using machines. Side effects: The most commonly reported side effects in Resolor clinical trials were headache and gastrointestinal symptoms (abdominal pain, nausea, diarrhoea) occurring in about 20% of patients each. These events occur mostly at the start of therapy and usually disappear within a few days whilst continuing Resolor. Other common adverse events in controlled trials included dizziness, vomiting, dyspepsia, rectal haemorrhage, flatulence, abnormal bowel sounds, pollakiuria and fatigue. Uncommon adverse events included anorexia, tremors, palpitations, fever and malaise. After the first day of treatment the most common adverse events were reported with similar frequency for Resolor and placebo except nausea and diarrhoea: these remained higher but the difference between Resolor and placebo was smaller (1 to 3%). Palpitations were reported in 0.7% of placebo patients, 1.0% of 1 mg Resolor patients and 0.7% of 2 mg Resolor patients. As with any new symptom, patients are advised to discuss new onset palpitations with their physician. Legal category: POM Marketing Authorisation Holder: Shire-Movetis N.V., Veedijk 58 (1004), 2300 Turnhout, Belgium. Date of preparation: March 2012. Further information is available from: Shire Pharmaceuticals Ireland Ltd, 5 Riverwalk, Citywest Business Campus, Dublin 24, Ireland. Tel: 01 4297700. Reference: 1. Resolor. Summary of Product Characteristics. December 2010. Adverse events should be reported to the Pharmacovigilance Unit at the Irish Medicines Board (IMB) (firstname.lastname@example.org). Information about adverse event reporting can be found on the IMB website (www.imb.ie). Adverse events should also be reported to Shire on 1800 818016.
IRE/LO/RES/12/0011 May 2012
In managing the symptoms of chronic constipation in women Resolor® is indicated for symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief.
Resolor works by targeting impaired colonic motility. In placebo-controlled studies, Resolor 2 mg was effective in helping to restore normal bowel movements* and alleviating a broad range of constipation symptoms in women.1 *Defined as an average of ≥3 spontaneous, complete bowel movements (SCBM) per week over the 12-week treatment period.
Important Safety Information Resolor (prucalopride) is indicated for symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief. Please consult the Resolor Prescribing Information before prescribing, particularly in relation to hypersensitivity to any of the constituents, renal impairment requiring dialysis, intestinal perforation or obstruction, obstructive ileus, severe inflammatory conditions of the intestinal tract, severe and clinically unstable concomitant diseases.
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END OF LIFE CARE
Hospice course supports important talk surrounding death What would any of us want if we were a resident in a nursing home? The answer is probably simple enough: to be well cared for and to be given every opportunity to really live life as fully as possible. This is the kind of question that participants are invited to think about when they take part in the Irish Hospice Foundation’s one-day training workshops, What Matters to Me, writes Hilary Maher, Education Coordinator, Irish Hospice Foundation
Right: Participants at a recent What Matters to Me workshop in Cork
T he workshops are relevant to all staff workin g in residential care settings. T heir purpose is to make staff aware of the power that they have to make a difference an d to help people to really live to the end. ‘ W hat Matters to Me’ focusses on core principles of the Irish Hospice Foundation, helping people live to the end and, when at the end, to have a good death. It engages people from the outset by asking them to think of their own end-oflife and what they might want or not want at that time. Among the things that residents want in their day-to-day care is to be noticed, to be engaged, to connect and communicate, to have choices, and to be really seen. It is often said that at the heart of palliative care is communication – quality of life at end-of-life is frequently about being able to and having opportunities to express our needs and knowing that someone is listening. Having these opportunities helps residents to connect and relate, to talk about what they want today and as they approach their passing (however near or distant that event may be), and generally ‘to put their affairs in order’. These, in turn, greatly reduce stress and fear. None of us want to face end-of-life with unﬁnished business, alone, in fear or in pain. A core theme of the What Matters to Me workshop is communication: how to
engage in conversations with residents, how to listen, how to respond to residents’ questions, how to make contact with and be with a resident who has dementia or other communication challenges. EARLY & OFTEN This begs the question, of course, about when is the best time to talk with residents. Experience suggests that these conversations are often many-layered and warrant repeat visits rather than trying to cover everything in one go. Some of these conversations can be difﬁcult for both the resident and the person they are talking to, whether that person is a spouse, a son or daughter, or a member of staff. Time and a slow pace are important: these are not the sorts of conversations that we want to have in a rush. In addition, we may need more than one opportunity to complete and even revisit these conversations, as our preferences may change as we age or grow more inﬁrm, or simply as life changes around us. For many staff, these are very difﬁcult conversations. Socially and culturally, we are used to ‘whistling past the graveyard’, side-stepping questions and discussions like these, perhaps offering false reassurance rather than dealing with reality. This can make it very difﬁcult for residents to talk about what they want,
and therefore difﬁcult to have their endof-life care wishes honoured. What Matters to Me workshops cover topics such as when and how staff can engage with residents about their end-oflife care wishes, and how to respond to residents when they initiate conversations about themselves and their wishes. Other ‘tricky’ issues in endof-life care are also covered, such as: P
What to do when there is a difference between what the resident wants and what the family want for the resident
Clarifying what person-centred care means in terms of actual involvement and prioritisation of residents
Clarifying the rights of residents in relation to the right to know (or not know) their diagnosis
Clarifying the rights of residents in relation to advance plans and Do Not Resuscitate orders
Looking after people when they are in their ﬁnal hours and care after death P
Further information in respect of What Matters to Me is available by contacting: Hilary Maher at 01 675 5971
NHI NEWS — 36
Nursing Homes celebrate the arts through Bealtaine The Bealtaine Festival 2013 ended as Spring moved into Summer. The theme of this year’s festival was ‘Grow Happy’.
his year over 115 nursing homes and care centers took part in the Festival, organising art exhibitions, performances, tea dances, photographic exhibitions, workshops, reminiscence events and other special celebrations. Dominic Campbell, Bealtaine Artistic Director said: "Creative engagement within Nursing Homes is becoming increasingly sophisticated during Bealtaine and throughout the year, as management and staff are increasingly aware that the arts as well as being a ‘good thing’, have measurable social, biographical, psychological and cognitive beneﬁts. The role of the arts in stress relief and pain management is increasingly recognised. Long term projects like the artist residencies ‘Burning Bright’ in Galway, tours by companies like Carnation Theatre, or the work of an individual within a centre all have their place in Bealtaine. We are delighted to promote their beneﬁts via research and reports like those available on our website, or to work with artists and care homes to develop the best possible practice."
The Bealtaine team wishes to thank publicly all Nursing Homes for their involvement in this year's festival. Bealtaine is Ireland’s largest collaborative arts festival. Its overall aim is to celebrate creativity as we age. The festival is co-ordinated by Age & Opportunity, promoting greater participation of older people in society. The Bealtaine festival presents a month-long programme inviting older people to engage with arts and cultural activity, providing a chance to reignite the ﬂame of creativity and unlock hidden talents through diverse engagement and participation.
More information about the Festival is available at www.bealtaine.com. An evaluation of the benefits of art in care homes can be found at : http://bealtaine.com/arts-and-care/touring-artsand-care-homes
Charitable causes benefit from New Park generosity during Bealtaine
esidents and staff of New Park Care Centre, Co Dublin, raised €2,000 for charitable causes during the Bealtaine Festival 2013. The Centre ran a fashion show titled Glam I Am on Wednesday 29th May, at which the home’s female residents modelled fascinators and hats. Pictured modelling such fashion are residents Patricia Kelly (top) and Aileen Dunne (bottom). Other fashionable items were modelled by staff members and musical entertainment was provided by the Latvian Youth Choir (pictured) and Bob and Connor Mc Quaid, who recently appeared on RTE’s The Voice. The two charities to beneﬁt from the €2,000 raised are St Francis Hospice, Raheny, and the Alzheimers Society of Ireland.
NHI NEWS — 38
NHI News Summer 2013