"Here is the news": Giving 200% and old conjunctions

There was an interesting conjunction today on BBC Radio 4 news:

The Today programme in the early morning has been featuring care of the elderly. This morning I listened to the latest report -

Care home life is 'slow death'

Deddie Davies is a sprightly 70-year-old.

But when she agreed to spend five days in a care home as part of an investigation into care of the elderly for Radio 4's Today programme, she found a pace of life far removed from her usual bustle.

Then driving home on PM (BBC Radio 4 at 5pm) there was discussion about the tendency for football players, their managers and many other people in the media to talk about "giving 110%", 120% and even 150% and so on. A mathematician discussed this with the presenter Eddie Mair as a light hearted news interlude - just how meaningful is this talk in this context?

This got me thinking about the heavy morning news and care of older people and the whole ever-present debate around the following:

1. caring as a vocation;
2. the aptitude of junior care staff;
3. the attitude of junior care staff;
4. what is that makes some (the vast majority!) junior care staff GIVE 200%;
5. the wages of junior care staff;
6. to what extent can 2-4 be taught and how can the gaps be bridged?
   

Between this diurnal news spectrum there is a further conjunction. This year a new solar cycle started (at last), the first sun spots have appeared.

So, POLITICALLY the weather is going to get stormy over the next five years or so. As far of care of the elderly is concerned it's going to be stormy for quite a while. Nursing or 'social care' - it is all about light and real heroes. ...

"Welcome (nursing) home?"

Sometimes of course people residing in nursing and residential care facilities become so ill they need to go into hospital. In community mental health terms this can mean that an individual's behaviour can be so disturbed they need specialist assessment and care. It is essential to ensure they can have the best quality of life that their circumstances can provide, without resort to 'care by medication'.

The job means listening to people in care asking to go home. Staff need to be skilled and sensitive in how they respond to such requests, especially when they are repeated time after time. Family members can really struggle with this; should they visit? It is amazing how things can change though...

Quite a while ago I visited a care home and had arrived a bit early. As I turned-up the lady I'd called to see had just returned back from a stay in hospital. It was remarkable to see her recognise the home as home. She responded warmly to the nurse in charge, the many greetings and reassurances offered plus the familiar surroundings. As we accompanied this lady through to her room, it made our day (my week) to hear the deep sigh of relief when the door to her room was opened.

She said, "Oh, it's good to be back."

Walking over to the side of her bed, this highly trained life-trooper stopped.

Sometimes when a tree falls in the forest and someone IS there, there is no sound - just emotion.

Suddenly this lady made like a falling pine in Grizedale forest. In slow motion she fell sideways to greet her bed with another sigh - satisfaction and rest. The home manager and I just looked at each other....

Close call that - just missing the wall - but so good to be 'home' at last.

Image source: http://www.english-lakes.com/grizedale_forest.html

Fundamental-ism lost to nursing

Nursing, health and social care are full of fundamentals:

- of care, aims, objectives, arguments, issues, targets, values ...

- and much more besides. Fundamentals fuel and provide the oxygen that sustains the research literature and media. Fundamentals are the constant heat for education, practice and policy. Amongst the definitions of -

fun·da·men·tal (fŭn'də-mĕn'tl) there is

Basic, base, foundation, central, core, essential, necessary, key, primary, significant ...

Language is amazing in how far a short detour can take us.

Fundamentalism has always been associated with religion and of course no less today; when the literal reading and interpretation of religious texts means that fundamentalism is tainted by beliefs and actions that extend from intolerance, through to extremist tendencies and terrorism. Fundamentalism in this extremist religious guise is not the focus here.

Looking at nursing text book titles fundamental still sells. At times seeking out high standards of nursing care makes you wonder whether a fundamentalist reading of nursing (and human rights) is needed?: and as you get older the need gets ever more acute.

In our informationally overloaded world maybe the message of high quality (fundamental) basic nursing care is lost in the noise. The problem I believe lies in the other meanings of fundamental -

Physics.
a) Of or relating to the component of lowest frequency of a periodic wave or quantity.
b) Of or relating to the lowest possible frequency of a vibrating element or system.

This means that even though those low frequency, infrasound messages can travel an awful long way and strike an occasional significant ethical chord: the population at large is hard of hearing.

Social Care in the UK BBC Radio 4 - starting Monday

On Monday BBC Radio 4 will begin a special month-long feature on the future of social care.

Two programmes Women's Hour (go figure) and You and Yours will take what sounds a very in-depth and challenging look at current plus future social care provision and the issues that concern us all. Podcasts will be available.

They are very keen to hear of people's experiences as a carer or people receiving care:

Have you been affected by cuts in care provision?
Have you had to arrange care; what has the experience been like?
Do you have examples of best practice?
Tell us your experiences.

There are also recent reports to listen to:

• Reform of social care funding
• The half a billion pound scheme to help people arrange and organise their own social care.
  

• Provision is shrinking
• Councils cutting back on care.
  

• The unseen workforce
• Unpaid carers could save the government £87 billion a year.
  

• Transition Care
• Who pays for a disabled child’s care after 18?
  

• The future of social care
• You and Yours special

Bye for now...

Risk: Triangles that Trip [ack. Siegel, HSJ 20 Dec. p.23]

Happy holidays to one and all! Your interest is greatly appreciated.

In last weeks HSJ Matt Siegel's Data Briefing featured Missing pieces of the emergency plan, the focus was the risk relative to the population average of emergency admission, outpatient and A&E visits for specific intervention groups.

One of the figures comprised a pyramid which lists the intervention strategies that aim to reduce these service contacts:

CASE
MANAGEMENT
[Very high relative risk]
DISEASE MANAGEMENT [High risk]
SUPPORTED SELF-CARE [Moderate risk]
PREVENTION AND WELLNESS PROMOTION [Low risk]

By pursuing case management of course we can reduce the number of people needing to visit or be admitted to health services. Siegel highlights that if efforts are limited to those at very high risk then we can only influence (at best) 10% of total emergency admissions.

I've been working quite closely with a community matron recently and this 10% are a worthy target, but looking at triangles there are two essential dimensions here. One concerns the 'ascent'. Although it usually takes time (and may even entail oxygen at home) we need to entertain people at base camp for as long as possible. Why?

Because when viewed in terms of the health career every one of us is a climber.

As the supported self-care and prevention labels reveal this is recognised and is very much a part of overall strategy - but; in the low-lands though, the fog can cloud our vision.

The other dimension also lies in the very structure of triangles. The sticky-out-bits: the feet - can trip you up. Siegel points out the need to intervene elsewhere; apparently for example, the two middle risk levels which account for 20% of the total population. In the saga of joined-up health and social care the value of day care for example seems lost in the debate about who/how it should be provided? I need to check the latest literature, but I thought the size and stability of an individual's social network is a key determinant in +ve mental health? Another research question relates to how the number of required day places is derived?

In looking to make changes in the towering heights, let's not forget the nitty-gritty of care on the ground.

It isn't just having these varied intervention programmes in place. It's about managing the traffic on the passes (now there's a subtle interface!). There are many communities out there and they are far from equal. Community care: define. ...

an·a·gram: triangle = alerting, altering, integral, relating

TI:ME-2-CARE

The developmental potential and scope of Hodges' health career model is obvious in this fusion of health and career. When using h2cm, development and to be more generic time can be found throughout.

I usually try to stress that the word career in h2cm, is not intended as an invitation to search the website for jobs, but refers to an individual's life-chances throughout their life. The model can represent individual, family, community, organisational and political development as illustrated below:

"Where are we?" Take Two, Three, F.... (witheringcare?)

In Five Senses, Serres does not overtly discuss mortality, loss, depletion and omission (Connor, 1999). Management consultants advise that to succeed ‘think outside the box’, but the population pyramid is casting an ever larger shadow, highlighting an ageing population and the box is frequently found full and yet empty? Plaques disconnect, disable the memory; the critical biological box no longer registers and connects. The noise that counts, the background bioelectrical hum is disrupted or absent. Memories once ready to roll downhill, surfing the wave of potential are inaccessible, if marshalled at all. Wither the neural crossroads; the informatique mote in Hermes’ eye?

Our older people, those not yet ephemeral have become peripheral, their personal space an adjunct to furniture. New quantities in life, beg questions of quality, especially quality of care and what it means to care. The concept of self, person-hood is a prime distinguishing factor in terms of describing the attitudes of cultures and communities to older adults and memory loss. In the developed nations the debate continues: is this the price of a long life, or a way of life? In a search for the locus of informatics: the sign on this door reads deep informatics. Listen carefully, as inside the seniors are cared for at home (touched*) remotely courtesy of telecare solutions. The values here of course extend from inappropriate use of informatics to lack of access to such services (Barlow et al., 2006). ...




*For Serres touch is the interface.




We must ensure remote care is not a total substitute for face-to-face interaction.

Barlow, J., Bayer, S., Curry, R. (2006). Implementing Complex Innovations in Fluid Multi-Stakeholder Environments: Experiences of ‘Telecare’, Technovation, 26, 3, pp.396-406.

Connor, S. (1999). Michel Serres’ Five Senses.
Retrieved May 19, 2007, from http://www.bbk.ac.uk/english/skc/5senses.htm

From submitted chapter: Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons - forthcoming...

P.S. Sorry about the two posts today - trying to figure some things out...

New Scientist: Application of RFID technology in Alzheimer's disease

Up to November 2004 I had worked in the community for some ten years with older people (and some well-under '65 years old') who were coping, usually supported by their families; sometimes struggling alone with "Oh, I'm fine!" dementia.


As an ICT enthusiast I've attended presentations that highlight the role that telecare and telematics is playing in extending independence and maintaining quality of life for people with chronic medical conditions. Of course people and families who are robbed of so much, deserve all the help that can be provided.

Having just completed 7,000 words on Hodges' model, selected works of philosopher Michel Serres and informatics, it has struck me the way that just as health and medicine has its many disciplines, so informatics has its various schools. There is community, social, health, e-government, biomedical and many others...

There are two key characteristics of the (western) population pyramid: form and implications. It's getting top heavy as older people far out-number the young. At that top heavy blunt-end there will be increased call on social and mental health care services. Meanwhile, at the sharp-end the younger generation will be (already are!) the 'new generation carers'. Optimist that I am - I'm on that cusp, you know that one where you are looking back and looking forward in equal measure. As a nurse you have to worry these days what passes as 'care' never mind 'nursing care'.

The 'youngsters' will rise to the challenge, won't they? Otherwise, the State will help...

If not, what other solutions are available? And hold on, whose 'solutions' will they be? Will those at the sharp end call for blunt solutions or sharp ones?

Informatics values are out there, but where is the value system that provides ethical assurance across informatics disciplines, health and social policy?

Whatever your age and state of health this New Scientist item begs reading and reflection - 'Plan to 'chip' Alzheimer's patients causes protest'.

I hope you don't have to say "best read the manufacturer's blurb now"!

Hodges Model in Residential Care, Ireland

Claire Welford, Clinical Link Facilitator – Gerontology: a joint appointment between the National University of Ireland, Galway & The Nursing & Midwifery Planning Development Unit, HSE West - e-mailed me to say she is using Hodges' model.

It was great to hear this news. I put some questions to Claire as follows:

Q. What attracted you to Hodges model?

A. Its ability to address social needs.

Q. What are your objectives?

A. To prompt staff to address older people's social participation needs in long-stay residential care. To include all team members in care planning, including Health Care Assistants.

Q. How are you finding using the model - pros and cons (any surprises)?

A. No major problems yet. Some staff are struggling with new terminology. So many staff are used to Roper, Logan & Tierney, which I believe is not suitable for older person care.

Q. What feedback are you receiving from staff and students?

A. Staff as above. Students are interested and their Clinical Placement Co-ordinators have attended the educational sessions.

Q. Any comments from your colleagues?

A. User-Friendly. Succinct.

Q. Did you use any resources from the website, Brian's notes for example?

A. I didn't really use the notes, just used the general theory and went from there myself.

Q. Have you created any tools to help you, or do you feel there is something missing?

A. I have included assessment tools for nutrition, pressure sores, continence, manual handling and falls risk assessment.

Q. Would you be interested in doing a podcast interview, (if I can fully master the technical aspects)?

A. Happy to do a podcast. It would be great to see Hodges' model used more.

Q. Can you tell me about your role and work Claire?

A. For my role please see above, while my research interests include:

* Promoting quality care for older people.
* PhD work looking at autonomy in long-stay care of older people.
* Person-Centred Care.
* Action research/Qualitative methodologies.
* Currently a member of the Departments research cluster for older person research.

Claire also forwarded a publication on care planning in relation to the introduction of this model.

It sounds like Claire's use of Hodges model is at quite a high level, which supports the idea that the model is not prescriptive in terms of care philosophy or approach (note also the range of assessment tools). The way the model has been adopted also suggests it is quite accessible. Hodges' model is helping to extend the thinking and reflection of staff as they assess, plan and evaluate care in the residential setting.

For some people there may be a problem with Claire picking up the model and applying it in this way. Where is the evidence that the model is being used consistently? What about quality assurance? This brief Q&A sesssion prompts many more questions, that I hope we will have an opportunity to explore in the future.

On the other hand information literacy and knowledge management allied with the Web, are supposed to encourage the dissemination AND use of tools and resources. Given Claire's role and skills she has made a professional judgement, evaluated and appraised Hodges' model and found it of potential use and has set about testing her assumption. She is not doing this alone, but has Clinical Placement Co-ordinators on board. Quality assurance and detailed research do need to follow (this is why I created the website), but lack of this should not hamper progress.

Claire asked about keeping in touch - definitely - and thanks++ for sharing your work.

[For an introduction to Hodges model there is a 30 minute podcast.]