After becoming chief executive of a care charity, I decided to learn about our services from a resident’s point of view.
Sara Livadeas with Cherry Garth resident Brian Pearson
When I told people I planned to move into a care home for the weekend, they warned me I risked losing my laundry, if not my dignity. But my experience was different.
I was appointed chief executive of The Fremantle Trust, a charity providing social care for older and disabled people, earlier this year and was keen to learn about our services from a resident’s point of view. I wanted to absorb the atmosphere, meet people, eat the food, try out the equipment and observe.
My aim was to show others, including colleagues, that if our care was good enough for the residents, it was good enough for me. I expected to see caring interactions, but also thought I might see practices that would concern me. I wanted to learn how it feels to receive our care and find out if I could do anything to improve it.
I spent three nights at a 60-place home, which is divided into four 15-person households, each with its own dining room and lounge.
My experience of the physical environment was mixed. The food was good and there was always a choice. But I was horrified to find that not only was my mattress covered in plastic but the pillows were too. Once I mentioned it, the housekeeper found me regular pillows at least.
My room was a good size and everyone had their own ensuite, but the walls were thin and my neighbour’s TV kept me awake. In fact, the ubiquitous TV was very much in evidence throughout the home. The TV creates an illusion of activity in shared areas, but it can get in the way of meaningful conversation. During the first night, staff spoke in normal voices, which disturbed me, but the next two nights were quiet. I had a bath and found much could be done to make the assisted bathroom more inviting.
The most fascinating insight I gained was into the strong sense of community. At first I was concerned about the apparent lack of privacy, the banter and sometimes the bickering. “Isn’t that confidential information?” I thought, as residents’ needs and whereabouts were openly discussed. I soon witnessed affection, playfulness and camaraderie between residents. If anyone was ill or absent, there was real concern for their wellbeing, not least for Maureen, who was receiving end of life care.
One day, residents insisted that staff phone all the hospitals in the area to find out what had happened to Enid’s regular visitor, Don, having heard that he was unwell. Enid was distressed by his absence and there was joy all around when he was located safe and well. There was solidarity in the face of adversity, arising not from living in a care home, but from facing illness and death together.
I could see the impact that loss of mobility has on people and how much time it takes to help residents with their needs. Those living with dementia need a great deal of attention; for others, the inability to get around safely without falling presented their greatest challenge.
Care workers were constantly busy, supporting residents to get up and about, to dress, to get to the toilet, bathe and take medication. Staff were endlessly serving food and drink and clearing up, not just to keep the place tidy, but to manage infection control. The call bell residents use to summon help was always answered quickly, but the request was as likely to be for a cup of tea as for help with personal care. It didn’t leave much time for chat, although staff did their best to socialise too.
I saw for myself how well care workers understood the needs of the people they support and wondered whether endlessly recording in care plans helps anyone. One resident observed: “I see them writing down a lot of junk every day.”
I was disappointed by how little the residents were encouraged to participate in the daily routines, especially at mealtimes, barely pouring their own tea. People arrive in care homes with a mix of abilities and care teams are expected to maintain their independence as far as possible. But staff were too busy to encourage residents to get involved and as a result they had come to expect they would be waited upon, perhaps losing their confidence along the way.
My overriding observation was the level of skill required of care workers. Staff must manage everything from the most intimate personal care tasks, to administering medication, record-keeping, assessing mental capacity, dealing with professionals, relatives and the bereaved, while at the same time giving control to residents to ensure care is person-centred. I was struck by how demanding the work is, yet staff receive minimal training, little emotional support and are generally paid the minimum wage. Even so they remained cheerful and dedicated to the people in their care.
We must address pay for care teams. And I want the telly off! I really enjoyed sharing in the fun and warmth in the care home community. I’m left with a strong sense of connection with the people who use our services and those who support them, and for that reason I would recommend this exercise to others leading care organisations.
My stay gave me insight that looking in from the outside never could, and I am grateful to residents and colleagues at Cherry Garth for giving me this experience.
• Names have been changed. This is an edited version of a post on The Freemantle Trust’s website