Evaluation of Local Health and Social Care Related Service - Essay Example

Evaluation of Local Health and Social Care Related Service -Nursing Home- 1. Nursing Homes and the Elderly Several studies have established a gradient of dependency for vulnerable older people between care setting such as home care, residential homes, nursing homes and hospital wards. Other studies have suggested that there is an increase in dependency in residents admitted to residential and nursing homes from in the 1990s (Mozley 2004, p.9). If there is an argument on what truly characterize ‘quality of life’ in general, there is also an argument concerning whether quality of life in old age should be regarded as different in by some means from quality of life of younger people. Some suggest that quality of life of older people should be characterize in a similar way to that of younger people. Other studies have found that younger and older people report similar overall health perceptions despite older people having poorer role function, lower energy levels and poorer physical function when objectively assessed. ‘Quality of life’ has been examined relative to the extent to which residents retain autonomy and self-respect within the home environment. These aspects can be influenced by frequency of dementia and physical dependency among the residents, staff attitudes and the physical structure of the environment (Mozley et. al. 2004, p.16). Older people living in care homes have multifaceted care needs and if we are to provide these needs, we have to understand normal ageing and the transformation that can transpire because of illness. In addition, we need the capacity to enable the individual to enjoy life regardless of the restrictions of any enduring condition. We need knowledge to enable the older person to do what he or she is able to do and to provide care that is sensitive and supportive (Nazarko 2006, p.11). The ability to enable people to communicate their needs is fundamentally significant and makes a real difference to the older person’s quality of life. When one knows the reasons why it is difficult for a person to communicate then he or she can develop skills and utilize these to eliminate the impediments to communication and enable that person to be heard. Although it is “distasteful to older people” (Cowart and Quadagno 1996, p.1), they are cared for in care homes, because it is no longer possible to provide the care required at their own home. Although nursing homes for several people are an ostensibly inescapable part of aging and provoke fear and anxiety, they are however plays a crucial role in every nation’s health care system (Harris and Benson p.3). The majority people living in care homes are in their 80s and 90s. More than 90 percent of people who enter care homes have enduring health conditions and need special care. A number of individuals are physically weak but very attentive. Some are actually well but perplexed. Others are both physically and mentally weak. Older people do not wish to leave their own homes and live in ‘a home’ since they often feel nervous and distressed because of the shift. They usually become recluse and reluctant to talk. Thus, it is essential to interact and become friendly with the person and persuade the person to convey his or her feelings (Nazarko 2006, p.3). “Half a million people live in residential and nursing homes in the UK” (Redfern and Ross, p.142). Nursing homes are mainly provided by the private and charity sectors. In the UK, to qualify for compulsory registration, they are required to meet the nationally drafted minimum standards set out in Regulations and reviewed from time to time. These standards cover accommodation, staffing, and levels of service (Pickard 2005, p.27). 2. Purpose of the Service and Intended Client Group The Flex Nursing Home located in Wales, is a care home that focus in the care of the elderly with specialist services like cancer care, hearing and speech impairment, Parkinson’s disease, Stroke, Visual Impairment, Cerebral Palsy, Epilepsy, and others. It has 30 single rooms, facilities, and services such as short stay care, respite care, physiotherapy, independent living training, assisted living, and garden for patients. The nursing home aims to provide care, comfort and consideration to all their service users and to create a tranquil, friendly atmosphere with the security and serenity, which comes from understanding that assistance is constantly on hand when required. Dignity and autonomy are valued and supported at all times and service users are encouraged to consider the nursing home as their home. In the matter of caring, best results are sought by customising the requirements of the service users through painstaking evaluation and planning. Service users are encouraged to contribute in developing their care plans and those relatives, friends or professional persons who would want to be involved. The nursing home has intentionally accommodated just 30 service users in order to promote an extended family atmosphere, which is frequently absent in larger institution. They receive all elderly people and do not discriminate against sex, race, creed, religion, colour or language. All staff from nurses, carers to cooks is very much concern in ensuring an affectionate and caring atmosphere while never disregarding the significance and rights of all service users to be cared for with dignity and respect. Effective caring results are gained by promoting involvement in activities, which will help build confidence and overall improvement in each person’s quality of life. Nursing and care staff in this nursing home incessantly trained both internally and externally to deliver the highest standards of care. All nursing and care staff are required to study for qualifications recognised and or deemed necessary by legislation, regulation and the National Care Standards Commission. The nursing home staff is consist of a manager, six registered nurses, 25 care assistant with 12 members having NVQ level 2 in Care, 5 catering staff will basic food and hygiene certificate, cleaning and domestic staff, and a handyperson. Staffs are conscientiously selected for good humour and patience. They are often reasonably skilled in caring for their own relatives or friends and create an atmosphere of exuberance. They are all meticulously vetted with references being checked systematically and whenever possible, they attempt to employ bilingual staff. All staff is required to pursue a minimum NVQ level 2 in care and encourage development of nurse through in-house and external training courses. These include fire safety, moving and handling, first aid, food hygiene, care planning, and abuse. For new staff, training for are provided immediately. Induction sessions covers various subjects including code of conduct, confidentiality, service user rights, health and safety, personal care tasks, specialised nursing tasks, general responsibilities, and abuse. Accommodation is available for thirty residents that include 22 single en-suite WC and washbasin facility, 6 single and 1-shared rooms. There are three lounges, a roomy dining room and a large conservatory, which acts as the main function areas as well as a seating area. All rooms correspond to the regulatory sized as specified. Two lifts which service the front and back of the building. A lockable bedside cabinet would be available if required in individual rooms for the safekeeping of small sum of money or medicines, should a service user choose to self medicate. Individual resident’s room can be supplied with a TV upon request. There is payphone located within the nursing home, which is accessible for the service. User’s privacy is offered by using the phone in the office. A number of individual rooms have BT connections or a member of staff can contact BT to arrange, to enable a service user to have their own private line. The service user would then be billed independently by BT. In addition, Fax and Internet services are available upon request. The nursing home provides an enclosed safe garden area for use and a hairdresser visits the nursing home each fortnight using the hairdressing salon located on the top floor. Service users are individually billed for this service. The bathrooms have hoist fitted to assist the less able, thermostats are fitted to safeguard from any scalding. The nursing home is centrally heated with thermostatic controls on individual radiators. Service users can use to the shared facilities but may stay in their own rooms if the want to do so, rooms can accommodate wheelchairs. More importantly, the nursing home operates a policy of no smoking within the home. Well balance nutritious meals are prepared every day in the contemporary stainless steel kitchen, using fresh meat, fish, vegetable, homemade cakes and pastries. Special diets/ cultural needs and personal choices are always available. Hot drinks and snacks are generously offered throughout the 24-hour period. The nursing home operates a four weekly rotating menu to circumvent boring repetition of meals served. Menus are varied with a substitute always being available when a particular item is disliked. During the year, the menu is altered in keeping with special occasions such as birthday parties, Christmas and Pancake Day. While service users are encouraged to eat in the dining room, meals are allowed to be taken in user’s rooms if they want to. The nursing home is a registered nursing home for the elderly although younger residents can be cared for at the home depending on their difficulty. The home offer nursing and personal care, friendship and comfort on a long-term basis for male and female service users. Such service users may experience moderate levels of physical, mental or learning disability. The main criterion for admission to the nursing home is that a person is able blend into the home without disturbing the general well being of the home for other service users. 3. Relevance of the Service to Health and Social Care Policies “Nursing homes can be frightening and depressing places” (Valins and Salter 1996, p. 79). Special attention and some extra courtesies and kindness which make an individual think that he or she is a well appreciated and respected person with a contribution to make towards their community, makes all the difference to the elderly person. There is a huge distinction between living in unfriendly environment and living in a ‘home’ from home atmosphere. Caring for people in the full sense of the word is much greater than attending to their fundamental needs. The nursing team at the nursing home are trained to weigh up the emotional and social needs in addition to the physical and nursing requirements so that they work with dignity towards achieving maximum potential and a good quality of life for their service users. In this nursing home, the resident has the right to a contract, a service user’s guide and clear statement of terms, which is in harmony with the National Minimum Standards for Care Homes for Older People. This is because the standard requires home to produce a statement of purpose setting out the aims, objectives, philosophy of care services and facilities or Standard 1. The home must provide ‘service users guide’ written in plain English and provide the resident with a contract stating the room to be occupied, and details of resident rights and obligations (DHS 2003, p.2). According to the minimum standards for care homes for older people, the homes should allow residents to manage their own affairs, have access to advocates and bring personal possessions to the home (DHS 2003, p.3). The nursing home did precisely what is required since they allow residents to consult a solicitor, advisor or advocate privately and have the right to be represented when necessary to put forward their point of view. When it comes to resident’s access to their personal records as specified in the standard, the nursing home allows residents free access to information about themselves, their condition, prospects, and be informed of the person ultimately responsible for their care. In addition, the nursing home provides its resident the right to choose, dignity, respect, confidentiality, fulfilment, and privacy at all time and in all matters. Residents are given the right to be independent and protected from any form discrimination. They have the right to contribute or not as they so choose in the activities of their home, and the community in general, and to enhance their quality of life by creating new hobbies, interest and friendships. They can accept visitors at any time and the right to retain the doctor of their own preference whenever possible, and to handle their own medicine when it s appropriate to do so. The can also demand for evaluation of their care and discussed at regular intervals and given informed choices of available option for future care. Similarly, they will be able to make known any grievance straight to the manager or the person in charge, and in the event of non-satisfaction, they may refer the matter to the appropriate government body. Finally, resident’s have the right to terminate their residency for any reason without recrimination. The standard demand that the home comply with good practice in relation to dignity and choice, and considering the above rights given by this nursing home to its residents, the nursing home seems to comply entirely with good practices. For instance, they have the required dedicated facilities for home care, rehabilitation facilities and equipment for therapies and treatment, their staffs have appropriate classifications and training, and specialist services are provided in sufficient numbers and delivered by competent and skilled professionals. More importantly, this nursing home demonstrated that routines and activities of daily living is flexible and reflect the needs and aspirations of residents by allowing them to choose and live independently inside the home. In addition, they offer open visiting, good meals, and allow residents to complain directly to the manager or to the National Care Standards Commission. 4. Influence of rights, policy, and the law on service delivery “Nursing homes have come a long way in the last 20 years and are now on the threshold of the greatest changes that have ever experienced” (Nazarko 2002, p.12). This is because consumers are insisting on better services, more amenities, and above all, more caring and experienced staff (Rantz et. al. 2001, p.11). In 2002, the Care Standards Act was introduced and currently all homes are known as care homes. A single body, the National Care Standards Commission, will regulate all homes and they have to meet national minimum standards. The Care Standards Act sets up systems to regulate care assistants. In relation to these regulations, government require all managers and staff of homes to have pertinent management and professional credentials (Nazarko 2002, p.11). Homes, as mentioned earlier are required to comply with national minimum standards. These standards are the minimum standards that homes must meet in order to retain registration. Consequently, nursing homes or care services has to improve and maintain the level of their services to at least within the minimum standards. The Flex Nursing Home is apparently aware of the law as we already mentioned in the preceding section, the home recognises the importance of dignity and liberty for the elderly. For instance, influences of policies are evident in improvements made by nursing homes to augment the quality of life of residents. They provide care in a relaxed, friendly, secured, and peaceful atmosphere. They treat their residents with respect and acknowledge resident’s right of privacy at all times. The home encourages decision-making and promotes free choice, action, and respects the resident’s decision. They help resident’s achieve fulfilment and all that they would wish to in all aspects of their daily lives. In general, as a major influence of legislations and policies, the home apply and respect basic human rights, no discrimination of gender, race, creed, religion, colour or language. 5. Appropriateness, Accessibility, and Effectiveness of the Service The purpose of existing government policies is to guarantee the quality of personal care and support which people obtain while living in their own home in the community. These policies recognize the exceptional and intricate requirements of individuals, and the supplementary knowledge, and skills required in order to deliver as services that are customised to the needs of each person. The law applies to all agencies providing personal care to the wide range of people who need care and support while living in their own home including older people, people with physical disabilities, people with sensory loss, mental health problems, and people with learning disabilities (DOH 2003, p.1). The service is appropriate in the sense that it provides the necessary facilities for quality of life for older people. It is accessible in the sense that its admission criteria are very simple, as it only requires that a person to behave and intermingle into the home without any problem. More importantly, before admission, it will assess a potential service user’s requirements and probable compatibility with existing service users for the benefit of all parties. The first month of a service users stay is considered a trial period for the service user and the nursing home. This is in the interest of all parties and is intended to permit an ongoing assessment of compatibility with existing residents. It also assures the new service user of his or her right to cancel out any agreement should he or she find the nursing home undesirable in any respect. For fees and other financial needs, the nursing home is committed to providing value for money. Depending on the individual financial situation, service users either may pay the fees or may receive help by paying through social services. Included in these fees are fully trained nurses and care assistants providing 24-hours nursing care. Good home cooking with provision for special diets and laundry service. Full central heating and non-alcoholic beverages and snacks are available at all times. Incontinence aids, general water disposal, clinical waste disposal including the safe disposal of medication, house newspapers and magazines, and therapeutic activities. All staff is trained to make every effort to care for and uphold the dignity, independence and privacy of all service users within a warm and caring environment, and responsive to the service users ever shifting needs. Service users are encouraged to make their own choices so that they can organize their own lives. The home positively encourages the use of advocates if a service user is not capable of acting on their own behalf. Service users are welcome to contribute in the monthly care planning reviews to point out their needs and demand. Following the requirements of the minimum standards for home care, service users are encourage to organize their own room using their own personal items, pictures, and small items of furniture. The home recognizes that service users are persons with differing interest thus they allow service user access to their special interest. However, the home manage to come together in small groups for activities most weekday afternoons that include chatting, reminiscing, exercise to music, entertainment from local visitors – local choirs and schoolchildren. Service users are free to attend religious services in or outside the home, as they so desire and the right to meet the clergy of their preferred denomination whenever they like. All visitors have the right to allow visitors or decline any visit and this right will be acknowledge and encourage by the home. The home conducts care planning to involve the service user and their advocate. Care is observed and reported on a 24-hour basis. At the end of a shift or when the nursing staff finish their span of duty, they handover a report to the nursing staff commencing duty on every service user at the nursing home. This is to ensure continuity and to maintain high standards of care at the nursing home. The home understand that they have no right to restrict any service users civil liberties, except and unless there is an apparent need to safeguard a service user from injury or self harm or to protect other residents and staff from injury or harm. They also know that they accommodate 30 service users that are typically unaccustomed to living in such a cohesive community. The service users are encouraged to contribute and present their views but the home will not tolerate any physical or verbal abuse or violence from any resident, visitor or staff member, any person breaching this regulation will be asked to leave the premises instantly the premises. 6. Evaluation of the contribution of field practice to the services “Women are the world’s caregivers’ ad the world’s nurses” (Kramarae and Spender 2000, p.1462). Women care for children, for the aged, and for those who require chronic or long-term care because they are weak, sick, or disabled. The spirit of nursing is caring for persons who are managing health and illness issues. ‘Inclusivity’ and advocacy are key essentials of nursing practice that do not fit well into health care pecking order. Thus, nursing continues to struggle with lack of advantage and influence within a system that is diffident to distinguish their worth and skills (Fabre 2005, p.4). Nurses make available education and referral services to assist individuals, families, groups, and communities in improving their health by making health-promoting choices. Although there are issues about the way nurses do their job in care homes such as being more occupied by paperwork than actual nursing (Ouslander et. al. 1997, p.1), a nurse generally work as partner with patients or clients to improve their health status. “|Caring people, not policies and procedures, determine whether patients receive quality health care services and many of these care people are nurses” (Fabre 2005, p.4). “Nursing homes are considered skill nursing facilities” (Kramarae and Spender 2000, p.1462) and physicians have only a partial role in nursing home care, and the quality of care depends largely on inspired and well equipped nurses (Mechanic 2006, p.110). “Nurses are one of health care’s greatest assets, health care gold” (Fabre 2005, p.3) and an “essential part of the health care team” (Galanti 2008, p.127). Nurses are vigorous care providers, doing many functions in care settings like hospital, community treatment centre, or home care services. The home care setting offers the client the chance to be in his or her natural environment and try new ways of coping. “This environment offers that highest degree of control to the client” (Barry 2002, p.19). A registered nurse is considered the team leader in the home responsible for the coordination of care. He or she supervises and assigns the functions of other caring staff in home care settings. The most important need of client is to have a plan with structure that will enhance and reinforce his or her regular coping techniques. Another is to have encouragement from his close family or others who live in the home. The nurse is in a good position to study the quality and nature of these relationships and can help the client to understand and react to others in an adaptive manner. Nurses help the elderly to attain best possible health, comfort, and quality of life. They value their contribution in providing care at home as there are indication that patients and families view greatly the contribution of nurses relative to other legal services accessible to them (Have and Janssens 2001, p.136). Nurses who are compassionate normally offer themselves to helping others and it is a challenge to connect others caringly and actually communicate to the heart. For many elder, the world is a lonely place. Nurses who have since desire to take action to ease or facilitate acceptance of the suffering of this vulnerable group are widening the circle of compassion in the world. Nurses instituted human-to-human relationship with elderly patients, incorporating care that understands the interaction of various issues that may be distressing the older person’s state of well-being (Butts and Rich 2005, p.199). 7. Bibliography Barry Patricia. 2002. Mental Health and Mental Illness, Lippincott Williams & Wilkins, U.S. Butts Janie and Rich Karen. 2005, Nursing Ethics: Across the Curriculum and Into Practice, Jones & Bartlett Publishers, U.S. Cowart, Marie and Quadagno Jill. 1996. From Nursing Homes to Home Care. 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Palliative Care in Europe: Concepts and Policies, IOS Press, 2001, Netherlands Kramarae Cheris and Spender Dale. 2000, Routledge International Encyclopedia of Women: Global Women's Issues and Knowledge, Routledge, U.S. Mechanic David. 2006, The Truth About Health Care: Why Reform Is Not Working in America, Rutgers University Press, 2006, U.S. Mozley Caroline, Sutcliffe Caroline, and Bagley Heather. 2004, Towards Quality Care: Outcomes for Older People in Care Homes, University of Kent at Canterbury Personal Social Services Research Unit, Ashgate Publishing, Ltd., U.K. Nazarko Linda. 2002, Nursing in Care Homes, Blackwell Publishing, U.K. Nazarko Linda. 2006, NVQs in Nursing and Residential Care Homes, Blackwell Publishing, 2006, Singapore Ouslander Joseph G., Osterweil Dan, and Morley John, 1997, Medical Care in the Nursing Home, McGraw-Hill Professional, U.S. Pickard Quentin. 2005, The Architects' Handbook, Blackwell Publishing, U.K. Rantz Marilyn Jean, Popejoy Lori, Zwygart-Stauffacher Mary. 2001, The New Nursing Homes: A 20-Minute Way to Find Great Long-Term Care, Fairview Press, U.S. Redfern Sally and Ross Fiona. 1999. Nursing Older People, Elsevier Health Sciences, U.K. Valins Martin and Salter Derek. 1996. Futurecare: New Directions in Planning Health and Care Environments, Blackwell Publishing, U.K. Read More