Care of the older adult has been my first passion since becoming a nurse 32 years ago. Having left the NHS seven months ago (latterly as Associate Nurse Director/Lead Nurse in Ayrshire), I joined Erskine (aka Erskine Hospital) where I continue to work in an area of care that excites me.
To be realistic my knowledge of care homes was limited, my mum, who had dementia, had been in one for the last four years of her life, care there was good, but all I did was go in, visit my mum, make sure she was ok and had what she needed – she would occasionally come home for a short time, but she grew increasingly anxious when outside the care home, so the frequency of these trips out diminished. I had little idea of the complexity of care carried out daily in the Home, in many ways I was like many of my NHS colleagues and some university lecturers (but that’s a story for another blog!), care homes were a foreign land.
So seven months into post what can I share, what have I learnt and what is next?
Firstly a little about Erskine, what made me want to go and work there – reputation – “it is Scotland’s foremost provider of care for veterans and their spouses, Erskine offers unrivalled nursing, residential, respite and dementia care in our four homes throughout Scotland for UK veterans”. Ok, that’s the corporate lines, but what’s it really like?
Well, let me tell you – it’s a dynamic environment which focuses on habilitation, the maximising of our residents abilities. Care is based on relationships, with a firm human rights foundation to our approach.
More corporate jargon, Derek!, I hear you say, what does that really mean?
It means we strive to maximises the choices available to our residents: Atul Gwande in his book ‘Being Mortal’ described this as autonomy “you may not control life’s circumstances, but you get to be the author of your life, meaning you get to control what you do with them [circumstances]”. Our approach therefore is based on choice, and that’s been the predominance of my experience thus far, it’s not corporate speel, it’s what our teams strive to deliver every day and it’s what makes me proud to be the Director of Care (but that also brings me great responsibility to maintain and develop services from a strong foundation).
At Erskine around 50% of our residents have a diagnosis of dementia, in some of the nursing Houses more than 60% of residents have a formal diagnosis of dementia. In these circumstances what does choice actually mean for a residents?
It means being able to chose where, when and what to eat/drink (albeit with broad perimeter rather than unlimited) – it means that freedom to be involved (or not involved) in the many activities that happen daily – in their House or in the Activities areas each Home has. It means freedom to stay in their own room reading, watching TV, resting but it also means freedom to access outside space/gardens.
I never worked somewhere that is perfect, and I still don’t, we know we can continue to develop and innovate, to learn new things that help and promote the independence and care of our residents – but Erskine has a wonderful foundation from which to build.
I have one disappointment – if I ever choose to go into a care home I can’t go to Erskine – I don’t qualify to be a resident at Erskine, and I’m now too old to sign up to one of the armed services to give me eligibility – but I know what my benchmarks going to be if I’m looking for somewhere to go.
Erskine is somewhat unique in the range of care opportunities we have on offer, almost 20 different direct care roles. We are also fortunate in having a willing and vibrant band of volunteers (>150) to provide day to day assistance (activities, therapy, drivers, porters etc) across the wide range of activities – they are wonderful people providing time, experience and enthusiasm which enhances the Erskine experience for our residents.
Training and development are important for us – using the Promoting Excellence Framework as our standard we have trained all our care delivery staff to ‘skilled in dementia’ level; a number of staff have been trained to Enhanced level, however no-one is at ‘expert’ level (yet!). Once our new Dementia Nurse Consultant starts work with us in April we will begin the process of upskilling staff from across the organisation.
The thirst and enthusiasm for knowledge and skills across the staff group is palpable. At a ‘Delirium/dementia’ training event we held two weeks ago, with around 100 of our staff, the overwhelming feedback was we want to hear and learn more, we want this session repeated across all staff groups. While everyone valued and appreciated the three technical (clinical) skills sessions staff were blown away with the Erskine relatives who spoke about things that helped and things that are less helpful, and of course they were engaged with Tommy Whitelaw who shared his own journey of caring for his mum Joan. Compassionate, person focused care, built around relationships with our residents is the primary driver to our staff – these training sessions serve to further highlight their desire to continuously learn.
So what’s next at Erskine?
As I said above we will be employing the UK’s first dementia nurse consultant based in and employed by a care home. The Alzheimer Scotland Dementia Nurse Consultant model has shown great results across NHS Scotland. We plan to adopt that same expert lead, direct input (teaching, training and working alongside) model but apply it within a care home environment. With up to 320 residents across our four care homes we feel there is always an opportunity to develop, to learn to be better.
Seemingly little changes have been shown to make a significant impact – the removal of wooden fences and replacement with wire ones in some areas has opened and lightened a ‘new outlook’. John, a resident in Ramsay House now talks about the wildlife he can see, he endgames fellow residents encouraging them to look outwards. Every night he sits in the south dining room just so he can see out to the Erskine Bridge and watch the rush hour traffic travelling across the bridge.
A simple thing like opening up the fencing means we have more useable garden areas, which in turn will allow us to develop more engaging and sensory based outdoor opportunities.
We are in the process of developing a cycle path round the main Erskine Home grounds – again feedback from our residents was they hugely enjoyed the outdoor activity centre they visited throughout last year. Our approach therefore is to bring that choice of activity closer to our residents, to make it a day to day option rather than requiring a special trip out.
In many ways the cycle path exemplifies Erskine’s approach – we approach issues with a can do ethos, even if some ‘can dos’ take a little longer to achieve. If it enhances the opportunities and choice of our residents, we are up for considering it.
Jimmy, one of our residents said on the BBC documentary that ran last year “…one day I’ll be leaving Erskine, but it will be in a box” – in the meantime if you were to see Jimmy at the moment he’s going to have a ball until that day comes.
Jimmy and the 319 other Jimmy’s and Janet’s are wonderful reasons to get up every morning and got to work at Erskine.
PS: if you want to know more about what happens at Erskine you can follow us on Twitter @Erskine1916 or our staff Twitter account @erskineP2C or on my Twitter account @dtbarron
Derek T Barron
Associate Nurse Director/Lead Nurse in Ayrshire
Having left the NHS seven months ago (latterly as Associate Nurse Director/Lead Nurse in Ayrshire), I joined Erskine (aka Erskine Hospital) where I continue to work in an area of care that excites me.