‘Travel to learn, return to inspire’

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‘Travel to learn, return to inspire’

Health Innovation Network’s Director of Operations, Rebecca Jarvis, is currently in Japan as part of her Churchill Fellowship exploring alternatives to care homes for older people.

Earlier this year, I was awarded a Churchill Fellowship to explore alternatives to long term institutional care for older people. I specifically chose to focus my research on this area because we have an ageing population in the UK with increasing demand on care services. Most people say they would not want to live in a care home when they become very old but they do not consider what the alternative could be, let alone actively plan for it. They carry on living in their own home which is maybe bigger than they need, but full of memories which are hard to let go of. And then crisis hits – a bad fall, or a partner dying and suddenly they can’t manage on their own, or make it to the upstairs loo, and then what? The hospital is desperate to free up the bed for the next patient, families and friends cannot provide around the clock care and suddenly there is pressure to move into a care home.

I selected Japan and New Zealand the two destinations for my Fellowship as Japan is a super-ageing society with 28 per cent of the population aged over 65, expected to rise to 38 per cent by 2015. Since the introduction of the long-term care insurance system in 2000, a range of community based alternatives to institutional care have been developed. New Zealand has a well-developed retirement village sector with some of the most advanced regulation and legislation in the world.

But this is not all about us learning from Japan. When we hosted a delegation from the International Longevity Centre (ILC) in Japan in August this year we were able to reciprocate the learning and used it as an opportunity to showcase some of the great initiatives underway in south London to support older people to remain physically and mentally active. The delegation was particularly interested in visiting reablement services, such as the Bexley reablement team where they have demonstrated particularly impressive outcomes in terms of reducing risk of frailty, and the Nelson Health Centre in Merton where the HARI (Holistic Assessment, Rapid Investigation) team of nurses, physiotherapists, occupational therapists and pharmacists help people recover from falls and other injuries / illnesses, reducing the number of hospital visits by an impressive 50% in their pilot year alone. When it was my turn to be hosted by the ILC as part of my visit to Japan, it felt like meeting up with old friends.

On the surface, we might seem like two very different countries, but when you reflect more closely the UK and Japan actually have more in common than we think. Geographically, both are ‘island countries’ on the edge of a large continental landmass. Politically, both have constitutional monarchies and both have a closer relationship with the USA than their European or Asian neighbours. And population-wise, both countries are ageing societies which, although this is more acutely observed in Japan, means that both countries are facing significant pressures on their health and care systems.

Japan is also experiencing a declining birth rate which is resulting in what they call a ‘piggy back’ situation; essentially meaning that where previously there have been two working age adults to support one older person, there will soon only be one working age adult to support one older person, meaning economically it is more crucial than ever before to ensure that the right provisions are being put in place accommodate for this.

Whilst the problems are similar in both countries, we are tackling them in different ways. For example, the Japanese health and care system has yet to make use of social prescribing, something that has increased in popularity in the UK as a way of addressing the ‘non health’ needs that were often raised by patients when they went to their GP. This was something our Japanese delegates were especially keen to hear about. Also, unlike the UK, the voluntary sector is very different in Japan and they don’t have large national charities providing services and support. A talk by Bexley councillors, commissioners, and people working for the Bexley voluntary service council, explained to the delegation from Japan about the massive impact that even a small charity could have in terms of the support it provides to vulnerable people.

Instead, Japan has the Long Term Care insurance system, introduced in 2000, and which everyone pays into from the age of 40 and as such a range of different models of community based care have been funded to support people in he own homes and communities. I have been fortunate enough to witness some of these initiatives first hand, such as the Silverwood Ginmokusei in Chiba Prefecture, the closest I’ve seen to a true alternative to a residential care home, providing accommodation for older people, many of whom have dementia and care needs, centred around a community space and an appealing restaurant, literally jutting out into the community. Residents work in the restaurant and sweet shop, and members of the community regularly drop by for lunch and the primary school kids drop in after school on their way home.

I also visited what is described as a small-scale multifunctional nursing home called Okagami in Kanagawa Prefecture. It provides support for people who have care and nursing needs but want to keep on living in their own homes. The facility looks like a family home in a residential area. There are six small rooms around a communal area. The clients can receive a range of support from a short stay in one of the six rooms, taking part in a group activity at the day centre, using the bath or receiving care and nursing support at home. The real benefit of this kind of facility is the flexibility it brings. Some people register as clients but only use the home care service or day care service. One client is over 90 and wants to continue living on her own in her own home, but she feels a bit nervous about it, so stays overnight at the centre from Monday to Friday and goes home at weekends. Many people use this facility as a safety net. It’s there for them in case they need it and it can respond flexibly to their needs. I didn’t imagine that I would see something that could support people with such severe care and nursing needs to continue to live in their own homes. There is no doubt that if it wasn’t for Okagami, many of these people would need to be in a care home.

There are many similarities in our approach as well. Professor Yoko Matsuoka from Kasei University in Tokyo eloquently described the paradigm shift in thinking in both countries, as moving from an approach of ‘doing for’ and ‘providing services’, to ‘doing with’ and generating solutions with the community. Both countries understand that older people themselves have a wealth of experience and skills which can they can contribute to support people to age well.

It is really fascinating learning about the Japanese health and care system, and how they are not only coping with, but embracing their “super ageing” population. Next week I will be leaving Japan for New Zealand to start the second leg of my Fellowship, which has one of the highest proportions of older people living in retirement communities in the world. I am particularly interested in why New Zealanders choose to move into a retirement village community and what their expectations are of these initiatives.

The Churchill Fellowship slogan is ‘travel to learn, return to inspire’. I am learning so much about alternatives to long term institutional care for older people on my travels and am looking forward to sharing what I’ve learn when I get back. It would be fantastic if we could adopt some of these good ideas from overseas in south London. After all, as an Academic Health Science Network, we are in a good position to try something new.

Read more about Rebecca’s experiences in Japan and New Zealand by signing up to her blog.

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Why do we need a leadership programme for care home managers?

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Why do we need a leadership programme for care home managers?

Written by Don Shenker, Project Manager for Healthy Ageing.

At the first workshop day for care home managers on the Pioneer Leadership Programme last January, participants were asked to list the things they did in a typical day as a care home manager. The 14 managers listed 55 tasks they typically undertook on a daily basis – ranging from dealing with funerals, preparing the staff payroll, dealing with complaints, checking medication systems and helping to move beds.

As someone who was very new to the care home sector, I was awed by the responsibility care home managers held and the loneliness of the job at hand – providing high levels of care to some of the most frail older people in society and dealing with the myriad regulations, controls and quality checks from CCGs, local authorities and the CQC. The managers on the programme nodded in recognition when talking about missed lunches, half-drunk cups of cold tea and waking up in the night, worried if everyone in their care home was alright.

To add to this, CCGs are continuing to push their care homes to reduce the number of residents going into hospital unnecessarily and to accept new admissions to the care home even at weekends – all to ease the pressure on hospitals struggling to cope with acute demand from a frail older population. One in seven over 85’s now live in a care home and there are three times as many care home beds as there are in the NHS. To add to this pressure on the NHS, emergency admissions to hospital from care home have increased by 65% between in the last six years (2011-2017).

The Health Innovation Network and My Home Life Care Home Pioneer Programme is a free leadership course for south London care home managers which aims to develop the leadership skills and confidence needed to lead care home teams in a demanding and pressurised sector.

The programme is run over nine months, with managers using exercises developed by My Home Life to improve deep listening skills, focus on collaboration, connect emotionally, discover what is working well and embed positive change together. The principle of appreciative enquiry is adopted – starting with recognising existing strengths as a team and building on that.

The overriding sentiment managers spoke of, to a packed room of care home managers, CCG commissioners and local authority staff on their Graduation day, in November, was how the programme had helped to build the confidence they needed to make changes and improve their home.

From changing how they ran team meetings to encourage staff to speak out, to developing culturally appropriate services and initiating new ways of involving residents in decision making, the care home ‘Pioneers’ spoke of how they had achieved a transformation in themselves and in their home. The programme evaluation shows a two-fold increase in the confidence managers felt in managing their team and their home.

Having developed our original Pioneers in 2018, the HIN is now recruiting a new cohort of care home manager pioneers for our 2019 programme, with the Pioneer Graduates being trained to co-facilitate and mentor the new cohort.

At a broader level for south London, the HIN hopes to support the care home Pioneers to now co-create the solutions required for older adult care with NHS, CCG and local authority colleagues to ensure continuing high-quality care pathways for older residents/patients. Having seen first-hand the remarkable resilience, strength and knowledge gained by the 14 Pioneers, I’m confident they will go on to achieve even greater things.

To find out more information and apply for the next cohort, please click here

Adventure before Dementia

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Adventure before Dementia

Written by Charlene Chigumira, Trainee Project Manager for Healthy Ageing and Patient Safety.

The Healthy Ageing team attended the 13th annual Dementia Congress in Brighton last month, and it was even more special than I had imagined it would be. 

Wednesday opened with people with dementia and their carers from DEEP (Dementia Engagement and Empowerment Project) and Tide (Together in Dementia Everyday) sharing their unique experiences with us (and inspiring the title of this post). Alzheimer’s International took the stage and shone a light on how informal carers were providing 82 billion hours of support to people living with dementia by 2015, a statistic that still surprises me. This figure is why they believe that both formal and informal carers should be viewed as ‘essential partners in the planning and provision of care in all settings according to the needs and wishes of people with dementia.’ 

The lived experiences of people with dementia and their carers were weaved in throughout the congress as they spoke in the different break-out sessions on various topics including culture, assisted living arrangements, music therapy and spiritual support. One ‘End of Life Care’ session I attended hosted by Hospice UK and Dementia UK opened with a carer explaining why every day care matters to her, and how it maintains the dignity and individuality of a person living with dementia. Subsequently, a dementia care advocate, who has the condition herself shared some of the ways it has changed her life, and how the right care can enable her to live ‘interdependently’ (with support when needed, but a degree of independence remaining). Personally, I don’t think this session could have come at a better time, as my team is currently working on a project around end of life care in care homes. I left with a deeper understanding of why co-production is so important in our project work. 

Finally, one of the many highlights of the congress was hearing Paola Barbarino from Alzheimer’s Disease International highlight the brilliant ways countries all over the world are supporting people living with dementia. Here were 3 of my favourite case studies:

1. China (The Yellow Bracelet Project) 

‘In 2012, the Yellow Bracelet Project was initiated to encourage safety and prevent people with dementia getting lost. Yellow Bracelet has now become a symbol of affection, and continues to attract attention across society’. More here

2. The National Dementia Carers Network (Scotland) 

The National Dementia Carers network in Scotland has been ‘fully involved in Scotland’s two National Dementia Strategies, including work on testing models of community support, improving acute care in hospitals and the monitoring of better support’. More here  

3. LMIC spotlight (Costa Rica) 

Costa Rica was the first LMIC to introduce a dementia plan in 2014. Asociación Costarricense de Alzheimer y otras Demencias Asociadas (ASCADA) works closely with the city council to achieve a Dementia friendly community. More here 

Health Innovation Network begins partnership with Alzheimer’s Society

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Health Innovation Network begins partnership with Alzheimer’s Society

Health Innovation Network has committed to taking action on dementia by uniting with Alzheimer’s Society in a strategic partnership to change the landscape of dementia care forever.

Dementia is the UK’s biggest killer, with 1 million people set to be living with the condition by 2021.

Having collaborated on a number of successful initiatives including Dear-GP and the “Red Bag” scheme, Health Innovation Network and Alzheimer’s Society are launching a formal partnership to tackle dementia together.

Through the partnership we will support one another in the development of new initiatives to ensure timely diagnosis and develop practical tools to improve health outcomes for people with dementia.  Each organisation will use its expertise and networks to increase the reach and impact of successful initiatives and facilitate the sharing of best practice in dementia care across health and social care.

Zoe Lelliott, Deputy Chief Executive at Health Innovation Network, said: ‘We’re delighted to be working in partnership with the Alzheimer’s Society. As one of the leading voluntary sector organisations at the forefront of championing the needs of people with dementia at a national level, we are excited about the opportunities this new partnership will bring for the benefit of people with dementia in south London’,

Tim McLachlan, Director of Local Services at Alzheimer’s Society, said: “Dementia devastates lives, slowly stripping people of their memories, relationships and identities. As the UK’s biggest killer, taking action with other charities and health organisations is vital to help us understand more about this devastating illness.

“I am delighted that the Health Innovation Network is uniting with us this Dementia Action Week. Whoever you are, whatever you are going through, no one should face dementia alone.”

Keeping active is a vital part of keeping steady

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Keeping active is a vital part of keeping steady

Written by Dr Adrian Hopper, Clinical Lead Falls Prevention & Aileen Jackson, Senior Project Manager for Health Ageing

Strength and balance, Strong, Straight & Steady and improving Mind and Body were some of the key messages given to our south London delegates who attended the Health Innovation Network’s Falls Prevention and Mildly Frail Older Adults workshop on Wednesday 18 October.

Delegates from health and social care, voluntary and leisure sectors heard how falls in older adults are really common. One third of people over 65 years of age will fall. These falls may cause a serious injury such as a broken hip or head injury which requires hospital treatment, but most falls go undetected and unreported but are likely to contribute to the individual’s confidence; ultimately, leading to social isolation and yet more serious falls. Some falls are “just” an accident, but for others a fall is caused by early changes, such as worsening balance, vision or dizziness that can be improved.

There is an established evidence base for the exercise and interventions that can really make a significant difference for strength and balance. Public Health England will be publishing a return on investment study later this year to evidence the cost savings of the interventions. Bone health is crucial to the falls prevention agenda and the National Osteoporosis Society are also due to publish evidence on beneficial exercise for people with Osteoporosis late 2018/19.

Speeding up the spread and adoption of evidenced good practice is a key mission for the Health Innovation Network and our event showcased the brilliant examples that exist in south London , including embedding vision tests in Falls Prevention services, reducing waiting times through innovative triage, sustaining exercise, video games, digital physio prescribing, allotments and gardening, London Ambulance and Fire Service initiatives.

Finally, do download Age UK staying steady booklet and all become ambassadors for the Strength and Balance message.

Are you or do you know someone over 65 who has had a fall or has a fear of falling? Check your balance – are you feeling more unsteady? Is it getting more difficult to do everyday tasks? If you are unsteady you can get better by exercising. This involves doing simple strength and balance exercises (mostly standing) for about 20 mins two or three times a week or more which reduces falls by 30% and will give you confidence to go out of doors again and live life.

Follow #StrengthAndBalance on Twitter or our watch our video for all the highlights from the event.