Health care and the promotion of physical wellbeing
Derbyshire House aims to provide a warm and comfortable environment and promote high quality health care practices based upon individuals’ needs as recorded in individual Care Plans. Care Plans are determined by a needs assessment and are drawn up in partnership between Derbyshire House and the person it concerns. It is important that the staff can identify any developing health care or wellbeing concerns promptly so that people may receive fair access to medical, physical, emotional or other health care resources. We believe that illness and illbeing is not an inevitable part of ageing, and that all older people should not be discriminated against with respect to health care provision, and should receive the same high standards of care and access that are expected by the rest of the population.
This policy is intended to set out the values, principles and policies underpinning Derbyshire House’s approach to the health and wellbeing care that we offer and/or source. We believe that people have the right to the highest quality physical, emotional and mental health care. It is our policy that the health and wellbeing care provided is flexible, consistent, culturally appropriate, reliable and responsive to changing needs and is individual.
Care staff will maintain personal and oral hygiene by giving the required help and support or by supporting a person’s own capacity for self-care. We understand that dental care is a major factor in the health of people, especially the elderly. Good dental health is vital because a healthy mouth and teeth are important for speaking, chewing, and general overall health. Poor dental health may lead to poor diet and eating habits as well as communication difficulties. There are a number of recognised problems associated with ageing:
- Teeth may become more brittle and more likely to crack or break under normal chewing pressure
- Plaque, a layer of bacteria that can cause cavities, builds up and may become difficult to dislodge, particularly if the individuals tooth brushing and dental hygiene becomes less effective
- Years of chewing may wear down tooth enamel making teeth more sensitive and prone to breakage
- Gums may recede due to periodontal disease and too forceful tooth brushing, thus increasing the risk of tooth-root decay
- Old fillings may fracture or leak around the edges allowing decay-causing bacteria to accumulate in the tiny crevices
Although losing all or some natural teeth is not an inevitable part of ageing it is a common problem for many elderly people to have dentures and experience difficulties with them. Taking proper care of dentures is therefore a very important part of the healthcare provision in our home.
Another problem for many individuals is the mouth itself, which comes from reduced saliva flow as a side effect of some medications. Saliva rinses and protects the mouth and teeth, removing food, plaque and acids which cause decay.
Derbyshire House assists and advises that all individuals are able to visit the Dentist regularly if they so wish and receive appropriate dental care. They may require assistance with their day-to-day oral health care for their teeth or dentures which we are happy to help with. Ultimately, we cannot force any individuals to do anything they do not wish, but we can recommend and assist along with the help of GP’s and Dentists if necessary. We are also able to direct residents to and/or help organise a dentist who can visit the home.
We have access to vision services who come to the home. They can provide an onsite eye-testing service and are able to ensure that any problems with residents’ vision is either noticed or maintained, should it be a long-term problem. i.e., cataracts, glaucoma, macular degeneration
They are also able to do referrals to the hospital, should people need further investigation.
They also offer a hearing service.
All costs for this service are payable by the individual directly to them if it is not covered under the national health service.
Many of our residents’ wear hearing aids. These aids are provided by separate companies or health care providers of their choice, most people have them before they move in. Our vision services are also able to do hearing tests at the home should we need to book anybody in. The Ropewalk Centre in Nottingham can assist with any resident who already has hearing aids and we are able to contact them for you. Our vision services are able to help with any new hearing problems if requested. Anyone that has appointments with the provider of their hearing aids and wants to stay with them should make appointments independently.
We also have trained member of staff who, after receiving conformation from the GP, is able to syringe ears after a 10 day period of inserting olive oil.
A foot-health professional visits on a six-weekly basis charged privately to the individual. Alternatively, residents can arrange with the senior and/or the manager for their own foot health professional to visit the home. Any foot problems identified through personal care practices by staff will be reported to the senior for them to refer.
Management and Prevention of Pressure Sores
Individuals that are assessed or are at high risk of developing, pressure sores, may be referred to the district nurses, through SPA, and a high-risk mattress may be obtained for a set period. We provide beds with pressure relieving mattresses to reduce the risk of pressure sores. Should staff be concerned in any way that pressure sores may develop a referral to SPA should be made without delay and the Community Nurse’s advice sought and followed. In the event of a pressure sore developing the Community Nurses will take responsibility for the healing of the sore and give staff the advice or instructions. Records will be kept on the pressure sore and how it is being treated in the community nursing notes. Derbyshire House aims to prevent pressure sores and maintain healthy intact skin in all individuals wherever possible and to treat pressure sores effectively if they do occur. Some staff have received training on the prevention of pressure sores and how to spot one early. Pressure relieving mattresses that home supplies as well as cushions help reduce the risk of pressure sores and the promotion of mobility, good skin care and good nutrition and hydration which is part of staff training. In addition to this, equipment necessary for the promotion of tissue viability and for the treatment for the prevention of pressure sores will be provided if thought necessary.
Derbyshire House aims to ensure that wounds are managed and dressed appropriately so as to minimise the distress that they cause and maximise healing. All chronic wounds will be documented and assessed by a qualified Health Care Professional, who will also take responsibility for the healing of the wound by visiting the home on a regular basis to dress and cleanse the wound. Small cuts, skin tears and abrasions can be temporarily dressed by a member of care staff but will be reported to the Health Care Professional for them to assess and redress by them if necessary. There are some wounds that can be cared for by staff in the home who have been trained by the District Nurses to do so. The Health Care Professionals for Derbyshire House are the local Community Nurses. These are fully qualified and visit Derbyshire House when a referral is made to them through SPA. They are on call to the home twenty-four hours a day through the SPA referral system or other health professional referral, for clients registered with them and are happy to give the home and its staff any advice or instructions or training they may require.
Derbyshire House believes that all individuals have the right to maintain intact healthy skin as far as possible. We aim to make the environment as safe as possible to minimise the risk of damage to the skin. Should an individual develop a leg ulcer, a prompt referral is made to the GP who will instruct local Community Nurses. They will then be responsible for the cleansing and the dressing of the wound and will have their own documentation in a file kept in the individuals’ room. Derbyshire House will be responsible for carrying out any instructions that the Community Nurses may give to help with the healing, such as facilitating rest and elevation, administering any antibiotics that may be given or a change in diet or referral to a dietician, should the leg ulcer not respond to treatment within their accepted clinical guidelines. Pain killers may also be required should the individual be in pain or discomfort. The individual will have the procedure and any questions they may have fully explained to them in order to gain full co-operation. All these details will be documented in the individuals Care Plan. Once the ulcer has healed, staff will work with the individual to prevent recurrence.
Advice relating to the promotion of continence will be sought/referred if and when needed, and acted upon and any aids or equipment needed will be provided, for example, continence pads, convene or urinal bottle. Continence is promoted by regular yet gentle reminders, for example, stating a need to use the toilet, then asking if they would like assistance – as this avoids order or a task. We will also assist, where necessary, discretely. If an individual has difficulty controlling bladder and bowel function, we send a SPA referral which the District Nurses are informed and contact us. This may result in a continence plan. The very last resort is catheterisation, which is only performed by the Community Nurses under the authorisation of the GP. District Nurses have carried out some training with some staff surrounding the promotion of good continence practice.
Catheterisation in Derbyshire House will only be considered as a last resort, should alternative methods fail. Should catheterisation be required, the local Community Nurses will carry out the procedure. The individual will have the procedure and the risk of urinary infection explained to them fully by the Community Nurses and that they be treated with dignity, respect and privacy throughout.
The home will be responsible for regular emptying of the leg and night bags, and the regular changing and ordering of them. The care staff will be taught how to keep the vaginal, or the penal area clean to avoid the risk of infection and any signs of infection or discomfort will be reported to the Community Nurses immediately. Some staff at the home are trained by the District Nurses to carry out bladder wash outs where necessary. Their clinical need for continuing urinary catheterisation will be re-assessed regularly, and the catheter removed, if possible, by the Community Nurse.
Use of Oxygen
We try to avoid the use of oxygen wherever possible. We currently do not store it or keep it on the premises, but in the event that somebody living here needed it we would be guided by the professionals who prescribed it and follow any instructions. When the oxygen is no longer used or needed, we can send it back promptly.
Individual’s psychological and physical health will be monitored and any preventative or restorative care will be reported to the relevant health professional and appropriate care will be provided. This is identified through a geriatric assessment carried out by the clinical lead designated to our home once a person has been admitted. A medication review may also be undertaken by the same team who liaise with the GP in order for people to receive the best possible outcome.
Exercise and Physical Activity
Staff should provide opportunities to people for appropriate exercise and physical activity using the equipment and spaces that the home provides. Fundamental to physical wellbeing is a good diet and regular exercise. For some individuals, this may be a walk in the grounds, chair-based exercises or just pottering within the home. Activity is dictated by any physical disabilities people may have, but reaching their full potential will still be encouraged. The equipment and activities that we provide to promote exercise further consist of a disabled friendly exercise bike, weekly activities, music for health and groups and activities to exercise the brain, and much more. Exercise will also encourage good bowel and bladder function.
Nutritional screening and preferences will be undertaken during the pre-admission assessment and on admission and subsequently monthly weights will be taken. Where there is a loss of weight a food and fluid chart will be put into place for 3 days and weights will be taken weekly. Any significant changes in weight will be reported to the GP and his advice sought. Any changes or difficulties in food and fluid consumption will be reported to the GP for referral to either a dietician or SALT team and their instructions followed with the full involvement of the individual and their family/advocates where required.
Staff are able to recognise when a resident may be deteriorating or at risk of physical deterioration by measuring a complete set of physical vital signs through the RESTORE2 process. The staff follow the five key components which are: the soft signs of deterioration, “what’s normal for this resident”, National Early Warning Score (NEWS), “getting the right help” and “get your message across.” This means that the resident can get the correct care needed early on before their deterioration progresses any further. Further information can be found in the RESTORE2 file in the administration cupboard.
- All Care Plans will include details of an assessment of people’s night time care needs and preferences recorded and cascaded.
- According to needs, the home will ensure that people will have access to appropriate: hearing tests, sight tests, specialist medical, nursing, dental, pharmaceutical, chiropody and other relevant therapeutic services, care from hospitals and community health services.
- All Care Plans will be reviewed and discussed with both the individual concerned and with the family or representatives where it has been agreed.
- Appropriate assessments, and where necessary, relevant referrals should be carried out for people identified at risk of falling, in need of dietician, physiotherapist, SALT team etc.
During periods of acute illness, all basic nursing care will be given with the support of the Community Nursing Services. Should chronic illness occur, Derbyshire House will aim to continue to care for the individual, but if the illness is such that the home cannot provide for all their needs, arrangements may have to be made for a more suitable placement. This would only occur after consultation with the person/representative services and as a very last resort.
Requests for the attendance of a GP (urgent and non-urgent)
All people must be registered with a local GP. Those who are not already registered with a local GP will be helped to register with one of their choice.
We are part of the one care home one practice and we have our designated surgery, East Leake Health Centre who provide us with designated doctors for continuity. They call the home and where required visit the home every week and carry out a ward round which provides residents with an appointment to discuss any concerns they may have and deal with non-urgent requests. It is on these rounds’ medication can be reviewed and altered as required and any referrals can be made. It is also an opportunity for family members to talk through their concerns if necessary.
It is the responsibility of the senior person on duty to assess the urgency of any health problems presented by individuals and to decide if an individual’s condition requires a GP immediately. Relatives will be informed of the individual’s condition and a member of staff will stay with them to await the arrival of the GP. A decision may be made by the GP as to whether an emergency admission to hospital is required and the Doctor will take the relevant action. The individual’s Care Plan will be kept up-to-date. If a GP is unable to visit, then a senior member of staff will call 111 and provide the necessary information for a decision to be made as to whether the emergency services are required or not.