Glossary Terms: Care Home Review Follow Up
This glossary applies to the summary responses to the public bodies, as well as the Care Home Review follow up report.
Advocacy: see Independent Advocacy
Anti-psychotics: Anti-psychotics (also known as neuroleptics or major tranquilizers) are a class of psychiatric medication that are used to manage psychosis primarily in bipolar disorder and schizophrenia. They are also used to manage perceived aggression or psychosis in people living with dementia, but this is combined with a significant increase in serious adverse events. NICE guidance therefore states that antipsychotics should not be a routine treatment for people with dementia; best practice is to promote the use of psychosocial interventions1.
Butterfly Care Home: Dementia Care Matters (see below) has developed the Butterfly model for care homes, recognising that managers and staff can struggle to change cultures of care through training alone. Care homes are provided with a culture change programme known as a Butterfly Project. Teams are supported via an initial one-year culture change programme during which they learn new ways of working to promote continuous improvement in relationship-centred dementia care.
Care home: A care home is a residential setting where a number of older people live, usually in single rooms, where they have access to on-site care and support. Some care homes are registered to meet specific needs, such as dementia or terminal illness. Care homes for people with additional care and support needs are often described as ‘residential’ or ‘nursing’ homes to specify the level and type of care provided. However, under the Regulation and Inspection of Social Care (Wales) Act (2016), care homes will no longer be registered in line with these distinctions; the kinds of support they deliver will be in accordance with their ‘statement of purpose’.
In the Care Home Review follow-up report, care homes are generally referred to in the broadest sense, to include residential and what have previously been described as ‘nursing homes’, and make a distinction between the two where this is necessary to make a point.
Care staff: Social care workers who are employed to care, assist and enable older people living in care homes through the delivery of personal care and support in their daily lives.
Cognitive function: The mental action or abilities of thinking, understanding and remembering. Where cognitive function is impaired people will often have difficulties with day-to-day memory, planning, language, attention and visuospatial skills (the ability to interpret objects and shapes). The impacts of dementia on brain networks are not always clear can also lead to difficulties in emotional, physical and social functioning, as well as limited cognitive function.
Commissioning: Commissioning in the context of health and social care is the process of ensuring that the services provided effectively meet the needs and wellbeing outcomes of people in their communities. Commissioning is about how Local Authorities and the NHS anticipate change, plan services to meet future demands and make effective use of the money available. Commissioning may be undertaken by individual organisations or jointly with others.
Confined to bed: Someone who is unable to be assisted to sit up and will frequently need assistance to be repositioned in bed to avoid pressure ulcers.
CSSIW (Care and Social Services Inspectorate Wales): CSSIW is responsible for reviewing and inspecting Local Authority children and adult social services, as well as inspecting independent providers of care and support services. They aim to ensure that regulatory standards are met and drive improvements to ensure the wellbeing of people in need of care and support in Wales. http://cssiw.org.uk/about/?lang=en
On 15 January 2018 CSSIW will be changing their name to Care Inspectorate Wales http://cssiw.org.uk/news/171220-name-change/?lang=en
DEEP (Dementia Engagement and Empowerment Project): DEEP brings together groups of people with dementia from across the UK. DEEP supports these groups to try to change services and policies that affect the lives of people with dementia. http://dementiavoices.org.uk/
Dementia Care Matters: is a dementia care culture change and training organisation. They promote a culture of care focussing on a model of emotional intelligence. http://www.dementiacarematters.com/index.html One of their developments is the Butterfly Homes model (see above).
Dementia Champion: The role of dementia champion is a vehicle for promoting ownership of good practice in the quality of life and care of older people living with dementia. This could be through the support of an external or internal change programme or through supporting a nominated, enthusiastic and motivated individual to drive organisational change, be a model of good practice and challenge poor care practice and outcomes.
Dementia Friends: This is an awareness raising programme that has been established by the Alzheimer’s Society to raise awareness of dementia across society. This is done through a growing movement of volunteers who provide training sessions that encourage people to think about dementia, question stereotypes and promote good practice. https://www.dementiafriends.org.uk/
EMI (Elderly Mentally Infirm): EMI is a term for services that are designed for older people who have mental health difficulties or a disease of the brain such as dementia. Whilst this term is commonly used, particularly within health services, it is more appropriate to refer to these as services for older people with mental health needs.
Enhanced Services (General Medical Services contract): The General Medical Services contract is the contract between general practices and Health Boards for delivering primary care services to local communities. Enhanced services are elements of essential or additional services delivered to a higher specification, or medical services outside the normal scope of primary medical services, which are designed around the needs of the local population. Enhanced services are commissioned by Health Boards. There are three categories:
- Directed (DES) – all Health Boards must commission or provide
- National (NES) – all Health Boards should commission or provide but this is not mandatory
- Local (LES) – optional commissioning of services based on local needs. One of these is a LES for care homes.
See further information provided by NHS Wales: http://www.wales.nhs.uk/sites3/page.cfm?orgid=480&pid=6064
Good work: A dementia learning and development framework for Wales (2016): A learning and development framework for the health and social care workforce, which aims to help them provide the best possible care and support for those living with dementia. The framework also aims to support people with dementia, carers and anyone who may come into contact with people with dementia. The resource is split into three sections:
- Informed: social and first point of contact workers, for example, receptionists, frontline facing public sector roles, and a requirement for the induction of health and social care workers.
- Skilled: social care workers, nurses and managers.
- Influencer leaders: commissioners and designers of services.
The resource was developed by the Care Council for Wales, NHS Wales, Public Health Wales and the Welsh Government to provide a better, more consistent approach to supporting people with dementia. https://socialcare.wales/resources/good-work-dementia-learning-and-development-framework
Independent Advocacy: Independent advocacy supports and enables people who have difficulty representing their interests to express their views, explore and make informed choices, or obtain support they need in securing and upholding their rights. Independent advocacy is a fundamental element of equality, social justice and human rights.
Intermediate Care Fund: In December 2013, the Welsh Government announced the establishment of the Intermediate Care Fund to drive forward collaborative working between social services, health and housing, and with third and independent sector partners. The Fund originally aimed to support older people to maintain their independence and remain in their own home. This includes avoiding unnecessary hospital admissions and inappropriate admissions to residential care, as well as preventing delayed discharges from hospital. The fund has now been widened to include disabled people and children.
Kitwood ‘Flower’: Tom Kitwood was a pioneer in the development of person-centred dementia care. He identified a number of fundamental psychological and social human needs which were framed into a flower motif. In 1992 he founded the Bradford Dementia Group at the University of Bradford. His specific ideas relating to person-centred care and developed positive approaches to people with dementia are discussed in his book Dementia Reconsidered: The Person Comes First (Rethinking Ageing) 1997.
Lay inspectors/Lay assessors: Lay inspectors/assessors contribute to inspections of regulated care services by talking with people who use services and their family, carers and friends. Care Inspectorate Scotland describe the lay assessors that they use as: ‘volunteers who have used care services or have helped to care for someone who has used care services. They are experts by experience and are a valuable asset to our inspection work’2.
Magic Moments: A programme of work and publication by Swansea University's School of Social Care Research, which seeks to highlight the 'magic moments' that sit at the heart of quality of life for care home residents, but very often go unnoticed or the significance of them may be undervalued. The Magic Moments booklet is available here: http://www.swansea.ac.uk/humanandhealthsciences/news-and-events/latest-research/researchteampublishesbookletofcarehomemagicmoments.php
Market position statement: An analytical document providing information that aims to enhance market functioning. It should draw together current population data and future trends, socio-economic trends, commissioning strategies, market and customer surveys to lay out the changes necessary to meet the needs of the population and how responsible bodies (such as Local Authorities and Health Boards) will intervene to achieve this.
Multi-disciplinary Team: A multi-disciplinary team is a group of health and/or social care workers who are members of different disciplines and professions (for example, psychiatrists, social workers, dieticians, physiotherapists). The team’s composition will vary according to client needs and local priorities. There are examples where representatives from third sector organisations will also be involved (for example, dementia support workers). Multi-disciplinary teams are better able to respond to clients who may require the help of more than one kind of professional. They should meet regularly to discuss individual cases and to plan the best course of intervention.
My Home Life: A UK-wide initiative that promotes quality of life and delivers positive change in care homes for older people. They work with care homes, statutory bodies, community organisations and others to co-create new ways of working to better meet the needs of older people, relatives and staff. A range of information and good practice resources is available on their website http://myhomelife.org.uk/about-us/ . From June 2017, My Home Life Cymru is being hosted by Swansea University, taking over the role from Age Cymru.
National Minimum Standards (Wales): The National Minimum Standards have been used to determine whether care homes are providing adequate care and are meeting the basic needs of the people who live there. These standards, monitored by Care and Social Services Inspectorate Wales (CSSIW) cover all aspects of life in a care home, including moving in, caring for residents, safety and privacy, and complaints about standards of care. The new Regulation and Inspection of Social Care Act (Wales) 2016 will move beyond National Minimum Standards (see below).
One Page Profiles: A One Page Profile captures all of the important information about a person on a single sheet of paper. It is not clinical in focus and aims to capture information such as ‘what people appreciate about me’, ‘what’s important to me’ and ‘how best to support me’. A One Page Profile can help health and care professionals to provide better person-centred care and support. There are different formats available.
Patch-based services: A variable range of health and care services (based on local need) that are clustered together to provide related services. This can include both statutory and independent sector organisations. Patch-based or ‘cluster’ services are being promoted in Welsh policy in an effort to promote service integration and place care services together where communities can access them more easily.
PEG management: PEG is an acronym of ‘percutaneous endoscopic gastrostomy’. PEG is used where people are unable to swallow or eat enough and need artificial feeding. Some conditions affect people for a short time and other people may need a tube feed for many years. Each patient has different needs and clinicians and dietitians will formulate specific plans based on these.
Person-centred care: Person-centred care is holistic care that focuses on the individual as a person with a unique identity, needs and wishes. This approach aims to enable someone to live a fulfilled life, reinforce their sense of identity and achieve a sense of wellbeing. This includes consideration of social, physical, intellectual, cultural, emotional, health and care needs.
Polypharmacy: Polypharmacy is the use of multiple medications at the same time, which can commonly occur for older people and care home residents3. Many of these medications may be excessive or unnecessary prescriptions if residents have not been part of a regime of regular medication reviews. Concerns about polypharmacy include increased adverse drug reactions and interactions, a decreased quality of life, decreased mobility and cognition, and related higher costs.
Prevention: This is an inclusive term that describes preventative interventions which can sustain and maintain people’s health, wellbeing and independence. It is defined by Age Alliance4 as:
- Any interventions designed to reduce the risk of mental and physical deterioration, accident, disease or ill health and/or to promote long-term physical, social, emotional and psychological wellbeing;
- Services that enable people to live independently or support people to live independently for longer;
- Services that aim to promote quality of life, self-determination and community
QUIS (Quality of Interaction Schedule): This is a method of systematically observing and recording interactions whilst remaining a non-participant. It can be used as both a qualitative and quantitative tool to provide a measure of the quality of interaction between staff, residents/patients and visitors. Used effectively, it can help to identify where improvements can be made. It should only be used by people trained in its use, and should be used sensitively and discreetly with full knowledge of staff, residents and relatives.
Reablement and rehabilitation: Reablement is help or assistance to enable people to learn or re-learn the skills necessary for daily living, often delivered after a period of ill health (such as a stroke) or an accident (such as a fall). While a focus on regaining physical ability is central, addressing psychological support to build confidence, as well as social needs and related activities, is also vitally important. Rehabilitation can be part of reablement approaches, as well as a stand-alone intervention. Rehabilitation aims to optimise patient function and wellbeing, to help integrate them back into their chosen lifestyle or occupation. There is considerable overlap in the way in which these two terms are used. For information on related research in the Welsh context see: http://www.prudenthealthcare.org.uk/reablement/
Regulation and Inspection of Social Care Act (Wales) 2016: This legislation provides a revised framework for the regulation and inspection of social care services in Wales. It embeds the aims of the Social Services and Well-being (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act 2015. It includes:
- reform of the regulatory regime for care and support services;
- provision of a regulatory framework that requires an approach to the regulation of care and support services focused on outcomes for service users;
- reform of the inspection regime for Local Authority social services functions;
- the reconstitution and renaming of the Care Council for Wales as Social Care Wales and the broadening of its remit; and
- the reform of the regulation of the social care workforce
Section 27 regulations will outline providers’ duties around person centred care. For further information see: http://gov.wales/topics/health/socialcare/regulation/?lang=en
SALT (Speech and Language Therapies): These therapists provide treatment, support and care for children and adults who have difficulties with communication, and may also be involved where people have problems with eating, drinking and swallowing.
Section 33 Agreement: Section 33 of the National Health Service (Wales) Act 2006 enables Health Boards, NHS Trusts and Local Authorities to enter into any partnership arrangements to exercise certain NHS functions and health-related functions as specified in the Regulations; however, some of this has been superseded by subsequent legislation (e.g. Partnership Arrangements (Wales) Regulations 2015).
Senses Framework (or Six Senses Framework): This framework identifies six dimensions that underpin ‘relationship-centred care’ and addresses the key determinants of care for the three groups of people in the care setting: older people, families and staff. This includes:
- a sense of security (to feel safe);
- a sense of continuity (to experience links and connections);
- a sense of belonging (to feel part of things);
- a sense of purpose (to have a goal(s) to aspire to);
- a sense of fulfilment (to make progress towards these goals); and
- a sense of significance (to feel that you matter as a person).
Mike Nolan and a team at Sheffield University developed the Senses framework (2006)6.
Social Care Wales: On 1 April 2017, the Care Council for Wales became Social Care Wales. The new organisation brings together the Care Council for Wales and the Social Services Improvement Agency, combining their functions for regulating, supporting and developing the workforce and using data and research to improve practice and service delivery. Its main functions are to:
- develop the workforce so they have the knowledge and skills to protect, empower and support those who need help
- work with others to improve services for areas agreed as a national priority
- set priorities for research to collect evidence of what works well
- share good practice with the workforce so they can provide the best response
- provide information on care and support for the public, the workforce and other organisations
SOFI (Short Observational Framework for Inspection): The original framework (SOFI 1) was designed for use by the Commission for Social Care Inspection in their inspections of services for people with dementia or severe learning disabilities. It has been further developed by the Centre for Applied Dementia Studies and Care Quality Council (SOFI 2) to capture the experiences of people who use services who may not be able to express this for themselves. SOFI should only be used by people trained in its use, and should be used sensitively and discreetly with full knowledge of staff, patients and relatives.
Task-based care: A term used in academic literature to describe care that is carried out in a mechanical and institutionalised way with little or no connection to the individual concerned or awareness of them as a person. Also known as token care, task-based care is devoid of the human qualities of kindness, compassion and understanding, and is defined by a culture where residents have things done to and for them rather than with them.
1 - Richter T, Meyer G, Möhler R, Köpke S (Dec 12, 2012). "Psychosocial interventions for reducing antipsychotic medication in care home residents". In Köpke, Sascha. The Cochrane database of systematic reviews 12: CD008634. doi:10.1002/14651858.CD008634.pub2. PMID 23235663.
2 - http://www.careinspectorate.com/images/documents/168/How%20we%20inspect%20care%20services%20and%20what%20goes%20into%20insp%20reports.pdf
3 - Duerden, M et al Polypharmacy and medicines optimisation; Making it Safe and Sound Kings Fund 2013. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf
4 - Age Alliance Wales Defining Preventative.Services, 2015 http://www.agealliancewales.org.uk/preventative-services
5- The 2006 legislation has not been repealed: see statutory guidance on part 9 of the Social Services and Wellbeing (Wales) Act 2014 http://dera.ioe.ac.uk/23038/4/150505pt9guidanceen.pdf
6 - NOLAN, M. R., BROWN, J., DAVIES, S., NOLAN, J. and KEADY, J. (2006). The Senses Framework: improving care for older people through a relationship-centred approach. Getting Research into Practice (GRiP) Report No 2. Project Report. University of Sheffield. http://shura.shu.ac.uk/280/1/PDF_Senses_Framework_Report.pdf