Safe in a Care Home? Part 2 of 2

A guest blog by George Coxon – Local Care Home Owner / Director of Classic Care Homes (Devon) and Margot Whittaker Director of Nursing, Southern Health Care Both members of the Devon Care Kite Mark Steering Group 
In part one of ‘Safe in a Care Home’ the scene was set for a more detailed exploration of what we mean by being safe in 24/7 care and some of the themes and issues this entails.
Our perception about care homes, influenced by much adverse media headlines, leads us to worry about the prospect of ‘ending up in a care home’ for fear of neglect or abuse. Yet many would argue the greater risk for older people is isolation and vulnerability in one’s own home with a common story of loneliness and preventable admissions to hospital for many.
There are several central issues that must be considered when both viewing and addressing being Safe in a Care Home

• Risk – we all take risks every day in how we live our lives. The question of what does safe mean might depend on from whose perspective we judge it – the resident or the onlooker? and therein lays one of the subjective difficulties. We always aspire to take account of the sometimes contrary nature of this.
• Choices and the Mental Capacity Act – exercising free will and giving people choices and independence does not cease when a person comes into a care home – the issue will however be influences by the MCA 5 principles – 1) assuming capacity, 2) giving people all the support needed to make choices, 3) people having the right to make unwise decisions, 4) acting in a person’s best interest and 5) any intervention must be the least restrictive so as not to prevent a level of freewill. Care homes undertake a delicate balance all of the time in how rights of the person are judged in relation to the responsibilities of the care home if things go wrong – a person in a care home would not be there if fully able to live a totally active and independent life. It’s also true that a person in older age will be dealing with a gradual, sometimes accelerated, change in capability and capacity – so a dynamic process of review of needs is an ongoing thing regarding safety.
• Culture and Values – how we apply the Institute for Healthcare Improvement (IHI)  principles of, for example, Psychological Safety in a care home context relies on a strongly bonded team ethos and belief in a culture of improvement, reflection and learning. Being receptive to ideas and making sure there is a real commitment to Person Centred Care must be an underpinning value in a safe and progressive care home.
• Partnership Working – The need to trust our fellow health and social care partners in a system that has widespread dislocation and pressure is an essential element to getting Safe in a Care Home Part one of the 2 part blog talked of a climate of blame and fear where being risk averse is the predominant position in how we work. We must not allow this to be the overriding and potentially negative ingredient in our working together. Perhaps the most crucial partnership however is that which we have with the person living in the care home and their family. It is upon this which rests our most essential success criteria not just for safety but a well lived life.
• Policies, Procedures and Paperwork – a fit for purpose workforce well trained competent and able to adhere to the copious forms of guidance and direction is an important part of ensuring safety for care home dwellers – making sure all we do is well captured in care plans and records too is part of retaining detail of care as well as communicating well with others

In terms of context the Care Quality Commission (CQC) for England regulates health and social care services and has a 5 question framework used to determine the quality of the service. ‘Is it Safe?’ is seen as the first of those questions.  We rely on a mutual understanding of the challenges to ensure safety but we are at risk of this being  the ‘perfect storm’ within the conditions we operate in, ‘allowing’ risk, but ourselves ‘at risk’ of not being Person Centred.  We want the same things – great care, freedom to choose, loving affection and happy lives for those in a care home having fun and enjoying life and as much as possible within that, being safe and secure.
Safe in a Care Home is not just possible but essential but so too is active, lively risk taking within a forum of lengthy (and often considerably expensive) learning and understanding if things go wrong.  The Care Act emphasized the word proportionality in its view on response to where things go wrong. Unfortunately, this isn’t always the case. The final words on the issue however should perhaps be always aspiring to ensure well lived lives for those living in a care home with safety being the most important of all elements.