What I do is who I am - the importance of activity in care homes
Occupational therapists help people to carry out essential occupations - the activities that make up our daily lives - from washing and dressing, the weekly shop, visiting friends and all the things we enjoy in life.
For older people occupations are vital for health, social inclusion, and mental wellbeing, but may become more difficult due to increasing frailty. Geriatricians will be all too familiar with the serious risks of immobility.
The College of Occupational Therapists, like the British Geriatrics Society, firmly believes in equal access to health and social care and developed the Living Well Through Activity in Care Homes Toolkit to ensure that people living in care homes have the same access to occupational therapy as those living in their own home. The resource is part of the College’s wider aim to champion dignity, choice, respect and control for older people, recognising occupational therapists’ unique skills in enabling occupation and understanding how dementia, co-morbidities, and other factors such as poor vision, impact on activity participation.
The Living Well through Activity in Care Homes Toolkit has been endorsed by the British Geriatrics Society and nine other sector organisations: the Alzheimer’s Society; Care England, Care Inspectorate Scotland; NAPA; Skills for Care; Carers Trust; Carers UK; Carers Wales; and Age Cymru. It supports the wider health and social community to increase activity in care homes and is divided into specific sections for care home residents, their family and friends; care home staff; owners and managers; inspectors; and occupational therapists. So far over 1,700 care home managers and staff have pledged their support.
More than the basics
A whole systems approach is needed for effective commissioning and provision of residential care which focuses on prevention, reducing unplanned admissions to hospital, and facilitating quick and effective discharge into a care home setting. Discharge must take into account someone’s immediate and ongoing occupational needs as key to choice, control and independence. Good residential care is more than providing a bed, attending to basic needs such as washing, dressing, toileting and administering medication – it must provide opportunities for occupation, a fundamental human need.
If we are aiming to deliver the minimum appropriate intervention - then it is in all our interests to keep older people as active as possible and maintain their existing skills and relationships. The prevailing culture in care homes is that older people are there to be looked after. Traditional models of looking after someone does not preserve a person’s strengths and skills and can often have the opposite effect- if you don’t use it, you lose it. But given the typical profile of an older person living in a care home, is it realistic to expect care home staff to have the knowledge and expertise to address complex needs, understand how to adapt their approach and the environment to support someone to be active?
Activity also acts as a measure of good care. It gives staff information about a person’s wellbeing, how symptoms may be affecting them day to day and their experience of pain. Less activity may be due to lowering of mood, energy levels and a sign of infection or increase in pain, enabling staff to spot the signs of potential decline and decompensation before it occurs. However, care home staff need training and support to pick up on changes in activity.
The Toolkit explores how to evaluate a service’s existing culture and possible actions. For example implementing supervision and training for care staff to understand how to reflect information gathered about a person from their life history and how to translate this into to day to day living. Other areas of care include balancing risk and choice, how to adapt communication and how to motivate residents, as well as ideas on how staff can integrate enabling activity into their daily practice.
Occupational therapists are uniquely placed to promote engagement in activities; by giving information and advice on appropriate equipment or adaptations, modifying the environment, manual handling, teaching safe techniques and supporting care staff to integrate activity into care planning and delivery.
Across the UK the College of Occupational Therapists is collecting examples of how the Toolkit is being implemented effectively and it is has already been recognised in the NICE Quality Standard for Mental Wellbeing of older people in care homes. By making activity a priority and integrated part of care home life, as well as embedding it more widely across health and social care, we can make a real difference to the day to day lives of our ageing population.
To view the Free Living Well Through Activity in Care Homes Toolkit visit the College of Occupational Therapists’ website http://www.cot.co.uk/living-well-care-homes
Senior Communications Manager
College of Occupational Therapists