We are often asked by our customers to provide some guidance on improving quality assurance procedures for compliance purposes, in addition we are asked for advice on improving innovative Person-Centred Care.
They are often sceptical when it comes to looking at the comparison of CQC Ratings, Occupancy and Income. We at RedRoyal Consultancy Ltd carried out our own piece of research to produce some facts that would provide comparative figures.
Our research was conducted by using the CQC Reports, taking the first ten from each rating, Outstanding, Good, Requires Improvement and Inadequate. Using the reports, taking two figures, registration for the number of residents and the occupancy at the time of the inspection. Any report that did not clearly display both figures was disregarded, and we moved to the next report. A total of ten reports were viewed for each of the ratings to provide a small sample of Occupancy rates for each graded category.
The figures below were produced on the 21st March 2019 giving a clear indication that occupancy rates are closely linked to the CQC rating.
Table 1 indicates the Occupancy rate by percentage by CQC Grading.
Table 2 shows the numbers recorded by category.
Table 3 is a guide that provides an insight into the loss of potential gross income resulting from lower occupancy rates per resident, with a weekly charge of £500.00.
Table 4 shows the same loss of income based on a weekly charge of £500.00 per resident in Residential Care Home that is registered for 30 residents.
In this example the losses that correspond directly to the lower occupancy rates and accumulate to a massive £239.850.00. If a service is charging £900.00 per week this loss could be increased to £431,730.00. This in my opinion can be the direct cost of not investing in quality Person Centred Care, though this is not the subject of this research the CQC Inspection is based on the delivery of High-Quality Care that should be Safe, Effective, Caring, Responsive and Well-led.
Our research clearly demonstrates the links between CQC Ratings and Occupancy, as the CQC Rating is based on the standards of care delivered it should be assumed this is the direct cause of the reduced occupancy and income. Look at your potential customers, and the journey they take as they choose a care home for their loved ones?
Research will take place, they may compare Care Homes in the area and if yours requires improvement or is inadequate, and just down the road there is an outstanding Residential Care Home, which are they most likely to choose?
There is a clear connection between CQC Ratings and Occupancy rates which in turn are linked directly to the loss of potential income. In any business there is a need to continually evolve and develop which involves some continued investment.
For example take a quick look at our roads which are extremely well developed, yet with out continued investment they literally fall apart, I’m sure I don’t need to mention pot holes.
With some ongoing Investment, High Quality Reviews of your provision against recent developments, Innovative and Person Centred holistic Care for Health and Wellbeing, Outstanding is the basic standard that should be achieved by Residential Care and Nursing Homes.
Person-centred care for individuals with dementia
Person-centred care simply means putting the individual at the centre of everything that you do. Initially this means an in-depth assessment of care needs, their interests, abilities, history including a full life story, relationship needs, preferences, personality and anything that can affect the individual’s wellbeing. This should include favourite music, tea or coffee, make up, shower or bath, anything that gives a feeling of wellbeing and identity.
Person-centred care helps to keep individuals connected with positive activity and routines ensuring people with dementia can take part in the things they enjoy, this of course is why a detailed assessment and care plan is so important. This can be effective in preventing and managing behavioural and psychological symptoms of dementia by reducing anxiety, distress and confusion.
There are key points to consider with person-centred care.
Treating the individual with dignity and respect.
Looking at situations from the individual’s point of view and understand their experience.
Ensuring there are opportunities and support to try new things and take part in activities that give stimulation and enjoyment.
Family and carers should provide their knowledge and understanding of the individual as this is extremely valuable and, combined with the individual with dementia (where possible) should always be involved in developing a care plan based on person-centred care.
Changes in Behaviour
Sudden changes in behaviour are often caused by physical health problems – especially when the person seems to be more agitated, confused or distressed.
It’s always advisable to visit the person’s GP to rule out any physical problems including infection, pain or constipation reviewing all the individual’s medication.
Mental health problems including depression and anxiety, may also contribute to changes in behaviour. These can often be managed with medication and non-drug strategies. These can often include taking more time to understand the cause of the distressed behaviour and providing support in a different way. Changes of this nature requires regular review which must be reflected in the updated Person-Centred Care Plan.
Reducing behaviour that challenges
Meeting the needs of an individual with dementia can help reduce behaviours that challenge.
Some examples may include:
Maintaining relationships with other people
Giving encouragement to do things they enjoy or interests them
Changing the environment. For example, reducing noise and improving the lighting, using colour contrast for easy identification, changing handles for easy grip.
Keeping familiar, personal familiar items close to them, such as a favourite scarf or keepsake.
Keeping their bedroom comfortable – for example, making sure it isn’t too hot or cold and has familiar items.
Allow them to live in their experience. For example, if they believe they need to go and collect their car from the garage, don’t argue. Instead acknowledge them, agree and ask for more information and gently take their thoughts somewhere else.
When an individual’s behaviour becomes challenging, there are numerous ways to support them. You should always remember that the individual is having a hard time, not giving you a hard time!
The care worker should always consider:
1 The cause of the problem:
Is it the individual with dementia that is causing the problem?
Is it the interaction with other people?
Is it the person’s living situation?
Is the individual in pain?
Are they getting bored?
Are they comfortable and stimulated?
2 Look at the situation:
Where or when does the problem happen?
Does the person always act in the same way in the same place?
Is the behaviour triggered with the same person or in similar circumstances?
Look for patterns in the behaviour in the daily notes, everything that was going on at that time that could have triggered the behaviour and should written in the daily notes.
3 Look at how the individual is feeling when they behave this way:
They may be unwell, in pain or uncomfortable?
May be getting too much stimulation, confused, scared or frustrated?
They may be depressed, anxious, having delusions or hallucinations?
Lacking stimulation, feeling bored, lacking in social contact and becoming isolated?
4 Identify anything the person could be reacting to:
Use what you know about the individual from the in-depth assessment and Person-Centred Care Plan to explore the cause of the behaviour:
Antipsychotic drugs may be prescribed by a doctor in some circumstances, for instance if there is evidence of delusions or hallucinations and the person is severely distressed, or if there is a risk of harm.
The Person-Centred Cared Plan
The Importance of the (Pre) Admission Assessment and the Person-Centred Care Plan cannot be over emphasised, the care plan can only be as good as the information it is based on. If there are gaps in this information, with the best will in the world, the care will be lacking and can cause considerable distress, anxiety or depression as a result.
Care plan reviews are required on a regular basis, and should certainly reflect any recent changes in mobility, nutritional requirements, changes in health or behaviour. Care provision must be based on the needs of the individual today. Needs can, and often do change rapidly.