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Best Practice in Care Environments: Seeing People in Later Life as Individuals, Not as Conditions

Professor of Nursing at City, University of London and executive director of My Home Life, an initiative that promotes quality of life and positive change in care homes, Julienne Meyer is passionate about best practice in care environments. We talked to her about the importance of relationships of all kinds in the care space - and the positive power of involving people in their own care decisions.

What inspires you about working in the later life space?

I’m passionate about inequalities, and you’ll always find me working at the margins. I feel the need to champion older people’s issues because I think ageism is rife in our society.

It’s probably not surprising then that I’m working with frailty and dementia, in care homes and at the end of life – I’m always looking at the sorts of places where not everybody chooses to go.

I think increasingly people are recognising the ageing population is presenting challenges that we all need to be thinking about and addressing because it’s going to affect us all. It’s not a case of “them”. Ageing is actually about “us”.

In terms of inequality, is there a sense that older people don’t often have a voice, especially in the case of their care needs?

Yes, because we’re an ageist society, we tend not to see older people as individuals, and really listen to what their needs might be. There are many other contributing reasons too – one of those being that not everybody wants to engage with this, possibly because they fear their own ageing and frailty. I think sometimes people don’t want to think about it until it affects them personally.

A lot of my work is about awareness and helping to see people as individuals, rather than as conditions. I look at the importance of involving them in decision-making about finding out what they want and what matters to them.

"For person-centred care to be delivered, we’ve not only got to think about the needs of older people but also, the needs of relatives who visit and the staff who work there."

What is the biggest area for improvement in care at the moment?

Well, we have to recognise the funding crisis, which is just massive. That has to be the biggest issue to be addressed and improved. But for me, improvement is also about what we can do in the situation in which we find ourselves now.

People talk about person-centred care, but I don’t think we’ll ever really get to that unless we pay attention to relationships between residents, relatives and staff. I do a lot of work in care homes, and I feel that for person-centred care to be delivered, we’ve got to not only think about the needs of older people but also, the needs of relatives who visit and the staff who work there.

If we don’t think about the needs of staff, how are they going to meet the needs of residents and relatives? We’ve got to value and respect the work that they do because often the care workforce is very marginalised and stereotyped.

We also need to think about the relationships between care homes and their local communities and help the public engage with care homes more. And we need to think about care homes and the broader health and social care system, and how we can better support care homes to deliver quality services for older people.

What are the principles of best practice for you?

I’m drawing on the work of My Home Life here because that’s been a big focus for the last ten years, but I’ve worked in all care environments, and I think best practice is a set of principles that can be applied across a whole range of settings and ages.

My Home Life draws on four conceptual frameworks, and one of those is about developing best practice together. We pulled together the evidence for best practice at the start, by asking ‘What do we know older people want and what works?’

"Everyone’s business should be connecting with the most vulnerable citizens in our society - and there’s lots that we can learn from doing so."

Within these there are eight themes, three of which I’ve already mentioned – maintaining identity, sharing decision-making, and creating community. The others are about managing transitions, improving health and healthcare, and supporting good end of life. We also need to think about keeping the workforce fit for purpose and promoting positive cultures.

Another framework draws on Mike Nolan’s work, looking at how what individuals have to say matters to them. He themed it around the fact that intrinsically, we all – whether you’re a resident, a relative, staff member or visiting student nurse – have a need to feel a sense of security, belonging, continuity, purpose, achievement and significance.

So we use that framework and encourage care home managers to think about it in care planning, appraisals, or in their interaction with relatives.

A third conceptual framework is focused on appreciative inquiry – and pays a lot of attention to the use of language. In traditional problem-solving scenarios, instead of seeing things as problems, the conversation begins with what’s working well and asking how we support that to continue. We can then envision how we’d like things to be, and how to work with others to realise that vision.

The last framework is about having caring conversations, and I think this is the most important one because if we all did this, the other frameworks would probably fall into place.

This draw’s on Belinda Dewar’s work and places emphasis on celebrating what’s working well, connecting emotionally and asking people about feelings, because we often don’t. I think having caring conversations helps us not only to find out what individuals want but can guide how we work together to deliver that. We need to be more curious and less judgemental.

Follow Julienne Meyers on Twitter HERE.

Julienne is a Professor of Nursing at City University of London.

Do you think we need more celebration and positivity around the work that is done in the care community?

Absolutely! It’s the little things that count, and sometimes people become very disempowered to care because they feel overwhelmed by the system. Yet actually, if we pay more attention to these little things, which are so often within our grasp, they can make a big difference.

How important is collaboration in delivering best practice in care?

I don’t think the care industry is naturally collaborative and what we’ve seen over the years, as a result, is an increase in a specialisation that has forced people to work in silos.

Now we are realising we need to break those silos down, and to collaborate much more, because we’ve got an ageing population, members of which are likely to have multiple things wrong with them – and they can’t have specialist teams going in to look at just one bit of them.

We’ve got to see people as people, and deal with their whole condition – and that is about health and about social care.

Do you think there’s an issue with a lot of research into best practice still staying quite theoretical?

Researchers and academic organisations often write for each other, and we get measured by our peer-reviewed academic papers. However, out there in the real world that is not necessarily what people are interested in. I think the academic world is waking up for the need to have more impact on the ground. But we’ve got such a long way to go.

One of the things I learned at the beginning of my research career was when I was feeding study findings back to multi-disciplinary teams, people really engaged and listened when we were able to communicate what the older people had said in their own words.

Researchers have got to be more creative about how they get their messages across, and for us, at My Home Life it is very much about storytelling and stories that come from the perspective of residents, relatives and staff - and those stories must be real.

The other thing is that we also need to learn from practice. Often out there in practice, people are having to work, in the absence of evidence. We need to learn from what people do and find out what they learn from what they do. It’s not just about academic research; it’s about practice-based research.

What area of research would you like to see more focus on?

Where I want to move to next is learning and understanding much more about community engagement with care homes. This includes how we can help the public engage with care homes more in the community – and I think by doing that we will see benefits, not just for residents, but for the public too.

We’ve got a social responsibility. Everyone’s business should be connecting with the most vulnerable citizens in our society - and there’s lots that we can learn from doing so.

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