Standards of care
The Department of Health, Social Services and Public Safety’s service framework for older people outlines the standards which they and their families can expect from Northern Ireland’s health and social care services.
Person-centred care
“All older people should be treated as individuals,” the framework affirms, explaining that this means full involvement in making choices about their own care and treatment and control over the way in which this is delivered. It follows that all older people should expect the same “opportunity of access” to assessment, care and treatment as the rest of the population.
It is the responsibility of all health and social care organisations to ensure that their communication is effective, whether to patients, social care clients or carers. Each health and social care trust should have at least one service level agreement with the voluntary and community sector, to provide information, advice and advocacy services.
Improving health and social well-being
These standards firstly emphasise the need for people to receive evidence-based advice, information and services – including advice on diet, body weight and dental health.
A healthy lifestyle needs to start much earlier in life. As of 2011-2012, only 26 per cent of men and 36 per cent of women were eating five portions of fruit and vegetables per day. More recent statistics are not yet available but the Public Health Agency wants to increase this by 1 per cent per year.
Falls are a particular risk for older people but can be prevented by strength and balance training and a generally more healthy and active lifestyle. Older people who have been in contact with health and social care services should be routinely asked about whether they have fallen over the last year and receive appropriate advice.
Safeguarding
Health and social care organisations need to put out a clear message that the abuse of older people is “unacceptable and will not be tolerated.” This is backed up by prevention plans, an alertness about situations where exploitation and abuse are taking place, and peer advocacy – whereby other older people support those who have been abused, exploited or neglected.
All procedures for tackling abuse should include timescales for responding to allegations. An adult safeguarding forum, to be fully established by March 2016, will give older people a say in how safeguarding services operate. In the meantime, all parts of the health and social care system and its contracted service providers are already expected to have safeguarding policies in place.
Managing care
Medicines should be “appropriate, safe and effective” and reviewed systemically to ensure that they are still correct for the patient. This review should be offered annually when an older people is receiving four or more medicines or living in a care home.
On the “transitions of care” theme, older people should be provided with single point of contact for information and advice when they start to require care. After this point, they must be offered a period of reablement. If this does not prove effective, the older person will be assessed for longer term support, with an emphasis on identifying health problems at an early stage.
A documented discharge plan should outline the communication that has taken place with the patient, his or her family, and health professionals outside the hospital. The importance of palliative and end-of-life care in nursing homes is affirmed and each older person with those needs should have a key worker who has overall responsibility for their care.
Accountability
The older people’s service framework was published in September 2013. The other service frameworks cover cancer, circulatory and respiratory conditions, mental health and learning disabilities – a final one for children and young people is currently being prepared. Queries about the standards and their effectiveness can be sent to the Service Frameworks Development Unit, which can be contacted on 028 9052 8283 or by email: serviceframeworks@dhsspsni.gov.uk
Carers
An older person’s carers should be identified at the earliest possible opportunity and health professionals are asked to take a particular interest in older carers. GPs have an important role here as they are more likely to be in contact with older carers whose own health is under pressure.
The department has produced a general A-Z guide for carers (March 2010) and expects trusts to produce up-to-date local information packs for carers in their areas. Trusts will also produce a communication plan to demonstrate how staff and carers are being made aware of the relevant information.
All carers should be “signposted” to organisations which can provide financial advice and they also receive timely respite breaks. While a shortage of respite breaks has been a problem for several years, the department has not yet estimated how many carers need or receive those breaks; this information should be available from next March.
Carers will also be encouraged to attend training e.g. on the manual handling of the person receiving care, stress management and identifying the symptoms of ill-health. The framework emphasises that carers should be viewed as “equal partners” in the care of the older person.
Common conditions
Older people are more likely to experience falls, delirium, incontinence and dementia. All older people should be assessed for the risk of falling and those admitted to hospital after a fall should receive a fracture assessment within 72 hours.
Each trust should have a specialist professional for continence and all older people who experience a major health crisis should be assessed for delirium. A small minority of patients with delirium may need specialist treatment but most can receive the right care outside an institution.
GPs will identify older people with advanced dementia and ensure that they have an advance care plan within three months of their diagnosis.
All older people who have a sudden and unexplained deterioration in their mobility should receive a ‘comprehensive geriatric assessment’ and be referred to reablement services, where appropriate. Reablement involves help from an occupational therapist with the aim of helping the person to become mobile and independent again.
