- Paul Burstow, a former care minister, chairs the Social Care Institute for Excellence
With everything from shops and salons to cinemas and cycling, a new scheme encourages residents to take control of their lives by designing care homes
In 2012 I set out on a mission to describe what the residential care of the future should look like. I wanted to find those who had already imagined the future and made it real.
My report [pdf] recognised the sense of dread and loss people associate with care homes, and mapped out the steps government, regulators, investors and providers could take to change this.
One of my field trips took me to De Hogeweyk, a gated model village at Weesp in the Netherlands. Designed specifically for people with dementia, the first thing that strikes you is how different it is to traditional care homes. No one wears a uniform, all staff are trained in hospitality, and the village is designed around a series of streets and places. It has a supermarket, bar, shops and small-scale homes.
This approach can now be found in the UK. Homes run by WCS Care cater for 450 residents across 12 sites, old and new, with a thirteenth home recently granted planning permission. I visited its newest home, Castle Brook, which is designed around six households of 14 people, each with a kitchen at their heart. The goal of the scheme is to design a care home around the everyday rhythms of life: going shopping, doing the washing up, helping with the cooking, laying the table.
Each household cooks in its own kitchen, where there is a choice of five hot meals, and in the mornings breakfast is laid out so that residents are encouraged to do things for themselves as far as possible.
Like any care home, Castle Brook has a laundry – but with a twist. It’s run like a traditional launderette. Staff are trained to work with their “customers” so they can do as little or as much of their own laundry as they want, as part of a daily or weekly routine.
The same approach has been taken to the provision of healthcare on site, with a dedicated health clinic offering GP and dentistry services. There is a waiting room, so the experience mimics the real world as closely as possible.
In fact, only one thing was missing on my visit: the constant drone of a television. There is a TV in each lounge but they only go on when residents want it.
The philosophy behind the scheme is freedom. The culture of the home is that everything should be driven by residents’ wishes and feelings, enabling people to just enjoy life and live in the moment.
The same approach is in evidence in the spa. Residents have showers in their own rooms but the spa is all about pleasure. For a small fee, the home even provides spa “guests” with a burkini-style swimsuit or trunks.
Head outside, and the grounds include a cycle track with side-by-side tandem bike that residents can help pedal. A shop offers a range of foodstuffs, including fresh fruit and veg. The hairdresser looks just like a high-street salon and the cinema has real theatre seats with cup-holders for popcorn. WCS Care is aiming to boost the amount of time residents spend outside to an hour and a half per week.
Medicine management is another area where WCS Care is challenging the status quo. Rather than using a medicine trolley and bulk packaging, residents’ meds are kept in a safe in their room. Using the original packaging reduces cost for the pharmacy and has enabled it to afford medication management software. The result: fewer medication errors.
Technology will be central to care homes of the future. One example is Castle Brook’s use of acoustic monitoring overnight. Sensors monitor sound levels in residents’ rooms using algorithms that react to a range of noises. They then send email alerts to the monitoring station, which helps staff to assess whether any assistance is needed. This has drastically reduced the number of in-person checks, which often disturb residents. This offers peace of mind for residents and their families, and protection for staff.
One of the other benefits was a 30% reduction in the number of falls at night in one of the homes. As rooms are monitored centrally for unusual sounds, staff can respond instantly to calls for help because they are not spending time knocking on doors during traditional hourly checks.
Night-time routines are important and care homes can badly disrupt them. In one home, WCS Care found 15 residents wide awake in the middle of the night. Instead of putting them to bed, it formed a “wide awake club” and engaged with the residents, playing games and doing jigsaws, eating meals, or having manicures or their hair styled in the salon, eating meals, doing crafts and jigsaws. The goal was to help them sleep at night by readjusting their body clocks. Over a short period, the number of wide awake residents fell from 15 to just three.
Much of what WCS Care does is about changing mindsets. Great care is taken about a life well lived; the everyday rhythms of life, relationships, laughter and hospitality. By keeping these at the forefront of everything it does, WCS Care has secured six outstanding assessments from the Care Quality Commission. At the heart of this success is an aspirational service model and innovative leaders unafraid to ask the question: why not?