Archive for November, 2012

How to Create a Personalised Care Plan

Do you worry that if your Mum had to go into a care home, they wouldn’t understand how she likes to take her tea, wouldn’t realise she has a favourite bed jacket etc? It is often the little things that make the biggest difference when it comes to providing care and support for an elderly person and making sure these things are documented in their care plan will help ensure they are not forgotten and give you peace of mind.

If your elderly relative requires a care service, either in their own home or a care home, the provider is required  to make a care plan by  the Care Quality Commission (CQC) who are responsible for ensuring national care standards are met.  From my personal and professional experience, this often ends up being a list of what a person needs. For example a good night’s sleep and the Why? When? and How? get forgotten. For example, think about how we like to settle for the night? Most of us like our pillows in a certain way, to have a drink and to feel fresh. If we were elderly we may like a reassuring chat before we go to sleep, the closeness of our hand being held, we may like to sleep on a certain side, and to have a hot water bottle to ease the pain in our back. We may prefer a duvet to blankets and so on. I think you get my drift!

Before a care plan can be produced it is important for have an assessment of your relative’s needs to inform their care plan. Local Authorities (LAs) are required to provide a Community Care Assessment for people who are vulnerable by way of age, disability or infirmity, regardless of whether they qualify for social care funding. So if you don’t have an assessment already you need to contact Adult Services at your relative’s LA and ask for one. Make sure you also ask for a written copy! If your relative is being funded by the NHS (Continuing Healthcare) ask the CHC nurse for a copy of their assessment instead.

Person-centred care planning should:

  • Enter the elderly person’s world and imaginatively consider the situation from their perspective.
  • Include the things that are important to them. This is especially important for people living with dementia, as they may be unable to give detailed information to carers themselves.
  • Be produced in partnership with the elderly person or if they lack capacity, with someone who knows and cares about them, such as a partner, relative or friend.
  • Be mindful of the way the person is communicated with and give them time. It is important for carers to be sure that the person understands the message and that  time is allowed to think through what has been said.
  • Provide the person with alternatives from which to choose but not too many, as it will confuse them

Busy care providers usually produce a care plan as part of their admission process or when planning service implementation. They tend to use their own template as a framework, so you will need to make them aware that you want to be included in the process. If the care plan is already in place tell them you would like to personalise your relative’s care and include the things that are important to them. This is exactly what I did for my own mother who is in a care home.

There are many different things that you would want to include for your own elderly loved one’s care plan. This is what I love about people. They are all different. There will be nearly eight billion of us by the end of 2012 and everyone unique with their own genetic make-up. How cool is that!

So keep thinking about your elderly loved one and the things that are important to them. Always keep them involved and at the centre of the planning process and they will have a great personalised care plan to guide their carers. Don’t forget to review it from time to time, as needs and expectations will change.

A personalised response to dementia care

When my mother was first diagnosed with dementia over 20 years ago, our world was turned upside down and presented one of the greatest challenges we have ever had to face. My father was in good health at the time and managed to minimise its effects on the rest of the family. However,  as the years rolled by and his own health began to deteriorate, I became increasingly involved with managing their care until it all got too much for my father and my mother had to move into a specialist care home for people with dementia.

One of the most Important things we did for my mother was to personalise her care plan and keep it updated..

It is so important for people with dementia to have a good person-centred care plan, regardless of whether their care is being delivered in their own home or in a residential setting. It is a vital tool for carers who rely on care plans to inform them about the individual.

When we recently updated my mother’s care plan, we included brief information about her personal history such as her previous occupation, hobbies and interests, likes and dislikes as well as how her health and well being needs will be met.

We developed the care plan together in a pretty album that includes photographs to illustrate her life and the things that are important to her as well as the things that are important for her. Here are some of the things we included. 

  • The need to keep calm around my mother as she can become anxious. Staff are reminded that people with dementia are generally very sensitive to feelings and can sense if others are in a rush.
  • As my mother has been plagued with depression for most of her life and especially low since my father passed away, she needs help to focus on the good times and happy memories. To help with this we put together a life storybook with carefully chosen photographs of family holidays, Christmas, birthdays and other significant events, in chronological order. Staff are encouraged to go through this with her when her mood is low, to help focus her mind on more positive memories.
  • Terminology is very important to my mother. Her dislike of the care home where she lives being referred to as her ‘home’ is documented in her care plan and carers requested to avoid using the term as it upsets her.
  • My parents enjoyed a glass of wine with their meal for many years and carers are reminded to give her a glass of wine (provided by family) with her main meal each day.
  • Staff are reminded to put my mother’s iPad on charge at night and remove it when they get her dressed in the morning. We use “Mindings’ a software programme that enables the family to remotely update her calendar, send photos and text messages and see what the family are up to on Facebook. Social tele-care helps older people keep up to date with family life.

These are just a few of the many issues that combine to make my mother’s care personal. She, like every other older person with dementia, deserves nothing less.


Caring for elderly relatives in the winter season

Caring for elderly relatives is important at any time of year, but when temperatures plummet and weather conditions are less than favourable this becomes even more vital. The winter weather poses a number of risks to all individuals, but those in their later years are often the most susceptible. Limited mobility is obviously a huge disadvantage when it comes to navigating icy paths.

Food and Warmth

Widespread financial issues left many older people with a difficult choice to make last year: eat or heat? Energy price hikes occurred across the board, with suppliers raising both their gas and electricity rates by considerable amounts.

This made it increasingly difficult for older people to afford what is after all, a basic amenity and a shocking number were expected to abandon heating altogether. A report in The Guardian from last winter detailed how Age UK predicted this action could lead to as many as 200 deaths per day, revealing that there had been over 26,000 excess winter deaths in the preceding year (2010-2011)

To prevent a similar situation arising this year, families are being urged to consider these basic needs when caring for elderly relatives. If you are worried that someone you know may struggle to afford food and warmth, then offer assistance.

This doesn’t necessarily mean paying for the services out of your own pocket, but could simply equate to helping am elderly loved one use their heating more efficiently in order to reduce their energy consumption and the bills associated with it.

Investigating whether they could benefit from changing energy suppliers or tariffs could also prove beneficial and looking into government incentives such as loft insulation, cold weather and winter fuel payments can also be helpful.

Health and Companionship

Perhaps the biggest problem experienced by the elderly over winter is deterioration in their health – both physical and emotional. Make sure you keep an eye on your relatives by visiting them regularly. This will help you detect any potential health risks early on whilst protecting their emotional health by providing companionship.

Routine vaccinations such as the flu jab are important defences against winter illness, so make sure your elderly loved ones are up to date with this protection. Ensuring they have appropriate winter clothing, such as thick coats and shoes with plenty of grip, will also help to ensure that they remain mobile over the winter – giving them the support and care they deserve. If your elderly relative is immobile then ensure they have the care and facilities, such as a stairlift, to remain active and to ensure have independence.


Unfortunately, the onset of the Christmas period means that our homes become bigger targets for thieves. This can make some elderly people feel vulnerable and concerned about leaving their homes unattended – thus negatively affecting their quality of life.

To combat this, make sure that adequate security systems are in place. This could be anything from investing in alarm systems to fitting decoy cameras and other burglar deterrents. If there is a neighbourhood watch association in the local area then make sure you speak to them in order to get additional protection for your elderly relatives.


Hearing Loss in older people

Today we have a guest blogger, Joan McKechnie BSc Hons Audiology & Speech Pathology, who is going to tell us about  hearing loss in older people. As my mother has a severe hearing impairment, I know first hand, just how challenging it can be.

Age related hearing loss, or Presbycusis as it is known medically, describes a natural decline in hearing ability and is likely affect you or someone you know at some point in time. The degree of any resulting hearing loss will vary from one individual to the next depending on a number of contributing factors that will be listed later on in the article.  Some individuals will be able to overcome this impairment by making simple lifestyle changes others will require the intervention of their GP and other healthcare providers. Sadly, there is also a small group of individuals who choose simply to just live with it, thereby accepting diminished hearing as a condition that they can do little about.

How Widespread Is Hearing Loss?

Until just a few years ago, the precise figures were unknown and there were only estimates based on other Western Countries. In 2005 the then RNID (now ‘Action On Hearing Loss’) a charitable organisation working on behalf of the UK’s hard of hearing, conducted a survey involving a focus group comprised of 20,000 participants.  It concluded that over 9 million UK individuals are thought to present the symptoms of hearing loss, amongst this group over 6 million are over the age of 65 amongst which age related hearing loss is the most common contributor to diminished hearing. Estimates today project the figure of hard of hearing to reach 14 million by 2031.

How We Hear?

 The hearing process is complicated and includes a number of organs and the brain working as one unit. Simplistically it captures sound (waves or vibrations in the air) via complicated structures in the ear that are sent to the brain to interpret. The inner ear contains many tiny hair-cells that pick up sound waves that are sent to the brain by means of the hearing or auditory nerve. When these reach the brain, they are ‘translated’ into meaningful information that makes sense to us. As the body matures, roughly from the age of 40 years old (but more commonly after the age of 65 years old) these hair-cells naturally die, become damaged or experience an overall decline in quality. The body is unable to regrow these hair-cells so without further intervention hearing won’t improve. Due to this inability to regrow hair-cells, age related hearing loss is permanent.

 The level of hearing loss will vary between individuals based on:

  • Family history as age related hearing loss tends to be hereditary
  • Exposure to harmful noise during our lifetime (NIHS – Noise Induced Hearing Loss)
  • Smoking
  • The amount of hair-cells that are no longer effective

 Common symptoms include:

  • Not being able to hear the telephone or door bell ring when others can
  • Sounds seem less clear
  • Other people may sound mumbled or slurred
  • Inability to hear high-pitched sounds such as “s” and “th”
  • Often having to ask people to repeat themselves
  • Having to have the television or radio turned up much higher than other family members
  • Feeling tired after participating in a conversation held within background noise

How To Manage Hearing Loss?

The date, there is no ‘cure’ to rectify the causes of age related hearing loss but there are means to manage the condition. Some means are even free from the National Health Service so there is really no reason to ‘just live with it.’

As with any type of medical concern, you must first seek the professional attention of a health care provider. Your GP or your local high street hearing centre will be able to conduct a hearing test. A more detailed test will be preformed at the local high street hearing centre, however your GP may well refer you to the local hospital audiology department for further checks. When the precise cause and level of the hearing loss is established, you will be presented with a number of solutions to mange the condition. These solutions are designed to overcome hearing impairment by amplifying sounds using a number of devices.

The most common are hearing aids. These microcomputers reside around or in the ear and amplify external sounds. Hearing aids are available from private companies and from the NHS (models are limited and a waiting period may apply). Even in these challenging economic times the NHS still retains its promise to supply hearing aids at no cost, which is a great credit to its governors.  Another group of devices used to manage hearing loss is made up of daily devices that have been customized for use by the hard of hearing. Such devices (commonly referred to as ALDs or Assistive Listening Devices) include phones for hard of hearing, amplified alarms and doorbells as well as aids to watch TV at the correct volume.

Hearing loss is a type of sensory impairment that can be managed. Just living with reduced ability to hear can reduce quality of life for you or for your loved ones and can easily be rectified and improved.

Article written by Joan McKechnie BSc Hons Audiology & Speech Pathology. Joan works for Hearing Direct and she writes a weekly blog about hearing loss.