Useful information and resources
From the Care Home Support Team
The Gloucestershire meaningful activity and wellbeing network is a network for activity co-ordinators and activity providers to meet, share information and learn new skills.
The network Facebook page is here.
The network’s Terms of Reference are available here.
An activities toolkit is available from the British Association of Occupational Therapists and College of Occupational Therapists.
Piloted in care homes across the UK, the Toolkit has been endorsed by the Care Inspectorate Scotland, English Community Care Association (ECCA), the National Association for Providers of Activities for Older People (NAPA), Skills for Care, Carers UK, Carers Trust, and the British Geriatrics Society.
Directory of Resources
This Directory of Resources (Excel spreadsheet download) is compiled by members of the Gloucestershire Activity Coordinator network and contains information as used by activity coordinators in homes throughout Gloucestershire.
Activity Provision: Legislation and Guidelines – Useful Links
The Care Home Support Team provides advice and guidance on falls prevention. The team also provides Falls Awareness training – if you’d like to request training, please complete and return this training request form.
The Falls Toolkit is below:
- Falls Toolkit Information
- Falls Flow Chart
- Falls action plan
- Falls Risk Ax
- Clinical Frailty Scale
- NHS Gloucestershire CGG Falls Protocol
- Medications that can cause falls
- Blood thinner Protocol
- Top Tips – Falls Prevention
- Falls Incident report help sheet
- Falls care plan
- History of most recent fall
- Falls Toolkit Environmental Audit
- Individual falls audit
- whole home audit
- Useful contacts
- NICE Guidance – Falls in Older People
- How to safely get up from the floor
- Getting to Grips with Hoisting (HSE)
- Make Movement Your Mission – YouTube videos
- Managing a fall that may require an ambulance during the Covid-19 pandemic (PDF download poster)
Our team primarily focuses on dementia and person centred care in care homes. There are various training packages available to care homes, to support their practice. We also have documents to support good practice in care homes available for download below.
Frequently Asked Questions
How do I refer a resident to the mental health services?
There are two routes to our community mental health nurses.
- Firstly, you can refer your resident via the GP. This will be sent to the local team, who will visit and assess the needs of that resident. They may then formulate an action plan or a care plan for treatment.
- Secondly, our team are able to visit informally to provide support, suggestions and advice. If this is insufficient, then a formal referral would be advised. Access is via the team’s single point of access – see details on the contact us page.
What do I do if I think my resident has a memory problem?
In this case, please consider referring to the team to gain support, advice and suggestions. You can refer formally or informally. Please see the information above. You can also contact the Alzeimers Society for advice, support and guidance.
It is important to know that not all memory problems mean your resident has dementia.
What do I do if my resident's behaviour changes?
It is important to exclude physical causes of behaviour changes prior to involvement of the mental health team. These include:
- Urinary Tract Infections
- Chest Infection
In addition, a GP visit is important, as he or she can exclude any other causes. After these are excluded, it is possible to access the team for advice as above. It may be helpful to have the above information to hand when the team visits to discuss this. You can also download an ABC chart to track behaviour changes and triggers during the course of each day.
ABC Incident Analysis form
Use this to monitor the triggers for certain behaviours with residents.
My resident has no relatives, friend or advanced directive, and we don't know if they have the capacity to make a decision. What should I do?
You can contact the IMCA services who will let you know if it is appropriate for them to come out and help your resident to make a decision.
Alternatively, you can contact your community mental health team, via a formal referral who may visit and assess for capacity.
The IMCA referral form is available for download below.
If your resident wants to make decisions for the future, in the event that they do lose capacity, please see the information on Lasting Power of Attorney below.
What circumstances does the Deprivation of Liberty Safeguards apply?
The circumstances are varied and individual to each resident and situation. However consider:
- Are the restrictive practices necessary to prevent harm?
- Are the restrictions proportionate to the degree of harm to the person?
Check care plan and change restrictive practices for less restrictive options.
Check care plan and apply for DoL Authorisation to the Supervisory Body.
Restriction does not need an authorisation. For example, A resident who wants to go out but needs to be escorted is restricted but not deprived. A resident who is not allowed to go out under any circumstances is deprived.
How do I make a best interests decision for my resident?
Residents are able to make decisions, however unwise, if they have capacity to do so. If they lack the capacity and you are making a best interests decision on their behalf, you must consider the following points:
- Giving equal consideration and non-discrimination.
- Considering all relevant circumstances.
- Regaining capacity.
- Permitting and encouraging participation.
- Special considerations for life-sustaining treatment.
- The person’s wishes and feelings, beliefs and values.
- The views of other people.
What do I do if we really can't cope with our resident's behaviour?
Rarely, the intervention does not work and the resident’s behaviour is not managable within the care home.
In this case, your first port of call should be the mental health team, if known to them, or the G.P. if the mental health team is not involved with this resident. They will be able to advise further action.
What do I do if my resident is sexually disinhibited?
This behaviour can be linked to particular illness and, in those cases, is to be managed as part of those illnesses.
Otherwise, it would need to be managed on an individual basis. Advice can be sought from the Care Home Support Team, via the Single Point of Contact.
What is a dietitian?
Registered dietitians are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level. Only dietitians registered with the Health and Care Professions Council (HCPC) can use the legally protected title ‘dietitian’.
Dietitians are the only nutrition professionals to be regulated by law and governed by an ethical code, to ensure that they always work to the highest standard. They work with both healthy and poorly people. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
What does a dietitian do?
Dietitians often work as integral members of multidisciplinary teams to treat a range of complex clinical conditions such as diabetes, food allergy and intolerance, eating disorders, obesity, malnutrition, kidney failure and bowel disorders. To do this, dietitians translate nutrition science into understandable, practical information about food, allowing people to make appropriate lifestyle and food choices.
Caterers can also access advice from a dietitian in order to ensure that they are meeting the nutritional needs of all of their clients, including people with specific nutritional requirements in the NHS and other care settings such as nursing homes.
Dietitians also plan and implement public health programmes to promote health and prevent nutrition-related diseases. A key role of a dietitian is to train and educate other health and social care workers.
Taken from the British Dietetic Association (www.bda.uk.com)
How does the Care Home Support Team Dietitian work?
The Care Home Support Team dietitian will focus mainly on training and education, empowering care home staff to provide appropriate nutrition support to their residents. In particular, enabling care homes to identify residents who may be at risk of malnutrition and identifying appropriate ways to treat this.
The Care Home Support Team dietitian is able to give general advice, but the process for giving patient-specific advice is currently under review.
If you would like some general advice about a resident in your care home then you can contact the Care Home Support Team on 0300 421 8293 and request to speak with the dietitian. Alternatively you can email your query to CHST@ghc.nhs.uk
Malnutrition is a serious condition that occurs when a person’s diet does not contain enough nutrients to meet the demands of their body. You could be at risk of malnutrition if you are underweight and/or have unintentionally lost 5-10% of your body weight over 6 months or less.
Identifying malnutrition using ‘MUST’ (Malnutrition Universal Screening Tool)
All Care Homes have access to ‘MUST’ training from the Care Home Support Team that will enable them to identify residents who are at risk of malnutrition and provide guidance on how to treat them accordingly.
The following links are the resources needed to complete ‘MUST’ scores for residents. Please ensure that you have followed the management guidelines fully before contacting the Care Home Support Team Dietitian for advice regarding malnutrition.
- Malnutrition Universal Screening Tool (MUST)
- Nutrition Assessment Record
- Management Guidelines
- Nutrition Care Plan
- Food and Fluid Chart
- Online calculator for MUST score
Here is a link to a useful training presentation on how to calculate MUST scores accurately and how to treat malnutrition in your residents:
If a resident has difficulties in swallowing, please refer them to a Speech and Language therapist for assessment. Details on making a referral are available online Information about the adult speech and language therapy service can be found here.
The new International Dysphagia Diet Standardisation Initiative (IDDSI) food and drink classifications are in the process of being launched in Gloucestershire. Find more information on the new IDDSI framework here.
Food fortification is the process of adding high calorie/high protein ingredients to every day food and drinks to make them higher in energy. This means that the resident will get more energy without having to actually eat more. More information is available in the publications below:
Sometimes it might be necessary to consider providing additional calories/protein in the form of dietary supplements. This should only be considered after food fortification has been thoroughly trialled and the resident has been shown to still be at risk of malnutrition.
Calcium and vitamin D
Calcium and vitamin D supplements are no longer available on prescription unless your resident meets specific criteria. Please speak to your care home’s GP or practice pharmacist for more information about this.
For more information please follow these links for the British Dietetic Association:
Water makes up two thirds of our body. It is therefore important that we drink enough fluid to maintain a healthy fluid balance.
People become dehydrated by not drinking enough fluid or by not replacing fluid that they have lost. The elderly are particularly at risk of developing dehydration through reduced thirst sensation and less awareness around the signs of dehydration.
Fear of incontinence may also mean that some elderly people restrict their fluid intake. Elderly dehydrated people are at particular risk of urine infections and falls. Fluid intake should therefore be monitored closely, particularly in warm/hot weather (British Dietetic Association, 2017).
- Fact sheet on hydration from the BDA.
- Drink tracker – useful if you have a resident who is showing signs of dehydration or you are concerned a resident is not drinking enough.
- Find the Good Hydration! implementation toolkit here.
Nutrition and Recovery from Covid-19
COVID-19 has had a direct impact on people’s ability to eat and drink, largely because 3 of the main symptoms are a sore throat, losing the senses of smell and taste, alongside feeling very unwell in those that are symptomatic. Residents are at increased risk of malnutrition following COVID-19 and therefore the Gloucestershire Community Dietitians Network have produced this information booklet.
Acute kidney injury following COVID-19
COVID-19 has resulted in a noticeable increase in acute kidney injury (AKI) and therefore it is more important than ever to monitor for symptoms of AKI alongside closely monitoring fluid intake in those residents who have had COVID-19. The below link contains useful NHS resources on AKI specifically for care homes. Please encourage your care home staff to familiarise themselves with these: https://www.thinkkidneys.nhs.uk/aki/resources/care-homes/
Pharmacists and pharmacy technicians
Care Home Pharmacists and pharmacy technicians work closely with the Care Home Support Team and are available to support managers and staff with all aspects of medicines management within the home. For example: reviewing ordering procedures, reducing medicine waste, advising on medicines policies and safe systems to reduce medication errors and providing training to staff. Pharmacists also carry out medication reviews for residents, the outcomes and recommendations are discussed with the resident, family / carer, care home and GP.
- The care home pharmacy team can be contacted by email at: firstname.lastname@example.org
- Pharmacy team referral form
Care home providers should have a medicines policy. NICE has developed a checklist for health and social care staff developing and updating a care home medicines policy. This should be used to check all the necessary information is contained in a medicines policy whilst ensuring it is relevant to the care home setting and scope of practice for the staff.
A homely remedy is a non-prescription medicine that a care home can purchase over the counter (i.e. medicines are owned by CH) for the use of its residents.
- Homely Remedies Authorisation Sheet – example sheet which can be adapted for use.
Care home providers may find it useful to look at the following resources with guidance and template policies which can be adapted for local use:
Good Practice Guidance Sheets
The team has developed the following guidance sheets. Some are still under development and will appear here when complete.
Tips For Reducing Medicine Waste
- Designate specific members of staff to order medicines
- Always check stock before ordering
- Communicate any medication changes to colleagues at hand over
- When ordering medicines, make sure you are referring to the current MAR sheet
- Keep a copy of your medicines order, and check this against prescriptions prior to being dispensed by the pharmacy (clarify any discrepancies with the GP practice)
- On receipt of medicines, check against the order and report any discrepancies to the pharmacy
- Remember, PRN (‘when required’) medicines can lead to waste, so only order what you need
- Check the expiry date of medicines
- If resident is unable to take medicines, refer to prescriber
- Record reasons for wasted medicines in your returns book
PrescQIPP has produced an e-learning course which supports the implementation of recommendations in the NICE guideline on managing medicines in care homes. It also supports statement 3 in the NICE quality standard on medicines management in care homes.
Medicines Administration for Carers – an online course available from Futurelearn
Continued Professional Development (CPD) Days
The April 2019 CPD Day presentations are available below:
- Covert Administration
- OTC, Homely Remedies and Self care
- Topical Preparations
- When required PRN medication
We offer support concerning tissue viability in care homes. These policies are available to download below:
- Wound Care Formulary
- Brief Formulary: Barrier Creams used in the Community
- The NHS Improvement guide, Pressure Ulcers: Revised Definition and Measurement
For guidance on the application of emollients, please see ‘Topical Preparations’ guidance on the medicines management section above.
For more information and to make a tissue viability referral to the Integrated Community Team, please click here.
Speech and Language Therapy
Please be aware that the Care Home Support Team does not have a dedicated Speech and Language Therapist.
A speech and language therapist can help people who are experiencing problems with:
- reading or writing
They do this by
- formal and informal assessment
- diagnosing the difficulty
- giving therapy- both specific to the identified problem and to increase functionality
- providing and training in the use of communication aids (if appropriate)
- using counselling skills
- educating and supporting family and carers regarding the difficulty and how to help
- giving training sessions
- working with other professionals
How do I access Speech and Language Therapy?
For swallowing issues, you need to ask your resident’s GP to make a formal referral to the service. This can only be done by a doctor.
For communication issues, anyone can refer to the service. You do this by contacting the Speech and Language Therapy Team
Where will I receive Speech and Language Therapy?
The speech and language therapist will initially visit you at your home. If the problem is with swallowing, we will need a referral from a doctor to see you. If the problem is with communication, the person, their family, friends or support workers can refer them. You may be invited for further therapy at out-patient clinics or you may be reviewed at home, depending on your needs.
If you are admitted to hospital the Speech and Language Therapist will see you in hospital and help to get you home as soon as possible.
Continence, UTIs and Hydration
Please contact Gloucestershire Hospitals Continence Service for any specific advice or ongoing training
The Public Health England publication, Urinary Tract Infections: A Leaflet for Older Adults and Carers.