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Inpatient rehab

Adventures in VR for care home residents

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Having fun in the snow and touching the clouds are some of the ways that residents at Exemplar Health Care’s Ribble View care home are using virtual reality technology to relax during lockdown.  

The team at Ribble View, alongside experts from Rescape Innovation, have been using virtual reality (VR) technology, DR.VR, to support therapy sessions in the home in Preston. 

This is part of Exemplar Health Care‘s commitment to investing in the latest life-enriching technology to make every day better for their people. 

Over the past few months, the therapy team at the home has been working with individuals to explore their likes and interests, and tailoring the VR experience to their personal choices.

Individuals can choose from a range of pre-loaded films that are shot in 360 degrees, so that once the headsets are placed over their eyes, they can be fully immersed into a ‘virtual world’.  

Lindsay Abraham, home manager at Ribble View, says: “Before we begin a session we talk to the individual to find out what they like. 

“If someone’s a keen traveller, we can load videos of famous landmarks onto the VR headset, so they can travel around the world from the comfort of their home. 

“The technology allows people to see a 360-degree picture and be fully immersed into the virtual experience.” 

Since the introduction of VR technology at Ribble View, the team has already seen lots of benefits. 

Pamela Hicken, therapist at the home, said: “VR has been well received at Ribble View. Some of our residents get very excited when they see me walking down the hallway with the headset.

“Everyone that’s used it has given positive feedback, and for many of our residents, it’s helped to reduce anxiety and pain. 

“We used the VR headset with one of our residents who was experiencing anxiety. Before the session, they rated themselves as 7/10 for anxiety and 4/10 for pain. 

“During the session, we used a calming snow scene on the headset, and incorporated massage and breathing exercises into the session, and we could see the individual become more relaxed throughout. 

“At the end of the session, they’re anxiety score decreased to 3/10 and pain score to 3/10, and they commented that they found the session very ‘relaxing’.” 

 VR can also be incorporated into physiotherapy sessions to support rehabilitation and mobility. 

Pamela continues: “For residents with athetosis, we’ve seen that their movements have become more purposeful, and residents with limited arm movements have been reaching out to touch things.

“We used the headset with one resident who has limited mobility, and they were moving their neck to look in different directions, and reaching out with their hands. 

“Throughout the session, they made comments such as ‘I want to do it every day’ and ‘this is heaven’. By the end of the session, their anxiety score had reduced by two points.” 

The benefits of virtual reality technology in care homes

DR.VR is a virtual reality distraction therapy that can support pain management and reduce stress and anxiety. 

It uses a headset, which, when worn, transports people to a 3D computer generated environment and immerses them into a virtual ‘world’. 

The technology can provide a safe and therapeutic experience for adults living with a range of neuro-disabilities and mental health needs. 

Adding these meaningful experiences into people’s everyday lives can bring huge health and wellbeing benefits. 

Research also shows that DR.VR can be effective in managing pain, anxiety and stress – the technology transports people to another environment, place or time, which can distract them from their current pain or stresses. 

Clinical nurse manager, Shannon O’Dea, says: “For our service users when they are struggling, DR.VR will help to deescalate and redirect when the environment is too stimulating. DR.VR allows them to get to their safe space through guided meditation, relaxation or distraction.”

About Exemplar Health Care 

Exemplar Health Care is a leading provider of specialist nursing care for adults living with a range of complex and high acuity needs.

They have over 32 community-based, specialist nursing homes and OneCare services which provide person-centred care and rehabilitation that focuses on maximising independence, building everyday living skills and empowering people to live as fulfilled lives as possible.

They support people on their journey from being in hospital or living in a secure setting to community-based living, as well as offering longer term support for people living with degenerative or life-limiting illnesses.

Read more about Exemplar Health Care. 

Inpatient rehab

Exemplar Health Care celebrates first cohort of nursing associates

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Specialist care provider Exemplar Health Care is celebrating its first cohort of nursing associates – a role vital to the development of the nursing workforce. 

In 2019, nine trainee nursing associates, who worked in frontline support roles across four of Exemplar Health Care’s then-32 care homes, started their two-year apprenticeships at the University of Sheffield. 

Since then, they have completed the programme, delivered via an apprenticeship route, which involves attending university alongside on-the-job learning in an Exemplar Health Care home and completing placements in other health and social care settings.

In November, two years later, seven Exemplar Health Care colleagues celebrated graduating from the programme and qualifying as nursing associates.

This group of learners will be the first colleagues to work in the company’s newly-formed nursing associate role. 

About the nursing associate role

The nursing associate role was introduced by Health Education England almost three years ago. It was designed to bridge the gap between healthcare support workers and registered nurses, and help build the capacity of the nursing workforce, providing a progression route into graduate-level nursing for those wanting to continue learning and develop their career.

Exemplar Health Care’s head of learning, culture and engagement, Claire Fretwell, says adopting the role will help grow talent from within, support retention of care colleagues and offer service users continuity of care.

“Many health care providers continue fishing from the same pond of qualified nurses,” says Claire.  

“However, the current talent pool does not offer enough registered nurses to enable us to keep delivering the highest quality of person-centred care that we aspire to provide for all our service users, and support the ambitious growth of the company.

“The trainee nursing associate programme enables us to develop existing colleagues, so that we can continue grow our nursing workforce internally.”

Overcoming the challenges of the pandemic

During the pandemic, learners on the trainee nursing associate programme have overcome the challenges of not being able to complete face-to-face learning and doing placements in a range of health and social care settings.

They’ve utilised online platforms such as Zoom, Microsoft Teams and Google Meet to attend lectures and meetings.

Many of the trainees also have young children, which made the balance of juggling home schooling with full time education and on-the-job learning, much more difficult.

Victoria Parkes, senior practice learning facilitator at Exemplar Health Care, shares: “The pandemic stopped placements for a time, which meant organising alternative opportunities for our learners, to ensure that they met the programme requirements for qualification.

“All graduates have had to juggle family life, learning and working though this pandemic.

“They have met these challenges head-on and have shown dedication, commitment, resilience and amazing strength throughout difficult times.

“They really have given their all and we would like to express our admiration in all they have accomplished.

“I am proud to have supported them over the last two years, and know they will do some amazing things in their new profession as Exemplar Health Care’s first nursing associates.”

Learn and earn as a trainee nursing associate

The trainee nursing associate programme gives colleagues the opportunity to continue learning and progress in their career, whilst still working and earning a wage.

This is what attracts a lot of people to do the programme.

“When I heard that Exemplar Health Care were offering an opportunity to boost my skills in care, I jumped at the chance,” said Gemma Walker, a recent graduate from Dearnevale.

“I’ve got a mortgage and a family to support. I’d never be able to train as a qualified nurse by taking three years out of work to be at uni. So, training as a nursing associate while staying in my role means I can learn and earn – which is key for me.”

A route into nursing

The trainee nursing associate programme and nursing associate role is a great route into nursing for those who are interested in progressing their career.

Jack Cooke, one of the recent graduates, shares: “When I started my career with Exemplar Health Care, I had great career ambitions. After 18 months of working as a support worker, I applied for the role of team leader.

“And when the company started offering the trainee nursing associate apprenticeship, I knew that I had to apply.

“This is one of the best opportunities that I’ve had to work full time and also study to progress in the area of work that I love doing.

“In the future I would love to become a registered nurse and continue providing the highest standards of nursing care to our service users – and the trainee nursing associate apprenticeship will help me to achieve this.”

This sentiment is echoed by Rachel Westbrook, who says: “I’d always showed an interest going into nursing long-term. Doing it this way is doing it in a place that I know I’m comfortable.

“The benefit is that it’s a full-time job. I don’t have the financial implications of being in university. Because I know the home and I worked here a long time, it seemed like the next natural step.”

Career development in the care sector 

The trainee nursing associate programme offers a progression route for health care assistants and activities coordinators working in one of Exemplar Health Care’s 35 specialist care homes. 

They support adults living with a range of complex needs including brain and spinal injuries, complex mental health needs and complex dementia. 

Exemplar Health Care is recruiting for a range of roles including health care assistants, nursing associates, registered nurses, physiotherapists and occupational therapists. 

Visit the website to find out more and apply: www.exemplarhc.com 

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Inpatient rehab

Stroke rehabilitation – an Askham success story

How one stroke survivor was helped to rebuild his life through traditional and robotic-led therapies at Askham Rehab

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Our patient lives in Guyhirn, near Wisbech, and is married with children. Having had a stroke earlier in the year, he was admitted to our team at Askham on May 26, 2021, for rehabilitation. 

The left-sided thalamic intracranial haemorrhage left him with speech deficits, as well as difficulties with active movement in his right upper and lower limb. 

Following our assessments, it appeared that he was also struggling with functional activities and tasks, and as a result, needed further neuro rehab to try and improve them.

 

Stroke Rehabilitation: Initial Assessments and Treatment

Upon his admission to our rehabilitation centre, each team assessed him (clinical psychology, occupational therapy, speech & language therapy and physiotherapy). Following on from the assessments, we felt collectively as a team that he required ongoing rehab in all four areas.

In addition to getting fit again, his main goals involved walking, speaking, being able to return home to his family and – at some point – returning to work.

Sara Neaves, our clinical lead and outpatients service manager, supported him throughout his treatment, and has since told us about her experience. 

“He was so incredibly motivated. He wanted to be active all the time, and wanted exercise programmes to continue his therapy when he wasn’t in sessions,” she said. 

“He was always pushing himself; once, he said ‘I’m bored’ – and this gave us the opportunity to face a new challenge and think outside the box to come up with engaging ideas and activities.”

His treatment started with very active, functional tasks with occupational therapy and physiotherapy, whilst working on strength training for the lower limbs. 

The two teams worked together on his upper limb, with a combination of hands-on therapy, robotics, Saebo and neuro-muscular stimulation.

The occupational therapy team proceeded to work on functional tasks with personal care, and the care team continued this work with facilitating movements and activities. 

Meanwhile, the PT team worked on strength training, targeting the pelvis and hip area to aid weight-bearing, and he was soon able to progress to stepping and mobilising.

Additionally, the speech and language therapy team worked with him on oro-motor exercises to aid movement and build tolerance. This involved word formation training, as well as work on sentence structure. 

Simultaneously, we started him on an exercise programme, and the psychology team supported him with strategies to help him with his mood.

 

Advancing to Robotics

Throughout his treatment, he made use of our robotics suite. He used the large gym and satellite gyms to support his therapy, and participated in groups and activities. He also used the outdoor spaces to work on different gait patterns and balance work.

We incorporated several of our robotic machines into his treatment, including the Omega Plus. This helped him work on his lower limb strength, control, exercise tolerance and cardiovascular training. 

He also made use of the Myro table for coordination and perceptual training, in addition to the Pablo device for core balance and work.

 

Stroke Rehabilitation Treatment: Reflection, Recovery and Looking to the Future

Commenting on his treatment, Sara said: “He responded to the treatment very quickly, mainly because he was so engaged and motivated to change. His speech also improved very quickly, and he was able to make his needs known. Very soon, he was able to step-transfer with the help of staff and a quad stick.”

When reflecting on the most challenging parts of his treatment, Sara said: “I think the hardest part for him was being so reliant on people initially, as he has always been so independent. He missed his wife and children a lot too.

“However, he was always very motivated and engaged. He would grab anything we asked him to do with both hands and pass it with flying colours.”

The location of his treatment certainly helped with his recovery. He was close to his wife and children, which meant that they could visit very regularly. The quietness and open surroundings also allowed him to venture outside and, towards the end of his stay, he often took himself outside for walks.

Working with our patient has allowed us to incorporate everything that we work towards as a team – from empowering residents to lead in their rehab programme to working towards a completely individualised and holistic approach to care.

After a five-month treatment programme, he can now hold a telephone and have face-to-face conversations using full sentences. 

Physically, he left us independently mobile with no walking aid. His mood was brighter, and required no care at home as he had worked so hard on the functional and personal tasks in occupational therapy.

Throughout his stroke rehabilitation treatment, we were granted extra funding for him to remain at Askham so that we could facilitate his independence. We were delighted to successfully achieve this, before discharging him from Askham on October 21, 2021.

Working with him has been incredibly rewarding. We were all able to push ourselves to get the very best out of him – and to see him walk out of the unit with his wife was amazing. 

His family supported him constantly throughout, and they are so pleased to have him home.

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Inpatient rehab

Meeting the growing demand for specialist nursing care

Exemplar Health Care is expanding to bring additional and much-needed resource to complex care provision

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Improvements in healthcare and living standards mean that people in the UK are living longer. However, chronic conditions, disease and disability mean that the number of people with complex needs is also increasing. 

Meeting the care requirements of these people, and ensuring that they get the right care, by the right team and at the right time, is a challenge for commissioners.

Exemplar Health Care is a specialist provider of nursing care for adults living with complex and high acuity needs, which currently has 35 care homes across England – and plans to double in size by 2026. 

“We have an ambitious growth plan over the next five years, and we are currently expanding in the Midlands, North West, North East and Yorkshire and Humber,” says Charlotte Lloyd, developments director at Exemplar Health Care. 

“We are different from other care providers. Around 60 per cent of our service users come to us following a failed placement, having not settled at their previous home or homes. 

“This is mostly due to their previous placements not being fit for purpose in terms of the environment, staffing levels and staff training. 

“There is evidentially a gap for younger adult services and we are the answer to that.”

Exemplar Health Care point to the factors it believes are its USPs as being crucial to its expansion – its strength in effectively supporting those with behaviours which challenge; its high staffing levels; the fact it creates ten-bed units to promote small group living; its focus on community involvement and re-integration; and the provision of in-house therapy teams. 

It also highlights the positive impact of its in-house Exemplar Positive Behaviour Support training which has been certificated by Bild ACT, and five of in-house leadership programmes which are CPD accredited. 

“Our high staffing levels of registered nurses and health care assistants, and holistic approach to care, ensure that people get the right care, at the right time, the first time round,” says Charlotte. 

“This reduces re-admissions to acute settings, facilitates faster returns to lower-cost community living and brings an end to the cycle of failed placements. 

“We’re building more specialist care services across the country, to meet the growing demand for complex and high acuity placements. 

“One thing that makes us different is that during the assessment process we do a ‘community fit’ assessment, as well as a care needs assessment.  

“This ensures that the home is the right ‘fit’ for the individual, and that they’re the right ‘fit’ for the people who are already living in the home.

“We work closely with a number of CCGs and local authorities to understand the gaps they have, and involve them in the process to ensure that our new homes are fit for purpose and meet local need and demand.”

Such demand for specialist placements is something that continues to grow, which inspires Exemplar Health Care to increase the resource available to people badly needing such specialist resource.  

“The number of children born prematurely or with other medical or complex conditions is growing,” says Charlotte. 

“So, too, is the number of older people developing complex needs in later life. This is leading to an increase in demand for complex care services. 

“High-quality, person-centred care for people living with complex needs often requires the support of a multi-disciplinary team, which involves registered nurses, health care assistants and other specialist roles such as clinical experts, psychiatry, physiotherapy and occupational therapy – as well as high staffing levels, an adapted environment and specialist equipment. 

“This comes at a cost – but public sector funding is decreasing. 

“These ongoing financial challenges can often lead to people being placed in an unsuitable or inappropriate setting, that isn’t able to meet their complex care and clinical needs. 

“This can have a detrimental effect on people’s health and wellbeing, as well as the wellbeing of their family and friends. There is also a high number of people spending an unnecessary amount of time in hospital settings due to the shortage of specialist nursing home providers. 

“We find that a lot of people are placed out of their area as there is not enough provision for specialist nursing homes close by – when opening a new home in a new area, we often receive referrals to support service users being repatriated.” 

The latest addition to the Exemplar Health Care portfolio is Blackmoor in Birmingham, a 30 bedroom home comprising three ten-bed units, which will support people living with complex mental health needs, including behaviours which challenge, early onset dementia and neurodisabilities. 

Its Tolkien Unit is a ten-bed male-only community. It supports those living with complex mental health needs, neurodisabilities, complex physical health needs and behaviours of concern.

The James Brindley Unit is a ten-bed mixed community. It supports those living with complex mental health needs, early on-set dementia, brain injuries and neurodisabilities.

And the Bournville Unit is a ten-bed female-only community, which supports those living with complex mental health needs, neurodisabilities, complex physical health needs and behaviours of concern.

It adds further to the provision from Exemplar Health Care in the area, with two specialist nursing homes in Birmingham – Otterburn and Maypole Grove – and Bridgewood Mews and Parkside in Tipton. 

While each home continues the provider’s overall commitment to delivering personalised care to each resident, the creation of each one builds upon the last. 

“Each time we build a new home, we’re continually learning and enhancing the design of the homes, and we implement lessons learned along the way,” says Charlotte. 

“At Blackmoor, we’ve implemented more energy efficiencies including under floor heating, LED and automatic lighting and all our new homes are fitted with electronic car charging points.

“A few months ago, we asked our service user council what enhancements they’d like to see in our homes.

“They fed back a range of suggestions including bigger bedrooms with more space for equipment, more communal living spaces, accessible outdoor spaces and a hydrotherapy bath – so we used this to adapt the design of our new-build homes, much of which has been incorporated at Blackmoor. 

“At Blackmoor, the overall size of service user bedrooms and en-suite bathrooms has increased. We’ve also included lots of communal spaces such as a hub area with bistro/coffee shop set up, a salon including hairdressing back basin, Barber chairs and nail bar, a multi-faith room and a sensory room. 

“There is also an assisted bathroom on each floor which has a hydrotherapy bath with sensory and spa-like features. 

“All of our homes benefit from the same support from central services including clinical experts, behavioural support specialists, learning and organisational development, marketing, HR and recruitment support.”

Blackmoor is also another example of the role Exemplar Health Care’s homes play in their local communities, with the provider keen to make a positive impact.  

“During the planning phase, we worked closely with the local authority and purchased seven new park benches for the local community,” says Charlotte. 

“The home has also created over 100 jobs for the area, ranging from nursing and health care assistants, domestic, administration, catering and management positions. Our first new cohort will benefit from a unique four-week induction and training experience to ensure the staffing team are well prepared for our new admissions.” 

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