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Management during a pandemic: what we’ve learned

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As the country faces the second wave of the coronavirus pandemic, the management team at Richardson Care reflect on their experiences so far. Richardson Care has six specialist residential care homes – three for adults with acquired brain injury and three for adults with learning disabilities. Caring for up to 78 people, many of whom are vulnerable brings added responsibilities and pressures, as well as additional skills.

Our experience in supporting people who are rebuilding their lives after brain injury or living with learning disabilities means that we are problem solvers. We support people to overcome challenges every day. Never has this been more important and we’re proud of the way that our management team and staff have responded.

We asked our Homes Managers for their personal views and experiences of the pandemic – from their initial reactions to plans for the future. We discover what we’ve learnt, and how we can change things for the better.

Resilience
‘The capacity to recover quickly from difficulties; toughness’ has been demonstrated by our team throughout the pandemic. Jane Payne, Operational & Clinical Officer at Richardson Care, takes us back to the beginning of the year: “On February 18th 2020 we informed staff that there was a new virus, and preventative measures were put into place; including hourly touch point cleaning, increase in hand washing and an increase in awareness. Ahead of government guidance on March 12th 2020, we took the very tough, necessary decision to close our doors to family and friends to protect service users. We made sure that all staff worked only in one home, so in the event of an infection, it would not be transferred from one home to another by our staff.”

“The management team have become incredibly solid; working as one in supporting each other, as and when each has needed, as we live and work through the rollercoaster that is Covid-19. I am proud to lead; and be part of such a strong group of individuals displaying a sole purpose of ensuring the care, welfare, safety and security of our service users and staff. Richardson Care has shown we are more than resilient, we have become stronger through experience. Care: it’s in our DNA.”

Jacky Johnson, Registered Manager at our Boughton Green Road home for adults with acquired brain injury talks about the realities of dealing with something that no one had ever experienced before. She says: “We were dealing with real disease: a real virus, in real time with real people…The guidance received from various governing and public bodies changed before the ink could dry…The initial fear demonstrated by some staff left others having to broaden their shoulders… taking on extra activities within their daily routines…The expectation on myself as a Manager weighed heavily, it felt like I should know all the answers to the questions they asked… I was clear of my expectations from my team and them of me… Resilience: it’s not about how many times you fall… it’s about how many times you stand up and face another day.”

Teamwork
It was important to create a positive spirit as we knew our response would impact our service users. Central staff were redeployed so each home had enough admin and maintenance support in their team. This means they have been able to form closer relationships with the service users, some have been helping out with maintenance jobs – developing their skills and feeling valued while completing meaningful activities.

The teams within each home became closer, bonding more as they faced challenges together. No job was too big.

Weekly management meetings moved online in February. The Managers have worked more closely together while being socially distanced. Helen Petrie, Manager at The Richardson Mews adds: “No-one has ever been in this position before. We’re all learning together and supporting each other. We’re there to boost morale when it’s needed, sharing experiences and insight to keep our service users and staff happy and safe.”

Resourceful
We’ve found more efficient ways of operating – reducing risk while continuing to help our service users develop their daily living skills. For example, instead of going out to the shops several times a day, there’s just one trip per day. This means planning ahead, so service users have been helping to plan the menus, write shopping lists and prepare for their daily needs. These all require cognitive skills.

We have all become much more tech-savvy, using the internet, apps, photos and video calls as well as phone calls and letters to keep in touch with service users’ family and friends. We’ve also been checking in with each other more too.

Wendy Coleman, Registered Manager at our Duston Road home adds: “For service users, routine is a major part of their life. When their usual activities are no longer possible – no home visits, day services, community activities – staff have shown how well they have supported service users, reassuring them throughout all this. They have also been dealing with more challenging behaviours due to service users’ complex needs and lack of understanding of what is happening. We have created different routines and activities, promoting health and exercise.”

At The Richardson Mews (inspired by Joe Wicks) the day now starts with ‘Morning Motivation’ – exercising to music every day to improve fitness, flexibility and well-being. We’re also making more use of our in-house gym equipment. One service user who has a brain injury thrived during lockdown: he was in a wheelchair in February and now he can walk 70 lengths of the parallel bars.

Although the service users have missed going out, we have had plenty of scope and opportunity to develop in-house activities. Our large gardens and outdoor spaces have been used for gardening, ‘coffee shops’, sports and games, trampolining and treasure hunts. Our indoor communal spaces have hosted quizzes, craft activities, music and karaoke sessions. We’ve celebrated birthdays with gifts, parties and barbecues. We’ve maintained structure when needed, providing mental stimulation, social interaction and fun, while supporting well-being and skills development.

Appreciating each other
“The new normal is valuing and appreciating the simple things in life and each other, focusing on the positives,” adds Wendy Coleman. As we have gone through the months, we’ve noticed positive changes in service users – improved bonding with staff due to them having much more 1-1 time. Individual service user’s communication skills have also improved.

“Staff have done all this whilst dealing with the impact on their own lives. I feel through all this we all have changed our priorities, we have learnt different coping skills, adapted to change, and have gained new skills.

“It is important to show how we value, support and appreciate each other, talk more, respect and most importantly listen to each other. Learning that showing praise and valuing people is so important in these difficult times.”

Never has the responsibility of managing specialist care services been so great. As we prepare for the next phase of the Coronavirus pandemic, we know that we have the experience, skills and resilience to face the challenges ahead.

Richardson Care provides specialist residential care and rehabilitation for adults with acquired brain injury and learning disabilities. An independent family business with a 30-year track record, it has six residential care homes in Northampton. Find out more at www.richardsoncares.co.uk

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Smoking linked to stroke in new study 

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Guido Falcone, assistant professor of neurology at Yale School of Medicine, was the senior author of the study

Adults who smoke, or are genetically predisposed to smoking behaviours, are more likely to experience a subarachnoid haemorrhage (SAH), new research has revealed.

The study found that while smokers are at a higher risk of SAH, that rises to over 60 per cent among those with genetic variants that predispose them to smoking.

The research, published in Stroke, a journal of the American Stroke Association, establishes a link between smoking and the risk of SAH for the first time.

While it has been proven in other types of stroke, this is pioneering research in its link with SAH – a type of stroke that occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.

Results of the study show:

  • the relationship between smoking and SAH risk appeared to be linear, with those who smoked half a pack to 20 packs of cigarettes a year having a 27% increased risk;
  • heavier smokers, those who smoked more than 40 packs of cigarettes a year, were nearly three times more at risk for SAH than those who did not smoke; and,
  • people who were genetically predisposed to smoking behaviours were at a 63% greater risk for SAH.

Researchers also stated that while their findings suggest a more pronounced and harmful effect of smoking in women and adults with high blood pressure, they believe larger studies are needed to confirm these results.

“Previous studies have shown that smoking is associated with higher risks of SAH, yet it has been unclear if smoking or another confounding condition such as high blood pressure was a cause of the stroke,” says senior study author Guido Falcone, assistant professor of neurology at Yale School of Medicine.

“A definitive, causal relationship between smoking and the risk of SAH has not been previously established as it has been with other types of stroke.”

During the study, researchers analysed the genetic data of 408,609 people from the UK Biobank, aged 40 to 69 at time of recruitment (2006-2010).

Incidence of SAH was collected throughout the study, with a total of 904 SAHs occurring by the end of the study.

Researchers developed a genetic risk scoring system that included genetic markers associated with risk of smoking and tracked smoking behaviour data, which was collected at the time each participant was recruited.

“Our results provide justification for future studies to focus on evaluating whether information on genetic variants leading to smoking can be used to better identify people at high risk of having one of these types of brain haemorrhages,” said lead study author Julian N. Acosta, neurologist, postdoctoral research fellow at the Yale School of Medicine.

“These targeted populations might benefit from aggressive diagnostic interventions that could lead to early identification of the aneurysms that cause this serious type of bleeding stroke.”

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New campaign to reduce stroke risk launched on Stroke Prevention Day 

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Almost nine out of ten strokes are associated with modifiable risk factors

A 12-week campaign is being launched today – Stroke Prevention Day – to help raise awareness of how the risk of stroke can be reduced. 

The campaign encourages people to make one small positive change to their lifestyle to reduce the possibility of stroke, which is the fourth highest cause of death in the UK. 

According to the Stroke Association UK, 89 per cent – almost 9 in 10 – strokes are associated with modifiable risk factors in the Western countries, including lifestyle elements that can be changed to reduce risk, such as weight, diet and blood pressure. 

New research commissioned by the charity, which is leading the campaign, has also revealed: 

  •  Only 1 in 20 (6%) UK adults think they’re at high risk of a stroke, despite the fact that the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women
  • Almost half (47%) of the country don’t know that high blood pressure is a top risk factor for stroke 
  • 3 in 4 people (73%) said that they have had no information about stroke reduction recently, which rises to over 4 in 5 (85%) of over-65s, who are most at risk of having a stroke.

Blood pressure is the biggest cause of stroke, with 55 per cent of stroke patients having hypertension when they experience their stroke. Further, around 1 in 4 adults from 55 years of age will develop AFib. 

“While these numbers are concerning, they also demonstrate that with increased awareness, we can all take simple steps to reduce our risk,” says Charlie Fox, sales director of OMRON Healthcare, who are supporting the Stroke Association campaign alongside Patients Know Best. 

“As an incredibly important risk factor for stroke, having a healthy heart should be a top priority and remain front of mind.”

AFib can be asymptomatic and may not be present during a medical appointment as episodes can be occasional, which means it is often left undiagnosed. 

But given its seriousness, those who may be at risk should routinely record electrocardiogram (ECG) measurements, according to current medical guidelines. 

Through doing so at home will enable patients to become more in control of their health, with OMRON being one of the companies developing the technology to support them in doing so. 

“The public wants and needs to be more in control of its health, which is why we create products and services that are suitable for use at home as part of our Going for Zero strokes pledge,” adds Fox. 

“OMRON Complete, for example, is an upcoming, clinically validated home blood pressure monitor with a built-in ECG which can help detect AFib which we’re excited to launch in the coming months. 

“It is our hope that through this awareness programme and by equipping the public with the tools it needs, we can make having an empowered and informed lifestyle the new normal.”

People with a Patients Know Best (PKB) Personal Health Record can also log readings to get a more complete picture of their health journey. This allows them to look back with ease and share readings with clinical teams and caregivers in a safe, secure and meaningful way.

Fox concludes: “Your blood pressure provides important health insights. Monitoring it regularly alongside your ECG readings empowers you with knowledge, helps you act sooner, and can even save your life”.

More information about the campaign and how you can make your one small change can be found here: www.stroke.org.uk/PreventionDay

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What are the IDDSI Levels and why do they matter?

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Wiltshire Farm Foods takes you through the importance of the IDDSI Levels

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Dysphagia, more commonly known as swallowing difficulties, can be prevalent amongst those in neuro rehabilitation. For those in recovery, understanding how their swallowing has been affected, what solutions are available and which nutritional, delicious and above all, safe, meals they should be eating, is of paramount importance.   

When someone starts to experience dysphagia, they are most commonly seen by a speech and language therapist (SLT) and a dietitian. Together, they will create a plan for the management of dysphagia. A speech and language therapist will explain in detail the importance of texture modified food and drinks and will work with you to carefully understand the right texture modification for you. 

What is IDDSI?

This is where IDDSI can help you understand your recommended texture modified diet in more detail.  IDDSI stands for International Dysphagia Diet Standardisation Initiative. This is a committee that have developed a framework of 8 levels which provide common terminology to describe food textures and the thickness of liquids for those living with dysphagia.

The purpose of IDDSI is to create standardised terminology and descriptors for texture modified foods and liquids that can be applied and understood globally – across all cultures and age spans.

Before the introduction of IDDSI, there were national descriptors in the UK which were formed by opinion rather than international standards. Having different terminology, categories and definitions in different countries caused some instances of food being of incorrect consistency. The IDDSI framework was fully adopted by food manufacturers and healthcare settings in the UK in March 2019.

The framework consists of levels for both drinks (liquids) and foods, some of which overlap as you can see in the image above. Here is a breakdown of each category in the IDDSI FOODS framework. 

Level 3 – Liquidised/Moderately Thick

  • Can be drunk from a cup
  • Does not retain its shape
  • Can be eaten with a spoon, not a fork
  • Smooth texture with no ‘bits’

Level 4 – Pureed/Extremely Thick

  • Usually eaten with a spoon (a fork is possible)
  • Does not flow easily
  • Does not require chewing
  • Retains its shape
  • No lumps
  • Not a sticky consistency

Level 5 – Minced

  • Can be eaten with either a fork or a spoon
  • Can be scooped and shaped
  • Small lumps are visible, but are easy to squash with tongue
  • Biting is not required
  • Minimal chewing required

Level 6 – Soft & Bite-Sized

  • Can be eaten with fork or spoon
  • Can be mashed/broken down with pressure
  • Chewing is required before swallowing

How can I check my meals are made to IDDSI standards?

You can check to see whether your food is compliant with the IDDSI Framework by watching these IDDSI Food Test videos.

To discover a Softer Foods range which is IDDSI compliant and created with your patients’ needs in mind, register here for the opportunity to try some complimentary meals from Wiltshire Farm Foods.

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