In what ways can people receiving care be affected by moving between care environments? What can carers do to support people during this process of change? I will begin with what different changes there are in care environments, places, duration etc and how this may affect how people react to moving. I will introduce my own case study to illustrate some of my ideas. Then I will look at how carers can support service users during their move and how, in my own area of practise we support the people attending the unit.
Many things can affect how people react and deal with changes of environment regarding their care. The type of move can be different for instance whether it is a permanent change of address or whether it is to attend a day center. Some may feel very comfortable attending a day center safe in the knowledge that they will be returning home. I currently work at a day center for adults with both profound physical conditions and learning difficulties.
We are open from 09. 30 until 15.30 and have unit transport that both collects and returns service users to their homes. We have a service user ‘Frank’ who attends Monday to Friday. Frank appears to enjoy his time at the center however the first thing that he wants to know when he arrives is who will be taking him home again at the end of the day. Frank is happy then to continue with activities, having received the reassurance that he will be taken home at the end of the day. A persons own attachment to a familiar setting may affect their willingness and attitude to.
For example, an older person whose move is essential due to their physical deterioration, may be quite depressed, anxious and possibly even angry about a move to a nursing, residential or warden controlled home, whereas Esther (Audio2, part 1) was happy to move. Her move came after a long wait and the premises that she moved to gave her more freedom as the house was fully adapted for her with access to the garden. She was also given four carers, two in the morning and two in the evening; these were the same carers’ everyday so she had continuity of care. They were aware of her routine and her capability.
She also had the option to “go to my room and shut the door”. Everybody has the right and the need to personal and private space at times; even if it is rarely used knowing that it can be is hugely reassuring. A move or change can vary depending on the person’s ability to cope with the physical and social disorientation they may occur. As service providers it could be easy to forget how upsetting a move can be for some people. There are issues of loss, security, independence, control, personal space, privacy and social relationships to deal with. It is extremely important to involve the person in as much of the decision-making as possible.
Some level of control over the move is extremely valuable to service user as it give them some feeling of ownership and independence. There are times when the move may happen very quickly, for example a visit to hospital or move to a home due to deterioration in health. At these times it is still important to explain why the move is necessary and what the long-term plan is. During a hospital visit for example it often helps to take belongings with them, even a photo and a soft toy or a particular ornament with the service user as this can be enough to help have some attachment to a place, which then gives a sense of belonging and security.
The Smiths (unit 7, p99) show how control over a move can affect the ability to adjust. During their first move together to the residential home they chose where they wished to live. They had each other and friends at the home. However when Mr. Smith had his stroke two months later, the subsequent move to a nursing home was essential and immediate. Mrs. Smith apparently accepted the move, but as something that she had no control over unlike their initial move to the residential home. During her interview with the researcher, she broke down in tears a number of times when thinking of her husband.
This illustrates it is also important to allow for someone to be given time to adjust to the idea of the move. Any move should primarily begin with a plan for action and be detailed enough to follow the process from beginning to completion. It should start with a conversation with the individual involved in the move, which should include an explanation of the cause for the move. There should be an invitation for the individual to raise any concerns or questions. Then time should be taken to ensure the right placement is found, followed by further meeting to discuss the potential placement and arrangements made for visits.
Once a placement has been visited and agreed upon the plan can be followed for the practical side of the move, the who’s, how’s, when’s and where’s are all areas which can cause severe stress for the service user and therefore their input into decision making should be sought. This to should be done with input from the individual. On the day of the move it should not be forgotten, that time for goodbyes must be allowed. The individual should be allowed his or her own personal space whilst remaining within a supportive network. Once the move is completed the person needs time to adjust and settle in to their new surroundings.
There still needs to be regular meetings with the service user to check that the settling in process is going well, answer any further questions and to discover if there is any thing else that can be done. Carers would use a similar plan for even a temporary or daily placement. For example if an individual were planning to attend the unit in which I work at we would initially have a referral followed by an appointment with the individual to discuss what it is that we can offer them and what it is that they would expect from us.
These meetings would be held along with parents and/or carers. We make it clear how many days a week would be available and what transport we could offer. Many of our service users are school leavers and we work very closely with the school to ensure a smooth transition. We would then visit the school at different times of the day for a couple of weeks to become familiar with the service user and to let them become familiar with us. We would then arrange a home visit to see how the service user behaves and copes in their own home environment.
This would be followed by a number of progressively longer visits to the centre made in the company of their parent, carer or school staff. Eventually the supportive staff would slowly pull back until eventually the service user were attending all day on their own. At each stage of the transition the service users behaviour is monitored (as many of our service users rely on behaviour, body language and facial expression for their communication). We ensure there are six monthly reviews in order to update any health or home changes, raise any issues and monitor the individuals’ progress.
In conclusion a move can be an extremely stressful time for anyone however if the move can be achieved slowly with the correct support the stress can be reduced and the service user will find a move can be a very positive event. Unfortunately it may be that the move is unavoidably rushed as a result of, for instance, illness. A carer’s action can still have some effect here. In short carers need to think about their actions and the result of those actions. The level and type of support although similar, needs to be particularly designed to the personal needs to be person centred.