How to improve move-related practice

We talked to older people, carers and social care practitioners about how to improve the process of moving someone to a care setting. They identified the following:

• Professionals’ knowledge of care settings
• Information for older people and carers
• Planning care moves
• Support for carers

Social care practitioners and others emphasised the importance of adult social care and healthcare staff having a comprehensive understanding of the different care settings (including alternative options to care homes) and charities available to older people and carers.

Professionals’ knowledge of care settings

A dementia café lead would like to be able to suggest care homes that would suit people’s individual needs.

Maybe an idea of the different care homes and what they actually deal with. So that then if we’re actually talking to people about moving them from home to a care home, we can actually say ‘well, this one would suit because of this’ and be able to give them a bit more information about what was available at the care homes.
Embed Print Transcript

A social worker explains why extra care housing is important

I think extra care is really important… without that a lot of people could be at risk of ending up in residential care or nursing care that perhaps didn't necessarily need to be there… I've supported a few people to move there [extra care housing]… generally people have been able to have their own front door which for a lot of people is really, really important.
Embed Print Transcript

A community navigator highlights the value of charities in supporting people’s moves.

“[It is important to] signpost to local, regional, national charities because they’re in their own right going to be available for specific groups of people.”

Information for older people and carers

People highlighted the importance of having clear, correct, and concise information that is easy to access and navigate and in one place.

An 80 year old man living with dementia would like someone to give him guidance about his accommodation options, not just information.

Age UK have provided me with some written papers on advising the sort of accommodation I could move to and contact, but I'm at a total loss, I don't know what to do… I think I've had conversations, yes, but nobody can actually suggest anything. Nobody actually says to me, I think what you ought to do is this. If somebody could actually come up with some recommendation of what I should do that would help me.
Embed Print Transcript

A 91 year old disabled woman, who also cares for a friend, thinks people need more information about nursing homes.

“I think [people] need to know more about the nursing home they’re going to, before they go there. They need to know what’s involved.”  

A man who cares for a parent thinks lots of information can be overwhelming.

There is loads of information for anyone who looks for it. You can go on Google and you can start searching. Lots of people can send you emails with loads of attachments and big brochures of things that you can read about. But when you’re in the thick of this environment and you’ve got so much to do… the last thing you want is an information booklet… you just want, like, for dummies… “Here is what you can do… this is the number, call these people.” I haven’t got time to read through a fifteen page document from the local authority.
Embed Print Transcript

Planning care moves

Being proactive or making decisions in advance about moving was identified as vital for older people and their families. Many people told us it is important to think about moving ahead of time rather than delaying the decision until a crisis or emergency arises.

An 80 year old man who is living with dementia says he has been thinking about the move for years but is afraid to take action on his own.

“I would like to move to smaller accommodation, but I have been in a way thinking about it for the last two years, and the very thought of what is involved in making the move frightens the life out of me. I’m scared of doing it because I’m just not capable of doing it on my own.”  

A woman who cares for her mum explains that planning ahead helps you make better decisions.

From my perspective that's a really, really important learning thing is timing. Because truthfully I think, and I’ve had a heard a lot of people say, when you need to make the decision you don’t want to make the decision because you’ve got a lot to lose. But by the time you make the decision it’s too late… There's things that we can’t control but I think what I learnt from my mum was, plan ahead. Don’t have to make the decisions in a crisis or in an emergency because the decisions you make in a crisis or an emergency, for yourself or others, are never as good.
Embed Print Transcript

A dementia cafe lead says it’s important to tell people what is going to happen, as far in advance as possible.

I think they just have to be there and be honest with what’s actually going to happen… if there's something like that going on, people need to be told at the beginning because otherwise it’s very traumatic when all of a sudden somebody has to move.
Embed Print Transcript

Support for carers

People told us that support for carers, such as regular updates, should also be provided to ensure they are informed and engaged in the process. Some people also suggested providing further support for carers following the move.

A man who cares for his mother talks about how he has been affected by the stress of being a carer.

it’s been enormously stressful. I don’t recognise the stress at the time, when it’s happening, I go into a more operative mode […] I have trouble sleeping some nights because I’m so wound up about things relating to my level of involvement versus other family members level of involvement. You start building up strange resentments, you start trying to understand what’s best to do. Meanwhile you’re grieving for your mother, your family member. So it doesn’t take an immediate toll on you like a car crash would, for example. It takes a slow pull from you.
Embed Print Transcript

A social worker talks about how they support the family of someone who is going into a care home.

I will follow up the next day when someone’s gone into care, with their family usually, if they have family, to say, ‘how did it go, is there anything you're already worried about’, just because sometimes again family need that bit of – I don't know the right word, handholding, comfort, reassurance for someone. A lot of the family will say, well, I don't know, I don't know. And you say, well, you don't need to know, you just – it’s that – just that reassurance about everything will be fine and you've just got to take it day by day, step by step because for some family members as well it’s a big wrench… And again it’s about signposting them I think to, say, Care for the Carers who can support them through – there's counselling available to support somebody through.
Embed Print Transcript

A discharge coordinator shares how they help carers.

“If there’s carers… we would refer that person to Involve which is a carer support. So that person in their own right, as a carer, that’s a – but I think it’s, every case that we get, we have to look at that person as an individual.”

It’s important to note that not all older people have family or friend support. Sometimes family and friend carers do not live nearby, and so it is not uncommon that older people live on their own or far away from their support during the moving process.

A woman who cares for her partner explains why she doesn’t like to lean on other people for support.

“I’ve got no family so I knew I’d got nobody I could call on. And with the best will in the world I’m not the sort of person who likes to bother anybody anyway. And you’d soon lose friends that way, wouldn’t you? So no, I’ve always been quite sort of independent.”

Making decisions with other members of the family was invaluable to a woman who cares for her mum.

That's another thing that was incredibly helpful and important, my brother, sister-in-law and actually my mum’s brother was, involved on the periphery. And we were all of one mind. We all said that we make the best decision we can with the information we have got at the time we have got it in the circumstances. And we didn’t look back and said ‘oh, we should have done this or you should have done that’. So being together as a family made a huge, huge difference to what happened really I think.
Embed Print Transcript

A man talks about the difficulty of caring for his mother from a distance.

I think the main difficulty was the distance. And it seemed that care agencies and care workers tended to assume that there would always be some family living locally […] the geographical distances with no local family members, and I know very few local friends either because both my mother and my aunt were in their late nineties, most of their friends had already died, so that they were very much on their own.
Embed Print Transcript

Support for practitioners

Here, social care practitioners talk about the support they need in helping people move between care settings. A key message is that organisations need to...