The document discusses the importance of individual identity and well-being for residents in care homes, emphasizing the need for personal choice, dignity, and active participation in community life. It highlights challenges such as cultural issues and lack of resources, while also pointing to an improvement program focused on physical activity, leadership, and person-centered care. Strategies for engagement, including walking challenges and physical activity resources, aim to enhance the quality of life for older people in care settings.

1. What matters to you matters to those living in care homes!
Edith Macintosh
Rehabilitation Consultant
Living life well in care homes

2. Arts in care
coming
soon!!

4. A bit of thinking and conversation!
What matters to you?
What’s living life well for you?
What do you need to do that?

5. Living life……….
• Personal and unique.
• Gives us an identity.
• Empowers us.
• Indicates there is choice.
• Purpose and meaning to life – participation/
occupation
• Physical, emotional, mental and spiritual well
being
• Provides a sense of dignity and self worth
• Joy, happiness and fun

6. Lets think about care homes - what is the Scottish picture?
Overall
Care homes for older people 866
Total registered capacity 37,657 places
Breakdown of providers of care homes (866 homes)
Private 626
Local Authority 121
Voluntary/not for profit 104
Health Board 15 (Highland) Highlands and islands
Care homes for older people – 79
Total registered capacity – 2233
Breakdown – Private 36, LA 17, Vol 11, Health 15.
Lots of scope to develop networks to support and sustain improvement and support older
people to live well
All figures as of 1st
April 2016

7. Challenges - the same everywhere?
• Cultural issues - doing to not with
• Lack of infrastructure – not like the NHS!
• Good leadership and mentorship
• Staff – turnover and capacity
• Access to resources and training
• Information sharing - across care sectors, health and social care.
• Accessing local, wider health and social care services- low priority,
they’re ok! Challenges for living well!
• Lack of involvement in local community/partnership planning.
• Lack of recognition that care homes are part of the
community – rights and citizenship
However ……there is an appetite for improvement and vital
networks of support are growing

8. Improvement programme
Health and well being
(enablement, active living, falls prevention)
Rights, choice and
citizenship
(person centred care,
contribution to community
life)
Workforce development
(inspire leaders, places of learning, developing capacity
and capability care sector and CI.)
Good practice
(self improvement
resources, sharing
and promoting good
practice)
Go for Gold Challenge
Improvement programme

9. Benefits of physical activity
• CHD and Stroke
• Osteoporosis
• Type II Diabetes
• Hypertension
• Improved sleep
• Depression and anxiety
• Obesity and overweight
• Colon and other cancers
• Reduction in accidental
injuries
• Improved cognition
Prof Gerry Morris (1954)

10. Drivers 2.7
Civil servants 2.4
Conductors 1.9
Postmen 1.9
Age for age, drivers of
double-decker buses —
who sat for 90% of their
shift — had substantially
more heart disease than the
conductors, who would
typically pound up and
down as many as 750 steps
to and from the top deck
every working day.
Incidence of coronary heart disease per 1000
London Transport workers per year

11. Physical activity is it important? Well……
• Research evidence is incontrovertible in terms of benefits.
• Specific benefits BUT huge impact on general health and well being.
• Risks around extended periods of sedentary behaviour.
• Falls prevention – 3 times more likely to fall in a care home.
Being active:
• Increases engagement,
• improves confidence, resilience and control,
• reduces anxiety and depression as well as reducing symptoms of disease,
• improves function and helps maintain independence.
• And we age and live well.
Ageing population – people are living longer and there’s US!

12. • Activity declines throughout life
• Benefits cannot be stored
• Physical function starts to decline around 30 and
inactivity increases decline
• Nursing home residents will spend 80% of their
time seated or lying
• Following a week of bed rest it would take over a
year of regular exercise to regain lost bone density
and up to 6 months to regain lost muscle strength
and endurance.
• Recent research (Healy et al, 2011) shows that
breaking long periods of sitting has a positive
effect on health.
Human
frailty
Time
DiseaseDisuse
(Spirduso 1995)

13. The UK CMO guidelines on
physical activity (2011)
• How much physical activity will bring
health benefits?
• Apply to all older people (65+)
• Interpret for use with frailer older people
• Less sedentary behaviour
• Some activity every day - some is better
than none!
• Accumulating 150 mins moderate
activity per week in bouts of 10 mins
• Strength and balance – twice a week
• Can apply to people living with dementia

14. GFG improvement story so far….
• Began in 2012 – WCAA and Commonwealth Games
– Promote/celebrate participation in physical activity in the care sector.
– Build capacity amongst staff through annual challenge events, piloting sporting ideas,
running learning events and developing resources.
– Develop links - care sector and physical activity organisations.
• Annual challenges (walk, dance, events, triathlon, anything!)
Incremental increase annually in numbers taking part
• Supported by a national network and reference group
• Learning events – 2/3 per yr
• Linked into strategic plans with SG
• Launch and implementation of self improvement tool - CAPA 2014
• Evaluation 2015 – starting to change culture
• GFG and CAPA implementation on going - 2016 and beyond

15. Some pics…
Show Dvd

16. GFG challenge 2016 - emphasis on walking…….Why?
Research clearly shows that the time and distance walked by older people declines with
age……….
– Nearly 90% of over-50s walk, at a sufficient intensity or duration to benefit their health,
less than once a week.
– Thirteen per cent of men and 15% of women aged over 70 are unable to walk for more
than 5 minutes on their own.
– The ability to walk, measured in time and distance, declines with age and declines
more markedly among women
– One quarter of men and women aged 70+ said they were unable to walk a quarter of a
mile on their own without stopping or feeling severe discomfort.
– The UK National Travel Survey found that about 50% of men and 70% of women aged
over 80 years who were interviewed reported that they had physical problems that
made walking outdoors difficult. (Source
Skelton 1999)
In care homes activity levels are even lower!
Look at - DH 2002. The Health Survey for England

17. Walking….
• Walking is a basic activity of daily living – functional fitness
• Integrates the balance systems and improves the endurance
system through the performance of a natural and rhythmic use of
arms and legs and both sides of the body
• Walking can range from assisted to self- directed to group activity.
• Can be functional, recreational, competitive and sporting - from
gentle, through moderate to vigorous.
• Walking styles and activities can be varied
Great opportunities for intergenerational practice
The Quiz!!!!!!!!!!!!

18. Ideas for action….
• Idea 1 - ‘Get up and go’
• Idea 2 - ‘Out and about’
• Idea 3 - ‘Walk with me’
• Idea 4 - Walking challenge events with
mass activity participation
Ideas for action booklet!!

19. • To get good results from any of these ideas for action it
requires
– Knowledge of those taking part
– Knowledge of local venues
– Risk benefit analysis
– Build on your achievements; explore how walking
can become a regular activity
– Use a checklist – can be helpful

20. Care…about physical activity - self improvement tool
1. A booklet with:
• an introduction to the resource, introduction to physical activity in care homes and
how to make improvements.
• the physical activity self assessment tool and guidance for its use
• a description of the three key principles to promote physical activity.
2. A DVD to support implementation of the resource pack.
3. Make Every Move Count – a pocket guide to active living.
4. A call to action poster.
5. Physical activity and self assessment tools.
An app is available to download which will provide education and awareness and
support the implementation of the resource from the app store.
The resource pack has been distributed to all care homes for older people in
Scotland.
Implementation supported locally through established networks

21. Care About Physical Activity

22. Working towards the guidelines.
The challenge
Sedentary
Meeting the
guidelines
Increased physical activity
Increased
benefits

23. Early feedback from evaluation…
• 91% - resource made staff more aware of the need to encourage physical activity
• 87% - resource helped staff support residents to do more activity
• 49% - impact had been ‘a lot’- staff supporting residents to do physical activity
• 41% - staff are more aware of the need to encourage physical activity
• 60% - positive impact on the amount of physical activity staff do themselves
• 82% - resource had had a positive impact on both the number of residents
undertaking activity and the amount of activity residents were undertaking; in both
cases, 30% or over reported that this impact was significant.
• The resource was reported to have had a positive impact on the emotional
wellbeing of residents by 86% of respondents, while 78% reported a positive
impact on reducing symptoms / managing existing physical or mental health
problems.
(Lisa)

24. Make Every Move Count
• Designed to make something small
but important happen on a regular
basis
• Principles of Make Every Moment
Count
• Ideas to enable the resident to
have a voice and make a
choice
• Realistic/achievable opportunities
• The resident at the heart of the
process

25. Activity
Working in pairs ……
select one of the Key Messages and
look at how you could use this to support
and older person to be active …………
What might you need to do to create
opportunities for physical activity?

26. • Gentleman who couldn’t walk took part in Vitality classes and turned up at the
office door a few weeks after starting!
• Lady who started swimming again now meets her old friends and swims locally.
• Gentleman who was failing physically and mentally reignited his passion for
bowling, life has opened up and heading up the bowling in the care home and back
at his local club.
• Dietetic student working with residents with dementia – ‘Rabbit Stew’ – had a huge
impact on communication, socialisation and positive interactions.
• Highland care home who organised a games event with their residents – huge
community involvement.
• Lady with dementia who began to communicate after many years because of
enabling her to enjoy the outdoors and contribute to the life of the care home.
• Many stories of companionship and the impact of friendship on people’s lives.
Often doing what seems like something small can make a huge difference to lives

27. Atul Gawande, is a practicing surgeon,
examines the ultimate limitations and failures –
in his own practices as well as others’ – as life
draws to a close. And he discovers how we
can do better. He follows a hospice nurse on
her rounds, a geriatrician in his clinic, and
reformers turning nursing homes upside down.
He finds people who show us how to have the
hard conversations and how to ensure we
never sacrifice what people really care about.
Phrases:
Giving lives meaning
Sustenance of the soul
Authors of our own story
We need people in the world who change
imaginations
Continue to be who we are
Debility and dependence does not rule out
autonomy
Sustaining the value of existence
(pages 140,146)

28. The challenge for us all - what can you do?
What one thing will you do differently
(in your role) to support people in care
homes to live well, live life and continue
to be who they are?

29. Home is a place where a person feels deep within himself
that this is a place where he can return to and be
comforted and comfortable, a place where a person can
feel physically secure because he is surrounded by
positive uplifting things. There is also a spiritualness
about home because home addresses every need we
have even the ones we may not consciously be aware of.
Alex Haley 1986 (Author of Roots)
Tennessee