Government guidelines

Government and Health guidelines and recommendations (UK)

From the Harp offers interactive activity using the harp as the medium for occupation. Activity analysis and grading is used to ensure sessions are inclusive for all, delivered by a Health and Care Professions Council (HCPC) registered occupational therapist with enhanced DBS check. Occupational therapy is founded on the core knowledge that occupation is essential for people’s health and wellbeing. Occupation is vital for older people in care homes who are at risk of increased health complications if left with nothing to do.

The Royal College of Occupational Therapists (RCOT), government and NICE guidelines have all acknowledged the importance of mental and physical wellbeing to older people in care homes. Providing meaningful activity is essential to keeping residents emotionally, mentally and physically well. It is the manager’s responsibility to provide quality care and there is a constant need to resource interesting activities.

With the involvement of their carers, people with dementia are enabled to take part in leisure activities based on their individual interest and choice, potentially including music. People have different interests and preferences about how they wish to spend their time. People with dementia are no exception but increasingly need the support of others to participate. Understanding this and how to enable people with dementia to take part in leisure activities can help maintain and improve quality of life.

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Care home standards in all four UK countries require care homes to provide ’meaningful occupational opportunities to promote health and prevent functional decline’ (Care Homes for Older People National Minimum Standards Department of Health 2003, standard 12). According to the RCOT’s Living Well With Activity Toolkit ‘a service that offers and evidences support to residents to participate in a range of activities and consequent evidence of personalisation, supporting dignity and wellbeing and of the care home’s integration into the community, will be better placed to achieve positive regulatory inspection outcomes and local authority commissioning objectives’ (RCOT p144).

NICE Advice LGB25 – Older People in Care Homes (February 2015) states that meaningful person centred activities should be provided and The Department of Health’s 2014 Fundamental Standards for Health and Social Care Providers emphasise the importance of person-centred care, including the provision of ‘meaningful’ activities that promote mental stimulation and can improve general health.

Staff should ensure older people in care homes retain their independence and identity by providing a regular daily programme of meaningful group and individual recreational and physical activities, tailored to meet individual needs, as outlined in the mental wellbeing of older people in care homes quality standard (NICE 2015 p9).

Providing a regular daily programme of meaningful group and individual recreational and physical activities can help ensure local authorities meet some older people in care homes NICE local government briefings of the key indicators in the Adult Social Care Outcomes Framework.  In particular, the outcomes on:

social care-related quality of life (1A)
service users with control over their lives (1B)
service users with as much social contact as they would like (1I)
people who use services and feel safe (4A)
people who say that the services they use make them feel safe and secure (4B).(NICE 2015 pg 5-6).

Key indicators in the Adult Social Care Outcomes Framework available at:https://digital.nhs.uk/data-and-information/publications/clinical-indicators/adult-social-care-outcomes-framework-ascof/current

It is important that older people in care homes have the opportunity to take part in activity, including activities of daily living, that help to maintain or improve their health and mental wellbeing. They should be encouraged to take an active role in choosing and defining activities that are meaningful to them. Whenever possible, and if the person wishes, family, friends and carers should be involved in these activities. This will help to ensure that activity is meaningful and that relationships are developed and maintained (NICE 2013).

Statement 1 in the NICE Mental wellbeing of older people in care homes (QS50) states:

“Statement 1 Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.”

A range of person centred activities should be offered to the person living with dementia to promote cognition, independence and wellbeing. For people living with dementia who experience agitation or aggression, personalised activities should be offered to promote engagement, pleasure and interest. For people living with dementia who have sleep problems, consider a personalised multicomponent sleep management approach that includes sleep hygiene, education, exposure to daylight, exercise and personalised activities. (NICE 2018)

The Care Quality Commission are the independent regulator of all health and social care services in England.  From the Harp can assist care homes to become ‘CQC Inspection-ready’ in your activity provision as well as working with individuals. You can evidence that your team are effective and responsive to people’s needs in compliance with:

  1. The CQCs Key Lines of Enquiry (KLOEs)
  2. Your Provider Information Return (PIR), including ‘relating information’ about the benefits of harp therapy
  3. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (The intention of this regulation is to make sure that people using a service have care or treatment that is personalised specifically for them.)

References

Department of Health (2003) National minimum standards for care homes for older people. London: Stationery Office.

NICE (National Institute for Health and Care Excellence) (2013) Dementia: independence and wellbeing Quality standard (QS30)

NICE (2013) Mental wellbeing of older people in care homes Quality standard (QS50)

NICE (2015) Older People in Care Homes. Available from: http://www.hullpublichealth.org/assets/NICE/lgb25.pdf

NICE (2018) Dementia: assessment, management and support for people living with dementia and their carers

A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care (2007)

National Clinical Practice Guideline Number 42 National Collaborating Centre for Mental Health. The British Psychological Society and Gaskell p 260.

Royal College of Occupational Therapists (RCOT) (2015) Living well through activity in care homes: the toolkit.