www.fote.org.uk

VIPS AssessmentValuing peop le with cog nat ive d isabilit ies and those who care for them

V1 V isio n

V2 Human Resources M anag eme nt

V3 M anagem ent E thos

V4 T rai ning and Staf f Develo pme nt

V5 Service Environm ents

V6 Quality Assurance

Indi vid ual ised Care - T re ating Peopl e as Indi vid ual s

I1 Care planning

I2 Re gular Reviews

I3 Pe rsonal Possessions

I 4 Individual Preferences -

I5 L ife Histo ry

I6 Act ivity and Occupat ion

Pe rso nal Perspect ive s - Lo oki ng at the world f ro m the perspect ive of the Perso n with Dem enti a

P1 Com municat ion with Service Users

P2 Emp athy and Accep table Risk -

P3 Physical Environme nt

P4 Physical He alth

P5 Challeng ing Behaviour as Com municat ion

P6 Advo cacy

Social Environm ent

S1 Inclusion

S2 Respe ct

S3 W armth

S4 Validat ion

S5 Enab ling

S6 Part of the co mm unity

Needs more work OK Good Excellent

ConclusionThe service provided at Howbury Lodge Day Centre is an exemplar of person-centred dementia care practice.

The chart below provides a summary of the assessment of the service against each of the VIPS indicators.It demonstrates that the service reaches the highest possible standards consistently in all elements of itsservice in 20 of the 24 indicators and good in the other 4 (good being defined as achieving a high standardwithin the indicator but with potential issues of sustainability in some aspects or for some of the time).This is a tremendous outcome and the service is a credit to the organisation and Worcestershire

VIPS Assessment of HLDC

VIPS AssessmentValuing peop le with cog nat ive d isabilit ies and those who care for them

V1 V isio n

V2 Human Resources M anag eme nt

V3 M anagem ent E thos

V4 T rai ning and Staf f Develo pme nt

V5 Service Environm ents

V6 Quality Assurance

Indi vid ual ised Care - T re ating Peopl e as Indi vid ual s

I1 Care planning

I2 Re gular Reviews

I3 Pe rsonal Possessions

I 4 Individual Preferences -

I5 L ife Histo ry

I6 Act ivity and Occupat ion

Pe rso nal Perspect ive s - Lo oki ng at the world f ro m the perspect ive of the Perso n with Dem enti a

P1 Com municat ion with Service Users

P2 Emp athy and Accep table Risk -

P3 Physical Environme nt

P4 Physical He alth

P5 Challeng ing Behaviour as Com municat ion

P6 Advo cacy

Social Environm ent

S1 Inclusion

S2 Respe ct

S3 W armth

S4 Validat ion

S5 Enab ling

S6 Part of the co mm unity

Needs more work OK Good Excellent

“The service isrespectful of people’s dignity. They are in

compassionate hands at Howbury Lodge Day Centre– they’ve got it right”

It is what you do –and the way that you do it......

Executive

Summary

Report on:

Friendsof the

Elderly’sHowbury Lodge

Day Centre

Association for Dementia Studies

Howbury Lodge Day Centre (HLDC ) is provided byFriends of the Elderly and commissioned byWorcestershire County Council. It provides 10 placesper day (50 per week) for people with moderate toadvanced dementia. In the first two years 77 peoplewith dementia and their families have beensupported. There is a constant waiting list for thisservice. At the point of the evaluation 22 people werereceiving support from the service with a mix of one,two and three days attendance. The majority ofpeople who have left the service moved into nursinghome care, with a small number supported at homeuntil they died.

The evaluation of HLDC was undertaken betweenNovember 2009 and February 2010. It wasunderpinned by the VIPS Framework, created byProfessor Dawn Brooker, developed from hersynthesis of existing evidence and definitions ofperson centred dementia care. The frameworkidentifies the elements required by a service aiming topromote high quality person centred dementia careand strategies for determining service performance.Evidence for the evaluation was gathered using arange of sources and approaches including:Dementia Care Mapping; interviews with the familycarers of people attending HLDC; individualinterviews with HLDC manager and staff;documentation review; and telephone and personalinterviews with health and social care professionalswho have used the service. Thanks are extended toall who gave generously of their time and experience.

Association for Dementia Studies

http://ihsc.worc.ac.uk/dementia

Key findings from the evaluation:

o The service is highly regarded by all who are in touch with it. It is viewed most positively as asupportive resource for people with dementia and their carers.

o The service is clearly fulfilling the aim, objective and outcomes identified by WorcestershireCounty Council within the service specification.

o The VIPS framework evaluation of person-centred dementia care (Brooker, 2007) found theservice to be achieving above good quality in every indicator and excellence in 83% of theindicators, which is hugely impressive.

o The people who attend HLDC clearly meet the County Council’s criteria of having moderate toadvanced dementia. From visits to carers and clients at home it is apparent that they have arange of complex needs, which could prove challenging in a day setting, but which the staff teamskilfully manage so that distress is minimised and wellbeing enhanced.

o The service is an exemplar of positive person-centred dementia care. The staff team arepassionately committed to ensuring that everyone who attends the centre has a high qualityservice, which meets their individual needs, promotes abilities and enhances wellbeing.

o Carers are confident that their loved ones are well cared for and have an enjoyable experience,which has a hugely positive impact on their own quality of life and ability to continue to care.The use of day services is often a compromise for carers; with loved ones only tolerating or evenresisting day centre attendance but going to provide essential respite for their carer. This isnot the experience at HLDC. Carers reported that HLDC provided them with genuine respiteand peace of mind to enjoy the time to themselves because they knew their loved one was alsohaving an enjoyable day. One carer reported that whenever passing Howbury Lodge theirloved one would ask with genuine excitement “Can we go . . .?”

o All professional colleagues interviewed reaffirmed the profoundly positive impact HLDC has hadon the lives of people with dementia and their families, one commented; “There’s atransformation for people.”

o The evidence from the Dementia Care Mapping was compelling; the staff members all know thelife story, preferences and needs of each of their clients and work tremendously well together tocreate a service, which enables people with dementia to build on their strengths and to feelvalued.

o The staffing ratio enables the team to deliver high quality person-centred dementia care, but alsothe positive and proactive approach of the manager and team appears to ensure that the culturesupports and enhances individual strengths and need.

o The experience of attending HLDC provides everyone with opportunities for social engagement,emotional support, making positive contribution, activities which were intellectually andphysically stimulating and provided a range of interesting and enjoyable leisure experiences.

“Howbury Lodge DayCentre is wonderful and we as a

family would be lost without it. Awonderful service and an

amazing team! “

“Dad always seems to enjoyhis day at the centre, especially the

warmth of the staff. They seem to beable to make their guests feel

special.”

o The staff worked together well as a team; supporting each other and intervening when anyone whoshowed the slightest indications of unhappiness or disengagement .

o During the Dementia Care Mapping over two days no episodes of negative interactions (PersonalDetractions) were observed, but conversely over 70 episodes of very supportive interactions(Personal Enhancers) were noted–exemplary practice!

o The physical environment is domestic in scale. The team has created a warm and welcomingatmosphere with resources provided by the charity making the environment stimulating andhomely. Clients arrive each day as if coming to visit favourite relatives and staff work hard tofoster that sense of wellbeing.

o The domestic scale of the room is both a strength and weakness. Everyone is automatically part ofeverything that is happening. It is easy for staff to notice anyone appearing to disengage or showdistress and to intervene or support each other in potentially challenging situations. However ondays when all 10 clients are present and respite users also gravitate to the sitting room, it can feelcramped and activities needing space are not feasible.

o The ethos of the centre is to welcome anyone from the respite unit and this is inclusive and inaccordance with its value base. Over the evaluation period the relationship with the respite unit hasdeveloped and this appears to be creating greater scope to meet needs of day centre clientsseeking quietness and continue to welcome respite clients.

o An excellent range of occupational diversity was observed and evidenced in documentation;activities promoted functioning across cognitive, physical, emotional, functional, creative, socialand expressive domains. Activities with high potential for engagement and wellbeing areemphasised, however the strength of HLDC lies not only in what happens but the way in which thestaff members facilitate each activity and each person to maximise their enjoyment, achievementand sense of self.

o The care taken to make lunchtime a pleasurable and enabling experience is commendable.Clients are empowered to assist in preparation, supported to make as many choices as practicableand conversation is facilitated by sitting with clients and those with eating difficulties are subtletysupported, demonstrating the range and texture of the team’s skills and knowledge. Theambience created is that of friends lunching in a cafe rather than a day centre, which is fabulous.

o Some of the carers interviewed believed that without HLDC their loved one would be in a nursinghome, a thought which some found unthinkable.

o HLDC provides a high quality service, which is making a significant contribution to the strategicvision of supporting carers and enabling people to remain in their own home.

“We know withHowbury Lodge Day Centre

staff that the flags will go upappropriately before problems can

escalate, and that we can worktogether to support people.”

“The manager is superb,up to her elbows in every-thing, but still with time for

us”