Care quality


as problems can be spotted and escalation avoided.


Putting theory into practice So what does this mean in practice? There are implications ranging from the details of daily life in homes, through to future planning for investment; from the decisions made at local authority level to national policies on delivery and funding. An important factor is the physical environment of the home - interior and exterior design can respond to and promote relational care. My research highlighted critical features and resulted in design guidelines developed and tested by The Abbeyfield Society, and now being incorporated into wider practice.


While much can be done to adapt existing homes, in terms of ethos, layout and use of available space, new build has far more flexibility to incorporate relational design. All the top ten guidelines that Abbeyfield devised in co- operation with their architects have now been reflected in one of more of its new schemes around the UK.


As an example, some of these are given below, together with quoted comments from managers of homes where they have been implemented. l To provide residents with variety and choice, at least two communal rooms should be provided in a small home, and three in a larger one. “There is always activity in the main lounge… .The second lounge has become the ‘quiet lounge’ and a sanctuary”.


l A garden room such as an orangery or conservatory should be considered if at all possible. “Having access to the garden room and outside area is hugely important for residents, many of whom spend much of their day in the house. Connecting to nature…. Adds to a wonderful feeling of contentment, of being in the right place at this stage in their lives”.


l Dining rooms should be designed to maximise natural light with attractive views over the garden and beyond to


ensure a pleasant experience, with plenty of light for the visually impaired. During my interviews, I was often told how relationships formed and grew during mealtimes, and how valued are dining rooms that promoted interaction. “The creation of an airy, spacious environment stimulates appetite …. And encourages them to linger after meals, promoting increased opportunity for sociability and enhancing wellbeing”.


l Staff should have a peaceful retreat away from residents. “The one [retreat room] that is used most is next to the kitchen. It is very peaceful and allows staff to get away from residents who can be hard work sometimes”.


l The lounge should be family-oriented, with access to safe drinks preparation. “Residents do like to be able to offer a cup of tea to guests – anyone visiting. It is the main focus of the lounge”.


One of the underlying principles of relational care is that everyday tasks like personal hygiene, selection of clothes, service of meals - as well as activities like singing, craft or exercise - should be carried out as part of the caring interaction


January 2021 • www.thecarehomeenvironment.com


Other ‘top ten’ guidelines, together with much more about implementation and the effect of a little ingenuity, are to be found in Making Relational Care Work for Older People.


Fit for a family


Suffice to say, taking the right steps to provide good amenities, cleanliness and attractiveness while moving away from beautiful but soulless décor and in the direction of a family home, brings warmth, atmosphere and a sense of belonging. As one manager told me, “I don’t think anyone wants to move into a hotel forever!”.


One of the topics that should be addressed in relation to family-style homes concerns balancing risk and safety. Family homes are notoriously prone to hazards that naturally have to be considered in a care home: threadbare carpets or slippery rugs, steep stairs, wobbly furniture with splinters are clearly no-nos.


On the other hand, over-emphasis on safety is the enemy of autonomy, and one of the aims of care provision must be to ensure older people feel they have some level of control and agency. Good managers will make and record assessments but will not be driven by risk elimination.


As one said: “The caring staff [can be] worried – the teapot is too heavy, too hot. This creates a barrier to self-care. We talked to the CQC; they say it’s home


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©The Abbeyfield Society


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