Praxis Care is a registered charity which has been in operation for
27 years. It is a major provider of support services for adults and
children with a learning disability, mental ill health, acquired brain
injury and for older people, including people with dementia. Praxis Care
operates in 4 jurisdictions: Northern Ireland, Republic of Ireland,
England and the Isle of Man. The organisation supports around
1,500-2,000 service users per annum and currently has over 1,000 staff.
Praxis Care provides a range of supported living
services including: residential care homes, shared group houses,
residential flat clusters, dispersed intensively supported housing in
the community, home support services for people in their own homes,
befriending, drop-in services, flexible day activity, workskills
projects and floating support.
Ethos and Value Base
The organisation’s value base
permeates all aspects of our services. It asserts that individuals using
Praxis Care services should be:
- Afforded opportunities, choice, privacy, the
right of self-determination and the right to take risks in daily life
having a quality of life which accords with those available to other
citizens.
- Given the opportunity to live within local
communities, and be provided with a standard of housing and local
facilities that accord with those available to other members of the
community.
- Encouraged to achieve their optimum level of
independence through receiving practical help and support in dealing
with everyday situations.
As such, the supported living services that Praxis
Care provides aim to support an individual to live the life they want
to, maximising their skills and abilities.
Praxis Care believes in partnership working -
partnership first and foremost with our service users, partnership with
their families and carers, partnership with our commissioners and others
involved in the service.
Supported Living Unit for Individuals with Dementia
Praxis Care has a purpose built supported living unit for people with
dementia called St Paul’s Court. St Paul’s Court enables older persons
who require housing support with care to live successfully in the
community. St Pauls is situated on land next to a church, hence its
name. It is located in a fairly quiet residential area on the outskirts
of the Lisburn town centre in Co Down close to shops and local
amenities. Praxis Care works closely with South Eastern Area Trust and
Trinity Housing Association to provide high quality support in a
sheltered environment. The St Paul’s Court scheme is primarily aimed at:
- People who have dementia.
- People who meet the Northern Ireland (NI) Housing Executive’s complex needs criteria.
- People who currently have a care package in place which is delivered by South Eastern Area Trust personnel.
Phase 1 of St Paul’s Court consists of 15 2-bedroom bungalows set in a
safe and secure environment, each with a small back garden, looking out
onto a “courtyard type street” with a separate resource centre. There is
also a separate block of 8 ground floor apartments situated around the
atrium. The bungalows and apartments are finished to a high standard and
have been planned with the needs of older people with dementia in mind.
Praxis Care staff are on hand 24 hours per day to provide advice,
guidance, support and care at a level appropriate to the individual’s
needs. Each person has a staff key worker who is committed to assisting
the older person to fulfil the aims outlined in his/her support plan.
The aim of the unit is to provide a place where people continue to have
independence whilst having their support and care needs met, as well as
supporting family carers. The environment can be adapted to the physical
and social well-being of the residents and offers individual
tailor-made care and support, depending on assessed needs. As all the
bungalows have two bedrooms, family members or carers may live with the
individual on a permanent or temporary basis. The development was
originally planned to provide a home for life and was designed for
people with mild to moderate dementia and people with complex needs.
Environment and Design
The Bungalows: Phase 1;
The houses follow dementia friendly design principles, with all the
rooms opening out from the front door entrance area. There are 2
good-sized bedrooms in each bungalow, an open plan lounge, a shower room
with WC and a fully equipped kitchen with partially glass-fronted
cupboards and back bedroom which looks out onto the back garden for each
house. Garden furniture, washing lines, sheds and seats are provided
for individual interests and tastes. Residents bring their own furniture
because it is familiar and particular to them.
he Apartments: Phase 2; Phase
2 of the unit was opened in February 2009. It provides a further 8
tenancies (7 single and 1 double ) within a separate complex on the same
grounds as phase 1 and is for individuals who have been assessed as
having mild to moderate dementia. Residents have been gradually moved
into their new home over the past few months.
The Resource Centre
The resource centre has a kitchen, two lounges,
dining area, toilets, hobbies room, office accommodation and a staff
sleepover room. Residents and carers use the lounge area frequently for
social activities. Staff members also promote a model of social
inclusion which encourages the older person to use social and leisure
facilities in the local community. The new phase 2 building has a large
atrium which is currently being used to host weekly Reminiscence Therapy
events delivered by a tutor from the Workers Educational Association.
Initial impressions are that these sessions have provided an opportunity
for residents to get together and help foster a sense of community.
Additional social activities offered include coffee mornings, lunch
clubs, film nights, ‘pampering’ and cookie afternoons.
Assistive Technology
Assistive technology is available and can be
commissioned to meet individual requirements. A call system is in use
and the older person can see the entrance to the scheme on a channel of
their television. The accommodation has been designed to ensure that
care and support can continue to be provided even as the person’s
physical needs increase, so that another move, towards the end of one’s
life, can hopefully be avoided.
The Evaluation
Praxis Care has an established Research Department
that conducts a wide range of in-house and commissioned research in the
health and social care field. The Department has carried out research
on topics such as self-advocacy and user involvement, community health
needs, volunteer befriending, alcohol related brain injury, and has
evaluated various models of service provision.
The Department is currently conducting an
evaluation of the St Paul’s phase 2 dementia unit. The researchers are
using multiple methods within a case study design in order to explore
the degree to which the unit meets its aims and objectives with data
being collected shortly after admission and thereafter at three monthly
intervals. The study is, at the time of writing, at the baseline data
collection stage but will include information from the older people,
primary carers and health and social care professionals. The evaluation
will use the Joseph Rowntree Foundation ‘6 keys to a good life’ (JRF,
2009) as a framework for data collection (see box below).
JRF ‘6 keys to a good life’
|
Evaluation Information Source
|
|
Social web and interview
|
- Personal Authority and Control
|
Interview and carer questionnaire
|
- Home and Personal Surroundings
|
Observation and interview
|
- Meaningful Daily and Community Life
|
Interview, questionnaire, observation
|
- Personalised support and care
|
Record analysis, carer questionnaire
|
- Personal identity and self-esteem
|
Interview, environment checklist
|
Some examples of the methods being used include:
- The six item Cognitive Impairment Test 6CIT (Brooke and Bullock 1999)
- The Bristol Activities of Daily Living Scale
BADLS (Bucks et al 1996) which measures the older person’s ability to
perform every day activities in areas such as feeding, hygiene and
managing finances.
- The use of informal interviews in order to ‘map’ the extent and quality of clients’ social networks.
- Structured observation in order to capture the
non-verbal cues of those clients who may not use speech as their primary
method of communication.
- Semi-structured questionnaires administered to carers, Praxis Care staff and statutory health professionals.
- Secondary data analysis e.g. supports plans, critical incidents and activity sheets.
The intention is to use 6CIT and BADLS data to
track change over time (baseline, 3 months, 6 months, 12 months) with
analysis being confined to the use of descriptive statistical methods.
The social network data for each resident will include both quantitative
and qualitative information on their involvement in a series of ‘social
domains’ (family, neighbourhood, services). This will allow the
researcher to describe and map the extent of a resident’s social network
over time while living in their new home. The research will also
examine the quality of a client’s social network using sociograms and
analytical concepts derived from graph theory (Nooy et al 2007). The
work on the application of sociograms and social network analysis will
form the basis of a poster which will be displayed at the Dementia
Service Development Centre’s International Conference (York Racecourse
14 – 16 September 2009) (see: http://www.dementia.stir.ac.uk/conference_welcome)
Although the study is at an early stage, a
tentative finding is that assessment tools like 6CIT may not be totally
appropriate for use with this client group as it is possible that a
client’s inability to answer standardised questions may unwittingly
undermine self-esteem and well being. Indeed, the phenomenon of
“personal detraction” or a negative interaction with a person with
dementia has already been described in the literature by Kitwood (1997).
As the research progresses, we will continue to explore the
appropriateness of a range of assessment tools which are reliable, valid
and sensitive to the emotional responses of clients.
If you have any suggestions or helpful advice on
any of the above areas of research, we would very much like to hear from
you. Please contact our Research Department (soniam awhinney@praxiscare.org.uk or paulwebb@praxiscare.org.uk).
If you would like to visit the unit or find out more about the ‘home
from home’ support that is provided, please contact our Central Office
(028 9023 4555).
References
Brooke, P. and Bullock, R. (1999) Validation of the 6 Item Cognitive Impairment Test, with a view to Primary Care usage. International Journal of Geriatric Psychiatry, 14, 936-940.
Bucks, R.S., Ashworth, D.L., Wilcock, G.K.,
Siegfried, K (1996) Assessment of Activities of Daily Living in
Dementia: Development of the Bristol Activities of Daily Living Scale. Age and Ageing, 25, 113 – 120.
Kitwood, T. (1997) Dementia Reconsidered. The Person Comes First. Open University Press: Buckingham.
Nooy, W. D., Mrvar, A., Batagelj, V. (2007) Exploratory Social Network Analysis with Pajek. Cambridge University Press: Cambridge.
Joseph Rowntree Foundation. (2009) Older People’s Programme. Conference presentation, Belfast.
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