ExtraCare’s Wellbeing Service - College of Medicine and Integrated Health

Changing the conversation about health

ExtraCare’s Wellbeing Service

Amanda KingMarch 29, 2012December 14, 2014 Healthy Living, Integrated Healthcare, Long Term Conditions, Older Age, Sustainable Health Solutions

	ExtraCare’s Wellbeing Service supports older people to live as independently as possible and be proactive in managing their own health and wellbeing. Wellbeing Advisors (Registered Nurses) support residents to make informed decisions about their lifestyle and health via a holistic Wellbeing Assessment. On average residents experience a 9% health improvement between first assessment and follow-up. The service also offers drop-in clinics, runs awareness sessions and helps overcome many of the barriers older people face in accessing health services.
Year established	2001
Number of staff	23, with approximately 400 volunteers in the past 12 months
Number of users	around 4,000
Is there a charge to users?	A small proportion of the weekly Amenity Charge paid by residents is used to help fund the Well-being Service.
What makes your project sustainable?	Financial Sustainability Originally funded by charitable donations, the Wellbeing Advisors’ costs are now incorporated into the relevant scheme’s operating budget. We have been exploring ways over the last year of getting Local Authority or Clinical Commissioning Groups to fund our work and will continue to pursue this. In some smaller schemes where a full-time Wellbeing Advisor cannot be justified, ExtraCare has developed the role of Wellbeing Captain, a resident support worker trained to NVQ3 in Health and Social Care, who assists in following up action plans, booking appointments, checking blood pressures, and acting as a point of contact when the Wellbeing Advisor is not on duty. Wellbeing Ambassadors (resident volunteers) help ensure the project’s long-term sustainability by organizing their own lifestyle or interest groups, thereby freeing up the Advisor’s time to focus on Wellbeing assessments, follow-up and advocacy.Environmental Sustainability ExtraCare participates in the CRC Energy Efficiency Scheme (previously known as the Carbon Reduction Commitment). ExtraCare achieved Code for Sustainable Homes Level 3 on the development of the Gloucester Retirement Village and at the recent he Hagley Road Retirement Village in Birmingham The new village in Bournville, Birmingham is also on track to achieve Code Level 3. ExtraCare’s Shenley Wood Village in Milton Keynes is built to achieve BREEAM Very Good standard. All three of these villages have Combined Heat and Power plans as do new villages being built. In many of our locations, corridor lighting has been converted to be PIR activated so that it is only used when needed. In addition, all new villages are installed with a voltage optimizer to regulate the flow of power, which helps reduce power usage. Refuse recycling systems have been introduced into the design of the villages in Nottingham, Shenley Wood and Gloucester. ExtraCare’s head office participates in Coventry City Council’s waste recycling scheme.
Innovation	ExtraCare communities comprise older people aged 55+. 33%-50% receive care (higher in the smaller schemes).The remainder live independently.Concerns • In 2001 a survey of independent residents at one community revealed that 75% had not accessed their GP for over a year, believing ill health, discomfort and disability to be a natural consequence of getting older. • More older people are prescribed medication for long term conditions but stop taking them due to either side effects, dislike of taking tablets or mistrust. • Anecdotal evidence suggested this group was more likely to develop sudden, serious health conditions, compared to residents receiving care via ExtraCare’s onsite team. Challenges • Managing expectations and maintaining focus on prevention and education – initially GPs, staff and residents thought the “nurse” was there to provide a triage service or carry out District Nurse duties (eg. changing dressings). Working well • Facilitating early diagnosis – recognizing early symptoms (including hypertension, diabetes, cancer, osteoporosis) and referring to GPs, giving treatment the best chance of success. • Self management – residents are encouraged to manage their condition well, by education, awareness, knowledge around their medication, and when to seek further help if needed. • Drop in clinics – residents who are unsure if they should visit their GP are given advice by the Wellbeing Advisors to make an appointment or not • Prevention of admission to hospital – infections that are picked up quickly can be treated at home, preventing more serious conditions that would need hospital care. • Intervention doesn’t have to be costly/complex to improve quality of life significantly – 105 people were identified with hearing loss, of which 48 benefited from almost immediate improvement due to ear syringing, hearing aid repair/adjustment. • Receptiveness of residents to concepts of self-help and peer support. We have witnessed lasting attitudinal change amongst residents towards their health and wellbeing.
How does it share the College’s ethos?	Read how Extracare shares the ethos of the College here
Patient-Centred, whole person preventative approach	Residents shape the Well-being Service in their ExtraCare community via their involvement as volunteer Wellbeing Ambassadors. The role often reflects their own health interests or issues:• In Northampton a group of residents, including a former clinical psychologist, supports other residents with dementia via regular cognitive stimulation therapy activities. • At one of our Birmingham Villages there is a weekly dog agility class in the village centre organized by residents for owners and their pets to be active together. • Elsewhere Ambassadors offer hand-waxing, which helps ease arthritic joints – some residents have been able to take up knitting again after some years thanks to the benefits of this complementary treatment. • In our larger communities, many Ambassadors volunteer in the on-site gym. In 2012 we introduced a new wellbeing data capture system, which enables us to build a local health profile for each of our communities and offer targeted initiatives based on local intelligence. As a result of the new system, we have already been able to identify a number of residents who have previously fractured a wrist.Statistics show a wrist fracture increases the risk of hip fracture. Identifying and treating those at high risk can reduce the risk of hip fracture by 50%, yet studies show that just one in five patients who had been seen with a fracture of the wrist, hip or spine had received treatment for osteoporosis.We are now working with these residents to develop individually tailored exercise programmes to improve balance, strength and stability, as well as making referrals to GPs for bone protection medication to try to prevent future fractures in the event of a fall. All the gym instructors have been trained in Otago (an exercise programme to help prevent falls) and offer Otago sessions in the locations.Another example is in a village where we identified a high number of residents with diabetes or at risk of diabetes. This is due to high levels of inactivity, higher levels of obesity and demographics of the area. The Wellbeing Advisor is then able to offer more advice and proactive work to reduce weight by running weight management classes, and increase referrals to the gym instructor.
Evidence informed practice/audit and evaluation	Read about the evidence base for Extracare’s work here.
Healing	Read about approaches to healing in Extracare’s work
Contact details	Shirley Hall The Extracare Charitable Trust 7 Harry Weston Road Binley Business Park Binley Coventry CV3 2SNt: 07989 375397 e: shirley.hall@extracare.org.uk w: www.extracare.org.uk