Residential/Care Home Nursing Home- EMI unit

Residential care homes

Residential Homes /Care Are where a number of people live together, supported by care staff who are available 24 hours a day. In certain circumstances, short term places are also available for people recovering from a hospital stay or illness, or to give the person who cares for them a break from their caring responsibilities. Care homes are run by local authorities, voluntary organizations, private companies and individuals. All care homes are registered and inspected by the CQC. Residential care homes should provide you with: day to day support personal care, such as help with getting up and going to bed, eating, washing, dressing and using the toilet a comfortable and safe environment to live in activities of real interest and enjoyment privacy, dignity and respect support for your physical, spiritual, intellectual, emotional and social needs

Nursing Homes
Nursing care homes are where a number of people with nursing needs live together, supported by trained nursing staffs that are available 24 hours a day. In certain circumstances, short term places are also available for people recovering from a hospital stay or illness, or to give the person who cares for them a break from their caring responsibilities. Care homes are run by local authorities, voluntary organizations, private companies and individuals. All care homes are registered and inspected by the CQC

EMI Unit (Elderly Mentally Infirmed)

EMI stands for Elderly Mentally Infirm. EMI nursing homes specialize in caring for elderly people who suffer from mental illness, such as Alzheimers disease. They typically have an emphasis on social interactions to help stimulate the mind and body.

Keywords for Nurses and Carers

Dementia is the severe loss of all or most of a collection of mental abilities known as higher mental functions. Such functions include abilities like memory and reasoning skills. This is often due to the brain simply getting old; however, dementia can include situations in which these higher functions have been loss due to disease or injury. Alzheimer's disease (AD) is a progressive, fatal brain disorder. It is the most widespread form of dementia, which is a brain disorder that affects a person's ability to carry out daily activities.

Parkinson's disease is a degenerative disease of the nervous system associated with trembling of the arms and legs, stiffness and rigidity of the muscles and slowness of movement

Pressure Sores and Their Grades and how to treat them

Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers.

What are the symptoms of a pressure sore?

There are 4 stages of pressure sores. Symptoms at each stage include the following: Stage 1. The affected skin looks red and may feel warm to the touch. The area may also burn, hurt or itch. In people who have dark skin, the pressure sore may have a blue or purple tint. Stage 2. The affected skin is more damaged in a stage 2 pressure sore, which can result in an open sore that looks like an abrasion or a blister. The skin around the wound may discolour. The area is very painful. Stage 3. These types of pressure sores usually have a crater-like appearance due to increased damage to the tissue below the skin's surface. This makes the wound deeper. Stage 4. This is most serious type of pressure sore. The skin and tissue is severely damaged, causing a large wound. Infection can occur at this stage. Muscles, bones, tendons and joints can be affected by stage 4 pressure sores. Who gets pressure sores? Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you are paralyzed, use a wheelchair or spend most of your time in bed. However, even people who are able to walk can develop pressure sores when they must stay in bed because of an illness or an injury. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of poor blood circulation. Where on the body can you get pressure sores? Pressure sores usually develop over bony parts of the body that don't have much fat to pad them. Pressure sores are most common on the heels and on the hips. Other areas at risk for pressure sores include the base of the spine (tail bone), the shoulder blades, the backs and sides of the knees, and the back of the head. How are pressure sores treated? There are several things you can do to help pressure sores heal: Relieving the pressure that caused the sore Treating the sore itself Improving nutrition and other conditions to help the sore heal What can be done to reduce pressure on the sore? Don't lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you're lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart. When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. When lying in bed, change your position at least every 2 hours.

When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. You should change positions every 15 minutes when sitting in a chair or wheelchair. If you cannot move by yourself, have your caregiver help you shift your position. How should the pressure sore be kept clean? In order to heal, pressure sores must be kept clean and free of dead tissue. Stage 1 sores can be cleaned with mild soap and water. You can clean stage 3 sores by rinsing the area with a salt and water solution. The saltwater removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore. Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that moulds to the pressure sore and helps promote healing and skin growth. These dressings can stay on for several days at a time. Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days. Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. For more severe pressure sores, dead tissue must be removed surgically. Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed to help reduce pain. Why is good nutrition important for healing sores? Good nutrition is important because it helps your body heal the sore. If you don't get enough calories, protein and other nutrients (especially vitamin C and zinc, which can help heal wounds like pressure sores), your body won't be able to heal, no matter how well you care for the pressure sore. Your doctor, nurse or a dietician can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently. What if the sore gets infected? Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away. Signs of an infected pressure sore include the following: Thick yellow or green pus A bad smell from the sore Redness or warmth around the sore Swelling around the sore Tenderness around the sore

Signs that the infection may have spread include the following:

Fever Chills Mental confusion or difficulty concentrating Rapid heartbeat Weakness How are infected pressure sores treated? The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, antibiotics are often required. They can be given intravenously (through a needle put in a vein) or orally (by mouth). How can I tell if the sore is getting better? As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing. How can pressure sores be prevented? The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously. It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, colour changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur. If you smoke, you should quit. People who smoke are more likely to develop pressure sores. Exercise can help improve blood flow, strengthen your muscles and improve your overall health. Talk to your doctor if physical activity is hard for you. He or she can suggest exercises that can work for you, or refer you to physical therapist that can help.

Diabetes the type the stages and the treatment

Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because your pancreas does not produce any insulin, or not enough, to help glucose enter your bodys cells or the insulin that is produced does not work properly (known as insulin resistance). Insulin is the hormone produced by the pancreas that allows glucose to enter the bodys cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life. Glucose comes from digesting carbohydrate and is also produced by the liver. Carbohydrate comes from many different kinds of foods and drink, including starchy foods such as bread, potatoes and chapattis; fruit; some dairy products; sugar and other sweet foods. If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood and isnt able to be used as fuel Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin. Insulin is the key that unlocks the door to the bodys cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. In Type 1 diabetes the body is unable to produce any insulin so there is no key to unlock the door and the glucose builds up in the blood.

Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood. Type 1 diabetes accounts for between 5 and 15 per cent of all people with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity.

Type 2 diabetes develops when the body does not produce enough insulin to maintain a normal blood glucose level, or when the body is unable to effectively use the insulin that is being produced. Treatments
All people with Type 1 diabetes will require insulin and eventually, some people with Type 2 diabetes find that despite having their diabetes medication adjusted, their blood glucose levels remain too high and insulin treatment is recommended by their doctor. Insulin cannot be taken in a tablet form because, being a protein, it would be digested in the stomach before it had any effect. Insulin can be given in different ways via an injection, using a syringe, pen device or via an insulin pump. The needle is small, as it only needs to be injected under the skin (subcutaneously), either in the stomach, buttocks, thighs or upper arms. The insulin is then absorbed into small blood vessels and arrives in the bloodstream. There are six main types of insulin available in various combinations and they all work in different ways. People with Type Two Diabetes are Orally Treated unless prescribed Insulin by their Medical Professional. Diabetic patients should monitor their Sugar levels daily and as directed by their Medical Professional and have regular Blood tests to make sure HCG levels have not moved.

What is a Stoma
A stoma is an artificial opening in your abdomen (tummy) to collect waste (either faeces or urine). Stomas to collect faeces connect to your bowel (intestine); stomas to collect urine connect to your ureter (the tube that carries urine from your kidneys to your bladder). This means you will no longer use a toilet when you open your bowels or urinate, as any waste products will pass into and be collected in a reservoir bag or pouch, on the outside of your body. The main types of stoma are ileostomy - an opening from the small bowel, to allow faeces to leave your body without passing through the large bowel colostomy - an opening from the large bowel, to allow faeces to leave your body without passing through the anus urostomy - an opening from the ureters, to allow urine to leave your body without passing through the bladder

Lifts & Hoists

Designing a fixed hoist installation is typically a complex process involving architectural, structural and electrical elements. It is not a project to be tackled by a handyman.

A residential hoist or ceiling lift can help people who have difficulty safely moving themselves or others in or out of bed, or in or out of a bathtub. Consistent with the philosophy of Universal Design, it takes little physical effort to use a residential hoist or ceiling lift to move people from one position to another or from one place to another. Residential hoists and ceiling lifts help many people for instance, seniors who want to remain in their own homes despite changes in their mobility, strength or agility; and parents of children with a disability who can no longer lift their children. A residential hoist or ceiling lift can allow a spouse, partner, parent or caregiver to help with transfers, which can help maintain independence and allow people to stay in their own homes. Universal Design People who inhabit and visit the houses and homes we live in come in all shapes and sizes, ranging from infants to seniors, with various everchanging abilities and skills. As we grow up, grow old and welcome new people to our homes, our housing needs change. A house or dwelling that is designed and constructed to reflect the principles of Universal Design will be safer and more accommodating to the diverse range of ages and abilities of people, who live in and visit these homes. What are Hoists and Lifts? A hoist is a mechanical lifting device that can lift someone from a seated position and transfer them to another location, such as a bed, a seat or a bathtub. Some hoists can move horizontally between areas within a room or between rooms. A ceiling lift is the commonest term for a type of hoist that consists of a hoisting unit mounted to a track in the ceiling. This type of hoist allows a person to be lifted and moved across a room, or between rooms. What Types of Hoists are Available? There are three types of residential hoisting devices: Wheeled hoists Stationary hoists Ceiling lifts

Wheeled Hoist A wheeled hoist is free-standing equipment that supports the person being moved in a sling or harness that is suspended from a cantilevered arm. The sling is placed around the person while he or she is seated or lying down. The person is then hoisted up, the hoist is wheeled to the new location and the person is lowered. One of the first things to consider is the amount of manoeuvring space a wheeled hoist needs. The wheeled base of the hoist must be wide enough to remain stable with the person in it. Consequently, wheeled hoists require a wide and unobstructed path of travel usually at least 1,100 mm (43 1/2 in.) and possibly more if turns are required. Another design consideration is clear space under furniture and fixtures, to accommodate the frame of the hoist. If a wheeled hoist is to be used for transfers in and out of a bathtub, the bathtub should have legs or be raised from the floor the hoist frame will fit under the bathtub. Stationary Hoist Stationary hoists are mounted to the floor or a wall. Although the base of the hoist is fixed, a support arm pivots to transfer the person sideways. Stationary hoists use a sling or harness similar to that of a wheeled hoist. The primary design consideration for a stationary hoist is the structural strength of the floor or wall it is attached to. The advice of a structural engineer is a must. Other considerations include the arc of the hoist swing (ensure it reaches the necessary elements) and making sure that clear space is available for the wheelchair during the transfer to and from the hoist.

Ceiling lift A ceiling lift is a hoist that is mounted on a ceiling. A ceiling lift is usually electrically powered, but there are manual units. An electric hoist with a sling system is attached to a ceiling track and the person is lifted in the sling and moved along the ceiling track. The primary consideration in choosing and installing a track-mounted ceiling lift is the structural strength of the supports in the ceiling. The advice of a structural engineer is a must. You must also provide a clear path of travel along the route of the track, particularly at door frames for a system that connects two or more rooms. Ceiling tracks can be provided in a variety of locations most electric hoists can be manually moved from one location to another. Some track systems also incorporate a turntable, allowing the hoist to move easily from one track system to another. Turntables can be manual or electric.

Induction Training Induction training is a requirement of the Essential Standards of Quality and Safety, which have applied to care services from October 2010 All new employees require induction training whether they have had previous experience of care work or not as each work setting and role will be different from anything previously experienced. Each Company has a Different term in how long the Induction Period can last some are paid and some are un paid some can last 2 days some last 6 weeks it depends on the individual homes. Throught the Induction you will be required to complete the following courses

Induction Training Overview this is a guide and will change from company to company Day 1: Induction orientation, Principles of care, Health and safety, Fire safety, Infection Control Day 2: Protection of Vulnerable adults (POVA), Food hygiene Day 3: Medication Awareness, Catheter care (Nurses) Day 4: Moving and handling Day 5: Emergency aid (basic first aid)

You will also receive additional training in Dementia Awareness and Communication.
Manual Handling Adequate training is an essential element in the safe use of hoists. A lack of adequate training is often cited as the main or contributory cause in the majority of accidents involving hoists. Care home managers have a duty under the Health and Safety at Work, etc Act 1974 and the Provision and Use of Work Equipment Regulations 1998 to ensure that all staff are appropriately trained to use any equipment that they are required to use in their work safely and without risk. Training should refer to the specific manual supplied with the hoist and staff should be urged to always follow its directions for use. It should include equipment selection and use, the principles of hoisting, the potential risks, how to use the specific equipment they have in their workplace and how to implement individual handling plans. In particular, staff should be trained that hoists should always be used within the limits of their tolerance and never used for something they are not designed to do. All staff that will be expected to use a hoist should be given hands-on training using the same or a similar device. Practical training is vital in ensuring that staff has the skills and confidence to use a hoist safely.

Full records of staff training should be kept and reviewed during annual appraisal to ensure that all staff has current training. Health and Safety Training Employers are legally obliged to provide suitable and sufficient health and safety training. The regulations require employers to provide adequate health and safety training when an employee is recruited to an organization. This is in addition to other legal requirements for health and safety training. Induction training generally presents information at three levels: o general information regarding health and safety in the organization o local health and safety information, such as fire arrangements, names of fire wardens and first aiders, etc o Job-specific information as is necessary to allow the person to begin working safely. Induction training may be required by existing employees moving to a new site, or workplace, Training should be carried out prior to an employee being exposed to the risk. Care service managers should always keep records of the staff who have attended health and safety training, including dates. Under the Corporate Manslaughter and Corporate Homicide Act 2007 companies and organisations can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care. Health and safety training may be based broadly on one of the following two methodologies: o face-to-face methods, such as classroom-based training, tool-box talks, job instruction, workshops, role-play and exercises o Resource-based learning, such as computer-based training and open learning/distance learning. Evaluation of training is vital to ensure its content has met the aims and objectives. The process of assessing what training is necessary, at any of these levels, is known as a training needs analysis. Organizations should appoint a suitable person to manage the planning and provision of safety training. It is important that care service managers ensure that any dedicated night staff are included in both induction and post-induction health and safety training. It is good risk management practice to include volunteers in health and safety training wherever possible and to provide them with suitable induction training. Health and Safety. According to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, service providers must by law ensure that they have suitable procedures in place to ensure the safety of service users and staff, including adequate health and safety training

Documents to be filled
Care Plan Example Care Plan for Mrs Jane Smith Mobility Evaluated on 10th July 2008 Current Situation Jane suffered a fall and broke her hip prior to coming into the home. She has lost confidence and is worried about falling again.She is fully recovered from her hip joint repair and is fully mobilised.She uses one walking stick. On some days she finds it difficult to initiate walking which she finds very frustrating. Objective To maintain Janes mobility. To avoid trip hazards. Action Ensure that there are no trip hazards in Janes bedroom. Offer to accompany Jane on days when her walking is difficult. Medication Evaluated on 10th July 2008

Current Situation Jane has Parkinson's disease which makes it difficult for her to swallow tablets. Most of her medication is therefore given in syrup or soluble form. On days when she is agitated she may refuse her medication. In these instances it is best to withdraw and try again.. Objective For Jane to receive the maximum therapeutic effect from her prescribed medication.. Action RGN to administer all of Jane's prescribed medication. If refused, withdraw and try again later. Monitor for therapeutic or side effects and report to GP. Body Temperature Evaluated on 10th July 2008 Current Situation Jane has no problems in this area. She is able to make her needs known and is able to request changes in her physical environment. Objective To maintain a stable body temperature and to ensure that Jane is comfortable at all times. Action Provide Jane with a warm and well ventilated environment. Ask Jane if she is comfortable and encourage her to request any changes she may require. Breathing Evaluated on 10th July 2008 Current Situation Jane suffers from mild asthma and has a history of recurrent chest infections with bouts of bronchitis in the winter months for which she requires antibiotics. At present her chest is clear. Objective To maintain good respiratory health. Action Ensure that Janes bedroom is warm and well aired avoiding draughts. Be observant of Jane if she develops a persistent cough when she will need to see the doctor. Be aware that Jane can show signs of confusion when she has a chest infection Communication Evaluated on 10th July 2008 Current Situation Jane has Parkinsons disease and is fully able to communicate her needs. She has asked that all staff call her Jane. She wears spectacles for reading and wears a hearing aid in her right ear. On the days when she experiences problems with her mobility she can be anxious and agitated.

Objective To maintain effective communication. Action Ensure that Janes hearing aid is operating efficiently. If she is experiencing anxiety take time to chat to her and give reassurance. Dying Evaluated on 10th July 2008 Current Situation Jane is a Christian and enjoys services and hymn singing. She has expressed a wish to be cremated. She has a caring family who will make all arrangements for care at the end of life. Objective To carry out Janes wishes. A c t i o n Inform Janes family of all changes in her health. Consult them for further information regarding wishes for any treatment that may be offered. Elimination Evaluated on 10th July 2008 Current Situation Jane is fully continent. She has a history of diverticulitis and is prescribed movicol to maintain regularity. Objective To prevent a flare up of diverticulitis. Action Monitor frequency of bowel action and inform RGN or GP if this becomes abnormal. RGN to administer movicol. Hygiene Evaluated on 10th July 2008 Current Situation Jane requires assistance with some aspects of hygiene from one carer. She likes to shower every other morning. Jane has very dry skin which requires application of emollients once a day. She wears dentures. Objective To maintain high standard of hygiene Action Provide one carer to assist Jane with hygiene. Offer her a shower or a wash daily in her en-suite. Assist with application of emollient to her back and legs after her wash. Offer to manicure finger nails as necessary. Offer to make appointments for hairdressing and chiropody as necessary. Mental Well Being

Evaluated on 10th July 2008 Current Situation Jane suffers with Parkinsons disease. Her cognitive abilities are unaffected but on days when she experiences difficulty with mobility she may become anxious and agitated. She enjoys company and looks forward to visits from her family. Objective To maintain stable level of mental well being. Action Spend time chatting to Jane and encourage her to mix with other residents. Offer reassurance if she is agitated. Nutrition Evaluated on 10th July 2008 Current Situation Jane has Parkinsons disease and has difficulty with swallowing. Jane likes most food and fruit but prefers to avoid hot or spicy dishes. She most enjoys a cup of tea and a slice of sponge cake. Objective To ensure that Jane receives optimum nutrition to maintain stable weight. Action Ensure Jane receives a soft diet. Encourage a high fruit and fluid intake to avoid constipation. Be aware of choking hazard. Weigh monthly. Pressure Sores Evaluated on 10th July 2008 Current Situation Janes skin is intact and she has no pressure sores. Her skin is very dry and requires application of emollient. Objective To maintain skin integrity and to prevent pressure sores occurring Action Inspect skin daily and report any signs of redness to RGN. Apply emollient to back and legs daily. Safe Environment Evaluated on 10th July 2008 Current Situation Jane is able to maintain her own safety. Objective To maintain a safe environment for Jane. Action

Ensure there are no trip hazards such as loose carpet or wet floor Sleeping Evaluated on 10th July 2008 Current Situation Jane usually sleeps well. She is not prescribed sedation. She likes to retire at 9pm after a warm drink. She regularly wakes at 3am but is able to go back to sleep until 7am Objective To enable Jane to sleep well A c t i o n Offer Jane a warm drink before she retires. Check two hourly during the night. Encourage Jane to call when she wakes in the middle of the night and offer a chat and a drink. Social Interaction Evaluated on 10th July 2008 Current Situation Jane is a solicitors wife and has spent all her life living in Guildford. She was a primary school teacher. She is a widow and has three children, a son and two daughters. They all visit Jane regularly and are very caring. Jane is a Christian and enjoys services especially the hymn singing. She enjoys the company of other people and joins in activities in the lounge during the day. She enjoys board games, especially Scrabble and is good at completing crosswords. She likes to go to her room after tea to watch television. Objective To ensure Janes social needs are met and that she enjoys her life here in the home. Action Ensure Jane has received her newspaper The Daily Telegraph every day. Keep Jane informed as to the entertainment and activities on offer for the day. Facilitate visitors at any time. Offer to play a board game with her. Talk to Jane about her family.