What inspired you to pledge this change?
Before working in one, I did not know of the existence of specialist nursing homes (SNH) and that rehabilitation took place there. I realised that if I didn’t know about them then maybe other people didn’t either. I’m hoping that raising the profile of physios who work in specialist nursing homes will lead to increased awareness of what we do and what we can achieve and allow discussions about some of the issues that we face.
When did you start enacting your pledge?
I started shortly before the Physiotherapy Works event. I wrote a case study poster with colleagues about reduced dependency and decreased care costs following rehabilitation in a specialist nursing home, which was accepted by PTUK 2015. (http://www.physiotherapyuk.org.uk/presentation/reduced-dependency-and-de...). I wanted to highlight a successful patient outcome to demonstrate what can be achieved in a specialist nursing home, that is 4 years post neurological event following slow stream rehabilitation a patient was able to return home to her family and care costs were significantly reduced. Writing the poster helped me clarify what some of the issues facing physios in SNHs are.
So far, promoting the effectiveness of physiotherapy has been on a local level within the nursing home that I work in by demonstrating to colleagues what physios can achieve. I am also in the process of creating and strengthening links with potential referrers to our nursing home. Making the pledge inspired me to work harder to promote the work that we do.
There are three main groups of people to whom I would like to raise awareness about the work that we do: staff within the nursing home I work in, the wider physiotherapy community, and commissioners.
One of the biggest issues that we have is that residents who have significant nursing needs and meet Continuing Health Care (CHC) funding requirements can get funding for therapy but those who are funded by local authority social services often do not have therapy funding. Those patients would have to pay privately if they wanted therapy, as was the case with the patient from the poster case study. Once she no longer qualified for CHC funding, therapy stopped and if the family hadn’t been able to pay privately for physiotherapy I’m not sure that the patient would have had such a successful outcome. Patients who are funded by their local authority might be at the right point in their recovery to benefit from rehabilitation or they might require slow-stream rehab to improve their function and independence, but because they do not require significant nursing input, they cannot get funding. It is a commissioning issue and something that is very hard to change.
I would like to make the CSP aware of the challenges we face, particularly regarding funding, as I’m not certain if they are aware of the issues in nursing homes.
What further support from the CSP would you find useful?
I would like the CSP to highlight the issue of CHC versus social care funding in relation to physiotherapy. I would also like them to promote the fact that SNHs are a good place for slow stream rehabilitation.
There is a document ‘British Society of Rehabilitation Medicine - Specialist Nursing Home Care for People with Complex Neurological Disability: Guidance to Best Practice’ published in 2013. http://www.bsrm.org.uk/downloads/bsrm-guide-to-best-practice-36pp-final-... It describes many aspects of SNHs and suggests that multiagency panels (comprising health and social services) may be useful in negotiating funding.
Could you tell me about any changes that you have made?
Where I work, we changed over to wearing traditional physiotherapy tunics. This allows us to stand out and increase people’s awareness of our profession. I had feedback from one member of staff who said he trusted us more now that we were wearing our uniforms. I have recently been promoted to a managerial role and as such I have access to more senior professionals and sometimes even commissioners so I try to promote our SNH and physiotherapy - not quite an elevator pitch but the intention is the same!
We managed to get funding for a walking hoist and when possible we use it on the unit so that staff can see what can be achieved with physiotherapy and the right equipment. Our residents really like it and I think that staff are quite impressed at seeing wheelchair users on their feet.
Were there any unforeseen benefits?
The Physiotherapy Works event was very stimulating and inspired me to be more creative. It made me consider that maybe we could achieve smaller things even if we can’t change the funding system and I am now much more solution based than before.
Do you feel more confident?
Yes, attending the event, listening to inspiring people and being aware of the effort the CSP was putting in made me realise the experience I have gained over time and my capabilities. Originally I wasn’t planning to become a manager but when I was offered the post I realised I did have enough experience and could do it. I have a great team and am enjoying it.
Would you do anything differently?
At PTUK 2015 I missed opportunities to promote the poster I had written.
What are your next plans?
Following a session on The Power of Social Media at PTUK, I would like to look into the feasibility of creating a Twitter account for the nursing home. The aim would be to inform residents and family members of events taking place, sharing successes and using it as a marketing tool. However, that will be for the future I think.
When producing our poster we used a score to determine how much care cost when the patient was admitted to our SNH, and how much it cost when the patient was discharged. I would like to collect more data to show how rehab in SNH can help reduce care costs, however our current residents do not have the ability to make significant progress like my case study patient. Without funding for physio and other therapy I won’t be able to get patients appropriate for the data collection, making it a vicious circle.
It would be helpful to collaborate with other specialist nursing homes to discuss common issues and solutions and collate evidence. However organising this would be rather challenging.