For anyone, seeing a loved one unwell can be difficult. Caring for that loved one when their condition is chronic is another challenge all together.

In Sunderland, an innovative way of delivering care across the city has been adopted – All Together Better.  And one member of the team is experiencing first-hand just what those changes mean for their mother.

Helen Gray, communications manager at All Together Better – which is bringing together health and social care professionals, along with local support organisations to deliver a joined-up approach to care – has seen her work and personal lives collide, after moving her mother, Rita, to a new care home.  And it has allowed her to see just how much of a difference the programme is making to people in the city, and those who support them.

“My mam has advanced Alzheimer’s disease, and with all of the family working and her needing special care, a care home made a lot of sense. Having mam in a home put all of our minds at ease knowing she had someone there 24/7,” explains Helen, who has been part of the team driving All Together Better’s integrated way of delivering care in Sunderland since the programme got started in 2015.

img-20160923-wa0004“As mam’s condition will continue to get worse, my sister and I thought it would be best to move her to a care home that was more focused on dementia care, to make sure she’s getting the specialist care she needs. It’s stressful moving a relative into a care home or to a new home, and while I had knowledge of what was planned and what was in place because of my work on All Together Better, it was interesting to observe the processes from the other side.”

Through the move, Helen witnessed first-hand how ‘GP alignment’ – a key part of All Together Better – is working for those who need extra care. Not only was she able to meet with the care home manager, the nurse attached to the home and her mother’s GP as a key part of Rita’s care, but Helen and her sister, Sharon, were also directly involved in the process of drafting Rita’s Emergency Health Care Plan (EHCP). Together they discussed, with confidence and compassion, exactly what was in Rita’s best interests and how she would be cared for in an emergency situation.

“It was really reassuring to know there was a clear plan in place for mam’s care, and that all of that was geared towards keeping her out of hospital and in the comfort of the care home. With All Together Better introducing Care Home Nurses – nurses who visit regularly to support care home staff in identifying issues before they become an emergency – it’s a weight off my shoulders to know she’s getting frequent check-ups with an expert.”

As well as ensuring Rita would receive visits from her designated Care Home Nurse, an urgent care team is also now on hand, should Rita need extra care, in the form of the Recovery at Home team. Rita’s care team also put in place a schedule for regular reviews of Rita’s medication and guidance for changes.

“All of this happened by the second day of mam’s move,” explains Helen. “But what made the transition so easy, were the little things.

“Along with her health and social care needs, mam’s well-being is a top priority, and meeting staff who clearly love their job and enjoy working at the care home was a huge relief. Having a named key worker; seeing staff coming out of training for care home tablets looking keen to get started; witnessing how well staff would comfort mam when she was anxious; and generally just seeing smiles on the faces on staff and residents around the home – are the things that make a huge difference.

“I can’t say the process of moving a loved one to a care home is easy – it’s emotional and stressful – but seeing All Together Better working and seeing it from the other side really did take some of the worry away.”

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