National Institute for Health and Clinical Excellence (NICE)
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New advice on mental wellbeing of older people in care homes marks bold step forward

NICE's new quality standard on the mental wellbeing of older people in care homes marks a "bold step forward" in terms of improving care, according to experts.

More than 400,000 older people currently live in care homes, a figure set to rise given the UK's ageing population.

While many older people in care homes are well looked after, recent high-profile cases have highlighted instances of substandard care, which suggests standards can vary.

A reason for this is the prevalence of mental health issues among older people, which can often complicate care. With loneliness, depression and low levels of life satisfaction widespread among residents in care homes, it can be hard for staff to offer the support they need.

NICE's 50th quality standard on the mental wellbeing of older people in care homes aims to address these issues through six measurable statements.

The first statement calls for older people in care homes to be offered opportunities during their day to participate in meaningful activity that promotes their health and wellbeing.

NICE recommends that older people should be encouraged to take an active role in choosing and defining activities that are meaningful to them. These can range from reading, gardening and arts and crafts, to group activities that involve family, friends and carers.

Another statement says that older people in care homes should have the symptoms and signs of mental health conditions recognised and recorded as part of their care plan.

While mental health conditions such as dementia are very common among older people in care homes, they are often not recognised, diagnosed or treated.

Consequently, NICE recommends that symptoms and signs of mental health conditions should be recognised and recorded by staff who are aware of GPs' roles in the route of referral. This can help ensure early assessment and access to appropriate healthcare services.

The positive impact of enabling people to maintain and develop their personal identities is also highlighted in the quality standard.

NICE says that staff working with older people in care homes should be aware of the personal history of the people they care for and respect their interests, beliefs and the importance of their personal possessions.

Older people should be involved in decision-making and supported and enabled to express who they are as an individual and what they want. They should also be able to make their own choices whenever possible.

Furthermore, older people should be enabled to maintain and develop personal identities during and after their move to a care home, as this promotes dignity and has a positive impact of their sense of identity and wellbeing.

George McNamara, Head of Policy at the Alzheimer's Society, said: "We welcome this quality standard, as it will help care home staff respond to the needs of people with mental health conditions such as dementia.

"Given the significant population of people residing in care homes with dementia or severe memory problems, it's a bold step forward."

Professor Gillian Leng, Director of Health and Social Care at NICE, said: "Throughout the year, many people are looked after extremely well, but others may not be so fortunate.

"For instance, some care home workers may find it hard to look after someone who appears disengaged or depressed when actually all they might need is a little extra support to lead a more fulfilled life. A decline in mental wellbeing should not be viewed as an inevitable part of ageing."

She added: "We hope the standards we have published will give care homes the help they need to ensure they're providing consistent, high-quality support for every person in their care."

Read more from George McNamara on the quality standard and the ways it can help improve the quality of care and experience of older people in care home settings.

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