1. Gwen Mooney, Service Manager, Older Peoples Services Donegal.

2. Overview of presentation Demographics Residential care /HIQA inspection Metrics Staffing /dependency tool Falls programme

3. Demographics There are 18,411 people over 65 in Donegal Rural, poor transport infrastructure. High dependency ratio (37 compared to 67 nationally). Second highest after Leitrim High levels of unemployment High levels of GMS/GP visit card (60% versus 40% national average) High levels of deprivation – 2 nd highest in Country

4. Higher proportions of oldest old (over 75,80 and 85 years), 5.8% compared with 5% nationally Higher numbers of people report their health as “bad/very bad” at 1.7% compared with national average of 1.5% Higher proportion of carers at 4.6% compared with National average of 4.1% Using European estimates, approximately 1959 people in Donegal have dementia 95% of older people in Donegal wish to remain at home or as near as possible to their community. (Choice Survey 2009

5. 12% of population are over 65 Donegal this is 14% Nationally on average 4.5% of the population over 65 years of are in long term residential care. In Donegal this is 2.8% 95% of older people in Donegal wish to remain at home or as near as possible to their community. (Choice Survey 2009) This equates to an additional 480 older people being managed at home with supports in Donegal.

6. A Simple Sum !! 480 people x €1,300 (avg. cost of Public Bed) = €624,000 X 52.2 = €32,572,800.00 Annual Savings This does not include the cost of maintaining people at home.

7. Residential care long and short term care beds Private Nursing Homes: 12 Nursing homes providing 528 Places Community Hospitals: 11 Community Hospitals providing 162 Long Stay Beds and 219 short stay beds. 60 of these are respite care beds Total Long Term Beds in Donegal: 683 Total Short Stay Beds in Donegal: 219

8. HIQA Registration- Improving our standards 11 units have gone through inspection process since 2010 Reports at start ; showed that care that was being delivered was observed to be of a good quality, people were treated with dignity and respect. Documentation was poor, care planning was inadequate 1:1 sessions with each staff nurse from people identified as good at care planning. From feedback and observation of the trainers we realised that there was a fear of inspection process and a lack of understanding. Subsequently developed a 3 day training programme Achieving excellence in older persons care for clinical nurse managers and senior staff nurses to up skill them in inspection process Feedback from this programme was that it was very valuable and all staff nurses should have access to this as inspection can take place at any time 2 day staff nurses 1 day for health care assistants. Reports overall show much more compliance with standards.

9. METRICS Metrics developed and introduced to community hospitals in 2012. Revised generic version introduced nationally 2013. All community hospitals collected monthly metrics. Reviewed by ops at workshop this year. Felt collecting a lot of data with limited resources. Not giving the level of detail/ depth they required for effort involved. Decision to move to 2 monthly and devise more in depth audit to make data collection more worth while and meaningful. 2 staff on national work stream to further develop for older people.

10. Staffing and Dependency tool Augmented IoRN; developed for the care home sector in Scotland The Tool took 4 years to complete and its development was supported by the Quality Care Commission in Scotland (HIQA equivalent) It is reliable and valid tool that looks at the relationship between the staff hours required to manage the assessed care needs of the residents. The resident dependency looks at both physical and mental health needs of older people unlike other assessment tools currently in use

11. The Strengths of Augmented IoRN The assessment tool can be completed by any staff member who knows the needs of the resident Easy to use Immediate outputs include: Staffing Skill mix and allows for benchmarking between units Hours of care delivered for Direct and Indirect care Dependency scores for individual residents and the whole ward area

12. How the Data can be Used Ward Level Tracks the care needs of individual resident Guides some of the training needs on the ward area Supports professional judgement with regard to staffing levels Supports the 4monthly review as set down in Legislation Senior Manager Level Used to review the resources deployed between units / equity of provision Used in business case management for staff replacement Allows for comparison with recommended staffing levels from a national perspective

13. Forever autumn falls programme Falls coordinator introduced to service Falls awareness training delivered to ‘Link’ people in each hospital nursing and health care assistants Training delivered locally New documentation introduced 26% reduction in falls in first year in residential services Roll out to day services

14. I would like to take this opportunity to thank staff in the service for their cooperation in introducing and adapting to all of the quality initiatives and changes that we have introduced and to their commitment to continuing to a providing a quality service. Thank you for listening. I hope you enjoyed the presentation.