For people living with complex health conditions, this can sometimes result in them displaying behaviours which can make safely caring for them a challenge.
While many people who display behaviours of concern are able to live safely in ‘mainstream’ residential care homes or supported living, others thrive in care homes that specialise in care for people living with these complex behaviours.
One company that offers this specialist care is Exemplar Health Care. They have 35 care homes across England that provide specialist nursing care for adults living with a range of complex and high acuity needs.
Julie Booth, head of quality at Exemplar Health Care, shares how their expert teams take a person-centred approach to supporting people who display behaviours of concern, to ensure that they feel safe, cared for and understood.
What are ‘behaviours of concern’?
The term ‘behaviours of concern’ refers to behaviours that can cause harm or distress to the person doing them and/or other people around them or associated with them.
At Exemplar Health Care, we specialise in supporting people who display behaviours which have made it difficult for them to interact with others safely or effectively, such as physical or verbal aggression or offensive language. Many of them have been deemed to have behaviours that are considered ‘too complex’ for mainstream nursing and care services.
Behaviours of concern can have a range of causes, often involving damage to the brain, such as through dementia, a stroke or a brain injury, or a mental health condition.
These conditions often affect a person’s ability to regulate their behaviour and emotions, and impact how they interact with others.
People may exhibit what are considered ‘behaviours of concern’ in response to something they’re feeling, but they’re unable to understand why they feel that way or to express themselves or communicate effectively. For example, they may show the behaviour because they feel ill, uncomfortable, confused, sad, lonely or overwhelmed.
A person-centred approach to behavioural support
Care for people who display behaviours of concern should be individual to them and the challenges they face.
Our approach to behavioural support focuses on how we can prevent the need for restrictive practices and reduce the frequency and intensity of behaviours of concern, so that people can live a fulfilling life and integrate with society without their behaviour restricting what they can do.
Our trained teams work with individuals to:
- understand the reasons for their behaviour
- learn the skills to manage their own behaviour
- identify, remove and reduce any trigger factors
- implement strategies to reduce the frequency, duration and impact of incidents of behaviours of concern.
We look at psychological methods of distraction and diversion before other methods are considered.
Our care homes have high staffing levels, often 1:1 or 2:1, which enable us to work at people’s own pace and build trust.
Our homes also have in-house activities and life skills teams to enable people to take part in everyday activities that are meaningful to them and to be meaningfully occupied. This helps to reduce feelings of frustration for people who display behaviours of concern.
Meaningful activity
Every day, we all take part in activities that are meaningful to us. And this shouldn’t be any different for people who live in care homes.
Being able to take part in meaningful activities can help people to manage and express their feelings which may result in them displaying behaviours of concern.
‘Meaningful activities’ depend on what’s meaningful to that person, based on their interests, history, experiences and hobbies.
This may include everyday activities that promote a sense of worth or purpose such as choosing clothes for the day or making a cup of tea, as well as social activities, interests and hobbies.
As part of some people’s rehabilitation, we work with them to develop independent living skills such as managing money or taking a bus journey.
A big part of care involves supporting people to integrate or re-integrate with their local community. The people who live in our homes regularly go out shopping, to the cinema and for walks in the local area, as well as attend local events such as concerts and gigs, and more recently, local Christmas light displays!
We will always take a positive and proactive approach to this. If there are any risks associated with people going out of the home, we assess these and ensure that we have strategies in place, in advance, on how they’ll be managed.
Ensuring safety
A concern for people looking for care for a loved one with behaviours of concern can be how the care home ensures that people are safe, particularly if they have aggressive behaviours.
As part of the assessment process, we do a ‘community fit’ assessment which looks at whether our home is the right ‘fit’ for the individual, and if they’d be a good ‘fit’ for the home and the people who already live there.
We carefully plan our care and support to minimise risk to everyone, and have stringent safeguarding procedures in place.
Alongside many of our care homes we have OneCare services. These services are flats or houses that offer specialist nursing care in a single or dual occupancy domestic living environment, that’s separate to the main care home.
They’re ideal for adults who have complex needs that cannot be met in a group setting. This may include those whose behaviours require that they live alone, or those who have difficultly tolerating living with others in a way that increases risk.
Supporting staff safety and wellbeing
Care work can be an extremely rewarding job, but it is not always easy. Supporting staff wellbeing in care homes for people with behaviours has to be a high priority.
All of our care and nursing colleagues complete our Exemplar Positive Behaviour Support (EPBS) training that’s been certificated by the British Institute for Learning Disabilities Association of Certified Trainers (Bild ACT).
The training provides colleagues with the skills and knowledge to protect people’s fundamental human rights and promote person-centred, best interest and therapeutic approaches to supporting people when they’re distressed.
We also have a central team of mental health and behaviour support specialists who support our colleagues and service users who display behaviours of concern, including crisis or rapid intervention when a person’s behaviour is escalating.
The team is also supported by our consultant psychiatrist, Dr Akande, who supports people to manage their treatment. Together, they offer a fortnightly clinic, as well as regular advice forums for all colleagues.
About Exemplar Health Care
Exemplar Health Care is a leading provider of specialist care for adults living with complex and high acuity needs.
Visit the website to find out more: www.exemplarhc.com
