Care at Home Pre-Registration Training

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Catriona Begg & Andrea Cox

Dietitians have historically delivered 1-1 therapeutic advice and support to service users in their own homes and care home settings. However, practice placements have largely focussed on training within clinical settings rather than social care. With Scotland committed to delivering care at home or in a homely  settings there is a compelling arguement for more diverse training models.

In 2014 a partnership group, comprising NHS Education for Scotland (NES), NHS Highland, Parklands care group and Robert Gordon’s University (RGU) piloted and successfully developed a model for the placement of student dietitians within care homes. The placements have been thoroughly evaluated and widely shared, and as a result other Health Boards are now implementing dietetic care home placements.

This new placement model has opened up our experiences of social care, allowing new dietitians to better understand how to work within this context. However 1900 people in NHS Highland alone, receive care at home and the provision of adequate nutrition and hydration can be a challenge within this setting yet student dietitians rarely have the opportunity to experience the reasons for this, or the opportunity to present solutions. As a result, in 2015 NES, the Care inspectorate, NHS Highland, RGU and Highland Home carers (HHC) agreed to go one step further than care home placements, and test another new model of training student dietitians; this time in the context of ‘care at home’ settings.

Now two student dietitians, Andrea Cox and Catriona Begg, have been given the opportunity to work alongside ‘care at home’ teams, in Inverness and Kirkhill as part of the very first care at home placement pilot. Andrea and Catriona spent two days per week over a five-week period observing, gathering information and carrying out project work to help understand the nutrition and hydration challenges faced by increasingly dependent service users and staff. They conducted an audit of care staff hydration; drew-up case profiles of service users’; assessed food and fluid storage and potential nutritional risks to service users; and presented their work to dietetic and care at home staff.

Stephen Pennington, managing director of Highland Home Carers, said:

“We are excited about being involved in this new development since we are committed to enabling people in the Highlands to have the best quality care in their own homes. The opportunity for dietitians in training to learn about the issues that care at home workers are dealing with every day and then contribute to their resolution, can only be of benefit to them and us. We continue to sponsor social care workers to undertake social work training and it is a logical next step to assist Allied Health Professionals with their development.”

Whilst there is still a great deal to explore and to plan so that service users can remain nutritionally well in homely settings, this model of placement offers opportunities to develop our learning about what service users want from care at home services. Registered Dietitian Evelyn Newman is currently evaluating the pilot, however Andrea and Catriona both believe the experience has been extremely beneficial:

“We were able to gain useful insight into the close working relationships of carers with clients and the challenges associated with providing food and fluids. We were able to work with patients who had a wide variety of conditions such as visual impairment, reduced mobility, dementia and Huntington’s disease.” said Andrea.

“This placement helped identify the possible challenges which can be faced in achieving adequate nutrition and hydration with those relying on support from carers.” said Catriona.

With the above in mind, initial results indicate that social sector placements for student dietitians can be used as an alternative model to conventional NHS-centred clinical placements. They can also challenge the differing perceptions among the profession about suitable learning environments for students and they provide a great opportunity for us to plan ahead and support the needs of individuals and their families, in a very proactive, person-centred placement model.

For more information please contact: Evelyn.newman@nhs.net (Nutrition and Dietetics Advisor – Care Homes) or follow on twitter @EvelynNewman17

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