The Front Door: closing and opening…
Work has certainly imitated life in the last few months and I’ve become slightly fixated on front doors. Let me explain. A couple of weeks ago we moved my fiercely independent, but increasingly frail, 95 year old mother into extra care accommodation. A few weeks earlier, I was part of a post-project benefits’ review team for a similar, albeit much larger, facility that had opened in the last two years. Both experiences have left me much to reflect upon, as a daughter and a professional.
Some of that reflection has focused on the significance of “the front door”. For my mother and many of the residents with whom I had the privilege to talk, one of the most important needs was summed up by having “my own front door.” It represented the way to ensure some of the essential requirements of semi-independent living could be met. It is about security and privacy and the all-important control of its opening and closing – the “comings and goings” into and from their new home. My mother has a splendid front door to her flat – complete with doorknocker – and her early anxieties about ensuring a sense of security, about which she is struggling to feel confident, have been assuaged.
But doors are for opening too – for getting out and engaging with the wider community beyond the door, along the corridor or down the stairs.
Both facilities I visited have terrific ambitions to ensure that alongside the provision of quality and personalised social care, a sense of community is developed. They strive to overcome feelings of isolation, to help people engage with their neighbours and give them a role in shaping that community and enjoying the potential it offers. Evidence for the benefits of this is easy to find, but their realisation presents a challenge. It has struck me that getting the front door open may be more difficult than ensuring it can be closed.
My mother is going to need a good deal of encouragement to join in. When she is ready she will, like many residents, also need physical assistance to get out of her flat – to the restaurant, the lounge, the garden. She will also need to feel that opening her door is “worth it”, that it will lead to something that interests her and not an hour or two of “enforced jollity.” Something of a tall order for already hard-pressed staff, even when residents are similar in age. It can be more difficult still when individuals across generations and with diverse interests and needs are living together. This was clearly articulated to me by a young man with learning disabilities who wanted a film night, not bingo.
Consideration of just these few things raises questions and issues for all those needing to work so closely to make this accommodation deliver its potential benefits. They range from the local authority and NHS commissioners, to accommodation and care providers, to the third sector offering to provide some activities and, of course, the residents themselves.
Achieving success involves understanding and addressing flexibility in order that spontaneity and, most of all, choice is provided. The implications of this are significant and impact upon the complex set of service and commercial relationships that are set, for example, through the assessment, agreement and management of need, risk, staffing, costs and contracts.
This rich mix makes me remember the young opera singer from my first blog and her ambitions to help elderly people relieve their respiratory conditions through breathing exercises. It is certainly about understanding the true cost of this care which I talked about in my second blog.
It’s going to take a lot to get some of those doors open but as a daughter and a public sector professional, I’ll be trying my best to get the handle turned. I believe it’s worth it.
Thanks for reading my blogs and I hope you’ve found something in them of interest and use.
Strategic Director, Health and Social Care Integration