Personalised respite care for the long-term ill is rarer than it should be. But at Leuchie House it’s the key to everything, says Tracy Ramage
I HAVE always been a passionate champion of the NHS, but found that in recent years there was more paperwork and less contact with the patients. There is less emphasis on actual nursing care. Since I started at Leuchie House towards the end of last year, the difference that has struck me most has been that person-centred care is at the crux of everything we do here – not just something we pay lip-service to.
Leuchie is truly a one-off in terms of respite. I have been nursing for over 30 years, as a hospital, hospice and then community nurse. As a district nurse, I was used to my patients going for respite breaks, but never like the sort of breaks that we offer here. It was more likely to be something they left until it became an emergency situation for their carer, rather than a break to look forward to.
The main difference is that the staffing levels are appropriate to the needs of the guests, which means there is time to sit and chat. This is something they are passionate about here and since respite fees don’t cover the costs of providing the service, it means they have to work very hard as a charity to raise enough funds to ensure staff levels remain at this level.
This is very important from a psychological point of view for our guests as many of them can feel quite isolated as their condition worsens. I’ve seen the staff here able to spend ages with a guest – particularly if they have not been for a respite break before – helping them eat a meal and at the same time just chatting away so they get to know their likes and dislikes. Some of the guests have severe speech difficulties, so just the fact that someone is willing to wait patiently while they get their point across is a huge psychological boost.
For guests who are making a return visit, you can see it’s like a second home to them. They are surrounded by folk who already know them and can look after them. We are able to build up that relationship because we’ve invested time in getting to know them.
Dealing with all the long-term conditions we see is challenging, but the trained staff makes for excellent nursing care. The expert staff are needed because of the range of different complex care issues we see. There are, of course, a range of clinical problems people experience when they have one of the long-term conditions we care for, but we also try to look after psychological and emotional side of things, which we can monitor and help sort out while patients are with us – and which can also have longer-term benefits.
At the moment, we have a guest who arrived with very severe mood swings and seemed very over-emotional. We are now taking a look at her medication because she might just need a change of dosage and will feel more on an even keel – particularly with the added benefits of being able to socialise and join in with trips and activities while she is staying here. She may not have much of a chance to do any of this at home, so it is vital that we assess her properly over her stay with us.
Things like wound management are also an important part of the role we play while a guest is with us, as is the physiotherapy offered to all the guests during their stay and the home-cooked meals and specialised diets we can make for our guests.
The assessments of all the guests, emotional as well as physical, can then be fed back to their local health teams to assist with their ongoing care until they are able to return here for another respite break.
My previous roles as a palliative and end of life care specialist suited me because I felt it was a very privileged position to be in, to help someone reach the end of their life, peacefully in their own home, surrounded by loved ones.
At Leuchie, it is even more of a privilege to be able to spend time with people – many of whom are living with pain, immobility and isolation – and watch them relax and enjoy a well-deserved break which they may not have previously thought was within their reach. It is more than a privilege – it is a joy to see.
• Tracy Ramage is a clinical nurse manager at Leuchie House in North Berwick