Model of Care and Support
QME Care, is a voluntary organisation that provides care and support for older people, specialising in care and support for people living with dementia and their carers. Our vision is ‘to be a centre of excellence in the delivery of quality care and support and to be the provider of choice in the Scottish Borders’. We believe in the uniqueness of individuals and we support them in a way that promotes them to be the director of their own care.
Self-determination Theory (SDT) is a well-documented and evidenced theory of motivation and well-being developed by Edward L Deci and Richard M. Ryan (1985, 2000). SDT has identified that human beings have an innate need for autonomy, competence and relatedness, which are referred to as three basic psychological needs. Where these needs are upheld and supported a person will experience motivation and well-being (Deci and Ryan, 2000); however, where these three needs are thwarted a person will experience ill-being and demotivation. It is important that the three needs are met, with autonomy being the central need. Research has evidenced that where the three needs are satisfied there is a positive increase in health and wellness (Ryan, 2009), therefore there is an increase in motivation and mental health. Ryan and Deci (2011) suggested that controlling environments, whether these are related to economic, familial or institutional, will have a detrimental impact on a person’s well-being and happiness, because such environments impact on autonomy.
Self -determination Theory (source Deci and Ryan, 2002)
To follow a real person-centred approach to care and support we promote rights based approached by upholding the three basic psychological needs identified through Self-determination Theory, which are, autonomy, competence and relatedness (Deci and Ryan, 1985,2000). Self-determination theory is contingent on social environments that support the three basic-psychological needs; therefore, the environments of our care and support facilities need to be supportive through design and culture.
Autonomy is where a person undertakes an action which they experience as an expression of self, they will identify with the action positively even if the action has been influenced by others, such as feeling autonomous in one’s action (Deci and Ryan, 2002). Being autonomous does not mean that an individual is abandoned, indeed people need support form other which supports feelings of relatedness, which will enable autonomy.
In our care and support settings we promote autonomy through the care and support that we provide to all our residents. The people that we support are enabled to be the director of their own care and support. It is important that we are aware of when we need to assist a person to help them make decisions, but we are also aware that most people are able to make decisions and choices about how they manage their day.
Our residents are given the choice about their daily routines, an example of how we are able to promote this is to have flexibility around meal times. We will serve breakfast from the time a resident gets up. Our residents will choose what they want for breakfast daily, rather than being offered the same breakfast every day.
Although we do have times when meals are served we also offer snack options and graze (picnic) boxes, allowing residents to have flexibility to choose when they want to eat. Some residents will have a late breakfast (brunch), therefore they prefer to have a light snack for lunch rather than a 3-course meal.
Competence is a feeling of confidence in one’s own abilities and skills within the environment (Clarke, Wolverson and Moniz-Cook, 2016) and relates to self-confidence and efficacy (Deci and Ryan, 2002). Competence refers to continued ability and challenges to manage activities of daily living and function within society.
This need of competence directs people to identify challenges to enable them to meet their optimum capacity, so a person will want to maintain activities, but equally undertake activities that further develop their skills and capacity. People need to feel challenged and for that challenge to be achievable. Where a challenge is too easy or too difficult the person is unlikely to be stimulated (Deci and Ryan, 2000).
In our care settings we are mindful about the need for competence and we will support those who we care for to ensure that we meet this need. Through assessment and care planning we can detail what a person is able to do for themselves and where they need support. Getting to know the person helps to develop a person-centred plan focused around the activities a person can do, rather than what they cannot do. Where we identify what a person can we are able to support the areas where they need assistance. We will work with the people in our care and support to enable and re-able them. Assisting someone to undertake tasks that they thought they could no longer do helps to support the basic psychological need of competence.
Social activities are also important and through careful planning and getting to know the person we will build an activity plan that focuses on the areas of interest to that person. We will help to reintroduce them to activities that they once used to partake in or assist them to try new challenges.Examples of this are where we have residents who have not been involved in creative art, but when introduced to this have taken part and felt accomplishment through making a card or creating a painting. We involve relatives in these activities which helps to support the need of relatedness for both parties.
Other examples of how we support competence are small things, such as ensuring a person is provided with specialist cutlery to enable them to eat and drink themselves. Where necessary providing a person with food that they can eat with their fingers, where they are no longer able to uses a knife and fork. Further examples of supporting the need for competence are around other activities of daily living, taking time to help or assist someone to wash and dress rather than just doing this for them.
Relatedness refers to ‘feeling connected to others, to caring for and being cared for by those others, to have a sense of belongingness both with other individuals and one’s community’ (Deci and Ryan, 2002, p7), to have unity with another and other through love and caring (Deci and Ryan, 2000). The need for relatedness is linked to the desire to feel connected and to be accepted by others. Relatedness also refers to the need people have to assist and support others.
In our care and support settings we support the need for relatedness through getting to know our residents and the wider network. It is important to enable the person and their relatives to continue to support and care for each other. Further, it is important that community connections are maintained.
Examples of how we support the need for relatedness can be identified through the team approach and the Key Worker system. We try to minimise the number of staff to resident, to assist residents and their relatives to get to know and build relationships with the team of staff who are supporting them.
Community connections are maintained through our links with the local churches. We also have links with Kelso High School, with students volunteering within the care homes.
Activities are also a way to ensure our community is connected to the wider community, through functions.