A clear and person centred approach to care
Our three pathways neuro rehabilitation, long term care and enduring care have been introduced to the home to provide a clear, structured approach in delivery of care to residents with neuro-disability.
Each pathway has a lead registered nurse, and each resident has a keyworker. The pathway approach enables the multi-disciplinary staff to gain a good level of understanding of residents needs and build close working relationships with the resident and their families and significant others.
There is a holistic approach to the person-centred care within each pathway and the MDT work collaboratively and creatively to meet the residents individual needs. Each pathway has regular multi-disciplinary and goal setting and planning meetings attended by all relevant staff members.
Shelley Park prides itself in its creative and collaborative approach to rehabilitation. Residents on the rehabilitation pathway have assessed potential to make rehabilitation gains through the provision of an individualised health, support and therapy program provided by the in-house multidisciplinary team. Each resident has regularly reviewed SMART goals which they're supported to work towards by the multidisciplinary team.
Shelley Park has a highly skilled experienced and diverse multidisciplinary team. Additionally the team draws on the expertise and resources of a large number of outside agencies. Shelley Park is situated within the heart of the local community with easy access within a few minutes to shops, the beach and park, cafes, and an excellent and accessible local transport network. It is through the skill of the multidisciplinary team and using these local resources optimally that Shelley Park achieves its success in supporting its residents to meet their rehabilitation potential. The duration of rehabilitation can be from weeks to months depending on agreed goals.
The residents on the complex pathway have enduring neuro-disability. The presentation of the neurological impairment is complex, and frequently residents have other co-existing medical conditions. Residents' needs are often unpredictable and or intense in nature within a single health domain. Interactions between health domains and or co-existing medical needs can add significantly to the complexity of the manifestation of the residents' symptoms and as a consequence their health needs. Management of residents on the complex pathway requires a multi-disciplinary approach. The multi-disciplinary team work collaboratively and creatively to provide the care/support, to risk-assess and goal set for each resident on the pathway.
Frequently residents on the complex pathway require one to one support to meet their needs and manage associated risks and support their safety. One to one support is provided by familiar, experienced, and highly skilled support workers under the guidance of the multi-disciplinary team. Shelley Park see the support of the families of the residents as an integral part of meeting the resident's needs and many goals for residents on this pathway are focused on maintaining enduring and meaningful relationships with those that matter most to them.
Residents may remain on the complex pathway long term or move to another pathway. Frequently Shelley Park's provision of a skilled and consistent approach to meet the residents’ needs enables their long-term needs to be managed in less intense care settings.
ENDURING CARE PATHWAY
The focus of care and support for the residents on the progressive/palliative pathway is symptom management and Quality of life. The safety, comfort and dignity of each resident is paramount. Often residents can be supported on this pathway for a long time period and the level of care and support is adjusted appropriately to ensure the changing needs of the resident are optimally met by staff. At Shelley Park we work collaboratively with outside professional agencies such as the Macmillan specialist nurse team and consultants to maximise emotional and physical comfort for the resident and provide specialist and extended support to their families.
Shelley Park is working in partnership with GP’s and other agencies as appropriate to ensure the wishes of each resident are known, clearly recorded, and seamless care-planning is in place.