High Support Services – Quality of Care

High support services provide specific health care to meet the needs individuals with severe and profound disability. The quality of care and the interaction between carer and the person requiring care can range from positive and meaningful to negative and institutional. An assessment tool such as the Quality of Interaction Schedule1, used by providers and regulators to assess a healthcare service can provide examples of good and poor care. It is used to evaluate the healthcare service as whole, not individual carers or single events.

A healthcare or medical model of service is not appropriate for services intended to support inclusion and active participation in mainstream community programmes and activities.

Negative or institutional care is not acceptable in any service.

Positive Care

Positive Connective Care	Examples	Verbal Examples
Evidence that staff know residents well and facilitate meaningful human connections throughout the day Score: +2	Meaningful connection Eye-contact Using appropriate touch Assisting with activity (appropriate level of help) Offering props Walking/talking together Sitting with individual	Greeting each individual by name Relating to the person’s life story Joining in the individual’s reality Validating individual’s feelings Encouraging to talk about experience Doing an activity together sharing the moment Allowing choice of action (lots of sugar in tea) Offering choice Laughter and fun

Positive Connective Care

Examples

Verbal Examples

Evidence that staff know residents well and facilitate meaningful human connections throughout the day

Score: +2

Meaningful connection
Eye-contact
Using appropriate touch
Assisting with activity (appropriate level of help)
Offering props
Walking/talking together
Sitting with individual

Greeting each individual by name

Relating to the person’s life story
Joining in the individual’s reality
Validating individual’s feelings
Encouraging to talk about experience
Doing an activity together sharing the moment
Allowing choice of action (lots of sugar in tea)
Offering choice
Laughter and fun

Task Orientated Care	Examples	Verbal Examples
Kind physical care, but conversation is superficial (instructive) and not personally meaningful Score: +1	Excellent physical care but with limited conversation Assisting someone to eat without eye contact or speech Walking a resident to the bathroom or dining room but in silence Residents being dressed kindly but with no choice	Keeping the conversation only to current activities; washing, dressing, toileting -task orientated conversation Informing individual what is about to happen but no further engagement Including residents briefly in conversation Conversation that is dependent on current context; ‘it is a nice sunny day today’

Task Orientated Care

Examples

Verbal Examples

Kind physical care, but conversation is superficial (instructive) and not personally meaningful

Score: +1

Excellent physical care but with limited conversation

Assisting someone to eat without eye contact or speech
Walking a resident to the bathroom or dining room but in silence
Residents being dressed kindly but with no choice

Keeping the conversation only to current activities; washing, dressing, toileting -task orientated conversation

Informing individual what is about to happen but no further engagement
Including residents briefly in conversation
Conversation that is dependent on current context; ‘it is a nice sunny day today’

Neutral Care	Examples	Verbal Examples
Passive and not stimulating Score: 0	Leaving individual to stare into space Long periods of sleeping Individual experiencing no interaction No stimulation No meaningful items around person Giving out tea or coffee without asking People left walking with no engagement	Not informing the resident what you are going to do Not talking individually to people, just to the general group Giving out meds without conversation Staff talking to other staff members without including the resident Putting the plate of food down without comment Assisting an individual at mealtime without conversing with them

Neutral Care

Examples

Verbal Examples

Passive and not stimulating

Score: 0

Leaving individual to stare into space
Long periods of sleeping
Individual experiencing no interaction
No stimulation
No meaningful items around person
Giving out tea or coffee without asking
People left walking with no engagement

Not informing the resident what you are going to do

Not talking individually to people, just to the general group
Giving out meds without conversation
Staff talking to other staff members without including the resident
Putting the plate of food down without comment
Assisting an individual at mealtime without conversing with them

Negative Care

Positive Connective Care	Examples	Verbal Examples
Individual care but the emphasis is on safety and risk aversion Score: – 1	Set mealtimes Set bedtimes Set times to get up in morning Being prevented from taking acceptable risks; discouraging free mobility Limiting environment to keep it safe Feeding people to prevent them spilling food on themselves	Telling a person what not to do, i.e. sit down or you will fall Telling people to be quiet because it upsets other people Talking over resident’s heads Let me help, it will be quicker Talking about people rather than to them

Positive Connective Care

Examples

Verbal Examples

Individual care but the emphasis is on safety and risk aversion

Score: – 1

Set mealtimes
Set bedtimes Set times to get up in morning
Being prevented from taking acceptable risks;
discouraging free mobility
Limiting environment to keep it safe
Feeding people to prevent them spilling food on themselves

Telling a person what not to do, i.e. sit down or you will fall
Telling people to be quiet because it upsets other people
Talking over resident’s heads
Let me help, it will be quicker
Talking about people rather than to them

Institutional Care	Examples	Verbal Examples
Regarding residents as a homogenous group who will fit into the established routine of the home. Score: – 2	Making a person wait for the tea trolley Putting someone in a wheelchair as it takes too long to walk Feeding too quickly Dressing too quickly Call bell out of reach Unnecessary medication Leaving zimmer -frame out of reach Returning a group of residents to bed before staff go off duty	Telling people it is too cold to go out the garden Telling people you can’t want to go the toilet; you have just been Don’t sit there, it’s X’s chair Labelling residents as ‘attention seeking’ to other staff

Institutional Care

Examples

Verbal Examples

Regarding residents as a homogenous group who will fit into the established routine of the home.

Score: – 2

Making a person wait for the tea trolley
Putting someone in a wheelchair as it takes too long to walk
Feeding too quickly
Dressing too quickly
Call bell out of reach
Unnecessary medication
Leaving zimmer -frame out of reach
Returning a group of residents to bed before staff go off duty

Telling people it is too cold to go out the garden
Telling people you can’t want to go the toilet; you have just been
Don’t sit there, it’s X’s chair
Labelling residents as ‘attention seeking’ to other staff

1. The Quality of interaction Schedule was first developed for use in long term mental health settings but has since undergone many refinements and has been adapted for general use in care homes and hospital settings. Dean, Proudfoot and Lindsay (1993). The Quality of Interaction Schedule (QUIS): development, reliability and use in the evaluation of two domus units. International Journal of Geriatric Psychiatry Vol PP819-826
www.hiqa.ie/sites/default/files/2017-02/QUIS_examples.pdf