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

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

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

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