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Filling the skills gap in stroke care

Stroke is the second most common neurological condition among care home residents, however there can be a gap in stroke-specific training and skills. Cate Burke explores specialist training and resources to help care providers understand the importance of stroke care and support.

Managing stroke prevention and care is a growing concern for care homes, and no wonder. Care home residents are particularly likely to have experienced a stroke, or to be at risk of having a stroke. A report from the Centre for Policy on Ageing, The changing role of care homes, reveals that stroke is the second most common neurological condition among care home residents, after dementia.

Stroke rehabilitation, six month reviews of stroke survivors, and identifying symptoms of stroke are all measures which can be taken in residential care homes to improve the treatment of stroke. This would be in line with the National Institute of Health and Care Excellence’s (NICE) current quality standard consultation on stroke care. Yet despite this, evidence shows that, prior to receiving any stroke training, people working in the care sector underestimate the number of stroke survivors in their care by up to 44%. This lack of awareness makes the provision of person-centred care for such individuals very difficult to achieve.

Best practice resources

There are a number of resources available to care homes to support them in delivering best practice, which gives residents and their families confidence that their stroke risk will be managed and the needs of those having had a stroke will be met.

The Department of Health’s Stroke Specific Education Framework (SSEF) outlines the knowledge and skills required by those who provide care for stroke survivors in all settings, from acute to long-term care. The SSEF consists of 16 Elements of Care, based on the quality markers in the National Stroke Strategy. Within each element of care there are key competencies that reflect the knowledge, understanding, skills and abilities a member of staff should possess if they work in that area of stroke care delivery. The SSEF is a freely available resource for anyone interested in stroke care. The SSEF website provides information on specific roles, and has courses to ensure that all staff have appropriate levels of training.

Specialist training

Stroke is the largest cause of adult complex disability, so specialist training is vital. The condition causes brain damage and the long-term effects caused by a stroke will vary greatly from person to person. Some effects can be quite obvious. For example, most people will be able to recognise one-sided weakness. However, other problems such as depression, sight loss or fatigue can appear ‘hidden’ and much more difficult to spot.

Despite great strides made by some care homes, there are significant skill gaps that need to be addressed. The Chartered Society of Physiotherapy and Stroke Association recently carried out research into how much stroke training is carried out in care homes and found that:

  • Three in five care homes are not following NICE guidelines that the needs of a stroke survivor must be assessed by a specialist within 72 hours of admission.
  • Less than half (46%) of staff said they received training covering stroke.
  • The median length of training was 2 hours.
  • Only a quarter (26%) of staff surveyed knew that they should use the FAST test if they suspected someone was having a stroke.
  • Only half of staff said the FAST test was included in their annual training.

In order to ensure as many stroke survivors as possible receive the best possible care in care homes, the Stroke Association (with the support from Skills for Care) has developed two training qualifications for staff.

The Qualifications and Credit Framework (QCF) Level 2 Award (GSCE equivalent) in Stroke Awareness and QCF Level 3 Certificate (A’ level equivalent) in Stroke Care Management reflect the demands of the SSEF. The two qualifications can be funded by the Workforce Development Fund in England for those who are compliant with the National Minimum Data Set for Social Care (NMDS-SC).

Stroke Care Award Scheme

Stroke survivors and their families want to have confidence in their care providers’ ability to meet their individual needs. The Stroke Association’s Stroke Care Award Scheme for care homes and organisations, is currently being piloted across the UK. The aim is to support care providers striving to improve stroke care and to help families make decisions about what is best for their loved ones.

The Stroke Care Award Scheme helps organisations to embed a culture that understands stroke and the needs of service users in relation to stroke. The Award is gained by the whole service achieving five core standards with the QCF qualifications, including:

  1. Training – different training requirements need to be met for each level (gold, silver, bronze) of the Award.
  2. Information – access to Stroke Association information should be available for staff, residents, service users and their families.
  3. Policy and signposting – a stroke and mini-stroke policy should be in use in the home as well as evidence of signposting to primary care and other agencies that are involved in the care of the individuals.
  4. Prevention – care staff should be able to demonstrate that they understand stroke as a preventable vascular condition and show how their organisation supports stroke prevention.
  5. Person-centred approach – the service should be able to provide evidence that the needs of the individual are being addressed and care and support is adapted as necessary.

People living in care are at high risk of stroke. These core standards improve the understanding, empathy and quality of care that staff can deliver to those affected by this devastating condition. Stroke survivors frequently have co-morbidities, so the recovery and reablement for stroke survivors is linked to support strategies that also can be applied to other neurological conditions (such as dementia, Parkinson’s disease and acquired brain injury).

Providers’ responsibility

Care providers and their staff have a huge responsibility to be ambassadors to those in residential care, to fight their corner, and to act quickly to give patients the best chance of recovery from stroke. The condition is extremely complex and can change people’s lives in a variety of ways. Dedicated stroke training can give staff the tools to help people make the very most of life.

The FAST test
  • Facial weakness: Can the person smile? Has their face fallen on one side?
  • Arm weakness: Can the person raise both arms and keep them there?
  • Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred?
  • Time: If you see any one of these three signs, it’s TIME to call 999. Stroke is always a medical emergency that requires immediate medical attention.

Recognising the signs of stroke or mini-stroke and calling 999 for an ambulance is crucial. The quicker a patient arrives at a specialist stroke unit, the quicker they will receive appropriate treatment and the more likely they are to make a better recovery. If you suspect a stroke, always dial 999.

Cate Burke, Assistant Director of Education and Training, Stroke Association. Email: Twitter: @TheStrokeAssoc

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