WMHD II c/o LSE: Investing in crisis care for people with schizophrenia makes moral and economic sense

“When someone has a mental health crisis, it is distressing and frightening for them as well as the people around them. Urgent and compassionate care in a safe place is essential – a police cell should never need to be used because mental health services are not available. For me, crisis care is the most stark example of the lack of equality between mental and physical health.” 

(The Rt Hon Norman Lamb MP, Care and Support Minister)

There is a strong moral and economic case for investing in innovative approaches that support people with schizophrenia to live independently in the community. Crisis resolution and home treatment teams and crisis houses can help reduce the need for expensive hospital admissions with some studies suggesting that the costs of care can be reduced by up to 30% through these service models. There is a clear potential for Clinical Commissioning Groups to make better use of their resources by investing in home treatment teams and crisis houses as approaches to crisis resolution.

Read more of this post

My source: The London School of Economics and Political Science, Health and Social Care blog email

Hodges' model in recovery ...

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

Rijksmuseum Amsterdam - health in art : art in health

I arrived in Amsterdam last night and spent today, 8 hours in the Rijksmuseum. It is an amazing experience, even to just scratch the surface. Early on it was not busy! Entering the building, is as publicised, to discover a remarkable series of spaces.

There are so many highlights of a rewarding day. One must be within the final hour 1610 finding one of Van Gogh's self portraits. Van Gogh finds himself placed in the interpersonal domain not just by virtue of this self portrait, but his struggle with mental health and  hospitalisations.

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Samuel Dirksz van Hoogstraten [Public domain], via Wikimedia Commons

There were many other (ill-)health related examples (and many that are also bright and humorous).

The sick child. The Sick Woman....

When initially viewing Visiting the Sick you have some searching to do. The sick individual themselves and the doctor are rather lost in the background. The painting stresses the sociological, domestic aspects of health past and present.

In Visiting the Sick and The Anemic Woman we get a view of the way outside (possibly of spiritual significance?) and another room through doorways. From TV, reading and my visit today, this is a common device within Dutch genre painting. If we have a diagnosis now in the 21st century, we still need to look through the windows and doors that relate to the individual and their social situation. In the age of the interface and partitions we still need to negotiate them.  Doorways, windows and portals as changes in knowledge content, can in the form of care domains illuminate the boundary of what is objective and subjective. This is central in health and social care.


Van Gogh self portrait source:
http://historiek.net/chinezen-zeer-geinteresseerd-in-van-gogh/13217/#.VCb5mRbivTo

The Anemic Woman image source:
http://commons.wikimedia.org/wiki/File:Samuel_van_Hoogstraten_-_The_Anaemic_Lady_-_WGA11719.jpg

UK - USA - Global health (physical care, mental health care, social care)

individual
INTERPERSONAL : SCIENCES

humanistic ------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

group

Affordable?	Affordable?
Affordable?	Accountable?

Prompt:
5 Megatrends With The Potential To Transform U.S. Health Care

Book: The Last Asylum

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

The Last Asylum	-sociology -medicine
medical- social-

group - population

Winwick Hospital remembered

Image source: Metro

... 11.12.13 . ... time to deliberate upon Dementia ... G(r)8

@dhgovuk

#G8dementia

News update: 11.12.13 posted 2024hrs UT 
BBC News G8 'will develop dementia cure or treatment by 2025'

See also:
Department of Health, 29 November 2013, England
Dementia: A state of the nation report on dementia care and support in England

Site: https://www.gov.uk/government/publications/dementia-care-and-support

Above banner source acknowledged and with thanks:
http://dementiachallenge.dh.gov.uk/category/g8-dementia-summit/

Part I: Pensioners, 'Health students' and Children NHS@75?

As the NHS celebrated its 65th birthday its mobility is clearly challenged.

There are signs of furniture-walking now. Admittedly, there are no asylums now to step from to the cottage hospital, oops nearly! Phew - made it - to the fever hospital. Thankfully, those mobility aids are no more - a great sign of progress.

The pressure for ongoing change is relentless. This week's HSJ is highlighting the true fact on its cover:

NOT READY FOR RETIREMENT

There's also a six month exercise by PWC - NHS@75

There are many strands one of which has the following graphic:

If the public is to be informed and proactive about their health then we had better start now....

Medikidz is absolutely great - depression is in there - but as PWC's initiative shows the NHS@75... is going to need much more than explaining illnesses.

Medikidz image: http://www.themarysue.com/medikidz-comic/

Living in the Memory Room: BBC Radio 4

Some people have no choice - they must become time travellers ....

There are 800,000 dementia sufferers in the UK. Kim Normanton presents a personal programme about memory and dementia, inspired by her mother's illness. She explores a new approach to treatment - recreating the past.

As her mother's memory of recent events was destroyed ... more

Mental Health at NWHealthHack Knutsford - Prof. Lewis (thanks)

NWHealthHack began with several briefings. These were all excellent in providing both technical and health care insights before projects were pitched in 60 seconds.

Prof. Shôn Lewis set the health agenda in the context of mental health. I'm really grateful to Prof. Lewis to be able to share two slides here. The first speaks volumes not only in the research spend across health care domains but the disability-adjusted life year (DALY):

Over the past 25+ years I'm aware of the change within community mental health nursing. I can summarise this as follows:

• 1985 one of six new community psychiatric nurses - CPNs
• Early 1990s newly built community mental health resource centers
• Mid-late 1990s CPNs criticised for not meeting the needs of the enduring mentally ill
• Early 2000s early intervention services, role of psychosocial interventions
• Mid-late 2000s reduction and closure of mental health day hospitals
• Early 2010s former community mental health resource centers turned to primary care (mental health)

I have mentioned here previously about the need to put the 'mental'' into public - health and the need to put mental health literacy on the map. It will be interesting to watch what happens now that this has landed in a very 'local' way within Local Authorities. Prof. Lewis reviewed the situation in mental health conjoining serious mental illness, services and self-care, making a critical point for those readers working in community mental health teams. This should also give pause for thought for those (like me) working in related services:

Prof. Lewis also shared an app - ClinTouch and reflections on the professional's response to the apps potential and the findings in practice. It's never easy being open to what is new and being ready as a consequence to re-invent yourself. If that's a problem for individuals then for professional groups and multidisciplinary teams it's an even greater challenge. ...

Community Informatics and Improving Health: New Special Issue

Colleagues:

The Journal of Community Informatics has just published its latest issue at

 http://www.ci-journal.net/index.php/ciej. We invite you to review the Table of Contents here and then visit our web site to review articles and items of interest.

Thanks for the continuing interest in our work,

Michael Gurstein, Ph.D.

Editor in Chief: Journal of Community Informatics, Vancouver CANADA Phone 604-602-0624 gurstein at gmail.com

The Journal of Community Informatics

Special Issue: Community Informatics for Improving Health Table of Contents

http://www.ci-journal.net/index.php/ciej/issue/view/40

Editorial

--------

Overview of ICTs and Health

                Lareen Ann Newman

Editorial: Community Informatics for Improving Health

                Michael Gurstein

Articles

--------

Developing decentralised health information systems in developing countries –cases from Sierra Leone and Kenya

                Edem Kwame Kossi,       Johan Ivar Sæbø,             Jørn Braa,            Mohamed Mumeneeh

Jalloh,   Ayub Manya

Improving community health equity: the potential role for mHealth in Papua New Guinea

                Belinda Jane Loring

Capturing Qualitative Spatial Data to Understand Social Epidemiology in Public Health

                William R Buckingham

Narrating Aboriginality On-Line: Digital Storytelling, Identity and Healing

                Naomi Adelson,                Michelle Olding

Decreasing Health Disparities through Technology: Building a Community Health Website

                Olga Idriss Davis,              Kristen Bean,     Dominica McBride

Bridging the Digital Divide: A Bilingual Interactive Health Kiosk for Communities Affected by Health Disparities

                Kristen Bean,     Olga Davis,          Hector Valdez

‘MYBus’: Young People's Mobile Health, Wellbeing and Digital Inclusion

                Bjorn Nansen,   Kabita Chakraborty,        Lisa Gibbs,           Colin MacDougall,           Frank Vetere

Concussion Information on the Move: The Role of Mobile Technology in Concussion Management

                Osman Hassan Ahmed, Andy J Pulman

With a little help from my friends: experiences of building a virtual community for children with cancer

                Paula Hicks,        Jane B. Grimson,              Owen P. Smith

Impact of Internet on delivery of critical cardiac health care  :

                Sudeepa - Banerjee

A review on mHealth research in developing countries

                Wallace Chigona,              Mphatso Nyemba,          Andile Metfula

Reports

--------

Socio-technical approach to community health: designing and developing a mobile care data application for home-based healthcare, in South Africa

                Retha de la Harpe,           Hugo Lotriet,      Dalenca Pottas, Mikko Korpela

Perceived Benefits Of Remote Data Capturing In Community Home-Based Care:

The Caregivers’ Perspective

                Nobubele Angel Shozi,  Dalenca Pottas, Nicky Mostert-Phipps

Health Impact Assessment of a UK Digital Health Service

                Sue Heather Wright,       Irfan Ghani,        John Kemm,       Jayne Parry

Points of View

--------

W(h)ither Community: Locating participatory approaches to ICT-enabled health and development

                Ian Pringle

________________________________________________________________________

The Journal of Community Informatics http://www.ci-journal.net

 

Hodges' model 'Always Waiting' with Michael Kiwanuka

Seeing and listening with Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

	Safety, 'Illness', ...?
LIFE HISTORY, several selves, ...?	LIBERTY ...?

ICN Congress in Australia 2013: a symposium - you, me and another nursing colleague?

I posted previously about the aspiration of visiting Australia and presenting at the International Council of Nursing 25th Quadrennial Congress next May.


Instead of opting for a 15 minute concurrent session I am wondering about the possibility of collaborating with two other speakers to prepare a symposium session of 80 minutes. Copied below is a *draft* abstract that could be adapted to include and reflect other speaker’s motivations and interests. The word limit is 250 including title and author details. It would be marvellous not only to present h2cm at the ICN, but sharing the challenge to produce a presentation that is coherent and informs nursing theory and practice today and tomorrow.

The deadline for abstracts is 14th September so if this is going to happen it needs to be very soon; otherwise I will submit an abstract for a 15 minute session.

If you are interested please get in touch. There may be points I have missed, for example I plan on staying for three weeks. If you have a place I can stay with a teaching opportunity I'd be very grateful for your support and the teaching/learning opportunity. Please spread the word...

I know this approach is unorthodox, but this is 2012. If this does not happen next year there may be other opportunities. Thanks for listening...

Draft abstract:

A global health care model for the challenges of twenty-first century care and self-efficacy

You?, me & presenter three?

Nursing is a discipline and profession with global aspirations in terms of supporting health for all. Professional recognition of nursing has in part been gained through the development of nursing theory and models of nursing. This presentation argues the need for a global, generic conceptual framework that has relevance for all nurses and citizens. While there is a marked variation - often for good reason - in nursing curricula having a common framework can provide a foundational standard, a conceptual basis for nursing that can serve as a common currency for dialogue.

Hodges' model, a conceptual framework created in the mid 1980s is the focus. This symposium is presented in three parts. Firstly, the characteristics of the model including its structure, content and original purposes are explained. Secondly, the model is demonstrated by mapping the themes of this congress. This exercise utilises the model’s knowledge domains, namely sciences, sociology, politics, interpersonal and spiritual. Finally, a critique is provided. As I seek to listen to patients, why should you listen? What does a 1980s model of nursing offer to professionals in the 20th century? Where do the values of nursing reside in what is yet another model of care, and how can this model affirm the positive aspects of nursing, global health care, well-being and self efficacy? What directions are there for further research? Additional resources will be signposted.

Image source: http://www.ausbird.com/


@h2cm

NHS Hack Day Past & Future + HANDI health

Whether it's web magazines, web design sites, Drupal, or Ruby presentations you cannot escape from the app.

Health is no different being a major field of development. I did not make the NHS Hack Day in May and I may be away for the next in September 22-23th which is planned at ADA Liverpool. If you can make it register now!

There is also HANDI and no doubt a multitude of other international groups working on innovative apps that can and already are making a real difference to people's health and social care outcomes.

London nhs hack day presentation may 2012

View more presentations from Carl Reynolds

Nurse First Programme Seeks Innovators

Dear Peter,

I hope you don't mind me picking your brains :)

We are currently recruiting for a new cohort for the UK's most intensive innovation and leadership programme for health professionals who work in the community. It is called Nurse First and is a free programme that has been developed with the Queen's Nursing Institute, Bucks New University, the Shaftesbury Partnership and Johnson & Johnson (who are sponsoring it).

What we are particularly looking for are creative and innovative clinical staff who -

• are passionate about improving services;
• have strong personal motivation and are resilient;
• are creative problem-solvers;
• are driven and who can keep going when the going gets tough.

We will help them to identify a significant problem or challenge in their area and develop an innovative solution to this. We will also help them bring in outside funding to get the pilot up and running. Many of the Nurse First projects have brought in between £10,000 and £100,000 of funding for their pilots. Our criteria is that applicants have to still be involved in clinical practice and work outside acute hospitals

If you know any clinicians like this who would benefit from the Nurse First programme, I would be really grateful if you could direct them to our site at www.nursefirst.org.uk and the closing date for applications is 31st May 2011.

Anyway, hope you are well,

Kind regards,

Dave
Dave Dawes
Nurse First Project Manager
The Shaftesbury Partnership

e: dave@nursefirst.org.uk
e: dave.dawes@shaftesburypartnership.org
twitter: @davedawes

Personal Health Records: Part II - revisiting Kim and Johnson 2002

Part I continued ...

What Kim and Johnson reveal is a level of transience that can be quite scary in this context. True, electronic health records can be archived and printed, but the latter surely defeats the purpose of the 'e'. Printing undermines the credentials. The virtual landscape presented in part I by checking the current status of these domains highlights the issue of ownership of data in a way that has provoked much debate in social media and the transferability of a person's data - information. If I want to move to another vendor, system, company (however the 'entity' is described) there needs to be standards and a degree of interoperability to facilitate this. 

Next, we have to bow to the notion of a year on the internet compared with 'real time'. M-health was a dream a decade ago. Here is another pressure on the PHR and its family members. A public-facing health record, whatever its nomenclature, must not only be responsive to the public and professional users and the 'total stakeholder community'. Now the record must be responsive according to device: from desktop, to tablet through to mobile phone.

In 2002 the PHR project was set to run and run. It had a slow, strong pulse with speedy recovery after exertion. The PHR looked fit for Olympic^* endeavors.

But then the algorithms set to change personal health care (to fuse ill-health and well-being) suffered a major arrhythmia. The fate of those who became the new PHR frontrunners, the heavyweights no less: NHS's Healthspace, the initiatives of Google and Microsoft suffered the same fate. This post is from 2009:

Self-care in e-space and the need to Impress

Given the changes since Kim and Johnson you have to wonder what the next decade will bring. Whatever there will still be fog, but that just adds to the excitement as we climb the trees. Then we realise that to all of the users of health information systems (remember the user and stakeholders?), whichever TLA is employed, they are all X-HRs by proxy.

Kim MI, Johnson KB. Personal Health Records: Evaluation of Functionality and Utility. Journal of the American Medical Informatics Association. 2002. Mar-Apr; 9(2):171-180. Selected for inclusion in the IMIA 2003 Yearbook of Medical Informatics. 

 ^*All trademarks acknowledged.

Personal Health Records: Part I - revisiting Kim and Johnson 2002

When I was at HC2004 or 2005 I was given a copy of the Medical Informatics Yearbook 2003 from the British Computer Society - Nursing Specialist Group stand. Within this volume of key papers for the year April 2001 - March 2002 I found the following:

Kim MI, Johnson KB. Personal Health Records: Evaluation of Functionality and Utility. Journal of the American Medical Informatics Association. 2002. Mar-Apr; 9(2):171-180. Selected for inclusion in the IMIA 2003 Yearbook of Medical Informatics. 

The paper identified candidate Personal Health Records [PHRs], then developed criteria examining the entry and display of data elements necessary for the PHRs to serve as adequate representations of information. Then in the final third phase a selected group of PHRs were assessed for their functionality and utility (p.370). Of the 12 PHRs assessed I thought it would be interesting to check  their current status (this was a quick visit to the published domains).

Several Personal Health Records 2002 - 2012

Web Site	Record	URL	Findings
Dr. I-Net	My Medical Record	www.drinet.com/	A good start! Still operational domain redirects from original www.aboutmyhealth.com Continues to offer a PHR.
HealthCompass:	Lifelong Health Record	www.healthcompassnet.com	While there are several site using 'Health Compass' the original version was not obvious.
MedicalEdge	Medical Register	www.medicaledge.com/	Domain currently offers support to physicians, so a PHR may be part of a package?
MedicalRecord.com	Your Medical Record	www.medicalrecord.com	This now appears to be a directory to electronic medical records.
MedicData	MedicData	www.medicdata.com/	This does not appear to offer a PHR and the homepage is 'under construction'. It looks like the domain may have a new owner.
Medscape AboutMyHealth	Personal Health Record	www.aboutmyhealth.com/	Now leads to GE Healthcare.
myhealthnotes.com	Personal Health Manager	www.myhealthnotes.com/	Server not found.
PersonalMD	My Medical Records	www.personalmd.com	Retired - leads to: www.eheandme.com/personalmd_announcement.html
TheDailyApple	Health Records	www.thedailyapple.com/	Social networking is vital to well-being but no PHR here.
VistaLink	Health Profile	vistalink.com	Domain for sale.
WebMD	WebMD	www.webmd.com/	Very much alive and kicking commercially, but my health record / PHR not in immediately in evidence.
Wellmed.com	Health Record	www.wellmed.com	This site leads to http://www.webmdhealthservices.com/

Kim and Johnson provide several lessons as a high quality contribution to the medical informatics literature. From the above we see that while we talk about timeliness in terms of the written record, time takes on a series of new meanings when it comes to electronic records, media, commercial companies and clearly the internet.

As I read the paper and reflected on the past decade other things fell into focus. At the end of the day a PHR should be what it says - personal. Reading Kim and Johnson this did not stop them looking at the PHRs from the perspective of doctors and informatics practitioners. There is nothing wrong with this. Although developers and political masters quite rightly seek to engage with the user, espouse usability and user testing - a system is aimed at a community.

If title [personal] follows function [record] and form [electronic] follows function then what do we have?

Don't worry if you're lost, me too (I'm musing again); let's add the fog....

It's crucial to know what's going on over the fence (similarly sometimes it helps to climb a tree). In this case the person in the form of patient is not the only consumer of the information in the record.

This is the point: systems are about a user AND a stakeholder community. Stakeholder is a much maligned word, found on the lips of those seeking to reach and engage remote ('difficult' to reach) community groups. It has a definite role here though.

Every health discipline has its record, that is a professional must. So in effect you have a series of 'X' -HRs. On paper they were - and remain in many cases - a mess. What we should have then is a hybrid health record that depending on the user morphs itself accordingly. But what is the point in pointing to users and stakeholders? Well, conceptually how far is personal from medical (nursing...) and how far again to personality? Add to the mix the question of where patient, well-being and health fit in to the management of long term medical conditions as per the critieria of Kim and Johnson, accurate entry of medicines, medical conditions, lab tests, monitoring ... and you see what is frequently a record breaking task.

This is (or was*) the challenge: to transform something that is generically personal (with the potential contradiction this implies) to something that is personalised as in 'I'.

*Part II to follow.

Alcohol: Messages in bottles, domains and anagrams

The perennial health news item that is alcohol has bubbled and overflowed this week. In 1987-88 I visited several nearby alcohol services in Blackburn, Preston and Salford with a questionnaire to compare and contrast with Chorley which at the time had no dedicated alcohol services. There was Alcoholics Anonymous AA and Al-Anon, but nothing specific through health beyond community psychiatric nurses. The project was for the CPN(Cert.).

Back then I remember a Consultant Psychiatrist saying that the level of alcohol consumption is directly related to cost. The literature I read also drew attention to historical comparisons. I think it was Alcohol Concern who supported this view and called for urgent action. Of course all that was some 24 years ago. Incredible that there is some movement in 2012. In 2007 the taxi driver from Elounda to Heraklion airport described the movement and horizontal stasis that adorns the pavements (and spills onto the roads) of Malia as we zipped by. The Brits do have a problem. A Consultant physician highlighted this from a hospital ward on BBC Radio 4 news today.

Don't get me wrong: I like an occasional drink but my enjoyment of alcohol has been tempered over the years by several experiences:

• An early party aged 15 (and at a church social club) preloading was already in vogue. No sooner were a group of us sat at a table than someone threw up on the table. It was alcohol.
• Biology and human biology lessons helped instil the impacts of alcohol.
• Having to say 'goodbye' to clients with a drink problem, duly referred by their GP. I cannot support them in their drinking after several attempts to effect change.
• Appreciating the link between drink and risk behaviours.
• Working with people whose 'ill-health career' has seen them having to live with, but not themselves recognise Korsakoff's syndrome.
• Seeing people over three decades who cannot be supported in the community with their family, relatively young for residential care, but given a lack of specialised facilities - there they frequently are.

Hopefully the policy turn will have a positive impact extending beyond news headlines:

Minimum alcohol price planned for England and Wales
http://www.bbc.co.uk/news/uk-17482035

Alcohol pricing: politics under the influence 
http://www.guardian.co.uk/commentisfree/2012/mar/23/alcohol-pricing-politics-under-influence?newsfeed=true

With the prospect of an alcohol and a new NHS information strategy in England you hope that some dots can be joined. Here are a few:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

Motivation    Psychological effects Attitudes to risk         Predisposition Personality     Education    Vulnerability	Data     Evidence      Public health Physical effects    Dual diagnosis Research       Violence - statistics
Social contradictons and attitudes - 'image' Upbringing       Cultural attitudes  Marketing          Media	Cost per unit      Services        Funding   Cost to health budget      Reporting Policy   Lobbying   Taxes   Commissioning

Beer label c/o http://www.beerlabelizer.com/

'Real Stout' = 'Sale Tutor'

[CIOP] Welcome to new list - Community Informatics for Older Persons

There recently has been an expansion of technology applications for older persons. These efforts include communications for elderly with others, connections with families, medical monitoring, group activities, assistance with hospital transitions, and tele-health. An important aspect is the framework of communities, either as a way to view applications or the use of the inforrmation and communications technology application  in a group setting, such as a wii activity by a group.

Especially promising are the research activities being done internationally.
This is demonstrated by the latest issue of the Journal of Community Informatics on Technology and Older Persons, with a significant collection of varied current studies. The work on this journal included the cooperation of an international group of professionals for nearly a year.

It will be exciting and worthwhile to have the discussions and online meeting of professional minds.

To subscribe to new elist Community Informatics for Older Persons send an email
To: sympa@vcn.bc.ca
Message: subscribe ci-for-older-persons

Or go to http://vancouvercommunity.net/lists/info/ci-for-older-persons

Gene
Gene Loeb, Ph.D.

My source: ciresearchers

Locating the Spiritual in Care: (very big) Plantpots vs Green Windows

Last summer, July 13 2011 to be precise, the cover of RCN bulletin #278 declared 'Prioritise spirituality'.

I am not a religious person, but quite a spiritual one (I think). This RCN news item reported Professor in Dignity of Care for Older People at Staffordshire University, Wilf McSherry's views on spirituality. It is central across health and social care, (it is also vital in terms of cultural and spiritual literacy):

The practice of spiritual and religious care is about meeting people at the point of deepest need,' Professor McSherry said. 'It's not just about religious practices but preserving dignity'.

Also in that month, the 30th in The Times (page 19):
'Sacred forests bear witness to religion's unsung role in fostering a rich variety of life'.

This news concerned the extent of religious forests, with a project by scientists in Oxford to create a global map of forests under religious ownership and control. Now under the guardianship (whether intended or not) such forests have assumed importance as examples of biodiversity. Ruth Gledhill writes: From the Garden of Eden to Avatar, sacred groves have been central to religion and myth ... between 8 and 15 per cent of the world's land is regarded as sacred or religious.

With many remaining exceptions places of care have changed remarkably over the past 30-40 years. There remain many residential and nursing homes that prove challenging for health care professionals (I know they have told me over several years), never mind the residents and their carers. Challenging in the spiritual sense of the surroundings. I posted in 2010 about the wail of call systems. Visually though we must ask: how green is that care home?

Count - plants real [3]* : artificial [13]^#
  
This isn't just the colour of walls and use of curves to soften the environment, but access to outside, to grass, to trees and flowers. The benefits of real plants in the office environment are well established.  Being able to see a green vista greatly improves employee productivity and well-being. For those people in care what is the view outside their window, the lounge(s), the dining room? How can it be improved? For those essentially bed-bound can the furniture and bed be moved around periodically to achieve a new perspective?

It is still upsetting to see that those physically less capable of reaching the outdoors are elevated to first and second floors. Even with positive spiritual acuity of staff (the outdoors matters to all) readiness to hand and soul - a sideways glance through a window, the sound of rustling leaves through an open window - can make a huge difference:

Spirituality, dignity and respect. ...

*And in need of water. ^#Five over-watered.

Image source:
http://www.fanpop.com/spots/avatar/images/9492947/title/avatar_promo-screenshot-screencap