At Birdie, we’re dedicated to helping home care providers to deliver the best care - to help us reach our goal of improving the lives of 1 million older adults by 2023. Never before has our mission been so important. And that’s why, in light of COVID-19, we’ve been running regular webinar sessions, to help care providers to access the information they need to deal with the challenges that lie ahead.
Team structure and management:
Buurtzorg - Dutch method of nursing, adopted by BelleVie Care
Servant leadership philosophy - Putting your team first, and yourself second
https://slack.com - Slack messaging service
Zoom - Video calls and training - using breakout rooms
Trudie and her Co-Founder Violaine founded BelleVie Care because they wanted to ‘do something different’ in home care.
Trudie, a former care worker, saw the difference that great care can provide, but also saw first-hand the difficulties. Having worked in a number of roles, she ultimately came back to care work, having been inspired by the model of nursing used in Holland, known as Buurtzorg. They use small self managing teams of nurses (and now care), which has been incredibly successful. The core of the business model is all about empowering and valuing care workers - BelleVie was founded to apply a Buurtzorg-inspired method and value the people who do amazing care work every day and empower them to take more responsibility, and pay them fairly.
Overall, it can be summarised as: Change. A huge amount of change, in a small amount of time. Some of the people we support for companionship have stopped visits entirely as they’re worried about extra visitors.
Some of our clients have increased visits as their family or neighbours who would usually help are self-isolated, plus we have had a lot of new people join us as hospitals have rushed to discharge, and they’re desperate for home care packages.
The team has also been impacted. If a member of their household is a vulnerable adult they may worry about being at work. Plus, there’s self-isolation if they have symptoms too - the rota has never seen so many changes. It’s been a huge amount of work to stay on top of things and make sure we’re delivering high quality care.
At BelleVie we have different teams. The central team in the office and then the self-managing teams. Our job in the central team is to enable the teams.
Their day will start by looking at Slack. We use Slack a lot - with so much change happening our usage of slack has increased a lot, we’re sending around 2,000 messages a week from one team!
Audience question: “What is 'slack'? Is it possible to explain that a bit more?”
“Slack is a secure, online communications platform. Originally created to help businesses to deal with overflowing inboxes, it’s an efficient and intuitive tool. You can have your entire company on one system to communicate, and there’s a free version you can download for your phone and desktop. It’s similar to WhatsApp but with different 'channels' to speak to different people. For example, channels like ‘rota’ or ‘check-in’. It’s like having lots of WhatsApp Groups, but all in one place.”
The teams manage their own rotas, which means that every day they’ll check in to see if any shifts have been changed, or if anyone is off, or a shift needs covering. They also use Slack to support each other and share good moments in our ‘moments’ channel, through the good and bad times.
Once they’ve checked their day through Slack, they’ll go on shift. They’ll use Birdie to record their visits as it syncs with our rostering system. They can also see any previous notes in there too.
We’re quite a young company, we’re only a year old, so there are some things we’re working out. The main principle is that the team is involved and makes their own decisions, in everything from their shifts to recruitment. Team members will take on additional roles, like a recruitment coordinator, for example.
The philosophy we adopt is the servant leadership philosophy (putting your team first, and yourself second). Our role in the central team is to serve the individual teams. Our job is to enable them to deliver the best care, through buying or building the right technology, making sure that we can bring on new people to support and that our recruitment campaigns, national branding etc are covered - but it’s all to serve them.
We agreed a comms plan to start with. The registered manager sends a weekly email with updates and information to the people we support and their families. But for more informal conversations and things within that week, each person we care for is assigned a link manager. A link manager is their main source of contact. So if they’re worried, and we have noticed that there has been a lot more phone calls and emails from families and the people we support, their point of call is their link worker.
In terms of coronavirus, we’ve been using Public Health England and the Government website. We have found that sometimes there is a bit of ambiguity in the government advice so we also use the World Health Organisation website, which has some really good and practical advice for things like using PPE.
More locally, we have been using the Oxford Association of Care Providers (OACP), and they have been brilliant at sharing information about what’s happening in our area.
We were quite proactive at BelleVie, so we started early and planned for the worst case scenario early on. We sourced PPE early on; our approach has always been to have at least one months supply of PPE on hand.
We started off by using our usual suppliers, but more recently, the most reliable place to find PPE has been through eBay. We also saw on Twitter a not-for-profit organisation called SOS-supplies.com. They’ve been coordinating logistics between different suppliers. You fill in a form and tell them what you need and they will try to find it. It helped us a few weeks ago.
It’s all about creative thinking, it has taken an inordinate amount of time for us to find what we need, but being creative will be key.
“In our last webinar we covered PPE and how to use it safely. One of the questions that came up was around communicating with clients about PPE. Some clients may have dementia and find it difficult to understand, some may request a mask to be worn even without symptoms, and there is no specific guidance around this. How have you, at BelleVie Care been addressing this?”
We have had both of those situations arise. We have ensured that every care professional has masks. Some of the people we support feel much happier if the care professional is wearing a mask, or keeping distance, and if that makes them feel more comfortable, then we will. But we have also had other people who really don’t want us to. We care for one lady who has been deaf since birth and she lip-reads, so a mask is tricky.
The most challenging are the people we support who are living with dementia. The team have decided that when they arrive at a person’s house, they will say hello at a 2 metre social distance, and then they will explain that they have a mask. If the person does not want them to wear a mask (if they are not showing symptoms) then they won’t, unless they are getting closer, doing personal care.
We will explain this every time we see a person with dementia. And we are finding that we are having to re-explain why a person can’t leave their house and why these masks are around, and what the problem is. Some people are quite distressed by the situation, so we’re always doing what we can to help them feel comfortable.
Audience question: “Do you think these changes will be permanent, eg. the use of PPE?”
It’s not like we will get to one specific date and the government will say it’s all over. There are some significant milestones before we get there, like when certain restrictions are lifted. The group that we are supporting, they will remain at risk, regardless of the changes. Until we have a cure or a vaccination, these people are at risk. Even next year, when things are resuming normality, the virus will still be here, so I think PPE will be vital in ensuring that we contain the spread.
We currently have two people self-isolating. One of our care professionals was showing symptoms, and one of our concerns was in getting her tested. Our co-founder has actually managed to find a local testing centre that has been set up by a philanthropist in our area, and they have agreed to give her a test. So do try and see if there is anywhere local that is testing. Care staff are just as important as NHS staff, so do try.
We have actually seen an increase in applications, which is likely linked to people in other sectors losing their jobs as a result of COVID-19. We are very keen to recruit people from a non-care background and train them, as long as they have the right values.
We realised pretty early on that we would need to recruit from areas outside care. We learnt from Wellbeing Teams, who we partnered with last year, that 70% of their recruits are from a non-care background, as they found it easier to work in a self-managing team.
A challenge we have seen is that we have had several good people go a long way in process and then have dropped out due to families not wanting them to be out working and delivering personal care at this time, due to the risk. That’s our biggest challenge.
We’re proud of our training and investment in people, but because our training costs are high, we want to employ people who will stay with us, not just those who want work during Coronavirus.
Audience question: “How do you do your moving and handling and first aid training online?”
That’s a tricky one. We have found some e-learning courses on moving and handling. We have kept in place our shadowing programme. If someone has come from a retail background for example and has only completed e-learning, that face to face element is really important. As shadowing is considered ‘work’ we have been able to continue with this and ensure that people are getting adequate training.
First Aid training is also a good one to cover as it is a mandatory requirement for all of our staff. What we have decided to do is, once the coronavirus restrictions are lifted, then we will do a big group face to face course so they can practice CPR on a dummy. We have also changed the expiry dates for e-learning courses. So if someone has done an e-learning course, their training will expire sooner than the traditional three years, which is a way to mitigate the risks where an online training course may not deliver quite everything. But it is still better than nothing.
I think the answer for all of us, is to look outside care. Jobs are being automated all over the place and there are amazing people who are caring and compassionate. If they have those innate abilities, let’s show them how worthwhile this job is. Let’s tell a different story to the one that’s painted in the press, let’s tell a different story, the real story, about how we put smiles on people’s faces every day. Let’s use that to recruit people. People who want to find a sense of purpose in work. Who want to give something back to their local community. Let’s bring the people with the right values into our wonderful sector and train them up. That’s how we solve the recruitment problem. That’s how we solve the care crisis and how we support our ageing population.
Audience question: “How do you provide training from someone coming from retail for example? Can you train online or do they have to be hands on?”
Before coronavirus we did a mixture of face to face and online training. The face to face was really important, because typically that’s around your behaviours, how you’d react in scenarios, both from providing great care but also in working in a self managing team because you’re expected to be proactive and take responsibility for resolving problems. So we also have a suite of e-learning courses and we have extended these. We have hosted video calls with external trainers, using Zoom and the breakout rooms in Zoom. We’ve combined these with standard e-learning courses.
If you had asked me a few months ago whether we could recruit and train a whole team of six remotely, I’m not sure I would have said that it is possible. But it is possible. We have done it.
We had a Business Continuity Plan that was previously for snowy weather, which tends to be over and done with quicker than a global pandemic. That did give us a really good basis for risk assessing everybody we support. So what we did was go through everyone and look at how we supported them - and how critical their needs were. And also to look at what other support networks they had around them, like families, neighbours etc. So if we did end up drastically short-staffed, we would know where we can cancel a visit and it won’t put someone at significant risk. We also communicated this with family members early on, to let them know that we may need to ask them to help so we can prioritise people who may be completely alone.
The central team also has a daily COVID call, where we can catch up with latest government guidelines, and we can see where we’re at with PPE and make quick decisions if someone needs to self-isolate.
We have done a lot of planning, but it’s important to realise that our planning may change, depending on the situation and who the person is. We would go back to the risk assessment, and look at whether the person we support has family or anyone else who might be able to help. If someone we were supporting had coronavirus we would support them still, but the way we support them would need to change. We would look at things like splitting the teams, so we would keep a ‘clean team’ who would not visit that person, to reduce the amount of contact with that person. We would look at getting them tested, but we have to work on the assumption that we would not be able to test them.
The other worst-case scenario would be if our team were drastically struck, and then we would have to go back down to the prioritising of the people we care for.
We also have a plan for what we call ‘distance care’. Distance care may be used when someone is healthy, but self-isolating due to risk, so we may just offer a phone call, to remind them to take their meds, which is the most important thing we need to do if we can’t be there. The distance care plans can include that all-important companionship element too.
We have found that we are offering a lot more phone calls. We didn’t previously do that many phone calls before, but sometimes it has been a family request to have phone calls only. We’re also looking at providing tablets for our people. A lovely lady we support is living with dementia and is missing visits, so we’re trying to set her up with a tablet and an internet connection, as that would make a real difference to her life.
Another idea that we’re talking to Beth from Birdie about is in shopping. It’s an increasing challenge, so we’re looking at how we can incorporate online shopping into our care provision.
The team has a weekly team meeting, which has been really important in helping them offload and share. We did, unfortunately, lose someone we care for very recently, not from coronavirus, but the team were very fond of her. So last week at the team meeting they all toasted each other virtually with hot chocolates (her favourite drink) and took some time during that meeting to share some memories. I think those video calls are really important to them.
On Slack, we also have a channel called ‘check-in’, where people can talk about how they’re feeling and get some support and empathy from their colleagues and that’s proved really valuable.
We’re also looking at some free online yoga classes on Tuesday evenings, which will be a great way for the team to unwind.
The most important thing is in how we behave… so stay calm.
The world won’t be like this forever, so stay calm so we can make rational, objective decisions. Be kind, because you never know how people will be affected, and what their worries are. If we all stay calm, we will get through this in better shape.
The second top tip is to risk assess everyone you support, and ask your care professionals for contingencies - they are the ones who know best. What are the other options, if you are short staffed? Plan assuming that you are going to be around 20% down on staff, as a proportion will be self-isolating. If you plan for that, you’ll be in a good state.
The third tip is to take time to reflect on sadnesses, or the good things that have happened. Get your team together to join video calls and bring the team together where possible to remind everyone of how amazing they are and how amazing the job they’re doing is.
We moved to Birdie not long before this happened. The interface is so simple and straightforward and simple to use - and it just works. It helps us do our job, and ultimately it means our care professionals can spend more staff caring, which at this time is so important.
The fact that Birdie is so helpful and has offered to support us in other ways and adapt to what's happening has been brilliant. It’s very appreciated.
If you have any questions, or you’d like to feedback on our webinar, you can email firstname.lastname@example.org. You can watch all of our webinars on-demand here.