The pile of pain relief tablets heaped up on Pat Richards’ living room table tells its own story.
It’s over 40 years since Pat damaged her back lifting a care home resident out of bed. Cortisone injections, physiotherapy and daily painkillers help to mask some of the pain. But this patchwork medical solution can never address the wider impact that relentless pain inflicts on Pat’s life: isolation, loneliness and a lack of mobility.
Because physical, mental and social wellbeing are so closely linked, you need to see the big picture to help people live healthy and fulfilling lives. And that is why Lisa-Marie Hawkins, a health and wellbeing co-ordinator from Age UK Merton, is sitting with Pat in her living room, with a pile of forms in front of her, gently talking through every aspect of Pat’s life. This is a Living Well assessment, effectively an MOT for Pat’s day-to-day life.
“I only heard about the Living Well assessment because I contacted Merton Council to find about getting some help with buying a mobility scooter,” explains Pat. “They told me about the assessment and I thought why not?”.
Helping people to live independently at home
The Living Well initiative began in July 2016. It aims to help Merton residents who are aged 50 and over, to remain living independently in their own homes for as long as possible. The scheme is funded jointly by the local NHS and Merton Council through the Strategic Partner Programme and the Better Care Fund.
Last year Living Well helped 679 Merton people with an almost 2-1 ratio of women to men. The greatest demand is from clients in the 80 to 90 age group with most people referred to the scheme via social prescribing, followed by GPs and adult social care. Some people at the younger end of the age group are referred from the Westminster Drug and Alcohol Project. Other referrals come from family and friends and sometimes people will ask to be assessed themselves.
For Pat’s initial assessment, Lisa-Marie asks her about all aspects of her life. Friendly and respectful, Lisa-Marie gains an idea of what Pat needs to live a more healthy and fulfilling life. Looking at someone’s whole life, rather than just a health condition for example throws up unexpected insights into people’s daily challenges. Visits to some clients’ homes can reveal issues with personal safety, nutrition, and hoarding.
“We ask questions about key issues under themes like; feeling connected, feeling positive, feeling safe and independent, staying active and healthy and, of course, people’s financial situation,” says Lisa-Marie. “The themes are deliberately broad because we want people to feel free to talk about what really matters to them.”
Lisa-Marie’s walk around Pat’s house reveals potential dangers from trip hazards, inside and outside. A bed covered with suitcases, though, leads Lisa-Marie to discover that Pat has been sleeping on her living room floor for over 20 years: the pain is so bad that this is the only place she feels comfortable. An urgent review of Pat’s medication and exercise routines is put right at the top of Lisa-Marie’s suggested action list.
Loneliness is a big issue
Lynne Mitchell, the manager of Living Well, says that the service was busier than ever during the pandemic. “We were home visiting from June 2020 when a lot of people weren’t visiting. People really appreciated this. Many contacts were related to loneliness because people were unable to get out of their homes.”
There are no hard-and-fast rules about who is referred to Living Well and what their needs are, Lynne says. Most clients have multiple issues and the prevalence of hoarding – which has complex psychological and social roots – has led to the development of a specific service called Fresh Start which focuses on decluttering.
GPs in Merton say the Living Well Service is making a huge different to their patients. Dr Vasa Gnanapragasam talks about why the holistic service it offers is such a game-changer: “Someone may have a health condition, but often it’s no good me preaching to them about living a healthier lifestyle when there is so much more going on in their life. When people are under stress – maybe because they are struggling to make ends meet or are lonely and isolated – they don’t have the headspace to hear the advice.”
He adds: “We need to work with people on the issues most important to them, until they are in a better place where they are ready to listen to us on the issues we feel are important too. When we look at whether we’re making a difference in people’s lives, let’s find out about their wellbeing, satisfaction and happiness in life, not just whether we’re treating medical issues.”
Help with housing and money issues
“About a third of our referrals come from social prescribing,” Lynne says. “There are housing and benefits-related issues and, increasingly, money issues are coming to the fore, especially with the increase in fuel costs.”
Partnership working is at the core of the Living Well initiative and Age UK Merton works closely with community organisations such as Wimbledon Guild. Lunch and activity clubs – even line dancing – are among the enjoyable ways that people are encouraged to make new friends and counter loneliness.
During Lisa-Marie’s visit, she proposes, among other things, an appointment with Thinking Works to find ways to get Pat’s fuel bill down. Lisa-Marie calls Age UK Merton’s Information and Advice Team to explore the potential for a grant to fund carpets to replace rugs that present a trip hazard. The Information and Advice Team can also support Pat to check if she is receiving all the benefits that she is entitled to.
When the two hour initial assessment is over, Pat Richards offers her verdict: “The most important part for me was talking about getting pain relief. I’ve been in constant pain for 40 years and I just want to be able to get out and about.
“I thought Lisa-Marie was very thorough and I was surprised at all the questions she asked. It was nice meeting her – she’s a lovely person.”
- To find out more about Living Well ring 020 8648 5792 or email firstname.lastname@example.org