Elderly Mentally Infirm (EMI) Adult Services

Historically, older people with enduring Mental Health problems were cared for in continuing care wards in a hospital setting.

It was recognised that this was not the correct environment for these older people, so since 2000, there was shift in how they were cared for on the Isle of Man. The services were transferred from Department of Health to Department of Social Services.

The existing patients from the hospital were relocated from hospital wards to Residential Care home settings. These are now managed by the Department of Social Care, Adult Services Team.

There are 3 long stay EMI units and 3 day centres which are situated in the North, South and Middle of the Island.

The unit in the South of the Island, Gansey Unit, opened in 2003. This unit is situated within an older peoples resource centre. Gansey Unit has 12 beds; 11 long stay and 1 short term bed.

Adjacent to Gansey Unit, there is a day centre, Gansey Day Centre, which can cater for up to 15 clients a day.

The middle unit, Thie Meanagh (Tie Main Oc) was opened in 2010 and has one 16 bedded EMI unit and a day centre which can cater for up to 15 clients a day. There is also a Residential unit within this building which caters for older people who need a little extra care.

The Northern Unit, Reayrt Skyal (Re at sky al) opened in Jan 2013. This unit has 14 long stay beds and 2 short stay beds. There is also a day centre adjoining this unit.

We offer long, short term and day care for the older person with functional and/or organic illnesses. The majority of the Residents we cater for have various types of Dementia.

We also offer a service called the 'good neighbour scheme' which is when clients can come and stay in any of the areas for periods of up to 4 hours a day whilst their carers attend to other appointments.

It is important to us that nurse's practising within EMI areas, act as role models whilst promoting their specialty as a positive and exciting career option.

Registered Nurses working within EMI areas have different and varied skills, knowledge and backgrounds. Each of them have unique skills and can make an important contribution to care we provide.

Because of the complex Mental Health needs of the residents and clients, it is desirable that we employ Nurses with Mental Health training/background, however, a registered nurse on any part of the register with the desire to champion dementia care and work with older people with mental health problems are considered.

The team in each unit consists of a Manager who is Mental Health trained, Registered Nurses, (Band 5 and 6 grades), Care assistants, housekeepers, laundress and chefs.

The Managers, who maintain a visible presence on the units, take an active role in the delivery of care and are very 'hands on'.

There is a two tier structure for Registered Nurses, band 5 and 6. As far as possible there will be two RN’s on each day shift.

All Registered Nurses taking up posts in EMI units are offered a period of induction. During this time they will have an identified mentor, who will offer them support and guidance whilst allowing them time to develop their competencies.

Registered Nurses joining the team will be given the opportunity to have a period of supernumerary status to enable them to settle in to the new environment, develop their confidence and become familiar with their care surroundings before taking on the responsibility of 'Nurse in Charge'.

Once the band 6 Registered Nurse has achieved the required competency levels and feels confident with their own ability, they will assume the role of Named Nurse, they are encouraged to act as an autonomous practitioner making decisions as and when required, taking charge of the unit on a shift basis, supervise a team of junior staff across various disciplines and work as part of the wider multi-disciplinary team, liaising with families and other professionals.

When the band 5 registered nurse has achieved the required competency levels and feels confident with their own ability, they will assume the position of associate nurse and they too will be encouraged to be involved in decision making processes as and when required, taking charge of the unit in the absence of a band 6, supervising a team of junior staff across various disciplines and work as part of the wider multi-disciplinary team, liaising with families and other professionals.

It is important to us that Registered Nurses play a central role in creating and developing a positive and enabling culture, where older people's rights are promoted.

Residents, clients and their families are actively encouraged to participate in all decisions regarding care plans, from the point of referral, through on-going reviews, right to the point of discharge.

In our experience training for staff working with this client group is often best delivered on the floor, where staff can share common experiences and knowledge.

However we believe that working with older people requires continuous updating of knowledge and skills which is why we prioritise access to education and training for staff.

Registered Nurses working within EMI units need to be capable of recognising their own practice limitations, critically analyse their own practice and identify their support and development needs.

Staff from all disciplines, are encouraged to actively participate in reflective practice through supervision; we encourage them to actively participate in care review meetings, peer supervision and unit meetings.

We offer training opportunities, lead and support skills development and assist Nurses to keep up-to-date with PREP requirements. We encourage all staff to contribute to and influence policy development.

All of these are designed to support the staff on a continuous basis, enhance practice and improve the care for the older people we are responsible for.

Within EMI services we are closely linked with staff from a variety of disciplines, including

  • Mental Health Elderly Admission Ward
  • Older peoples Mental Health Service (Community Team)
  • Social Work Team
  • GP's
  • Learning disability teams
  • Private sector care homes
  • Social Services Older people's homes

We are frequently invited to participate in fully integrated Mental Health Service multidisciplinary team meetings.

We regularly accept student nurses undertaking training in both general and mental health. If a registered nurse believes he/she has the skills to take on the role of Student mentor, this is encouraged. It is a great opportunity for developing the registered nurse skills as well as that of the student.

As we are the only environment within the Government to provide long term care for the older person with mental health needs, we are able to embrace the culture and history of the island and its population. We recognise and reflect this in our approach to the services we offer.

'It takes a special person to work with older people with mental health problems. It is hard work, demanding and challenging. It is also rewarding, satisfying and worthwhile.'

Rosaleen McCaffrey Manager for EMI Services