Specialist care

Tracheostomy care for adults with complex needs

While undergoing a tracheostomy can be a traumatic process, living a fulfilling and independent lifestyle afterwards is easily achievable with the right support from expert clinicians.

And getting the right specialist support can ensure a person lives a fulfilling life, both physically and psychologically.

Exemplar Health Care currently has over 30 adults across its homes who have a tracheostomy or other respiratory requirements, and is a specialist in providing the care and support they need.

With 20 years’ experience of caring for some of the most complex and acute individuals, Exemplar Health Care supports people who may otherwise be in a hospital setting if not living in their homes.

Across its growing portfolio of homes, its teams are highly trained, and its homes adequately equipped, to safely care for people with tracheostomies and other complex respiratory requirements.

Here, Sharon Jolley, clinical specialist nurse - respiratory support at Exemplar Health Care, discusses its capability in tracheostomy care and how it supports people through the process and towards recovery.

Delivering specialist care from the point of referral
At Exemplar Health Care, we support adults who require long or short-term tracheostomies, and work with them to achieve their individual goals.

Our expert clinicians, who have experience and expertise in delivering tracheostomy care, focus on assisting individuals to live a fulfilling and happy life, despite the challenges their tracheostomy brings.

We support people with different types and makes of tracheostomies, including cuffed and un-cuffed, fenestrated, non-fenestrated, and subglottic tubes to help to support with the management of excess secretions whilst maintaining a safe airway.

We also have the expertise to support people who require mechanical and manual cough assist, adhering to their personalised regime, and also those that require continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BIPAP). From the first point referral, we take a person-centred approach to tracheostomy and respiratory care.

Our clinical assessors work with individuals and professionals to understand their care needs prior to admission, and develop a personalised care plan to ensure their safety.

When someone moves into one of our care homes, we take the time to get to know them, and carry out an in-depth assessment to understand their holistic care needs, including their communication needs.

We work with each individual to identify which communication strategy is right for them and identify their aims and goals for their future life. We also work closely with other members of the multi-disciplinary team such as speech and language therapists, respiratory physiotherapists and assisted technology specialists, to enable people to have the best opportunity to fulfil their communication needs.

Specialist staff giving bespoke support
Our homes are led by an experienced nurse-led management team, and supported by a trained in-house team of registered nurses and health care assistants. Each of our homes has a high ratio of registered nurses and health care assistants, which enables us to provide attentive care and minimise the risk of, and respond to, complications which may arise from people’s complex respiratory needs.

Our health care assistants and nurses are trained to complete daily tracheostomy care such as cleaning the stoma site, changing tapes and dressing, changing inner tubes as per individual protocols, tracheal suction techniques and ensuring that the correct Heat and Moisture Exchange (HME) is used, including mechanical HME.

They regularly monitor basic vital signs, including temperature, heart rate and oxygen saturations, and are able to detect early warning signs of infection and respond appropriately.

Colleagues are trained in emergency care and follow the National Tracheostomy Safety Project emergency protocol, alongside individual emergency protocols issued by the Respiratory Teams that manage service user care as outpatients.

Our teams are also experienced in the use of Passy Muir Valves (PMV) for those that use them, and Invasive Ventilation (IV) for those who require invasive respiratory support from a ventilator, both short and long term. We have an in-house competency process to train and validate our nurses to complete full tracheostomy change, either routine or in an emergency. This ensures that our care is proactive and dynamic, which reduces the need for hospital admission.

In-house teams of skilled professionals
Many of our homes have in-house physiotherapists who can carry out respiratory assessments, and advise on suction techniques, patient positioning and optimal respiratory therapy.

Our life skills teams support people to adapt to life with a tracheostomy and respiratory needs, so they can continue to live a full and fulfilling life in the way they choose.

We’ve also facilitated training for family and friends to enable those with a tracheostomy or complex respiratory needs to maintain their connections and activities outside of the home.

Our in-house clinical experts deliver bespoke training to ensure that colleagues are confident and competent to understand people’s needs, and deliver safe tracheostomy and respiratory care, including with those who display behaviours of concern.

We tailor training to the needs of our service users, and colleagues are empowered to develop personalised plans for addressing behaviours of concern. We review training and competencies regularly to ensure that colleagues are up-to-date with their knowledge and skills.

‘We’re committed to delivering the very best standards of care -
it’s as simple as that’

NR Times meets Komplex Care, one of the most recent entrants to the care sector, to learn more about its ethos and plans

As one of the most recent entrants to the specialist care sector, Komplex Care is already making its mark.
Founded in 2019, it works nationally to deliver nurse-led care to people with highly complex needs in their own homes, working alongside their rehab provision to provide comprehensive all-round support.

An ambitious and forward-thinking national operator, Komplex Care was founded by a group of care specialists with vast experience of working in the sector and are committed to using their insight and expertise to lead positive change.

Having accelerated each year since its inception, Komplex Care recently expanded into new headquarters in Telford to accommodate its fast-growing team, and to give it more space to deliver it’s nurse-led specialised training programs - another increasingly in-demand area of the business.

It is also a fully digital care provider, with adoption of paperless records and communication throughout the business - something that has often been approached with caution more widely in the sector but is seen as vital to Komplex Care.

“We're a well-formed but expanding team and we all work together, we all have exactly the same ambition - and that's to make sure that we're delivering the best possible highest standard of care,” says Arron Zaib, managing director of Komplex Care who joined in 2021 after two decades working in the field of complex care.

“We like to use a practical and relatable measure when looking at our delivery of care, as team we’re always assessing ourselves and think ‘Would that be good enough for my loved ones?’. If we can answer yes, then we know we’re probably on the right track of where we want things to be.

“Ultimately, we all want our loved ones to have the best possible standards of care, and that’s what we are committed to delivering. It’s as simple as that.”

Komplex Care prides itself on the clinical-led support it gives to those with complex needs at home, and is appointed by growing numbers of Clinical Commissioning Groups, Integrated Care Boards and case managers nationally.

“Our goal has always been to be the provider that is first choice, based on our reputation and the service we deliver,” says Arron, who also oversees sister companies Komplex Health and Komplex Community, which cover the Shropshire area."

“For me, at this point when we’re just about to accomplish three years as a business in sector, it’s about broadcasting our name out there in the marketplace – and can only achieved through delivering the very best standards of care, which is where our focus will always be and should always be without exception.

“We are already competitive in the sector even after such a short space of time and this is due to the fact that we offer an effective, efficient yet bespoke service that once again puts our clients care first.

“We are committed to doing our utmost, but we won’t ever hide. It doesn’t go perfectly well all the time, and any provider who say it does is not being truthful or transparent. Our process is to recognise an issue, analyse its facades, create a solution, and be actively visible on how we’re going to do it better.”

Komplex Care’s adoption of a digital methodology also makes it stand out within the sector, with Arron himself being an advocate in the importance of such systems.
Indeed, families and Commissioners can also gain more insight into the care of their loved one or client through Komplex Care’s digital adoption, with both groups being given access to electronic care records, with the client’s permission.

“Our advocacy of the integration of software into the care sector is constantly evolving and we’ll always looking at ways in which it can play a greater role not just for ourselves but for the industry as a whole.” says Arron.

“For us, we’re trying to get everything digitalised and as streamlined as possible. It means the margins for complete compliance are that much more water-tight and in turn the safety of our clients exponential increases with each passing day. Rather than being under-utilised as a tool just for preparation for inspections, it allows us to show everything in real time and gives a far more accurate picture of where you sit as a provider.

“It provides access to family members better connected care, and Commissioners too. Lots of people are concerned about their loved ones who are receiving care, but we can show them in real time what’s happening with that individual. No matter the distance, we give you reassurance that they are being looked after.

“With Commissioners they can see what is happening as efficiently as possible, meaning that the constant stream of data on each package that is fed to them helps to ultimately justify the care that they’re paying for.

“I think with the pandemic, more people working in care have started to realise the benefits. Healthcare was not geared up to work when offices were closed. Suddenly, people were having to think about how they’re going to get care plans re-issued when an office is closed, how do you get things printed off when you don’t have access to the printer? Basic things like that can make a massive difference to how a care operation can function.”

With Komplex Care continuing to grow, equipping its team to deliver the best possible service is central to its approach, says Arron.

“Many of the referrals we had initially as we came out of the pandemic were for people who had not received the care they deserved to a standard that they were entitled too because of lockdowns, and as a healthcare professional of 20 years that’s really heartbreaking to see,” he says.

“But we’ve got an incredible multidisciplinary team here who are committed to that, as they were during the pandemic - we hadn’t tried to overreach ourselves and kept our client group, but now we are able grow and take on cases who need more support and specialist care.

“We are creating our own Komplex family here, where the field-based staff around the country are very much part of it. We include them in everything and make sure that we're engaged with them.

“We believe that our outstanding person-centred care starts and ends with the carers.’Therefore, we provide high-level in-house training, which is a blended learning experience of online, face-to-face and practical. The hands on training section is delivered here in our specialist training room that has been designed to simulate as close to a true care environment as we can.

“We also want them to come here and meet the office staff. Not all care providers bring their people in for physical training, so the people in the office are just a name to them. But we see the huge value in putting a face to a name here, no one should ever just be a number in care, staff or client, and this is part of the whole ethos of our business and how we operate.

“When care staff come to us, they can also move their career through the different brands. They may come to us to work within home care, but then find they want increase their skillset and transfer into the complex care. There are always options when you come to work for us.”

And as the business continues to grow, the Komplex Care ethos remains the same.

“We stand for - quality, transparence and honesty, and delivering the best possible service for our clients and Commissioners.”