The crisis in care homes

As a person who, whilst getting older himself, knows next to nothing about care of the elderly, how can I write a post on the subject? Yet write it I must, as becomes apparent below.

We could start with one of the most immediate blights on the elderly in this country – Elfansafetee. What moron dreamed this one up?

The HSE warns that bed bars should only be used if there is ‘no alternative’ as their use can be construed as an unlawful deprivation of liberty under the Mental Capacity Act 2005.

And the result of that piece of idiocy can be seen in the photo top left. Then we have:

Nurses ‘have no time to talk to older patients’ because shortage of qualified staff is ‘compromising care’ on wards

Nurses have to be told talk to patients: In a damning indictment of care on our wards, an order from Cameron

Nurses fear reprisals for blowing whistle on poor care

It goes on and on. As for care homes themselves:

10 care home workers charged with neglect after undercover filming ‘exposes abuse’

Second care home owned by company at centre of abuse probe closes

Whistle-blower at centre of ‘barbaric’ care home abuse exposé raised alarm last year – but was ignored by regulator

Frail and elderly face care home lottery

Pensioner died after spending EIGHT HOURS in freezing cold outside care home overnight

Frail grandfather threatened with eviction from care home

‘A quivering, malnourished shadow of her former self’: Southern Cross care home accused of mistreating grandmother, 89, in her final days

What’s going on? Where’s the compassion of nurses? Where is any sort of “care” in care homes? These headlines were from the Mail, which admittedly likes its sensation. yet stories abound.

One Australian blogger friend wrote that she’d heard from a lady in this country, via a forum, whose mother was in a nursing home and was having a tough time of it. Her mother had fallen many times [thoughts of the case at the top of the post] and staff had not been there to help. This “lady forum user” was at the end of her tether.

To be fair, the elderly lady has, as many have, increasing dementia and the nursing home is shortstaffed. Shortstaffed is the word and perhaps this has something to do with it:

If nurses seem anything less than compassionate towards the elderly, it’s because they’re overworked and bogged down by paperwork

I was asked if I could publicize this situation but as I know nothing about it, I had to ask. One blogger who knows a fair bit about such things is Witterings from Witney and so we Skyped, with me taking rough notes on advice I could give to the daughter about what to do concerning her mother. Hope I get this right:

The first thing is that there are care homes and care homes and it pays to visit those in your vicinity to observe, around mealtimes, say 11 a.m. The first thing is that there are care homes and care homes and it pays to visit those in your vicinity to observe, around mealtimes, say 11 am. If the home is council run, detailed notes should be with the local council.

Witterings spoke of checking whether it’s a tenured cook at the home or someone brought in. He spoke of cuts to councils from central government – these have impacted on local authorities who are losing money left, right and centre anyway on PCism and housing benefits.

He said to check whether the home tries to use agency workers or if there is a contract to cover holidays, sickness etc. It’s worth checking the policy on staff being asked to work overtime.

This apparently is also an issue in care homes:

Nurses who can’t speak English put patients in danger: Lord Winston’s stark warning over NHS workers from Romania and Bulgaria

Then there is the care home boss him/herself:

Care home boss told police ‘s*** happens in our business’ after autistic resident choked on ham sandwich

And:

‘Don’t bother calling an ambulance, she’ll be dead by the time it arrives’: What care home manager said as patient, 94, choked to death

It seems wise advice to check the care home out thoroughly:

5,000 complaints a month over care home abuse fears

And:

Care home matron admits to residents abuse

Then there is the arrangement within a local area re Housing Associations providing sheltered housing, as a result of a shortfall of places in care homes. Do HAs provide extra care to sheltered housing residents, in schemes with the addition of full time live in nursing care?

Witterings makes the point that HAs are so bound up in statutory requirements, ethnicity issues in staff, form filling, social policy issues and so on that this impinges on the quality of care.

Regarding the elderly lady in question, she keeps on falling and being left there without anyone doing anything. Witterings says the “lady forum user” has the right to get her mother transferred from one care home to another if the level of care can be shown to have been poor and she should get herself lasting power of attorney because the care home can then do nothing to her mother without her agreement. Apparently, that can cost £500-£600.

The Senior Officer at the home then goes over her care plan with the daughter and it requires a signature whether she’s happy or not with the arrangements.

Witterings advises that it’s as well to be familiar with and be able to quote from the care home act.

Regarding rent increases and service charges, landlords are meant to have consultations with tenants to determine service charge increases – there needs to be notification on something called Form 4B, 28 days prior to the increase.

There’s a Safeguarding Vulnerable Groups Act 2006, clause G which gives some protection to people in sheltered accommodation.

This underlines that many people such as our “lady forum user” have a knowledge deficit which can be overcome by checking. It’s as well to know that the bulk of council funding comes from Westminster, that councils are often ringfenced, that even something as diverse as the wardens wages can impinge on this, that councils do have other money from Westminster in general grants to spend as they see fit and it’s worth checking how much of this is spent in the care home area.

Apparently a localism act has just been enacted, which could impinge on care homes.

Witterings mentioned that Catalyst Housing [HA] are one of the few who believe in wardens or scheme managers employed by HA on a scheme, rather than being brought in itinerately. Under the last government, with a view to saving money, the idea was born of “floating support”, where someone like a scheme manager would look after 4 or 5 schemes – only visiting every 4 days or s0, for an hour or so. This is not on and could be the case with your care home for your parent.

Everything’s done to save money, rather than to provide care. As that manager said in the link above, it’s a “business” like any other. And so on.

As others see us

An American article addressed the issue of care on this side of the pond:

50% of UK Nursing Home Patients Abused By Government Health Care

Fans of government health care keep telling us that government can do the job, and they point to countries like the UK as examples where single payer, government run health care systems deliver high quality, compassionate care.

They are either grossly ignorant or they are lying through their teeth.

A recent study by a British healthcare regulator finds that half of all elderly people in Britain’s nursing homes are being denied basic health services.

Half.

Some older people were forced to wait months for a doctor or nurse to treat simple health problems. No doubt they were waiting for the Bureau of Bedsore Management to review the proper procedures before issuing a bandage-changing permit.

Over the polite grumbling of many advocacy groups, the British Parliament can be faintly heard tinkering away at some far overdue legislation. No doubt the grannies will get some relief just as soon as the House of Commons passes some new laws, the House of Lords (whoever they have there now that they have chased the actual, you know, Lords out of it) sagaciously tinkers with it, the Queen signs it, the bureaucrats get all the regulations nicely written, and the memos and administrative procedures get delivered to the proper offices.

Of course, the National Health Care service has been around since the 1940s and somehow these lingering little problems haven’t quite been cleared up yet. It’s obviously just a question of getting the right regulations in place and any century now the system will by running like a fine tuned machine and there won’t be any problems at all.

There have been several disturbing revelations of abuse and neglect of patients and other mismanagement in the UK’s national health service. This report, suggesting massive neglect and abuse of the elderly, is, sadly, not alone.

Unfortunately the US Congress seems to have delivered some kind of misshapen system that will combine the bureaucracy and inefficiency of huge government programs with the cost structure of a private sector that is systematically distorted by perverse incentives and driven into overdrive by malpractice madness and defensive medicine.

But every cloud has a silver lining. If we ever do get single payer, government health care on this side of the Atlantic, we won’t have to worry about all those death panels critics keep warning us about. Given the bureaucratic delays and inefficiencies in the system, patients can be confident that, abused and neglected as they will be in government-run nursing homes, they will die of old age before the death panels ever meet.

In conclusion

Who would get old or sick in this country? Leaving aside the state of pensions, the level of care for the elderly must be a major source of concern for both the elderly or their middle-aged children who need to arrange these things. It’s worth checking things such as:

Can I offset mum’s care home fees against income tax?

Mark Wadsworth might be able to throw some light on that.

This has been a rambling and bitsy post, something which generally happens when the writer is not personally au fait with the situation and has to get snippets from elsewhere. I’m not sure how the “lady forum user” should proceed on the poor treatment of her mother and the physical damage she’s suffering.

It might be worthwhile her going along to her local Citizens Advice Bureau and/or check out their Advice Guide which covers such matters.

Perhaps some of you readers could throw some light on it all?

I’ll post this at both Orphans and at my place. If you can give some good advice, it would be appreciated.

4 comments for “The crisis in care homes

  1. Maaarrghk!
    April 13, 2012 at 10:29 am

    My Dad dropped dead 2 months ago and left no will. My Mum has Alziemers, dementia and osteo-porosis.

    The house, that automatically goes to Mum is riddled with damp and requires a lot of work so that it can be rented out. Until LPA comes through I don’t even know how much there will be to spend.

    We took Mum in until she got her flat about 5 doors down the road from us last week and it drove my wife to the verge of insanity – especially as we have a baby.

    Mum seems to be settling in nicely and is getting 3 daily visits from the SS as well as a daily visit from me – 2 at weekends.

    The Doctor who originally saw her when she moved in with us strongly suggested “residential care”. Not a chance matey.

    I would definitely recomend anyone in a similar position to me to go down the route I have taken. As an only child I already have LPA for all Mums health issues. I only have to apply for financial LPA.

    She cannot be moved into a home without my permission as this constitutes deprivation of liberty. I will only allow this to happen when it is in Mums interests.

  2. Twisted Root
    April 13, 2012 at 11:04 am

    Too little information to offer any meaningful advice, but I feel a post about the whole issue coming on.

  3. April 13, 2012 at 9:45 pm

    If you have one, it may be worth asking your solicitor about local care homes. Some have clients in care homes who they visit regularly. My solicitor told me which were the best and which to avoid when I was looking round for my father.

  4. April 24, 2012 at 10:39 am

    “If you’re considering a move to a care home, here’s my top five questions to ask before you make a choice:
    What’s the manager like?
    Research into the quality of care homes always highlights the crucial importance of the role of the manager. Find a good manager and you’re pretty likely to have found a good care home!
    Who owns the care home and is the company stable?
    Several big brands are involved in the care home business, as well as owner/operators. Remember, big is not always best. And research suggests that there is no difference, in terms of quality, between homes’ operated by charities or private companies.
    Complaints and how they’re dealt with?
    Every care home is required, as part of it license, to have a complaints procedure. The smart question to ask a home manager is: what have you done to change things as a result of a complaint?
    How many agency staff on duty?
    When you visit a home, ask the manager how many staff are on duty and how many of them are not permanent members of staff. A high ratio of agency staff could be an indicator of poor quality.
    Who has a social care qualification?
    Ask what proportion of the permanent staff group has a social care qualification. This will tell you something about the quality of care on offer and the willingness of the home to invest in its business”

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