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.

9 Responses to “The crisis in care homes”

  1. Moggsy April 13, 2012 at 06:52 Permalink

    “Who would get old or sick in this country?”? No one who had any sense I guess, unless they can afford to.

    “Leaving aside the state of pensions” Why leave that aside? Didn’t the the UK government under Chancellor Brown actually raid them and then mess with the tax allowances making the “holes” the government is beating people up over.

    You can not trust the state to get it right. You probably can trust them to mess up somehow. If they were a clutsy neighbour you woulnt let them take charge of anything after a few experiences.

  2. Bill Sticker April 13, 2012 at 07:21 Permalink

    All the ‘compliance’ stuff never happens over here in the care homes I’m familiar with in BC, Canada. The patient is the object of care, regardless of race, creed or colour. There is a certain amount of form filling, but nothing like the bureaucratic stuff you get in the UK. If a patient dies from neglect, it’s not Management you answer to, it’s the RCMP.

  3. Rossa April 13, 2012 at 08:42 Permalink

    There is one point you may have overlooked James. Nurses are generally working in nursing homes. Care homes don’t need to employ qualified nurses. They can use care assistants who are trained to a much lower level and standard of care, with maybe a nurse in charge or a matron. Which type of home you end up in depends on your needs. Some even offer both. My grandmother was in a care home in a room on the first floor. Once she broke her hip and then became bedridden she had to be moved downstairs to the nursing floor. Cost is higher for nursing than care too.

    My neighbour (84) is facing the prospect of putting his wife (82) and an Alzheimer’s sufferer into a care home. In spite of her mental health she is physically fine. She is currently in our local hospital with a chest infection and the staff have been very good with her. One good thing is that her food is served on a red tray. So what you may say, but it means she has to be fed by someone. Too many reports of food being left beside a bed when someone can’t reach it or even feed themselves.

    They are in the middle of moving house to be nearer their daughter so this is a massive upheaval for the husband. His wife hasn’t got a clue so has no input into the process. They are at least moving into a bungalow but now she is in hospital there is a question mark by the ‘authorities’ as to where she can go when she is discharged. Once in the system, the elderly don’t have a say. The social workers and other ‘experts’ will now decide what is best for her.

    A care home near the daughter is £650 a week. They do have money but at nearly £34,000 a year it won’t last long. And what do you get for the money? As the husband said the other day, all they do is get her out of bed, give her breakfast, dress her and dump her in a chair. Well he feels he can do that in their new home with the help of a carer in the morning and evening. But will he have that choice?

    When my other grandmother ended up in hospital last year after a fall at home, the family had to fight for weeks to get her back home. The ‘experts’ wanted her in a care home, we didn’t. The number of hoops we had to jump through felt like it was never ending and some major arm twisting had to be done. And she already had a live in carer at home.

    She had had a previous fall in 2007 in hospital while being treated for something else. That was as a result of the bars on the bed. She wanted to go to the toilet, couldn’t move the bars so climbed over (94 years old!). Fell and broke her leg. So in some ways I have to agree that the bars aren’t always safe. The nurse said they were there to keep them in the bed……didn’t work that time :-)

  4. Rossa April 13, 2012 at 08:56 Permalink

    There is also the scandal of so called care for the elderly in our hospitals. The Mail at the weekend had an article highlighting that people over 70 are being denied treatment for things like cancer, even conditions that are not terminal, because they are perceived as frail old people who are about to die anyway so we’ll save the money. 70 is the age you are officially elderly in the UK.

    The example they gave was of a 76 year old denied an op and chemo for cancer. Wouldn’t even do a minor procedure to make things easier for him so he had to use the toilet every 20 mins. Couldn’t sleep which made him worse. Daughter, ex midwife, paid for a second opinion with private consultant in a different area who got him the treatment on the NHS. Still here 5 years later, drives a sports car, goes to the gym and is a regular competition winner in rowing. A life he wouldn’t have had if the first consultant had had his way.

    Daughter reported it but was told it was only his opinion which he was entitled to so no action was taken. They protect their own not us.

  5. Moggsy April 13, 2012 at 09:10 Permalink

    Rossa, Absolutely. I always knew there was a good reason not to tell your age. It will come in handy when the time comes. ^_^

  6. James Higham April 13, 2012 at 09:42 Permalink

    There is one point you may have overlooked James.

    I’d say there are many points I’ve overlooked.

  7. wiggiatlarge April 13, 2012 at 15:47 Permalink

    All the above and more…
    The problem is the general publicare forever being told of the ever rising costs in looking after the elderly as if “something” will have to be done in alleviating that cost wether it entails taking away their homes to pay for it lengthening the retirement age or paying more through enforced taxation or compulsory crap private pension schemes.
    Sadly many older people accept their lot and being “old school” feel that making a fuss as they put it is just not them and put up with the rubbish hand they have been dealt.
    Our NI payments were ment to provide a pension in the future, but that money paid in has been nothing more than a giant ponzi scheme and used as is all taxation for other things, hence this country ends up despite our recent status in the world with the worst state pensions in Europe and private pensions that have been raided and attacked by succesive governments and have had appaling returns on top of hugely disproportionate management fees, i know it happened to mine.
    We also have a welfare state that bends over backwards to give to those who have never contributed or have recieved the same despite never working or intending to work, i can give two personal examples at both ends of the spectrum , a niece now 36 who has two children by the same father who has never been asked never alone forced to contribute to their upbringing and she who has never made any move at all to find work of any kind.
    At the other end my mother of 98 lives alone still (for how much longer it difficult to say) is fiercely independent and lives in a housing assc flat that suits her fine, but to my knowledge because she has just over the required amount of savings and thinks its wrong to offload the small amount required to to get help with rent etc is struggling to make ends meet(no she doesnt go without we see to that), is the only one of a few in the the complex of about 24 dwellings to pay the full rent , next door as an example is a migrant family who claim everything – they actually told me- and work , they also run a part time taxi business there are others…..
    Whilst we have this lasse faire attitude with our money from government and little fight back from those affected they will crapped on from a great hight ad infinitum.
    And if i hear DC say again what a wonderfull thing our NHS is in the scheme of things and its FREE? i’ll put a brick through the TV or at least I want to.

  8. andy5759 April 13, 2012 at 16:48 Permalink

    Thanks for this JH. Over the next year or so I will be in need of all the help and advice I can get, so will be keeping an eye here and at OOL. It is my fervent desire to keep my mother out of the clutches of the State machine where I would literally fear for her life. Anna Raccoon has visited this subject too.

  9. Bill April 14, 2012 at 11:10 Permalink

    Getting ‘power of attorney’ is essential but you won’t see this being highlighted by the govt. If you become unable to look after yourself and have no spouse then the govt will step in and take control of you and decide where you will stay , how you will be treated and what will happen to your house and any other assets.
    Power of atorney only costs about £80 ( in Scotland) to set up. Do a living will at the same time. This will allow your relatives to throw the switch if you become a sad screaming shadow of your former self. Which has sadly happened to my relative.
    Her care home is staffed by non English speakers which confuses her even more.

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