Thursday 6 December 2012

No Care At The Care Home

Recently, the Equalities Commission has released a report, organised conferences and promoted interest in the question of care for the disabled and the aged.  The recent raft of legislation and regulation has made this necessary, together with a number of adverse reports on some care homes and community care providers.

We are being made aware that the difficulties in these areas have increased in recent years.  There are many reasons, one being medical advances enabling the survival of many severely disabled people and others together with the increasing expectation of life, and therefore care.

Initially, in the UK most of this was shifted out of private and local provision some time ago with the creation of the National Health Services and with changing ideas.  The old workhouses, geriatric wards, and asylums were closed.    For private options down the years, the lodgings, guest houses and hotels with long term residents on annuities or pensions have largely gone.

Then many local authorities created residential homes for the elderly and disabled both to keep them in their communities and in part to release housing for families in their council houses.  As the numbers rose and the degree of care needed in individual cases become more demanding, so the costs of resident care have risen

So we have outsourcing of care to private providers together with a great deal of reliance put on “care in the community”, that is delivered to the homes of the individuals.  This has become more and more outsourced as the complexity increases.  This meant staff, rather than being located in one place, moved around from home to home to deliver the necessary services.

Regulation and enhanced health and safety requirements together with a great deal of employment and other legislation have added to the costs and to the work to be done at management and intermediary levels.  In and amongst all this there is a great deal to do that is apart from and too often above actual care.

Then there have been the twin curses of the cult of modern management coupled with the intrusion of financial rent seeking extractive investors fastening on a sector that can only grow and whose clients are both vulnerable and weak. 

Management by targets depends on the targets.  If the targets are driven by “efficient” daily routines and turnover and throughputs then what is paramount to the accountants and the owners will take precedence over the unpredictable and messy business of having to deal with difficult patients on the ground.

Now we are in a situation where for those in residential homes a large part of the sector whose owners went in for high leverage lending for takeovers and speculation is now in financial trouble and this has cascaded down into the quality and nature of the work in the bedrooms and lounges of the homes.

Low paid staff with little training and pressured to complete work and duties in ever shorter periods of time cannot give the care, attention and medical awareness to each and every resident.  Their laundry is skimped, their hygiene is forgotten and a few are left to lie until the bed sores rot their bodies.

For too many, the nutrition and food quality is bad and it is common for residents to suffer at least mild and sometimes severe dehydration.  The emotional effects of this are dealt with by shoving increasing quantities of anti-depressants down their throats.

For those remaining in their own homes there are many for whom it is an unending struggle in which they are almost always defeated.  Again, even if the intent and hope is there many of the transient carers have little or no time to spare to do anything other than the specified duties on their task sheets.

Also, few receive training at such a level as to make them aware of the first signs of deterioration or onset of really serious problems in the people they try to help.  One key area here is those with incipient dementia and another the little things that are mini-strokes or TIA’s that signal danger.

The consequence of this is when the inevitable happens for many there is too little too late done and a crisis occurs.  If a Care Provider has rather too many people on its books, not enough carers and a lot of people at risk, then their management may simply stagger from medical crisis to medical crisis.

It is then that the hospitals have to try to pick up the pieces, if they can or if they are equipped too.  One of our local hospitals figures in the twelve with the highest proportion of patient deaths.  It is not a surprise given the number and nature of the very elderly arriving in the emergency ambulances.

We now have a report suggesting that too many hospitals are close to “bursting point”, again no surprise, I always did feel that the official estimates for the future demand for hospital treatments were wildly optimistic and removed from realities.  Over the last decade there have been a couple of close calls, will this winter be the bad one?

All this was beyond the capability of the NHS management system that has just been discarded which was no better than the one it replaced.  The new one that has been introduced, because of its internal contradictions, seems certain to be overwhelmed in this sector. 

Because the management systems are designed for management preoccupations they cannot cope when complexity, where rapid medical decision making and treatment are essential and thorough individual care facilities are needed.  Nor is there any sight of what can be done long term for individuals in need.

Of course, the first priority is to meet all those big Private Finance Initiative bills coming in both now and for decades to come.  What can we look forward to?

The Return of the Workhouse?


  1. "The consequence of this is when the inevitable happens for many there is too little too late done and a crisis occurs."

    That's my experience. When serious decline sets in, support is always late. Assessments are made, boxes are ticked, reports are written and by then the situation has worsened.

    So care plans are out of date before they are implemented.

  2. Of course back in the day, when granny got a bit old and doddery she moved in with her daughter, who would look after her for the rest of her life. No doubt this was hard and sometimes unpleasant but it provided a human aspect and nobody would treat their own parents (or even their own dogs) the way old folk get treated these days.

    But then we used to look after our own children too - as recently as when mine were young - but now we outsource that to various state agencies (if we're not stinking rich), so that we can all run faster in the hamster wheel.

    Something's gone wrong somewhere.