Happy New Year!

I hope that everyone has had a happy and restful break. I certainly did, but have had to cram a couple of weeks work into five days in order to catch up!

Hence the lateness of the greeting.

One of the things that makes Christmas for me is the BBC.

It all starts with the Christmas Radio Times, and then Carols From Kings, The Reith lectures, The Royal Society Christmas Lectures and delightfully this year Terry Pratchett and Neil Gaiman’s Good Omens!

The Reith Lectures by Professor Atul Gawande were a huge pleasure this year and I can highly recommend them.

Click here to go the BBC website to listen to them

The first lecture explores the topic of why doctors fail, and explores the factors which affect medicine, Ignorance (lack of knowledge) and Ineptitude (failure to use existing knowledge).

The second lecture is titled the century of the system,  and interestingly describes some simple systems that care and nursing homes would do well to copy.

Lecture three is about the problem of hubris and looks at the issues of aging and death and how society has a problem recognising the limits of what professionals can do.

The final lecture the idea of wellbeing is for me the highlight, and explores ideas around end of life care and assisted dying.

If nothing else, for me, the whole series re enforces the importance of the fact that people providing care need to care. A simple concept,but one that’s often overlooked.

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The Smell Test

I always tell people not to rely on the smell of a home as an indicator of quality. Yes an overall odor is unpleasant and a sign of something not being as it should be. However it may be passing odor, and quality of care may still be good.

That said, I visited a home in Southport on Merseyside for a client recently, and the smell at the door was in fact an indication that all was not well when one dug deeper.

Clearly the owners of the establishment hadn’t invested in the business for some time. Sadly a symptom of the financial, political and regulatory system in which care for the elderly is provided.

That’s not to exonerate the owners, who are making a profit, at the expense of the care and comfort of the residents. It’s just a hobby horse of mine about how care is provided in the private sector. Whilst there are standards in law below which the standard of care should not fall, there are no standards which cover how the care should be financed. This allows unscrupulous providers to put profit before care. The decor is an example of how excess funds available after what are seen as unavoidable costs (staffing, food) are seen as fair profit for the owners. Allowing corners to be cut.

The smell and decor alone, still did not provide the full picture of poor care though. Talking to the staff on duty, residents and relatives. It was clear that care was poor, with not enough staff for residents needs, poor nutritional care, and signs of corporate incompetence.

What do CQC think of this home? They list it as compliant, sad but true.

I have made my findings available and reported concerns to the local authority safeguarding team.

Remember that free advice is available to help you find the best care for you and your loved ones.

http://www.scotting.org/free_advice.html

 

 

 

 

There’s no such thing as a free lunch

“There’s no such thing as a free lunch” or to paraphrase ” There’s no such thing as free advice”

I’m always wary of companies offering free introductory offers, clearly there is some sort of catch or obligation to purchase further down the line.

So why do I offer free advice?

I guess if I’m being honest the first reason is at yes, I want your business. So there is a catch, albeit a soft one. I offer free advice in the hope that you will like me, my services, and quality of service so much that you will buy my paid services.

It’s a well known marketing technique.

But secondly, I like helping people, it’s why I chose care as a career and it’s what’s kept me at it for the last twenty eight years.

In that time Ive learnt a lot about a lot. I can spot good care and point out bad care.

If I can help folks and make a living I’m a happy person, and if my free services and resources are a help then please use them and feel no obligation.

http://www.scotting.org/free_advice.html

The News at Ten

Actually it was eleven when I started typing, but i thought the title might get your attention.

I was just updating my news stories, when it occurred to me that there are a limited amount of subjects that are reported on, when it comes to care.

I monitor the news on a daily basis for stories about care, that will inform my work, and help to advise people looking for good care.

Stories tend to fall into a few categories-

1-Care scandals, these are the ones that make national news, and usually involve criminal behaviour. Orchid View being the lastest example.

2-Failing care service. Usually reported in local papers with the a headline like-“Care Watchdog slams poor care” These are the stories about CQC inspections of services.

3-Stories promoting services. Again usually promoted in local press, but occasionally national when there is a special event on, such as National Care Home Open Day. Local stories tend to be of the Garden party/100th birthday variety.

4-Good care stories. These are the hens teeth ones, and are so few and far between that it’s not possible to spot a trend.

5- Finally there are the Government Policy type stories, such as the recent Care Act/Care cost Cap.

So what can we conclude from this?

Is the lack of good news stories a result of media bias, or a drought of good news in care?

I would like to think it’s media bias, but sadly I think the Bad news stories outweigh the Good.

There is clearly a need for the providers of care to pull their fingers out and focus on care quality and promoting the benefits of good care.

Listening to The Archers last night, I wonder if part of Peggy’s current unhappiness isn’t the worry about going into a care home.

Many people in later life that I speak to worry about care. Part of this worry is well founded, but part is also due to the media delight in reporting bad care.

As always I would say get some sound advice before buying any care service.

www.scotting.org/free_advice.html

BBC Panorama, Behind Closed doors:Elderly Care Exposed, 30th April 2014

Okay I confess I chickened out.

I didn’t watch it.

The plan was to read all the comment and debate, watch the programme, and then make a post from an informed point of view.

I have seen the clip of a lady being slapped as she was being changed, and that was more than enough for more me.

It makes my blood boil and I see red, so yes I didn’t watch the whole programme.

However I have read a lot and thought a lot and here is my tuppence worth.

Disclaimer-whilst I think the people who did this, or allowed others to do this, are despicable and deserve punishment, I do think there are wider systemic, social and political issues that need to be examined.

 


Why do people like that work in care?

Let’s be clear, in my experience, it’s a small minority of people.They are very difficult to spot in an interview situation, and can usually hide their behaviour long enough to be seen as credible. Even when colleagues start to have suspicions, they are skilled at manipulating teams of people and rationalising their behaviour.

As we see on the video, and have seen before in Winterbourne view, when they do wrong they are easy to spot and catch.

In the last 28 years I have sacked two of these people, and reported another two.

I dislike the medical model in describing social behaviour, but I can only describe these people as having a Personality Disorder.

They enter the care sector to have control over people who are reliant on them. They feel justified in treating people like they do.

I would also point out that the other 99% of people working in care, enter the sector because they care. Indeed that was my motivation as young man, and remains so.

However the environment and systems in which we work make this increasingly difficult.

I’m sure you know the mantra-Low pay, long hours, working nights and weekends. etc etc

Yes its a tough job, that has never changed.

What has changed is that care has become a commodity.

And so people who came to care aren’t allowed to because-

  • Its not in the budget
  • Health and Safety
  • HR won’t allow it
  • No time
  • Doesn’t tick a box
  • Not one of our targets
  • We won’t get paid for it
  • It’s not good business
  • Can’t afford enough staff
  • Can’t afford equipment/repairs/maintenance

I could go on but I best not.

The point is even those who start off caring, are worn down, burnt out, and leave.

or worse give in.

Won’t CCTV stop it happening?

Quick answer-No

HC-One the company that owns and runs The Old Deanery, have promised to put CCTV into rooms.

CQC have floated the idea of its use.

Yes it will catch people in the act, as has sadly happened several times in the last few years.

But perpetrators of abuse will know where cameras are, how to avoid them, and how to cover up.

It would be money and time better spent looking at how a culture of care can built in a home. This will sideline the abusers and help others stand up to them and out them.

And yes let’s make caring a job that people are proud to do, pays well, and has a work life balance.

Is nationality an issue?

This one is a can of worms, and it’s a brave person who enters the minefield!

Here we go!

In some ways it is. I would point out that as many White Anglo Saxon Protestants, abuse as anyone else. I have also worked with some marvelous care staff who weren’t born in this country.

But there are issues of language, culture, and residents preferences that need to be addressed.

Language, and the ability to communicate clearly with someone who may have sensory deficits, is obviously an essential quality for someone working in care. Not just that but the ability to read and write in English, to understand instruction and training. All essential for the safety of all involved. Yet not something people are screened for regularly at interview.

Culture, politicians do like like telling us we should be more like X, as they look after family. I wonder?

I would suggest, with no research to back it up, that some cultures view the elderly as a burden, working in a care home as a stepping stone to get into a country and labour market, and people in a care home as less than human.

 What were CQC doing about it?

I have worked with the various incarnations of social care inspection since 1997, and I have never met a bad or negligent inspector. Sorry had to get that off my chest, CQC as an organisation has come in for a lot of stick in recent years. I can assure you it’s not the individual inspectors fault, they are without exception, in my experience, knowledgeable caring individuals who want to ensure the best care for the people who receive it,

What has happened is that over the years the organisation has become smaller, and further away. Systems and processes for inspection have changed, detracting from the professional judgement of the inspector. Regulations and Standards became over simplified and generic to attempt to cover too many types of service.

And of course resources have been taken away. This means that CQC spend more time on failed services, rather than working with failing services to prevent failure, and the associated human misery.

Corporate Liability

It’s a secret, but I’m going to let it out of the bag. The NHS was privatised in the 80s and 90s. Didn’t you notice? When I trained as a student nurse I worked on Geriatric wards in NHS hospitals. Those wards have mostly gone, and the people who were cared for them are now cared for in Nursing and Residential Care homes. Those homes are in the main privately owned and run. There are a few council ones out there still but few and far between. So what does this mean for care? The ownership of these homes has changed dramatically over the last twenty years. From being owned and run by small operators who may have had one, maybe two homes. Usually from a caring and/or medical background. So Doctors and Nurses. To large corporate enterprises, financed through various investment vehicles. They will all say in their blurb that care is their priority, but lets be honest, the bottom line is! Ask Southern Cross, BUPA, HC-One, all of whom have had large care scandals.

By my reckoning, each of us is worth a clear £18,000 profit during an average stay in a care/nursing home.

Those sort of profits are very attractive to large corporate investors. Quality of care is not such a priority for them.

How would you fix it Kris?

Its not rocket science! I know I’ve been there, done that, got the T-shirt! There are four key areas I would focus on-

Money-Throwing money at a problem won’t fix it, very true, but the distribution of money in the system needs to be revised. Wages for those providing direct care need to be raised above the ASDA level. By this I mean that people who are looking for work in the sector are looking for a career and fulfillment. rather than choosing between options of minimum wage jobs. Profits need to be capped, and re distributed, with minimum levels required for re-investment in the home. I would even go as far as suggesting that rules for property investment are imposed, to prevent corporate landlords siphoning off capital (Southern Cross). Finally  CQC need the resources to be effective in prevention rather than cure.

Registered Managers-Love them, pay them, support them. Yes I’m biased having been one, but the pressures of the job from so many angles make it an almost impossible task. In my mind the ideal job description for a Registered Manager is-Care for the residents. Leave H+S, property maintenance, finance, marketing etc. etc. to someone else!

Staff-Recruit for beliefs and values above all other factors. Ensure they have proper training, by proper I mean more than a DVD/online thing and make sure a proper test of learning is administered. Provide them with Terms and Conditions of employment that are attractive. Believe me care work looses its shine after your third weekend in a row on duty!

Name and Shame– Make sure that poor providers are named and shamed. with  the current Capitalist model of care provision, the best way to ensure quality care becomes important to the companies is to hit them in the wallet.

If you are worried about the issues raised please get in touch, visit my website, use my services!

www.scotting.org

Here’s what other people have been saying-

http://www.socialistparty.org.uk/issue/810/18565/07-05-2014/care-homes-abuse-scandals

http://www.bbc.co.uk/programmes/b042rcjp

http://www.cqc.org.uk/blog/andrea/behind-closed-doors

The saddest goodbye

A very sad poignant portrayal of the development of Dementia.

http://www.dailymail.co.uk/health/article-2623800/The-saddest-goodbye-Endless-words-written-dementia-But-ANY-match-poignancy-cartoonist-Tony-Husbands-account-watching-steal-away-father.html

Highly recommended viewing, but also watch the Dementia friends ad at the bottom and visit

http://www.dementiafriends.org.uk

Did i mention I’m a Dementia Friends Champion, and available to deliver information sessions?

Derek Series 2

I knew something was bugging me about Derek, the television series set in a care home.

Hannah, one of the lead characters, and manager of the home, is never seen doing doing paperwork!

She spends all her time looking after people, and making sure they are happy.

What a shame it’s so unrealistic, I’m sure most Registered Managers would agree that it would be wonderful if 90% of the paperwork went away, so they can do what they came into caring to do.

Sorry Ricky Gervais you need some reality on the writing team.

Update: 8th may 2014 and then you let me down Ricky by overstepping the mark with the sex stories is week. Not the sex in later life story, but everything else that was going on. It’s looking like a downward trend, sorry.