Hospital admissions from care homes

Hospital admissions from care homes.

Some strong words and sobering facts in this article from the British Geriatric Society blog.

Residents of care homes have complex healthcare needs, reflecting multiple long-term conditions, significant disability and advanced frailty. Care provided to this complex cohort of people is often fragmented. Day to day care services are delivered to a variable standard often with high staff turnover and limited support from the wider health system.

I would like to know about the figures for admission compared to the general population. I think they need unpicking more to allow for the possible increased vigilance and potential risk aversion of care home staff. Both of which could contribute to the higher rates of admission.

What’s going on at BUPA?

February was a busy month for me, and I didn’t get to the keyboard often. So I’m having an office day catching up with this blog.

Fist thing first check on the bad care reports for February

It may take a while, because it looks like there are a lot. Yes CQC are rolling out their new inspection model, yes they have raised the bar, but I don’t see that as an excuse for any responsible provider. Clearly those that are good and outstanding have been rated as such.

So first week in Feb, two BUPA homes in trouble.

What’s that about, when BUPA clearly have resources, don’t they?

I can guess at the answers, having experience of working for large organisations, but I wouldn’t like to post them here without a lot more evidence to back up any claims and avoid a libel case.

So in general my experience in large organisations would suggest that maybe these areas need looking into-

1-Priorities of the organisation. What is the balance between providing good care and making money?

2-Central focus. Does the centre know whats happening on the floor and vice versa?

3-Branding. Are these BUPA homes or homes that BUPA run?

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.

Welsh report is uncomfortable reading.

The Older People’s Commissioner for Wales, review into the quality of life and care for older people living in care homes, A Place To Call Home, says that many people living in care homes have an “unacceptable quality of life”

Care homes are seen as places of irreversible decline, by staff, relatives, residents and commissioners.

This is a worry for many of my clients, who dread moving into a home and wish to avoid it at all costs. Such a shame when good care is out there and will enhance people’s lives.

The commissioner in her introduction says:

When older people move into a care home, all they are
doing in effect is moving from one home to another. The
word ‘home’ should mean something special, a place that
we hope will be filled with friendship, love and laughter.

Sadly this isn’t the case for the majority in Wales, and the rest of the UK.

The full report can be found here:

http://www.olderpeoplewales.com/Libraries/Uploads/A_Place_to_Call_Home_-_A_Review_into_the_Quality_of_Life_and_Care_of_Older_People_living_in_Care_Homes_in_Wales.sflb.ashx

Registered Care Home Managers

Here’s a story that’s close to my heart. Having been a Registered Manager for several years, managed the work of a group of Registered Managers as Responsible Individual, and having gained the qualification as a Registered Manager (RMA NVQ4) I feel my opinion comes from a well informed stand point.

I often say to clients that the Registered Manager accounts for 90-95% of the quality of a home. So it is important to-

1-Make sure the home or service has one.

2-Check on their qualifications and experience.

3-Find out how long they have worked in the home or service.

It’s good to see the issue being debated nationally, the headline story being that a proportion of services providing care do not have a manager registered with CQC.

This despite recent efforts by CQC to improve this figure.

Here is what the piece in the Telegraph of 10th October has to say-

More than 2,000 care homes looking after elderly or disabled adults have no registered manager, according to figures to be published this week.

The results mean that 12 per cent of all care homes in England lack the leadership required to ensure that vulnerable people, including frail pensioners with dementia, are cared for properly, according to a study to be presented at the Liberal Democrat conference on Tuesday.

Paul Burstow, the Lib Dem MP and former health minister who obtained the figures, said the figures showed that “a revolution” in care homes was needed.

There are a number of factors underlying these figures and I would like to unpick them here.

The main one in my experience being turnover of managers. The position has changed over the last decade or so, and the focus of the job is diluted by the various stakeholders that the registered Manager finds themselves pulled between. A clear example is the needs of owners to run a profitable business weighed against the needs for care. On the surface one would expect owners to be in care business out of altruistic motives, indeed this was more the case in the past. However more and more the ‘owners’ are venture capital companies more interested in the bottom line. Care decisions are overidden by financial constraints. This leads to the high turnover of registered Managers in the sector, the majority of whom come from a caring background as opposed to a business background.

Lack of support for registered managers is another factor that influences the lack of candidates for the sector. The old saw ‘it’s lonely at the top’ is never more true than it is now for the Registered Manager. As well as the pressures from divergent stakeholders as outlined above, there is the lack of peer support due to the business model of care provision. How can one go to another registered Manager locally for support when they are in fact business rivals? The same is true of the sharing of good practice in care throughout the sector.

Finally where do these managers come from? The skill set required to be successful in these posts is quite unique. A mix of care professional, business manager, HR professional, diplomat, carer supporter, pharmacist, CQC inspector-I could go on! There is a case for the industry taking along hard look at where it recruits from, what skills and knowledge it’s looking for and how these are developed and accredited. Yes I know Skills for Care do a good job of this, but they do it from outside the industry with one foot in the political camp of the current government regulators. Does anyone tell Costa where to get their manager from and what qualifications they must have? No the market decides that, however in the market of care, the qualities needed to manage aren’t clear.

Here’s The Telegraph piece on the story

Listen to the You and Yours item here.

CQC Sandwich Generation Survey

I covered this story briefly earlier in the month when it was featured on BBC Radio Four’s You and Yours.
It’s a really useful piece of work though, so I thought I would cover it in further depth.

CQC commissioned Mumsnet and Gransnet to carry out a survey of the users of their sites. They were in particular looking for those that are described as the Sandwich Generation.

These are people who described as juggling caring for children and older relatives.

Eight out of ten people surveyed identified choosing care as major source of stress. Going as far as describing it as more stressful than divorce, separation, choosing a school, getting married or buying a house!

I have always described the process of finding good quality care as minefield. This survey clearly re enforces this.

Whilst I take no satisfaction in the fact that finding good care is so hard, clearly all care should be good! It is refreshing to see the CQC tasking steps to gain views and improve the information they provide. The infographic they provide shows what people want to now about care providers. All of which are included in one of my reports.

www.scotting.org/services.html

If you need some help and advice call my freephone line 0800 0016694 always happy to help .

Heres a link to the report on CQC website.

http://www.cqc.org.uk/content/sandwich-generation-carers-say-choosing-care-one-lifes-most-stressful-events

 

 

 

A busy month for bad care stories

I’m sorry to have to report that it’s been a busy month for bad care stories.

The levels of poor care, abuse and neglect in homes across the country are worrying.

Fortunately I’m not alone in highlighting the issues, and sooner or later people will have to take action.

The most upsetting aspect for me is how avoidable most of the poor care is. Common themes emerge, and if good practice was shared and encouraged, things would be better all round. Sadly in our mostly privately run, for profit, elderly care system, sharing of good practice is seen as giving away trade secrets.

So if you are looking for good quality care always get help and advice.

www.scotting.org

and to read the bad care stories- https://ksccltd.wordpress.com/2014/04/14/the-bad/

CQC to publish guidance on using CCTV in care homes

There has been a lot of noise about this issue in the press for some time, and last week it blew up again with CQC announcing the possibility of publishing of guidelines on the use of CCTV in care homes.

Here’s the headline from The Daily Mail 6th October:

Families given official green light to spy on care home staff if they fear their elderly relatives are being abused

I think the CQC position is more nuanced than that, but in effect will sanction families and employers using cameras to spot abuse.

I have made my thoughts on this clear several times since it was first mooted. In a nutshell they are-

1-CCTV will not prevent abuse.
2- CCTV is useful in gaining convictions where abuse is suspected.
3-Better recruitment, retention, training and pay will reduce abuse.

My views are echoed elsewhere, The Guardian on the 8th October ran a piece with the title

CCTV in care homes: secret cameras are not the way to improve care

Rather than allow covert filming, the Care Quality Commission should focus on driving up standards

The main thrust of the article is about the underlying causes of bad care, and I would agree, these need to be addressed as opposed to using CCTV to spot the symptoms.

The full article can be found here-

http://www.theguardian.com/social-care-network/2014/oct/08/cctv-care-homes-secret-cameras-improve-care

The CQC statement can be found at-

http://www.cqc.org.uk/content/statement-about-use-cameras-monitor-care

New CQC report published today

CQC have published a damning report on the state of dementia care.

In “Cracks in The Pathway” CQC have identified that nine out of ten hospitals and care homes are providing less than adequate care

This means that most folk with dementia will experience poor care some point in their illness.

click here for the report

Local Government Ombudsman finds council top up fee policy to be illegal

The subject of third party top up fees is one I’m often asked about.
More often than not the people involved in working out who owes what to who, do not have enough information and experience to work it out correctly.
This story shows how one council got it wrong, by effectively requiring a lady to top up her own fees, which is against the law. (National Assistance Act 1948)
Underpinning the argument here is the basis of funding for health and social care. Health care-Free at the point of delivery. Social care-Means tested. This political hot potato is one that the political parties have been juggling at their conferences in recent months.

http://www.communitycare.co.uk/2014/10/03/ombudsman-criticises-council-forcing-resident-pay-unlawful-care-home-top/ For the full story

http://www.scotting.org for more on paying for care