Let’s get physical

Thought playgrounds were just for small children? Think again.

A new playground designed specifically for fun-loving over 65s has opened in north Manchester, kitted out with equipment to give people a gentle workout.

The £15,000 Older People’s Play Area has six pieces of equipment, such as a ski-walker, that strengthen hips, tone legs and the upper body.

It goes to show that you’re never too old to play. I’m sure many grandparents have watched enviously as their grandchildren played on swings and slides, never daring to have a go themselves. But now they have their chance without having to feel self-conscious.

While this may sound a bit frivolous, there is a serious point to the playground. Regular, but gentle, exercise is important to help keep older people healthy and mobile, yet most don’t do enough. If something like this, which is fun and quirky, can help older people to become more active, then it should be applauded.

Who knows, perhaps in the future it will be granny pestering the kids to go to the playground and not vice versa?

Money money money

The Commission for Social Care Inspection’s (CSCI) report into the state of social care in England paints a grim picture of a system failing many people.

CSCI estimates that more than 250,000 people with care needs receive no services or informal care. Meanwhile, 450,000 older people who do get some care from family and friends and/or state services have a shortfall in their care.

Overall, in the past five years the number of people using council care services has dropped by 27,000, despite the population over 75 increasing in that time by 3%.

The reason why more people are receiving less care is simple; money. Cash-strapped councils are raising the eligibility thresholds for who qualifies for care to try and balance their books. CSCI found that 62% of councils raised their eligibility threshold to ‘substantial’ in 2006/7, with the percentage expected to go higher in 2007/8.

Perhaps stating the obvious, CSCI’s chairwoman, Dame Denise Platt, says “there is an urgent need to create a fair and equitable social care system, which is sustainable and affordable.”

The crux is the “sustainable and affordable” element. To do this will require money – and lots of it. But where will it come from?

Would the government have the guts to raise taxes to pay for increased state care costs? Higher taxation will never be a votewinner and with a general election on the horizon, and poll ratings not exactly stellar, Prime Minister Gordon Brown may be reluctant to do anything that may antagonise voters.

Likewise, while the current means-tested funding system is almost universally disliked – a recent Caring Choices report said that 90% wanted an end to it – finding another system that proves to be popular will be tricky.

It is accepted that people needing care will have to pay for some element of the services they use, but how great a percentage and whether a universal element should be included are hotly debated points. Many older people resent having to use their savings or sell their house to pay for care because they see it as depriving them of their life’s work and their children of an inheritance.

These are just some of the arguments around care funding, and demonstrate how difficult it will be for the government to find a solution that at least some people will be satisfied with.

But while there are some difficult decisions ahead, the government will have to bite the bullet because if they don’t, this situation will only get worse.

Jumping the gun

Another day, another cure for Alzheimer’s disease is announced.

Recently it was claimed that a special helmet worn for 10 minutes a day could reverse the effects of Alzheimer’s within weeks of starting to use it. The contraption, which looks like something out of a TV science fiction series, bathes the brain in infra-red light to stimulate the growth of brain cells, which can reverse memory loss.

This follows an announcement last week of research that has identified certain proteins that can reverse the effects of the disease within minutes of it being injected into a sufferer.

A quick trawl through the news section on Bettercaring (http://www.bettercaring.com/editorial/channel3.aspx?id=92) reveals several other stories during the past few months of researchers excitedly declaring a cure or treatment for Alzheimer’s, but in most (if not all) cases there is a caveat saying that research is at an early stage and further analysis is required.

It is this that stops me getting too excited about the news. While a treatment or cure for Alzheimer’s would be an amazing breakthrough that would transform the lives of millions in the UK – sufferers and their families alike – anything that could be prescribed by your local hospital or GP is still years away.

The real time to get excited will be when – or if – wider, more in-depth research is completed that reinforces the early findings and scientists are looking to commercialise a product.

Until then, Alzheimer’s sufferers will have to make do with current treatments, which at best can only slow their decline, and the hope that these discoveries are as good as the scientists claim and get to market in time to make a difference to them.

Time for a change

The news that many people who care for dementia sufferers feel abandoned by the NHS will have been no surprise to those who are in that situation.

While it means they are not alone in being let down, it demonstrates the extent of the reforms needed to bring social and health services up to scratch for the more than 700,000 dementia sufferers in the UK.

The House of Commons’ Public Accounts Committee (PAC) report into dementia services was damning, including criticising GPs for a general lack of knowledge about the disease and the wider NHS for generally depriving many sufferers of specialist care when they are in hospital or a care home.

But the PAC report was not just about criticising services. It also made some sensible and practical – if not a little obvious – recommendations on how to improve services, such as making more respite and domiciliary care services available, especially to those who care for their loved one at home. In the later stages of dementia especially care services are crucial to help carers cope with what is often a 24-hour job.

In response, health minister Ivan Lewis has – to his credit – acknowledged that services are failing and pledged to transform the support available to families.

While this sounds good, Lewis stopped short of saying how and when services will be transformed. Instead, he said that the recommendations of the PAC report will be considered “in the context of the work taking place on the strategy”.

This means carers will have to wait a while longer yet for any changes to their lot, but with powerful cross-party Parliament committees such as the PAC throwing their weight in, it seems likely that change will come sooner rather than later.

A Hollywood Ending

The Oscars panel love nothing more than a good terminal illness and, for the noughties at least, Alzheimer’s seems to fit the bill.

For example, the 2001 film ‘Iris’, which focused on the relationship between the novelist Iris Murdoch (Dame Judi Dench) and her husband (Jim Broadbent), received three Oscar nominations for its all-star cast, which also included Kate Winslet. It raised the profile of Alzheimer’s considerably, yet only ended up with one Oscar to show for it – a best supporting actor gong for Broadbent.

This year Alzheimer’s could again take centre stage at the show. It has a real possibility of joining the likes of cerebral palsy, autism and AIDS, which all received major attention after picking up one of the big three awards – best film, best actor or best actress.

Julie Christie is in the frame for best actress for her portrayal of an Alzheimer’s sufferer in ‘Away From Her’. Having already picked up the equivalent Golden Globe, and with a further BAFTA nomination under her belt, it means for once there could be a happy ending for such a tragic disease.

Fit for purpose?

A recent post on the Bettercaring forum (http://www.bettercaring.com/community/forum.aspx?id=150) cannot fail to move all those that read it.

The author of the post, Lonestray, alleges the care home system for Alzheimer’s sufferers is “not fit for purpose” after witnessing the treatment his wife received some years ago.

Lonestray says his wife’s teeth were never cleaned, nor was she ever visited by a dentist. Her ears and nostrils were not properly cleaned, her nails were dirty, and she was pumped full of drugs.

Disillusioned and disgusted by her treatment and fearing his wife was heading for a premature death Lonestray took her out of the home and has cared for her himself for nearly five years. She was only given weeks to live in the nursing home.

While Lonestray and his wife were obviously failed by the carers in the nursing home, it should be noted that there are also many examples of Alzheimer’s sufferers receiving excellent residential care.

However, the point is that all Alzheimer’s sufferers in nursing homes should receive the same standards of care and not be reliant on the good fortune to have a good home in their local area and being able to afford its fees.

Standards in nursing and residential care homes are steadily getting better, so incidences like Lonestray’s should be declining, but there is still a lot of scope for improvement.

Lonestray has his own ideas on how care could be improved. For example, he recommends that Alzheimer’s patients receive one-on-one care from someone with a deep understanding of the condition.

It is these sorts of opinions that the government should listen closely to as they plot the future of social care and how it is funded in the coming months. If it is serious about providing dignity to older people, taking measures such as this would be a big step forward.

Making a tough decision tougher

For many people, Sir Norman Wisdom will forever be the clown in the ill-fitting suit falling over in black and white movies. But now, aged 93, he is a shadow of his former self, suffering from vascular dementia and sometimes unable to recognise his own family.

When Sir Norman was first identified as having dementia in his early 90s, his two children, Nick and Jackie, along with his faithful PA, Ann, shared the caring duties between them.

But as Sir Norman’s dementia worsened, Nick and Jackie were faced with the decision to try and carry on caring for him themselves or to put him into a nursing home where he could get round-the-clock care. For any family, this is a tough and emotional decision, but most don’t have to deal with the scrutiny of the media as well.

Sympathy was seemingly in short supply. Some fans were upset at their decision, one tabloid ran a story that the family were not letting anyone see him – not true, they say – and a radio station said they should be shamed “into doing something humane”.

This reaction shows the ignorance and prejudice that still surrounds the plight of carers who take the decision to put their loved one into a home.

All too often they are portrayed as heartless. Some people – who more than likely have never had to care for someone with dementia, or know how serious the disease can be – assume that they couldn’t be bothered to look after them anymore and abandoned them in a home. Nothing could be further from the truth.

This only serves to make the carers – who probably already feel very guilty about the decision they’ve made – feel even worse, when they’ve only had their loved one’s interests at heart and in all probability made the best move for them that will improve their quality of life. It serves no-one.

Sadly, carers are still a hidden group in society, and it is almost a taboo subject. These barriers need to be broken down and exactly what is involved in caring for someone with dementia and how hard it is should be publicised, loudly and often.

In addition, the notion that a care home is just a way of shutting someone away and forgetting about them needs to be addressed.

Hopefully, the first step will be a documentary on Nick and Jackie’s decision to put their father into a home. The documentary Wonderland: The Secret Life Of Norman Wisdom Aged 92 ¾ is on BBC2 at 9.50pm tonight. With any luck, it will give the critics of Sir Norman’s children a new insight and maybe they will think twice before criticising anyone else that makes the decision.

Read all about it

After years of being ignored, elderly care, care homes and carers seem to be flavour of the month in the media.

The BBC is running its month-long ‘Care in the UK’ season on Radio 4 and online, while the Daily Mail has been running its ‘Dignity for the Elderly’ campaign for some time. Meanwhile, several other national daily newspapers have carried in-depth articles on elderly care in recent weeks.

The BBC especially seems to be pushing the topic, with features all month on Radio 4's Woman’s Hour and You and Yours. These have included Gordon Brown talking yesterday on Woman’s Hour about his plans for social care, as well as TV presenter Tony Robinson last week discussing his mother’s battle with Alzheimer’s and experience of putting her into a nursing home on You and Yours.

All this is welcome news. For too long care for the elderly has almost been hidden, pushed down the national news agenda in favour of ‘sexier’ issues involving younger people.

If elderly care has made the news, it is often for the wrong reasons, such as an example of a care home resident being abused. As a result, many people know little or nothing about the true state of elderly care.

With an emphasis on the human angle, and real life experiences of care, the BBC’s programmes should hopefully jerk a few heart strings and demonstrate that older people in residential care are still people and should not be dismissed as “past it”. Who knows, it might even help to change a few attitudes in society.

But while it will get people talking now, the key is ensuring that after this season of programmes has ended elderly care remains near the top of the news agenda and isn’t forgotten when the next topic du jour comes along.

Only by keeping the sector in the news will there be a chance of changing attitudes and influencing the government’s policy – the forthcoming Green Paper on care funding will shape the sector for years to come. This is an opportunity not to be missed and all organisations involved in the care sector should ensure they do their utmost to keep up a flow of news.

Still caring after all these years

So this weekend, I found myself musing on how some people seem to have an endless ability to give.

For some of us, just getting through the week and keeping our heads above water is more than enough. But over Christmas when out for the obligatory Boxing Day walk, we walked past a group of people of mixed ages, who looked like they were having the type of Christmas that everybody aspires to: lots of laughter; children screaming – in a good way; people smiling.

It turns out that the couple at the heart of this group are foster parents, and the others with them were past and present foster children – some of them now grown up, and returning for Christmas. And all of them looking like they were enjoying being together. How many “traditional” families manage that?

I was told they had been fostering for years, and had many, many children pass through their care, and they looked to be still going strong.

For me, this is something to aspire to.

Become a carer? Why bother…

So, one trainee home-carer in Essex stole more than £1,000 off two vulnerable elderly clients, and another care worker in a Bolton home attempted to torch the place after being suspended.

And that’s just in the last two days.

Countless other examples exist of where those in a position of trust abuse their power, hurting or endangering the lives of our loved ones. These people, who probably account for less than one in a hundred care workers, succeed in tarnishing the good work that everyone else in the industry does.

So how can we protect our elderly from these rotten apples?

For starters, better employment procedures should be put in place, to stop these bad eggs getting jobs working with the elderly. Thorough police checks, in theory, are carried out on everyone who works with children, yet it would appear the elderly aren’t afforded the same luxury. But they both need protecting.

Moreover the image of the industry needs to change. It has a very lowly perception from almost every conceivable angle. The media rarely give it any credit, families struggle to praise the dedicated staff, and workers often feel undervalued and underappreciated by employers and PCTs. It’s one of the first areas to get hit by budget cuts, staff morale is often at rock bottom, and even dedicated overseas staff are in constant fear of being deported thanks to immigration laws.

And they wonder why they have trouble attracting decent candidates…

By tackling these issues – and looking at the pay rate of carers – this could make it more attractive to prospective employees, and attract a better class of person to care for our nation’s elderly. It won’t happen overnight, but something desperately needs to be done if we don’t want to read of abuse, arson and robbery on a daily basis…

All change

Very few people like the current care funding system, according to Caring Choices’ report, ‘The Future of Care Funding – Time for a Change’, which was released on Monday. This will have surprised no one.

Likewise, everyone already knows the system is generally complicated, irrational, unfair and under funded.

But while Caring Choices states the obvious somewhat and calls for the government to overhaul the system as soon as possible – a Green Paper on the future for care funding is promised later this year – it gives some pointers that the government would do well to heed when it comes to put the report together.

For example, 99% of people believe the care funding system will need more cash, and 90% want to abandon means testing to determine who gets state assistance in favour of a more universal system based on want rather than wealth or income. Acquiescing to both of these wishes would instantly get a lot people onside.

Caring Choices also puts forward some realistic alternatives to the current regime, barring the 20% that reckon care should be fully state funded, which the government would never do because of the big tax hikes that would be needed to achieve it – a sure-fire vote loser.

Most favoured is a system of ‘co-payment’ where the person receiving care pays a fixed percentage of the cost, a system that is already successful in countries such as Japan.

This system – with a couple of caveats thrown in to ensure the poorest are not penalised – seems fairer than means testing, which tends to penalise those that have saved and have assets, and would be more popular than tax rises.

So if the government is to come up with reforms that are to please – or at least appease – the majority involved in the care industry, it needs to do some serious thinking, starting by taking in the criticisms and ideas of Caring Choices.

I’m listening

Ruth Marks, who was yesterday appointed the first Commissioner for Older People by the Welsh Assembly, has said she is “here to listen”. I’m sure there will be no shortage of pensioners out there itching to tell her exactly what they are unhappy about and what she should do to put it right!

But whether Marks, already dubbed the ‘pensioners’ czar’ by more than one newspaper, can make a difference to older people is another matter.

Wales has a higher proportion of older people than in other parts of the UK – more than one in five people in the principality are over 60 – so she is batting for a large proportion of society.

But many of the issues affecting older people are potentially expensive to the government, such as residential and domiciliary care funding and the level of the state pension. And this is where the problem lies. Governments often loathe giving out more money, especially at a time when the economy is looking wobbly and there are more headline-grabbing areas, such as education and healthcare, which tend to take precedence in these matters.

Also, Marks want to address the neglect and isolation of many older people. Not only will this take money, it will also take a change in attitude from certain people in society, which is again hard to achieve.

Marks may be saying all the things now that older people want to hear – talking of ensuring that the voice of older people is heard and that they are involved in every aspect of policy making and in the decisions that affect their lives – the real acid test will come when she starts work in April.

Hopefully she will be given the power to make a difference in policy and isn’t just a high-profile sop to appease the older people’s lobby.

Stop playing politics and put people first

Just as everyone shakes off their post-Christmas blues and post-New Year hangovers, spare a thought for poor Yvonne Slater. The 84-year-old pensioner was turfed out of Hereford County Hospital in her nightdress at 3am on New Year’s Day and told to make her own way home. The 25-mile taxi journey cost her £80. Not much to celebrate there.

Meanwhile, a few days later it was claimed by the Tories that 140,000 patients were discharged after being badly fed on NHS wards last year. Moreover, the number of people suffering malnutrition or other nutritional deficiencies increased to 139,000 last year from 74,000 in 1997. Given that health and the NHS is such as political hot potato, it’s probably wise to be careful of figures being bandied around by the conservatives. Nevertheless, even the Department of Health figures for last year showed that the nutritional condition of 8,500 patients actually worsened while in hospital.

Frankly, whatever the argument over the figures, this is clearly a serious health issue that has to be addressed, pronto. Given that the NHS is in many respects a service for the elderly, and that the link between decent nutrition and recovery in older people seems so obvious, the idea of healthy eating is absolutely crucial to good nursing and to the recovery of so many older patients.

Just last week care minister Ivan Lewis spoke of New Labour revolutionising social care during its tenure in office. In the same breath he also told the press that 2008 would be the year of a government drive to make sure that “every older person matters”.

It’s about time politicians stopped playing political oneupmanship and “put people first, politics last”. Now there’s a good campaign slogan for the year ahead Mr Lewis.

Only the lonely

Pity poor Olive Archer.

She spent the best part of her life caring for her invalid mother, and so passed up the chance of having her own family.

So it’s a tragic irony that when 83-year-old Olive passed away, she did so alone with no family or friends. She spent the last five years of her life in a care home, in which time nobody came to visit her.

Indeed, it was likely that the only people at her funeral would have been the minister and a funeral director, until the Reverend Akasha Lonsdale stepped in. Touched by her story, Lonsdale appealed for any relatives or friends to make themselves known and come along to pay their respects. So far, this call has yielded more than a dozen responses and ensures the pews will be at least partly filled when her funeral takes place on January 14.

But there are a multitude of Olive Archers out there who do not have a Rev Lonsdale to publicise their passing and each week go to their grave without a send-off from anyone.
While Olive’s is the sort of story to send shockwaves through the younger generation – the “I hope I never end up like that” mentality – many do not think about how it is already a grim reality for many older people.

Indeed, Help the Aged reported in October last year that some 300,000 older people go for more than a month without speaking to anyone and more than one million are always or often lonely.

So why does this still happen?

It would be easy now to rant about the death of society and how older people are neglected, but it would not address the issue that many older people are isolated – from society in general and also care services.

More should be done to encourage older people to use communications technology – one of the easiest and increasingly cheap ways to combat loneliness. For example, in the Republic of Ireland, there is a scheme to help older people learn to use mobile telephones, computers and the Internet. There is no reason why that could not be replicated across the Irish Sea.

Also, some of this isolation could be curbed if social services such as day centres were not cut back. Many local councils now focus on people with acute or complex needs, rather than those with lower level requirements, and services such as day centres – vital to those that use them – are starting to vanish, leaving some older people with nowhere to go and few means to keep in touch with friends.

What about radio waves?

Is GPS tagging really the answer or just another knee-jerk campaign that unravels under scrutiny?

Apart from obvious ethical questions about the Orwellian road to authoritarianism, the rise of Big Brother etc, there's another more prosaic issue at stake here. GPS products can be easily blocked; by buildings, by bridges, even by the ubiquitous winter cloud cover. Radio waves are more reliable if you want to keep tabs on someone. Regarding the Alzheimer’s Society’s advocacy of tagging, it’s probably advisable for them to do thorough research into the technology before setting up a standard for the campaign ahead.

Ground control to Major Tom-Tom

The Alzheimer’s Society has started the New Year with a bang, proclaiming electronic tagging as the way forward for dementia sufferers. A bold new approach to dealing with wandering, the plan is to fit the subject with an electronic tag so they can be tracked should they go missing.

A Godsend to the families that struggle to care for their confused, demented loved ones, electronic tagging is being hailed as the complete solution to ease their wandering concerns.

But isn’t it like shutting the gate once the horse has bolted? Shouldn’t more be done to stop people from getting outside in the first place? Pressure sensing pads and motion sensors are widely available, and it only needs a moment of swift action to put the confused wanderer back to bed once it has been triggered.

Wandering will always happen – and for home carers it is a big concern that mustn’t be trivialised. But surely more can be done to stop people wandering before they’ve left the house, rather than relying on the same technology that powers your sat-nav?

Talking to my friends

It’s amazing what you learn from your friends, when you start to ask them about care.

My friend Paula has encountered the less friendly face of social work recently. Her grandmother is starting to show early signs of dementia, and it’s got to the stage where she shouldn’t really be alone all the time. Her grandmother lives in the Lake District, and has lived in the same house for years.

Over the past few months, Paula has been to visit her gran several times to sort out various bits and pieces. She’s found that her gran is starting to lose her memory, and will go to the post office 3 or 4 times a day. Sometimes just for the company.

Paula is concerned that nobody is keeping an eye on her, but she can’t move closer, and her parents live in Canada.

Her father flew over to come and try to get more formal care in place. They arranged for a social worker to come. According to Paula, the social worker was there for less than an hour, in which time she decided that Paula’s gran was fine. The social worker said they could arrange their own private care if they wanted someone to come in every day to check on her gran.

Paula certainly felt this fell short of the mark.

Contrast this to the conversation I recently had with a friend’s mother, who is an ex social worker. She said she really felt social workers were drowning under all the different assessments and mounds of paperwork they are now required to fill in. How, she argued, could social workers do their job when they were increasingly desk bound?

Yet before she retired, she was managing to maintain such good relations with many of her service users to the extent that she invited some of them to her leaving party. Her comment was that no matter what accusations are levelled at social workers, she has yet to meet one who isn’t totally devoted to the job and who does anything other than work exceptionally hard.

Fascinating.

Benefit ignorance

Talking to pensioner Les Fox for an article this week, he revealed that it was only after he had a coughing fit – due to his emphysema - during a meeting with Age Concern that he found out he was eligible for disability benefits.

Following this, Les was given forms and advice by Age Concern and now claims various benefits, including Attendance Allowance and Savings Credits. In all, he reckons he and his wife are about £120 a week better off – a massive difference given that the basic state pension is only £87.30 a week.

If he hadn’t had the luck to have that coughing fit, it is probable that he and his wife would still be struggling to pay his bills on their meagre state pension; he knew nothing of what he was entitled to or how to claim it before Age Concern stepped in.

Various statistics are bandied around as to how much unclaimed benefits are out there – Help the Aged recently said it was £4.5 billion – but the government seems to be doing little to help older people claim what is theirs. While there is help available through local councils etc, it is only useful if people know about them – and often they do not.

Some well-placed advertising – TV especially – to publicise how older people could be eligible for benefits and who to contact could help to address this, but whether the government will is another matter. A national campaign would cost millions and with the economy facing uncertain times ahead, it is this sort of spending that is generally axed first.