Stop talking start acting

I’m getting a sense of déjà vu.

In the news today MPs have urged the government to clamp down on the “dangerous over-prescribing” of antipsychotic drugs to people with dementia in care homes.

MPs say about 105,000 people with dementia are given prescriptions they do not need because antipsychotic drugs have no benefits and could even worsen residents’ conditions.

These drugs have been associated with an increased risk of stroke, social withdrawal, accelerated cognitive decline – especially verbal skills – and severe sensitivity reactions. Essentially, they can leave a person with dementia in a zombified state.

Haven’t we heard all this before? This story seems to keep coming back into the headlines about once every couple of months – indeed, I blogged about it back in February [http://bettercaringblog.blogspot.com/2008_02_01_archive.html]. Panorama also had a programme on it late last year.

Last time I wrote about this, I said it was good that the issue was being revisited because it should prompt something to be done. But it seems that – still – nothing is being done, except a lot of hand-wringing and points-scoring soundbites about how “the government must end this needless abuse”.

Various people in parliament and beyond have been saying this for months. Surely the time for talking has ended, there needs to be action to stop this drugging of care home residents now. Even if it is a directive to care homes and doctors telling them to stop prescribing antipsychotics unless they are a last resort, it would be something.

But this is not going to happen. While it seems that action will be coming, it will only be once the government’s much-vaunted National Dementia Strategy is published sometime later this year.

For some people, you can’t help feeling that it will be too late by then. For the 100,000 or so people still stuck in a zombified state – or even ushered to a quicker grave by needlessly prescribed antipsychotic drugs – time is something they do not have.

Tomorrow’s world

The so-called ‘iPad’ promises plenty for the pensioners of the future – but is it more a pipedream than a panacea for loneliness?

If the Life Trust Foundation is to be believed, the granny flat of tomorrow will be an Aladdin’s cave of webcams, wall-to-wall plasma TVs and intelligent appliances.

This will help tackle loneliness and allow grandparents to ‘virtually’ baby-sit their grandchildren from the comfort of their plugged-in palace. Combine this with email, web-chat and social networking, and the pensioners of the future will never need to leave home to stay connected.

Sensors underneath cookers and baths will be able to tell if they’ve been left on, making it a safe environment for people to live in. Only those with serious needs will require social care – and even then, care homes will be replaced by ‘boutique hotels’.

So, on paper the future looks good. But isn’t this just papering over the problem of loneliness? Viewing your grandchildren through a TV screen does not compensate for the real thing – unless they’re monsters fed on a diet of violent games and virtual experiences.

And then there are there is the problem of the technology itself.

If the doom-mongers are to be believed, the Internet will come crashing down within 10 years because of the public’s hunger for downloads, Internet TV and content streaming.

Although that’s the worst case scenario, how will a 73-year-old – a little unsteady and living miles from the family – cope in the digital age when the Internet decides to serve its last Google search? Given the dependence on technology, it could be a disaster as people are forced to go out and do things themselves – possibly for the first time in generations.

Despite this, the granny-flat of the future offers plenty of opportunities for isolated and lonely individuals – especially if it is done correctly.

And you’d hope, with all that expensive kit inside, it would have an ingenious way of alerting you to the bogus salespeople who come knocking…

Stop the charges

My partner was recently admitted to the local county hospital and while her stay was mercifully brief and she received excellent care, there was one notable downside; parking charges.

Without wishing to sound Scrooge-like, I only went to this hospital four times but still ended up shelling out about £15 in car parking fees. A stay of a little over two hours (the length of visiting time) cost a whopping £3.30.

Many hospitals have been charging car parking fees for several years now. While they tended to start fairly cheap – 50p, no matter how long you stay, for instance – prices have jumped in recent years and are now on a par, if not more, than your average city centre multi-storey.

To me, this is morally wrong. It is unfair to penalise anyone visiting a relative or friend who is sick, even more so if it is a long-term condition. Imagine a pensioner having to visit his wife who has a broken hip. She will not be going anywhere for some time, and if he wants to visit her every day – a not unreasonable desire – the cost will quickly mount up. While you can get discounted weekly or season tickets, it would still take a significant chunk of the basic state pension.

These charges are essentially a licence to print money, taking advantage of a captive market. There is no way out of them.

The excuses hospitals give for introducing charges do not wash, such as deterring commuters parking in hospital car parks and cutting congestion. These are minor problems at worst and the end does not justify the means.

It wouldn’t be so bad if all the money from the charges went towards patient care, but often it doesn’t, especially in those hospitals that outsource the running of their car parks to a private company.

Hospital car park charges should be scrapped; it’s morally wrong for people visiting sick relatives or friends – especially those needing long-term care – to have to pay for the privilege. There is no need for it and it only succeeds in putting more stress on people at a time when their energies should be focused on the person in the hospital bed.

A Lidl bit of what you fancy…

Just imagine doing your weekly grocery shop and picking up a grab rail alongside your grapes, or packing a bath seat next to your tins of beans.

Ten years ago, such a thought would have been ludicrous, but supermarket chain Lidl is now offering customers the chance to purchase home aids as they peruse the shelves.

This move has enormous benefits for elderly shoppers, particularly those on low incomes. For starters, it is cheap; a Lidl grab rail costs £4.99 compared to B&Q’s that will set you back £9.98.
It is also far more convenient to buy these things in a supermarket than having to make an effort to go to a DIY store. And if you haven’t had a needs assessment but feel you require some help getting around the house, it provides a cost-effective solution.

Obviously, there may be differences in the quality of the products offered by specialist manufacturers and DIY stores compared to Lidl’s modest range of big-buttoned telephones and leg pillows – but it is a welcome addition to a largely-untapped market.

Hopefully the bigger supermarkets will follow Lidl’s lead and offer similar products in-store, instead of shunting them to the website, where they remain hard-to-find.

End in sight for postcode lottery?

Finally.

After years of grumbling by people in the care system, the government has finally announced that the eligibility criteria governing older and disabled people’s right to receive care services is to be reviewed.

In theory, this review could see the end of the unacceptable ‘postcode lottery’ of care services. But we should not get too excited – the credit crunch could see any reform stymied.

One of the most common gripes I hear is the unfairness of the care services system, where someone in one area is denied – in some cases life-saving – drugs, while elsewhere they’re available.

The Commission for Social Care Inspection has been asked to undertake the review and report back to Care Services Minister Ivan Lewis in the autumn. CSCI’s brief is to focus on national definitions of need and the application at a local level.

At least the review is focusing on the right area. A set of national guidelines for eligibility, which are not open to interpretation at a local level, is crucial. All too often local officials have their own take on the rules and this needs to be stopped. Access to care services should not rely on the luck of where you happen to live.

But much of the postcode lottery is borne out of a lack of adequate funding for social care services. Many councils have ramped up their eligibility criteria in recent years to save money and plug huge holes in their budgets.

And with the credit crunch and resulting economic downturn, it is unlikely the government will start pouring extra cash into council budgets to fill those holes.

So while this review is to be welcomed, how much effect will it really have? If any major reforms happen, they will be down to the economic situation and the prospects for the moment are looking grim.

Do you feel lucky?

Continuing care should be given to everyone when they need it. But the current system is hampered by a postcode lottery, depriving many because of where they live – and this is only going to get worse.

New government guidelines have increased the eligibility for access to ‘Continuing NHS Healthcare’ by more than 5,000, Age Concern says. Yet in many areas of the UK vulnerable people are seeing reductions in the services offered.

If you live in Mid Essex, Sandwell and Wandsworth, the situation can’t get much worse.

All three authorities have reduced the continuing care services offered by more than 80%. East Riding, meanwhile, halved the number of people receiving continuing care – some achievement considering they had the second-lowest number of service users in the first place.

The gap between the worst Primary Care Trusts and the best is one that deserves much consternation and head-scratching, and is evidence of the postcode lottery facing people who access healthcare.

If you live in Coventry and Plymouth you’re in luck – both have reported a growth in the number of people using the service. Better still, Derby, which had the lowest number of people accessing continuing care in 2007 – 1.5 people per 50,000 – has grown to 25 people per 50,000.

How some PCTs can offer such extensive continuing healthcare while others fail is a mystery, but by naming and shaming Age Concern has successfully highlighted the inequalities found throughout the UK.

In the case of some – particularly Derby – it’s great to see moves being made in the right direction, and the PCTs should be praised for raising the standards. But this still remains a postcode lottery that needs cracking.

Where has all the money gone?

That was the question asked by Age Concern recently when it reported that an estimated 2.2 million pensioners had not claimed council tax benefits. Elsewhere, 1.7 million were not claiming Pension Credit, and 310,000 were not receiving Housing Benefit. Total all this up and it amounts to some £2,000 a year per household in unclaimed benefits.

There may be a stigma attached to claiming benefits, but £2,000 is a lot of money – especially for pensioners who may be funding care, may still have a mortgage to pay, or may be caring for somebody else.

But, above all, can government do more?

In a sophisticated modern state like Britain, it’s disquieting to think there’s not a central database that contains all this information. Government is eager to catch tax dodgers, but seldom eager to pay out when it should.

Moves are being made in the right direction with the initiative on self directed support, a buzzword that means people will be given the freedom to choose their own kind of care out their own personal budget, supplied by the local authorities. This will also give people the right to question the benefits system – and hopefully encourage them to take the benefits that are on offer.

Nevertheless, self directed support will take years to roll out across the country and each local authority will have its own idiosyncrasies regarding services. It’s certainly not a quick-fix panacea and, meanwhile, older people will continue to lose out on essential benefits.

So what’s the answer?

If you can, go to your local social services, speak to your social worker and demand to know what benefits you are eligible for. This really is essential; it could be the difference between a cosy, heated home or days spent under covers in the bedroom during the latest cold snap.

Care home attitudes need to change

When many newspapers recently carried stories about hundreds of illegal immigrants working in care homes, one question was left unasked: why are so managers willing to employ them?

The answer, it seems, is that most British people don’t want to work in care homes.

Recently I attended a conference where I was told that the available social care workforce in one English town dropped by 10,000 after a Morrison’s superstore opened up nearby. To put it bluntly: most British people would rather work in a hypermarket stacking shelves than help to care for the elderly and disabled.

Unfortunately, it’s a scenario that has been repeated across the country and should surprise no one in the caring industry.

Working in social care requires dedication, but it’s low paid, the hours are long and the media publicity is almost wholly negative. It’s hardly an incentive to want to join the industry.

To state the obvious: a sea change in the perception of care homes and care home workers is needed. But the question is how to achieve it.

A good start would be to emphasise the positive work that goes on in many residential homes. For example, schemes such as Art for Age, in Kidlington in Oxfordshire, a joint project between the Glebe House care home and Beckley Primary School, showed what can be achieved. The public display of artwork late last year was a great success. See www.bettercaring.com/editorial/channel3.aspx?id=370 for the full story.

Highlighting the tireless work that many care home workers and managers put in to the job would also help the industry. This could help restore a sense of pride in their work.

As well as this, pay rises for care home workers would help to retain the best staff and provide an incentive for others to progress.

Many care homes, especially those run by the local council, operate on tight budgets, with little in the pot for pay increases. With the government showing little sign of increasing funding for social care, staffing concerns and adverse media publicity are probably set to continue.

Benefits system needs continuing reform

With a benefit called ‘continuing health care’, you would expect it to be paid out to all those with long-term serious healthcare needs. But apparently not.

Currently, more than 400 people are suing various health authorities after they or a family member were refused continuing health care. They allege they were not given proper assessments and had to pay out hundreds of thousands of pounds in some cases for nursing care as a result.

While the plaintiffs are seeking compensation, it highlights the confusion around what constitutes social care – which is means-tested and carries a charge – and health care, which is provided free by the NHS.

The distinction between the two has been muddled for years, and has often come down to the local Primary Care Trust’s interpretation of government guidelines.

Unsurprisingly, it has led to some frankly baffling decisions. I have heard anecdotally of a man with the later stages of dementia – he could not walk, barely talk, was doubly incontinent and needed help for the most basic of tasks – refused continuing health care.

How a man with such care needs, and who’s health clearly won’t improve, does not warrant continuing health care funding is beyond me.

This provides another example of the urgent need to reform care funding. The guidelines for awarding benefits such as continuing health care need to be clearly set out and the distinctions between the various benefits need to be made clear to all.

If this happens, it could stop people being wrongly forced to pay for their care. Estimates in the press speculate that if the judge were to rule in favour of the 400, thousands of pensioners could be in line to claim refunds from the government – a bill that could run into hundreds of millions.

It is a bill the government could ill afford, but may help galvanise ministers into action to ensure that such cases do not occur again and that the care funding system is finally made simpler and, for many people, fairer.

Bogus nurses: a care home conundrum

If fighting against perceived poor standards and public perception weren’t enough, care home managers now have to contend with fake nurses.

This goes far beyond poorly qualified staff and involves people pretending to be registered nurses to work in a care home.

The story of 49-year-old Carol Dabbs is one that should alarm every care home manager – and the families of anybody who lives in a care home.

Dabbs is alleged to have lied about being a nurse, and worked at a couple of care homes in Wales between 1992 and 2006. She was allowed to administer drugs and care for vulnerable frail people with no qualifications or training.

She now faces criminal charges of deception, supplying class A and class C drugs and wounding. A helpline has been set up for people who may have been treated by her.

At Bettercaring we hear of numerous cases of people unqualified to do the job, but few are as serious as this.

That Dabbs got away with it for almost 15 years is frightening and astonishing, and part of the blame must lie at the doors of Neath Port Talbot Social Services and the two care homes in question for not vetting the staff appropriately. Even the Care and Social Services Inspectorate Wales (CSSIW) should face an inquiry for such an enormous lapse.

But it begs the question – how easy is it for someone to get a job in a care home without the right qualifications?

I recently spoke to Diane Smith, the manager at Cantelowes House in Barnet, and was impressed with the standards of recruitment in the home. She refuses to use agency staff and ensures there is a paper trail associated with every member of staff.

New members of staff don’t start work until all of the checks have been carried out, and this paper trail makes it impossible to falsify records – training and experience. It’s an almost foolproof system.

Diane admits it’s a long process, but it means there are no false nurses on the books – and she can sleep easy when CSCI come to visit.