Can Gerry Robinson Fix Dementia Care Homes?


This evening, BBC2 are running the first of a series of two programmes about the state of dementia residential (and presumably nursing) care in the UK. Gerry Robinson, a successful businessman, who, in 2007 brought us ‘Can Gerry Robinson Fix the NHS?’ returns to focus his attention on what might be done to improve the care that is meted out to those who live in 24 hour dementia care.

I have to try and hold my cynical tongue from just crying out ‘money’ although it’s hard to escape from that as the premise. Staff in care homes are poorly paid and poorly rewarded as regards career development and I speak from personal experience as I worked in residential care for about seven years doing ‘hands on’ care and reached a point where I felt the only way to progress apart from through the management structure (which I really didn’t want to do) was to return to university and train as a social worker.

I still consider those years that I worked in that area to be a crucial part of the process of my professional and personal development. The fact that I worked on a day-to-day basis in a residential environment has given me a much wider understanding of the room for growth in that field and have informed my judgements when assessing the quality of care homes as I have had to do over the years in making placement decisions and reviews and taught more lessons that I can recount in making and establishing relationships and the importance of dignity.

But back to Gerry Robinson and ‘Dementia Care Homes’. Apart from the cynicism that only those open to change would be willing to ‘let him in’, I hope that the attention on this area of care will focus some more on what needs to be done to provide the excellent standards of care that we all should be clambering for.

It has been too easy for poor quality care to go unchecked and we can look to the CQC (Care Quality Commission) and its predecessor, the CSCI (Commission for Social Care Inspection) and their move towards ‘desk inspections’ and away from the system of announced and unannounced inspections as one reason for this. Another is that often ‘old age’ is an area that people want to forget. It happens to ‘other people’. The less we move older people, and unwell older people at that, the more that some people try to shrink away and pretend that it will be different for us or our families. The truth is, it isn’t. However loving and caring a family is, there are some people that will need more care than can be provided at home and these residential homes and the quality that they achieve (or don’t) should be a concern for us all.

I often thought that there was no reason, except money, of course, that residential care homes for older adults need to be accommodating so many people whereas those for younger adults with learning or physical disabilities can be run on a much less ‘instittutional’ basis as group homes. Where are the ‘group homes’ for older adults who demand the same quality of care?

We come back to a lack of money and investment and probably interest in the wider population. As long as less can be spent on care without it being seen as scandalous or some kind of electoral issue then it will be.

Again, going back to my experience, good care does not have to be expensive care. I have seen some excellent, forward-thinking homes that are no more expensive – but the massive difference is not so much physical environment as commitment and quality of staff. While some excellent staff are willing to work for mininum wages, the way to improve the quality of care would be to add more incentives to keep good staff – that doesn’t need to always be through higher pay although that wouldn’t go amiss,  but by a wider and broader valuing of those who work in residential care, better training and development opportunities,more flexible working practices and quality supervision.

I expect it to be an interesting programme and will try and summarise after I’ve seen it. Ultimately more attention paid to this issue can only be a good thing.

BBC 2 – 9pm – Tuesday 8th December + Tuesday 15 December

EDIT 10/12/09

I thought I’d add a few thoughts about the programme after having watched it. I was impressed by it to be honest and surprised in a way. Not by some of the attention to the care (or lack of it) that exists in the sector but at the real attempts to explore what works.  I am mostly glad that there is some focus on the quality of care delivered in these enterprises that are, for the most part, profit-making private ventures. Most interestingly. I thought, was the highlighted fact that for all the inspection regimes tick-boxes that can be completed, there is more to quality care than ensuring the boxes are ticked and really, it is about putting yourself into the thoughts and feelings of that person and not treating people as commodities or homogenic.

I was appalled by the first manager who appeared and had no training in dementia care and referred to the elderly residents as ‘little ones’ – I can’t remember the quote exactly. I know that we need to move away from language but I think it is indicative of an inner thought process that is both patronising and infantilising. What was really heartening was to see some care homes that did things well. For me, as mentioned above, I think one thing that was obvious was respect to care staff who are there on a day-in day-out basis and are responsible for the happiness of residents in a much more real basis than some of the managers and owners. Respect is not only about pay (although that helps!) but about training and ‘perks’ – one thing emphasised by the programme was that ‘free’ meals on duty were being denied care staff at little cost to the owners and was a considerable source of resentment to the staff. I can well-understand that having worked in that setting.

A part of me wanted to quit my job and buy a care home to implement some of the more progressive ways of working immediately to be honest. It should be a programme more widely watched by those involved in the sector and I’d urge any interested party to pick it up on the BBC iPlayer in the meantime.

22 thoughts on “Can Gerry Robinson Fix Dementia Care Homes?

  1. Pingback: Twitted by GeorgeJulian

  2. Thanks for sharing these interesting thoughts about care homes. It’s great to see a programme like this provoking so much thought and passion about this issue – hopefully it will help improve the sector.

    From that article, I think one of the most powerful aspects is about the quality of care missing in most homes. As Robinson says:
    “No one was going out of their way to hold someone’s hand, to bend down so that they were at eye level, to organise activities, to indulge a wandering mind and join in with their conversation, however fanciful it might seem to us.”

    And that’s the crux of it, really. Having the resources to create a caring atmosphere. Regulation and licensing are vital, but there can also be a revolution that works bottom up. See what you think about the work I’m doing in this area on my blog: http://www.patientopinion.org.uk/blog/post/2009/10/Change-in-the-world-of-commercialised-care.aspx

    Thanks!

    Kate

  3. I’m trying to make up my mind whether or not I’ll watch this tonight; it might be too near the bone for me. But I’m glad they’re making it and that elderly care is getting a higher profile. Good on Gerry Robinson.

  4. Hi,
    Great blog you have here! I’ve just blogged about this myself:

    http://hodges-model.blogspot.com/

    I will be watching wondering what themes will come out… care transitions, dignity and respect, training, occupation for the residents….

    You and your readers may find Hodges’ model of interest it’s a care model ideal for health AND social care?

    http://www.p-jones.demon.co.uk/

    The model’s four care domains each has a links resource, e.g. SOCIOLOGY:

    http://www.p-jones.demon.co.uk/links3.htm

    Hope this proves of interest.

    Best regards,

    Peter
    ——-
    Peter Jones
    Lancashire, UK

    http://hodges-model.blogspot.com/

    Hodges Health Career – Care Domains – Model

    http://www.p-jones.demon.co.uk/

    h2cm: help 2C more – help 2 listen – help 2 care

    http://twitter.com/h2cm

  5. Yes, I think you’re right – staff in care homes are poorly paid and with few career development chances. And they are also poorly motivated – which the Gerry Robinson programme highlighted. It was an excellent programme – and the one word that jumped out was ‘caring’. It’s not about money – it’s all about caring. And that includes caring about the staff, and making the staff feel needed and wanted.

    Caring enough to want to provide surroundings that anyone would be proud to call ‘home’. Caring enough to want to enhance the life of the people living in that home. To want to motivate the staff sufficiently, so that they also can feel wanted and fulfilled in their work. Caring enough to want to train the staff in all aspects of dementia care. That’s what I call providing care.

    The one couple in the Gerry Robinson programme that I wanted to throttle were the couple who were so resistant to all advice, and who certainly cared more about their bank balance than they cared about the people living or working there. Half a loaf of sliced white bread warranted a tantrum from the Owner?? That summed up a standard of neglect, nothing to do with care. If they could begrudge their poorly paid staff half a loaf of sliced white bread, then what chance for the vulnerable elderly residents with dementia?

    The responsibility for our disgraceful standards of dementia care rest with the care providers, the local authorities, the regulatory body CQC.

    It’s all to do with the desire within the for-profit private care providers to maximise their own profits rather than to care enough to make sure that their residents thrive while in their care. But then again, they are ‘for-profit private care providers’, so who allowed our care services to be handed over to profit-making vultures? Don’t answer that!

  6. Thanks for the comments. I am amending the main post with a ‘review’ part of the programme. I am looking forward to next week to see the rest.

    • For me what came over very strongly was the sheer avarice of the first 2 home owners. A £4 million house? An argument over half a loaf of bread. Shame on them! (Brilliant of the documentary makers to give us a tour of the house)

      The example of a model home with happy residents showed what could be done and emphasised the misery that those less fortunate must be experiencing.

      I was very touched by the devotion of the man who visited his wife every day.

      • Yeah, that was pretty much my reaction as well. I was so annoyed by the avarice of the home managers regarding meals for staff as well.

  7. I’m a student nurse (adult) and this programme, for the first time made me think I could work in a care home and frankly inspired me to do so. It was so annoying that services are money, rules and regulations led rather than the fundamentals of life/living/freedom/laughter.

  8. You said:

    “A part of me wanted to quit my job and buy a care home to implement some of the more progressive ways of working immediately to be honest.”

    That is exactly how I felt. Except that I wouldn’t need to quit my job – because I’ve already done that!!

    Are you up for it? Anyone else out there interested?

    Are you interested in helping me to do it, Gerry Robinson? To find one single care home where we could make that definitive difference. Because we care, care enough to care about making it work.

    I have had more than enough of the crap quality of care for elderly people that we can do nothing whatsoever to change, no matter how hard we try. UNTIL NOW.

    Perhaps we can make a difference after all.

    Where there’s a will – there’s a way.

    Does anyone have any connections to Gerry Robinson? Are you reading this, Gerry Robinson?

    If so, you only have to ask … and I’ll be there. In the front row.

  9. I am torn between jumping in and being desperately worried about how to manage as the sole wage-earner of the household – which is why I said it’s only a part of me that is able to pursue the dream..

  10. These programmes always make me angry- and this one was no exception! As you say cb, that first manager who infantilised her residents- and couldn’t even define what EMI stood for- appalled me, until I saw the two owners who had put her in charge…then, sadly it all made sense!
    What provoked my anger most I think was the other home shown where residents took part in the tasks involved in their home, and the care was so obviously much better, yet the expenditure of running that home was no higher than the others. Seeing the contrast, that it didn’t have to be that way, really made me feel so sad and angry on behalf of all those other people.
    Like you, I also indulged in a few fantasises/ dreams of what I would do if I had control of a home, and the difference I would make….

  11. i watched with enthusiasm Sir Gerry Robinsons programme about Dimentia and was not surprised at the substandard care envrionment exposed during the programme!! our government needs to URGENTLY address this issue but not by inspecting and assessing but by training and employing a competent workforce who are skilled to undertake the very challenging task of caring and working with the elderly suffering from dimentia. my own mother was misdiagnosed early on when feeling unwell and it was not until much much later that it transpired as a diagnosis of dimentia. As a family we have had to use every ounce of our energy to fight the systems in terms of poor standards in hospitals, abuse and neglect of our mother and long drawn out assessment processes undertaken by unskilled workers which leads to further delays for decision making. we have had to learn and understand so much about continuing care assessment, medication, dimentia, physical and emotional care in dimentia all on our own without any help from the local authority, nhs or complaints systems. if i had not had some knowledge as a childrens social worker of how it works for children then i would have been totally helpless to my mother. if it were not for my sister going in to see my mother every day to monitor her care in the various hospitals she was in prior to the home then she probably would have been dead by now. Gerry’s programme was a breath of fresh air in terms of ‘how easy it can be’ to provide a level of care, dignity and emotiuonal warmth to our elderly citizens with dimentia. we would not treat children or animals the way in which we treat our elderly population. i want to get in touch with Gerry now and do some ‘real work’ in terms of changing and breaking the cycle. most care home managers have little knowledge or understanding of dimentia and are only in the business to make huge profits for example like the couple in the programme who were not willing to listen and make the changes but only worried about loosing their 4.million home.
    the gentleman who had taken on the job of making a difference in his home by involving the residents and providing a stimulating and caring environment deserves a recognised national award as far as i am concerned and as a governement and society we should be encouraging him to lead us into the future with improved conditions for our elderly with dimentia and our staff that care for them.
    i must also add that Oakhurst Grange in Crawley West Sussex have been absolutely brilliant with our mother. their communication and feedback is always excellent, they provide a caring and warm environment with limited resources and always listen to us as a family and work with us in the best interests of our mother.
    i would be very interested to work with you Sir Gerry Robinson in making a difference in Oakhurst Grange where our mother is and i am sure that they as a BUPA home would be willing to work with you!!

  12. My mum is in an emi home just like the one in the tv programme.I find it horrific at times,My wish is to have my own home and boy would it be good

  13. What a great programme and insight for un-enlightened people to be made aware of our Care Homes and how they are run. I work in an establishment which comes under Supported Housing for people with dementia where are training is second to none. Mr Robinson did make a short programme on our work place which is Sydenham Court based in Belfast Northern Ireland but it was never shown which is a shame as it is a wonderful place where people with dementia have full emotional support with their daily living and retaining their independence. Keep on with this kind of programme to make more people aware and maybe it might make a difference. Thank you. Caroline Meharg

  14. Where can I get access to the programme as iplayer will no longer work. Are they going to release it on DVD or allow it be be publised elswhere

  15. hi all interested parties, on reflection and reading recently updated comments, i feel that all we ever do is make comments and not take any action.
    maybe we need to be working together to make a difference and to start putting pressure on the powers that be who make the decisions about what is ‘good enough care’ and how we can achieve it.
    what is gerry robinson doing since the documentary is he involved or was he just presenting?
    be good to hear from people who want to make a difference.
    christabel

    • You can certainly count me in.

      I also wondered what Gerry Robinson might be up to now. And I’ve failed in finding a way to contact him to ask. BBC don’t reply because they get too many emails to be able to reply.

      Gerry R definitely has a personal connection to that thing we all call ‘Dementia Care’ but I’m beginning to wonder why we call it that. There are so many ‘high profile celebrities’ who all have personal connections, but there are far more ‘normal human beings’ (no disrespect intended!) who are crying out for better care.

      How do we change things? How do we all make enough of a difference to make those in positions of control LISTEN TO US AND DO WHAT WE ASK, rather than the tick-box exercise and the accompanying statistics-chart that they all seem to do to validate their own existence?

      So, please count me in as someone who will stand up and be counted.

      All other suggestions will be gratefully received by me.

      • I’d be happy to pass on email contacts if you want to send me a note through the ‘contact me’ page.

  16. Having worked in a BUPA care home for twelve years, I saw on GR’s program the same demoralised and disillusioned care staff that I work with every day.

    A caring manager and staff morale, as I have tried to explain to the manager at our particular home time and time again, is the key to a successful and happy home. She agrees of course in principle, but that hasn’t stopped her from withdrawing lunches for staff, being inflexible where rotas are concerned, and barely meeting (and sometimes not meeting), the minimum staffing levels.

    In twelve years I have worked with nine managers. Four of them have been wonderful and our home flourished under their leadership. They had the residents and staff at heart, as well as the company’s fortunes, and it was possible to create and maintain a happy house, and at the same time earn the company income. Two of those managers when they left, both admitted that they were asked to put profit before care, and not being able to do so, found it impossible to cater to BUPA’s wishes.

    We have a home manager who herself admits is only in it for the money (including bonuses), and has no particular interest in the field of care. To her it’s just a job.

    She has lowered morale in our home to rock bottom over the last three years, and when morale is low the residents are definately affected by it. Whether it is because of increased sick leave by staff, staff being rushed from one resident to another, or the fact that staff members no longer enjoy their work because tey feel so low. A home with low morale is a failing home.

    BUPA themselves delegate people that are responsible for our home, but most of them have never been inside a care home in their lives. They do not have a clue what goes on a day to day basis, or what the needs are. Those that do visit the home do not ever ask to meet the residents or the staff. They are there regarding company accounts only. Which leaves the home in the care of the appointed manager.

    I even resorted to whistleblowing to the company,regarding this particular manager’s bad practices. Instead of looking into the issues and acting accordingly,someone in the chain of command of BUPA, informed the home manager of my efforts, which compromised my anonimity, made my life at work forever hell, and put off forever any member of staff from ever complaining to anyone again.

    I have been to many of our care homes of course, that do not have the problems we have, and like our home used to be, they are lovely places to be. With the right manager in place our home will bloom again I am sure.

    Until that time I watch as what’s left of my long term workmates simply leave for pastures new. To be replaced by imported, inexperienced, very young and very underpaid people.

    I won’t leave though. I’m too conected to the home and it’s residents to be able to walk away. I feel very stressed the way things are at the moment, but I will continue as always to hold my chin up and be the happy bloke that all our residents are used to seeing. Actually that’s not difficult at all to tell the truth.

  17. Peter, thank you for that insight. It doesn’t surprise me to be honest and it reflects my own experiences of residential care homes – that there is little connection between the companies running them who are obsessed about profits and often being squeezed more and more by local authorities looking to cut costs and payments – and excellent staff who are driven out by appalling conditions.
    I hope it serves as a reminder that there are excellent, devoted staff working in residential care but the management can be actively obstructive to providing the means to create a good atmosphere. Often it is as much about attitude as money.

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