I see that the Alzheimer’s Society having published a book called ‘Enabling’ which provides models for observation in residential care facilities in order to improve care, as there was an article about it in Care and Health.
I think it raises an important point about the need for something to be done in care homes for older people where the abuse that has gone on, sometimes wilfully but often through lack of care in staff and either laziness (although that does sound harsh, I have spent a lot of time in and around residential care!) or just awful modelling by bad management.
Good practice is something that most certainly does feed down the chain though and a good and strong management structure, I’ve found, as is the case in most working environments, can produce a positive working environment.
Thinking of the area I work in, I can compare two Dementia Nursing/Residential Homes. They are both run by the same company (which is another story entirely – don’t get me started on that one!) and the company in question, like a lot (but not all) private providers, have a very tight bottom line and emphasis on profit above.. well, above everything really.
But of these two homes, one has, what I consider to be an excellent manager. She runs the home efficiently, she listens to her staff but also talks to them when she spots anything that might resemble lack of care. And the staff that I have spoken to, seem to respect her a great deal (as do I because, in my eyes being a GOOD manager of a residential home, especially when the company behind it is so tight, is one of the hardest jobs around!). Apart from that she is extremely personable and approachable as an individual.
Move to the other side of the local authority, and another home, run by the same company, has a manager that is pleasantly incompetent, staff that basically run each of the floors in their own merry way (which often involves lots of sitting around with cups of tea) and an almost neglectful culture of care or lack of care. They are eager to raise issues and difficulties without any kind of creative planning but more importantly, without any care! (and just as an aside, have been subject to so many complaints – including a few by me – that it makes me wonder what kind of checks and balances do and should exist).
A bit of observational practice would, I think be enlightening in that case.