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
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.