Panels

Since I’ve been employed as a social worker one of the constants in my working week has been the presence and existence of ‘panels’ in many different forms. There was a brief stage when we were told not to refer to them as ‘panels’ but rather meetings but it’s all the same thing at least, in the setting in which I’ve been working. They are groups of managers and professionals of a variety of provenances making funding decisions on behalf of the local authority or health service.  Of course sometimes they say it is about joint decision making (which is why the word ‘panel’ is frowned upon now) but that’s really a facade. I make recommendations but I have little authority over funding decisions.

Different local authorities often have different mechanisms so my explanations of the panels that I might attend come with the proviso that things are arranged and organised in a variety of ways.

We have panels which primarily make decisions about packages of care that exceed a particular baseline cost. That baseline has changed a variety of times but generally managers in each team are given a certain ‘threshold’ to which they can approve funding requests but above that and any application for funding for residential or nursing respite or long term care have to navigate a ‘panel’.

We have separate panels for high cost personal budget packages which would be provided for care at home and those which approve residential and nursing care/respite and continuing health care (which authorise applications for long term payment for care by the NHS )

Going to panel generally involves the transfer of reams of paperwork. I’d probably say it’s the most obvious way though that I provide the function of advocating for a particular service user or family member when I ‘present’ the situation to those who make the ultimate funding decisions.

Contrary to what some people might think, I have absolutely no vested interest in the local authority or NHS ‘saving’ money by not agreeing to a particular package – indeed, I won’t tend to bring something to the panel if I don’t wholeheartedly agree with it myself. I am a great advocate of money being spent where it is needed.  I have a general wish to see public money well-spent of course and I understand the need to ration resources but if I bring something to the panel and authorise an assessment, it is because I believe that that is what is needed according to my professional  judgement and as far as that’s concerned, balancing the rest of the local authority’s budget is not an issue I consider (which is obviously why these panels exist!).

Similarly with the Continuing Health Care Panels  I cannot conceive of a situation where I would bring someone to that panel if I didn’t absolutely want and believe that they should get that funding.  If I attend and collate a report it is because I and the multi-disciplinary team behind the report, believe in it.  I absolutely want people to get what they are entitled to and have no ‘secret instructions’ to try and deny the funding. The rules though are not altogether clear but it suits the funding parties and the governments to keep the rules complicated and unclear. There’s a lot of money at stake.

The panels are open to service users and carers but for me, personally, it’s very rare that service users or carers attend with me.

I have more often  had family members attend Continuing Health Care Panels with me and found it is a much better way of working as it allows a lot more transparency and removes one of those bars between me trying to put the words of others in my mouth.

By now, I know the people who sit on the panels and they know me. That’s a massive advantage in being able to persuade and cajole. It makes me realise how useful it is to have built up links and a reputation among the more senior management. I like to think that a trust develops.

Panels used to scare me because I’d be questioned, often in detail about the proposals that would have a substantial monetary implication for the local authority. My paperwork and assessments are examined in great detail and a level of scrutiny applied. Now that I’m more confident, I tend to take pride in presenting my reports and welcome the questioning as I know what to prepare, what to highlight and what to expect.

I’ve had panels where paperwork alone is assessed and where we are not required to attend in person.  I prefer being there ‘in person’ especially when there are any question marks that I feel I can clarify.

One of my favourite tasks in my work is feeling that I am genuinely able to advocate and navigate a person or family through the muddy mired waters of local authority funding streams and decisions. I wouldn’t say I enjoy the panel process although there is a satisfaction in having something approved especially if it is something you feel might be hanging in the balance, but I don’t dread them as much as I used to.

As for now though, it’s just another part of the process of seeing a paper ‘plan’ through to fruition.  I know they work differently in different areas – indeed, I’ve seen them in different forms in the local authorities I’d work for – but that’s how they work – whether they are called meetings or panels, the effect is the same.

And that’s the explanation of what the panels are – the other side of each discussion I have and each decision that is made by the faceless ‘management’ that I sit in front are that they are desperately important decisions to each person who is reliant on the authorisation of that funding to allow them to life their lives more fully, to allow their family to have access to respite services. My job as I see it, is to bring the paperwork and paper assessments ‘to life’. I am not only writing about a person on a pro forma, but I’m able to flesh out the requested questions and documents with a person, with a family, with relationships.

That’s why I don’t mind attending  these panels as much as  I used to. I’m not frightened of them anymore. I see them as an opportunity to take a crucially important role in someone’s life and to speak for them and not  just about them.

Initial thoughts on the Dilnot Report on Funding of Care and Support

Scheduling and exhaustion meant I didn’t have time to look at the Dilnot proposals in detail yesterday so this morning I have fired up my browser and am going to make a few initial comments on the baseline main recommendations and hopefully over the next few days can look at some of the details.

The Dilnot Report on Funding of Care and Support runs at 82 pages.  It attempts to forge a solution for the currently antiquated and inequitable system of care funding that is currently in place. Much talk has been made of the current threshold of £23,250 of assets, at which people currently become responsible for paying for their own care services but little made of the current discounting of homes in certain circumstances and the ability to raise a charge on a property to postpone payment of costs for care services. Nevertheless, this threshold was deemed as being too low. People who own houses like to keep houses for children. People don’t like those who ‘haven’t worked as hard’ or ‘saved as much’ getting something for free.

The system is broken though, don’t get me wrong, I just think the focus of the discussion has been too much around middle class fears of actually paying for something they believe should be free. Now, I’ve got that off my chest, back to the report.

The main recommendations are

– to cap lifetime costs of care between £25,000 and £100,000 – with a suggested threshold (which is used throughout the report for ease) of £35,000

– means-tested assistance will be extended to those who have between £23,250 and £100,000 of assets.

– Those who ‘enter adulthood’ with support needs will not be means-tested and care will be provided free.

-Universal disability benefits will continue but may be some differences in names regarding Attendance Allowance. (erm.. DLA?).

– There will be a cap on so-called ‘hotel costs’ in residential care between £7,000-£10,000

-There should be a national, portable eligibility framework which is more transparent.

– A government awareness campaign about planning ahead and preparing for potential age-related disabilities. And their costs.

– There should be a new information and advice strategy to help people through the confusing forest of knowledge.

– Better carers support and information.

– More health and social care integration

Of course, these recommendation run alongside the Law Commission’s report for changes in adult social care law. Together they could create a much better and clearer system than we currently have.

The ‘lifetime cap’ allows for insurance policies to be generated and probably very profitable ones too for the insurance companies. Most people do not need high level social care provision but the fear generated by the media is enough to drive right minded people into the arms (those who can afford it and who have substantial assets) into the arms of the insurance companies. I’m not sure how comfortable I am with the lifetime cap on care costs. It means the more wealth someone has, the more they are protected. I understand the logic behind it in that noone chooses ill-health and disability but the more than government spends on those who do have substantial assets, the less there is for those who cannot afford it and the higher the criteria to access support rises.

I just have a few queries which may be answered in the details. If Mrs Smith has a house worth £300,000 and she lives alone with no other substantial assets – say, for example, she has savings of £10,000 – is her house sold to release the asset worth up to the cap of £35,000 – assuming she doesn’t have an insurance policy? If she chooses to live in a care home which is private, but then the money runs out, will the local authority still move her? Will she ‘top up’ the local authority fees, paying above the ‘cap’ to do so? What is she lacks capacity and has no family?  I suspect all these answers are in the report but they will be questions I will be looking for.  The system of deferred payment is mentioned and I’ll hunt around for clarification.

The cap though, seems to be there to protect middle class votes.

I do, however wholly support the increase in the level of means-testing. I think it is entirely right to continue to means test up to £100,000 and I’d even go further than that. I don’t have a problem with mixed funding, I am just not entirely comfortable with the capping.

Again, the clarity of the coverage of those who ‘enter adulthood’ with care needs is entirely right. There is a necessary distinction between working age adults with care needs and older adults with care needs but quite rightly it is wrong to have a distinction fixed at a specific age. Indeed, Dilnot proposes that those who develop long term care needs before the age of 40 should continue to have a zero cap and costs should be met fully by the state. Above the age of 40 there will be some kind of tapering of the cap up to retirement age where the full proposed £35,000 cap would be reached.

Regarding the accessibility of universal disability benefits, Dilnot clarifies that he does not propose any reform that would lead to anyone losing their disability benefits and that attendance allowance will continue. I do wonder though how this ties in with the government plans to remove 20% of DLA claimants.

There are some recommendations though to change Attendance Allowance (AA). Firstly to change the name to something more understandable and an appreciation that many who are eligible for it do not claim it. That absolutely reflects my experience.  People who reach the cap when the government takes over payment will not continue to receive Attendance Allowance (or whatever it will be called) because the government is fully paying for their care needs – which makes sense to me.  The Personal Expenses Allowance (PEA) is proposed to continue – this is the payment that is made to people whose costs are met by the government in residential care and is currently about £23 pw – there is a suggestion that it should increase but not a recommendation.

The cap on hotel costs is excellent news in my view because I saw this as a potential ‘get out’ clause for residential homes. I do want to know how some of the private homes will adapt to these new systems though and what the cap will mean for overall quality of care provision.

The idea of clearer, portable assessments is a good one and long overdue. Eligibility criteria interpretation can differ wildly and there needs to be more transparency.   The minimum threshold would be applied at the ‘substantial’ level of care so I wonder how this portability will work for those who live in areas that meet lower levels at present.  It seems that there is some kind of recommendation to do away with FACS over the longer term.

Can’t be soon enough – a new assessment framework will be developed ‘with experts’. Please please please can front-line practitioners be involved in these developments – not just people who professionally develop policies and have never needed to use assessments in their lives. This is why we end up with unusable systems. There is also a way of building self-assessments into these new models. That’s the idea anyway.

The last recommendations about building awareness and improving quality of information seem to be sound all round. Nothing to argue about there.

I am interested in the recommendations as they relate to carers. As far as I am concerned, I want more than just an assessment for carers, I want the provision of more services. Supporting carers very well both financially and with practical and flexible support is probably the one aspect which can potentially save the government more money in the longer term than anything else – but more than that, it is an issue of ethics and morality. I know that doesn’t often come into government services but it’s something I feel very strongly about.

There is more commentary about the details of Dilnot in Community Care, the Guardian has extensive coverage (including an article I wrote before the details were known).

I also recommend Arbitrary Constant for links and discussion about Dilnot.

CQC and Southern Cross – a retrospective

I’ve bemoaned both the changes in the CQC and the financial troubles of Southern Cross over the last few years since I started writing this blog.

For today, a bit of a ‘lazy post’ – I thought I’d collate all the posts that I’d made on those two subjects. It provides a little bit of context and stops me repeating myself.

Southern Cross

Trouble at Southern Cross (2/7/2008)

Active Care – Another Tale of Southern Cross? (16/8/2008  – READ THE COMMENTS!

Alton Centre, Active Care and Southern Cross – An Update (5/9/2008)

Southern Cross and Hillingdon (19/12//2008)

Frozen Reading (12/2/2009)

8 deaths – 10 days (26/2/2009) – oh the irony when I comment that Southern Cross own a lot of real estate.

The concerns and worries about the financial management of Southern Cross go back a long way. This is not ‘new’ news. The ‘new’ news is that the company is now close to the brink of collapse. There is almost an inevitability in this as those who sought to make a quick buck in the care sector realise that sometimes the figures don’t add up. Property doesn’t always pay. But making money on the back of what was a public monopoly (provision of care services) can lead to some rich pickings until some of that money needs to be spent. Corners are cut. Staff costs are cut. Older people are warehoused in increasingly larger residential and nursing homes while the roll-out of the so-called personalisation agenda rings very very hollow at the moment for those who are the most dependent and those who need long term care. Where this the personalisation within residential and nursing care services? Where are the small group homes with support for older adults with dementia? They don’t exist because they wouldn’t make a profit.

That is what those involved with personalisation need to address. Not how people who have capacity and ability to manage personal budgets or have families to help them will manage but how will personal budgets (health and social care) and personalisation help and create better systems for older adults in dementia nursing care. Give me an answer to these questions and I’ll have more faith.

CQC – Care Quality Commission

From the first day the CQC came into ‘being’

DoLs, IMHAs and the CQC (1/4/2009)  – these were all introduced on the same day. Do look at the quote from Barbara Young, the first Chair of the CQC. VERY telling.

Britain’s Homecare Scandal (10/4/2009) – another Panorama investigation.

Inspections (3/12/2009)

Can Gerry Robinson Fix Dementia Care Homes? (8/12/2009) – another TV programme.

Linford Park Nursing Home (3/8/2010)

Closing Care Homes (30/9/2010)

Lessons from the Care Sector (26/10/2010)

Trouble at the CQC (3/11/2010)

Johann Hari’s Manifesto for Change in Care Homes (26/1/2011) – one of which was ‘proper inspections’.

Scrutiny, CQC and ADASS (15/2/2011)

Excellence Ratings for Care Homes (1/3/2011)

Inspections and the CQC (11/3/2011)

Whistleblowing (7/4/2011)

Which Care? What Care? (19/4/2011)

Care Home Crises (16/5/2011)

So is this surprising? I wish it were.  I want to emphasise though that it is the management of the CQC that I feel is badly serving those who need support and care rather than the individual inspectors who I know have as many criticisms of the system as the rest of us do. How did this, or the last government allow regulation so toothless just as they are ratcheting up the OFSTED inspections? Does it say anything about how we, as a society, want to value or hide away adults with disabilities?  I suspect it does.

Means Testing and Social Care Funding

Community Care reports that  Dilnot who is chairing the latest in a long, long line of consultations into care funding has heard overwhelming opposition to retaining the £23,000 savings threshold before people have to start paying towards their social care needs.

Charges for social care are a delicate political issue so not content with one report, each government seems to want to commission a dozen until they find one that says what they want to say politically.

As someone who doesn’t have any ideological issues with means-testing, I find the constant pushing of limits hard to understand.

If someone has money, surely they can and should pay for a service and if someone doesn’t have the money, the state should subsidise. Seems quite a good system.

That’s not to say there aren’t problems with the system as it is at the moment. There are lots. It is overcomplicated for a start. There is an element of the ‘postcode lottery’ about it.

The costs are increasing rapidly and, this is the rub, no-one wants to pay for social care. No-one. Whether they have £50 in the bank or £5000 or £5000000 – people have become used to receiving health care free and seem to make assumptions about the provision of social care on the same basis until they are actually made aware of the costs involved.

One of the most perfidious arguments I come across is the ‘I/my mother/my gran worked hard all her life so why should she pay when Mr Brown who has been on benefits all his life doesn’t?’.

Perhaps because you/your mother/your gran actually have the money to pay and Mr Brown doesn’t.

There is a lot of righteous indignation around in this country with people measuring what they have against what others have and what they get against what others get and seeing things as ‘unfair’. Unfair is a government that gives those who ‘have’ a free ride even if they have assets in the hundreds of thousands and restrict access to services for people who have the same and higher needs and fewer assets to pay for them.

Maybe you would prefer Mr Brown’s life of poverty on benefits or in a low paid job to your life where you’ve received a dignified wage and been able to save?

Or does it all come down to stamping ones’ foot and wanting to save your children’s inheritance?

I know this isn’t a popular view. Certainly Dilnot is going to reject it. The thought of – gasp – having to pay for social care if you have savings is such an anathema to the middle classes who have the loudest voices in the political process that it seems already to have been summarily dismissed out of hand.

The thought of having to sell the home to pay for care has been put up as the massive failing in the current system. Is it a failing? I’m not sure. The houses are are discounted from the sums if there is a partner who is disabled or over 60 living in them.

A charge can be put on the home by the local authority so the sale can be delayed until after the death of the person in question. Rental charges can be used to pay towards care fees if the family doesn’t want to sell the home.

Anyway, that’s likely to change because the home-owning electorate don’t like to pay for care for their parents when Mr Brown-on-benefits my be getting something for free.

One thing I am in favour of though, is the capping of care costs at a certain level if someone has very high needs. We used to have this in the local authority but as we’ve moved into more austere times, it has been abolished. While I think means testing is, by its nature, fairer, I don’t think anyone should be penalised if they have extremely high care needs.

The problem of course is that if people who have funds won’t and don’t pay – then who will? Why the state of course. Perhaps through the hideously conceived ‘insurance’ policies that the Conservatives dreamt-up pre-election which showed an ignorance of the details of care but could ‘insure’ someone with a lump sum payment (£8000 was suggested)  against care home costs in the future.  Another of Lansley’s gems. We really are seeing the measure of the man now.

I’ll be following Dilnot’s recommendations with interest. Just as I’ve tried to follow the very frequent and oft ignored proposals that have popped up again and again about the funding of long term care until the music stops and the government decides on the one that will win the most votes for them.

It’s a shame that so many games are being played in the name of ‘fairness’ where ‘fairness’ seems to only be referring to the wealthier, home-owning middle classes – but that’s where the votes are.

Cynical? Well, perhaps just a little bit!

Which Care? What Care?

Lakeview Care Home. One of two modern care hom...

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Another day, another story of sub-standard care in residential homes in the UK. Today, the Guardian publish a story which relates to a Which? investigation

It explains some of the way the survey was conducted

In the most extreme case, a member of staff was witnessed dragging a resident towards the toilet by one arm, while another was repeatedly pushed back down into their chair by the head and shoulders when trying to stand up. Which? reported this to the health and social care regulator, the Care Quality Commission (CQC), which suspended admissions to the home immediately.

Anyone spot the problem with this? Yes, that’s right, the CQC waits for incidents like this to be reported to them and then subsequently take action. The CQC or any regulation or inspection authority should be the ones uncovering poor practice rather than being solely reacting to complaints that are made to them.

The Guardian goes on to say

The care homes were selected at random by Which? – one had previously been rated as poor by the CQC, two were deemed satisfactory, and one had been rated good – and the actors’ resulting diaries were analysed by a panel including an expert in inspection, an expert in activity and daily living, and a dietician.

Again shows a problem that has occurred since the scrapping of the ‘star’ system. Homes are still advertising the ‘stars’ and claiming to be ‘good’ or ‘excellent’ when it is outdated system demonstrating outdated inspection reports but still it is the first thing that people looking for residential care for family members.

It is very telling that a Consumer Organisation found the evidence rather than the official regulatory body.

But back to these homes and we’ll see the real fallacy in the ‘ratings’ and the inspections because despite the so-called ‘good’ inspections,

n three homes, residents sometimes had to wait 16 or 17 hours between dinner and breakfast without food, and in one home lunch was served just 1.5 hours after breakfast at 10am. For dinner one researcher was served a small sandwich and a chocolate-covered ice cream, despite them previously stating they didn’t eat chocolate.

There was a worrying lack of activity in all four homes. In one, residents constantly said they were bored, and in another not one of the advertised daily activities (including exercise, a quiz and a singing session) took place.

Does any of that sound ‘adequate’? Let alone ‘good’?

How is this allowed? Because the reduction of age and disability to irrelevance and unimportance in our society. Because care homes illicit a sense of guilt that we barely want to look behind what actually happens behind those closed doors.

This Which? investigation took four homes at random.

The CQC chair, Jo Williams is quoted as responding

The evidence Which? shared with us describes care that falls below what people using social care services have a right to expect – in one case so seriously that we acted immediately to ensure admissions to the home were suspended, and are now considering the best action for residents currently living there.

So this random sample of four included one home where the treatment and findings were so bad that it warranted an immediate suspension of admissions.

She goes on

“CQC listens to the views and experience of people who use services and look at what data tells us in order to identify possible risks, then reviews and inspects services. Seeing for ourselves what is going on in care homes is a key part of our regulatory regime – and almost all of our visits are unannounced. Where necessary, we require improvements against clear timescales or take enforcement action, following up to ensure these improvements have been delivered.”

Almost all of their visits are unannounced and they are ‘regular’ but tellingly, they are NOT frequent. Why is she not proud of the frequency?  The views and experiences of people who use services are important but how often will people feel safe in complaining.

Lest we forget, the Chief Executive of the CQC is a Cynthia Bower, who was Chief Executive of the  West Midlands Strategic Health Authority which was responsible for overseeing the Mid-Staffordshire NHS Foundation Trust where over 400 patients were found to have died due to neglect and poor care. How was she seen as able to take up the role of Chief Executive of the CQC? Not exactly a glowing track record on the regulation front.

Yesterday, Bower was facing the inquiry into the appalling levels of care in Stafford Hospital.

The Independent explains that

She told the inquiry, chaired by Robert Francis QC, that it had been “distressing to learn of the failings of care at Mid-Staffordshire Hospital and I offer my utmost and unreserved sympathy to patients and their carers and families. “I am deeply sorry for what happened and for the fact we had oversight of the NHS in the region at that time and we didn’t pick up failings in care.”

In addition to complaints, there were other alarm signals, such as reports of poor care from the Health Care Commission, the CQC’s predecessor, and of serious untoward incidents. But she said these were not enough to reveal what was going on.

“I wasn’t conscious at the time there was intelligence that we could have put together that would have said there were major failings of care,” she told the inquiry.

“I accept there were some issues we lost track of that would have generated more concern, but I don’t accept there were serious failings to put the pieces together.”

Ms Bower said the SHA did not have the capacity to have a detailed oversight of all of the region’s health services. She said the last NHS reorganisation in 2006 had caused a big upheaval and staff cuts of 60 per cent.

The first thing that springs to mind is ‘didn’t she learn anything about her role in the Stafford tragedy about the importance of GOOD regulation in the care system?’ The second thing is amazement that she should have been appointed to the CQC position anyway after such a horrific track record.

The government’s solution to this? To increase self-regulation and to out-source the so-called ‘excellence’ ratings for those care home providers that can pay.

The answer? Well, it would be more expensive but it would be more spot checking of the things that actually matter to the quality of life of users and residents in these services. How about a radical proposal that every care home is subject to the ‘excellence’ ratings whether they pay or not?

In some ways, nothing saddens my heart more than pounding on and on about poor quality care homes and poor quality inspection regimes – especially as I know that there are many very good care providers out there but unfortunately with a system of inspection which is so broken, those that are good are not recognised and those that are not good are not castigated and closed as quickly as they should be.

How have we ended up with a system that offers so little protection to some of those in our society who are in the most need of advocacy and support? By not caring enough about these stories.

Perhaps  more advocacy is a solution but it costs. Everything that is a potential solution costs. And that’s the problem.

But this is not something that can be swept under the carpet. These stories will return and I hope they do return to haunt those who are responsible for the destruction of the regulation system.

Because until they develop a conscience and a backbone, they will not go away. It’s just a matter of how many stories can remain hidden. And for how long.

Bullying

Bullying on IRFE in March 5, 2007, the first c...

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Bullying – it’s a very loaded word. As adults we’ve been through the school experiences where, if we didn’t experience it and weren’t perpetrators, we’d probably know people who were in one or the other camp.

School is just a community where identity takes hold and is shaped and as such, with children growing and developing there personalities and thrown together merely on the basis of age and location or wealth(in the case of private schools) there is no reason to believe that everyone will get on and live happily together.

Fortunately, there are some wonderful resources and help available for children who might experience bullying. Often parents will be very supportive.

Let’s turn that perception on its head though because this week, I have been discussing and processing the implications of bullying in a residential care home for adults with dementia.

This is not bullying by managers of staff or bullying of residents by staff.

This is bullying of residents by other residents.

In some ways, I’m surprised that there isn’t more debate and discussion about this. After all, in some cases, people who require residential care and who have dementia may not have many decisions about where they live. Adults are proverbially thrown together merely on the basis of age (and diagnosis), location and wealth (in the case private homes).

Why is it more surprising that the tribal nature of the human condition becomes any less apparent than it would with children?

We are still working with and alongside people who are vulnerable but are there any resources available for adults who are bullied in these circumstances or the families of adults who are bullied in these circumstances.

As mentioned above, I am involved in various safeguarding processes for an adult in a residential home who is being unfairly targeted by another resident.

Without too many details, the decisions that are taking place around the people involved  relate almost entirely to series of best interest meetings and discussions.

Should we move the target who is not even necessarily aware of what is going on around them but who is settled and has already moved a couple of times?   Or should we move the perpetrator who is adamant that they do not want to leave?

At what stage does this ribbing and teasing or just two people who don’t get on, become an imbalance in power that is usually present in ‘bullying’.

While we have come to a solid and I think, acceptable decision that is protective for both parties (and as the care coordinator for the ‘target’, she has been my primary responsibility), this case has led me to reflect on and consider other cases that I’ve been involved with where abuse has taken place between older adults in residential care settings and day centres.

I’m very surprised there isn’t more research and information about it and some of the staff in these settings seem to be constantly amazed that all people regardless of background, culture and history don’t just ‘all get on’ in the lounge to sing ‘Knees Up Mother Brown’.

Are we denying the humanity of older people by trying to pretend that they are somehow less human because they are not succumbing to some of that most human activity in ‘community environments’ of picking off the weakest or the most ‘different’.

I think by not actively and forcefully discussing issues of bullying and having plans around them, we are doing a disservice to all older adults for whom we, as a society, have a duty to care.

One day, newspapers, communities and the public will be as interested and as horrified by the stories of bullying in older people’s communities as they are in schools.

It shouldn’t really surprise us when you think about it. As I’ve said many times in person over the last few days, this is what happens in communities of humans – and there are various almost tribal elements at play as communities form into ‘stronger’ and ‘weaker’ elements. Why should this be different when we age or become unwell or a memories begin to fade? We don’t stop being human.

As a service and as a profession, we need to have plans that are as strong and protective for older adults experiencing bullying as we do for children as often there aren’t the forceful parents around to protect and defend. It is left to us, as professionals, to take that advocacy role.

There also has to be a broader understanding that things don’t always happen in the way we would like them to and more care homes and placements need solid guidance and frameworks for managing and working with communities where sometimes people don’t get on or choose to be and particularly where were a very different power balance elements at play due to differing physical and mental health needs and differences of dependencies – dislike can lead to bullying within the environment if it is not addressed.

Bullying is about power differentials. That doesn’t cease to exist when we leave the playground or the workplace. It is the unfortunate aspect of community building and the human condition and it can’t and mustn’t be swept under the carpet.

One day I want to see the same resources, organisations and policies around bullying within care homes and sheltered housing communities as exist around bullying in schools.

The Generation Game

Yesterday, I watched ‘The Generation Game’ on BBC1. It irritated me. The programme seemed geared very much to a comfortable middle class scared of losing their right to their parent’s properties. There was no ‘cutting edge’ in the debate. It was geared towards a particular audience that doesn’t link in with a large swathe of people that I might come across on a day to day basis. Remember, the poor woman who had to sell her mother’s house that she knows she and her brothers and sisters would have inherited, chose a care home which was not on the list approved by the local authority and cost £900 per week. Who exactly does she think should pay the £900 per week? Also, if all care home places were funded that would leave a massive gap in funding and at least the way of ensuring that people who can pay, do, means that more of those who cannot pay can receive services and no, this are not people who have ‘frittered their lives away’ and not paid attention to saving – but people who might have have different circumstances and situations that might have arisen or who have had lower paid jobs. It is not as simple as drawing a line and saying ‘everyone should save’. Not everyone can.

I’m not saying the current system is fair. It needs to change. But the picture painted in the first part of the programme was unrealistic and actually false in some parts.

Where the programme failed was to actually look at support for those who don’t have resources to fall back on.

Yes, the extra-care sheltered scheme was fine but if they were like the schemes in our local authority, they don’t like to take people who have anything verging on what might be considered a ‘mental health’ diagnosis (and yes, that does include dementia – ironically). I have a lot to say about extra-care sheltered schemes in general and should probably leave that for a post in itself…

I wonder if I’m the only person that thinks paying for care needed in life from ones’ estate is actually quite a good idea and has no ethical issues with a ‘death tax’.