Help me find out how to address the UK’s care crisis


9:04 am - May 22nd 2013

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by John Kennedy

Ever since I first worked as a care assistant in the mid-1980s, care homes have been in some kind of crisis or turmoil. The issues are the same now as they were 30 years ago. The pressures, though, are growing more and more acute as our society ages.

I am now responsible for the management of a range of services including care homes and housing-based support and I want to find out what we can do about it. That is why, supported by JRF, I am embarking on an inquiry into risk and relationships in care homes.

What is it that needs to change? The half a million people currently living in care homes is likely to rise significantly in the near future. These people are our parents, our siblings, our friends and one day ourselves! Chronic concerns about quality of care, funding, pay, regulation continue to persist, in spite of numerous commissions, inquiries, regulators and Government interventions.

I want to get under the skin of care homes in the UK and discover what people really think, what has to change, what is good and why.

Over the next 12 months, I’ll be visiting care homes and talking to people with real experience; residents, relatives, friends, care staff, managers, cleaners, volunteers.

I’ll also be posing a series of questions to expose the real issues, get an honest debate going, and expose the contradictions and misconceptions that exist in the relationship between care homes, residents, staff and the general public.

So please let me know what you think, by:

What do we already know?

Care homes just don’t seem to work for us. Or do they?

A recent MORI survey found a surprisingly high level of satisfaction amongst care home residents. Are care homes that awful? Are our expectations too high or too low? What is the reality?

What makes a good care home and what gets in the way? Is there something about our attitude to risk? Do the ‘rules and regulations’, designed to protect and ensure quality, do so or do they actually get in the way? Are they the right ‘rules and regulations’?

What do I want to do?

I want to get out there and visit people and places known for excellent relationships – to understand how this has been achieved. I also want to visit and speak to people in places that are not succeeding. I want to hear why. What is in the way?

I want to encourage people with experience and knowledge to talk about what they think is really the problem. I am sure there is plenty of ‘unspoken’ truth just waiting to be heard. I also want to speak to people with no experience of care homes. What do they think, what is their perception?

This is personal, because if I am fortunate enough to live to a good age I want to be cared for in a nice place by valued and compassionate people – people who treat me kindly and have the time to care.

So please join me on this journey and let’s see if we can make a better future.


John Kennedy is Director of Care Services at JRHT

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Reader comments


1. the a&e charge nurse

‘Care homes just don’t seem to work for us’ – I think your first instinct was correct – but I would go further, care homes never have, and never will work for us, not really.

First of all who in their right mind would want to live in such an environment – sharing a characterless day room with a community of coffin dodgers?

People only go to such an artificial environment because they are so desperately isolated, or have the sort of needs that even their own family can’t manage.
Put another way, who, looking at all of life’s choices would see the care home as anything more than an admission that life has become so circumscribed that it it must be placed in the hands of care assistants, a poorly paid, and socially unvalued role.

Who was it who said that the main job of government will soon revolve round the problem of getting money from young people in order to pay for the care of the old?
I’ve heard it said the average cost of a care home placement is now getting on for 30k each year.

Some figures say there were 18,378 registered care homes, with a total of 453,472 registered places in England – around half this population suffer dementia.
http://www.rcn.org.uk/__data/assets/pdf_file/0006/314547/Policy_Report-Care_Homes_under_pressure_final_web.pdf

I can’t help thinking that since care homes have always been regarded with a sort of dread, I don’t imagine this situation will change anytime soon.

2. white trash

“coffin dodgers”???

I’ve had my doubts for a while, but please, please, please, tell me you’re not a real nurse …

3. the a&e charge nurse

[2] I agree with Martin Amiss
http://www.youtube.com/watch?v=ZUN496K1MxM

‘Coffin dodger’ may be an upsetting term for some sensitive flowers but the mass form of self denial that goes hand in hand with great age, and dying is a bigger problem in my opinion.

4. white trash

Question neatly avoided, “nurse”.

People are in a pathetic and cowardly state of denial about the facts of life and death though, too true. Sickening isn’t it? Just think of the resources lavished on the globally privileged to wring out a few more months or years, while young people in the impoverished countries are being denied even the most basic nourishment and health.

Ultimately it’s a cultural issue for rich Westerners. At the moment the fashion is for clutching desperately onto any sham of “life” in ourselves or loved ones, regardless of how degraded or downright agonising it is.

We need to be working towards a better situation where dragging things out ignominiously is recognised for the disgrace it is, and it becomes the cultural norm once again to face facts and a good death with courage and dignity.

5. the a&e charge nurse

[4] is it your proposition that anybody who uses a phrase like ‘coffin dodger cannot be a ‘real’ nurse – or maybe you think nobody can distinguish between personal opinion and professional responsibility?

Don’t fret yourself, A&E staff are bound to treat/resuscitate ALL patients no matter how old, or frail they are (unless there is a signed do not resuscitate order) – none are sent back to the care home until they have been examined and investigated.

I’m just saying (language side) that care homes have always been fraught with the kind of difficulties that go hand in hand with batch living and institutionalisation – sorry if such views are incompatible with being a ‘real’, or perhaps you meant registered nurse?

6. white trash

Ooh, seem to have struck a nerve here. Sorry, clearly I must apologise for facetiousness, levity and persiflage; naughty slap on wrist.

“… maybe you think nobody can distinguish between personal opinion and professional responsibility?” Well, some can and some can’t, it very much depends on the person. However, since this OP was clearly initiated by John Kennedy as part of an inquiry into a sensitive topic, the term “coffin dodger” seemed risibly and shockingly out of place in the serious context.

Nurses that I know simply wouldn’t use the phrase in public. A lot of them wouldn’t even speak like that in private because they’re Xian religious obsessives.

7. the a&e charge nurse

[6] perhaps he will prefer terms like the ‘sham of life’, and he must be thrilled to learn those in the care homes are ‘globally privileged’?

Anyway, shroud the subject in pseudo-gravity if it makes you happy? But it is just rhetoric, it won’t affect the daily reality of those consigned to gods waiting room.

8. white trash

“Perhaps he will prefer terms like the ‘sham of life’, and he must be thrilled to learn those in the care homes are ‘globally privileged’?”

Ha ha, doubt it. But then I’m not claiming to be any kind of nurse caring for these people am I.

If you don’t appreciate that everyone here in the UK is incredibly privileged, even including “poorly paid, and socially unvalued” types like me, then you need to spend some time living in Syria, Somalia, Chad, Burkina, Nigeria, Sudan, Ethiopia, Mozambique, the list goes on and on … to see the reality of the polarised world.

9. Planeshift

If you worked in an A+E and had to deal with elderly people dropped off in A+E with “chest pains” whilst their families went on holiday – and had the same family turn up again next year – you might end up with a slightly negative view of humanity as well.

The short answer to the question is that social care is the responsibility of local government, therefore almost by definition it is crap.

10. white trash

If you worked in an A+E and had to deal with elderly people dropped off in A+E with “chest pains” whilst their families went on holiday – and had the same family turn up again next year – you might end up with a slightly negative view of humanity as well.

Well, you might think so, and indeed I do have a “negative” as you put it view of humanity (I’d prefer to call it realistic, obviously)

In contrast, however, nurses I have come across tend to have a creepily optimistic view of humanity, often, as I say, because they are Christians, which is frequently why they went into nursing in the first place; it attracts people who want to spend their time ministering to the sick.

11. Charlieman

@9. Planeshift: “The short answer to the question is that social care is the responsibility of local government, therefore almost by definition it is crap.”

As an old fart liberal, I reckon that social care and health care should be run by a (reasonably sane, economically rational) local authority. Give local government something to do and change the tax system to permit local choices. That is my ideal.

Returning to the argument: care for the aged and general health care are intertwined but nobody wants to pay for either; a system that creates ping pong between LA care home and NHS makes everything more expensive; so dump everything in one local budget owned by one local controller.

12. Uncle Beelzebub

For what it’s worth, I spent a large part of my early childhood in what were then called Old People’s Homes – this when they were still run by the LA.

By the age of 7 the old men had taught me how to punch someone in the liver, break their nose, chop the carotid sinus, rabbit punch the back of the neck, insert a knife down between the collarbone and shoulder-blade so that it would sever the main blood vessels in the neck and pierce both the heart and lungs, and kick a door in and shoot the occupants before they knew what was happening. They also taught me to stoke the boiler, stand up when old ladies came into the room, roll cigarettes, and swear like a trooper.

It was an excellent education for a young child. I think that I brought a great deal of happiness to a quite a few old men – so much so that I was left two sets of medals.

None of that would be allowed nowadays though so I suppose any suggestions from me are out of the question.

12

Having spent the last year visiting care homes, I can confirm that there is little chance of learning the skills you describe and there’s probably good reason. Not that those skills could be useful, but the majority of people who now reside in care homes have very complex mental and physical health needs. The fact is, we as a society are totally unprepared for the problems now encountered by old age, one reason is that people are now living longer and dementia has become more prevalent.

Re; the OP, FWIW, my own experience of care homes suggests that homes within smaller local communities, and staffed by people from the same community, tend to produce the best outcomes. Larger care homes within urban/town areas appear to fair worst.

Unfortunately, A & E Nurse says it how it is, we, as a society, do not value the aged, few families can’t or won’t take responsibility of their relatives and we are totally unprepared for the reality of old age.

The ageing society has been described as a ‘demographic time bomb’ and that is exactly what it is.

14. Charlieman

@12. Uncle Beelzebub: “By the age of 7 the old men had taught me how… [censored]”

So what did you do in life with those skills? There must have been loads of jobs during the cold war years for an international assassin.

Apologies for trying and failing to take the michael out of an old man.


The stories that old people tell are illuminating. But old people clutter the streets, and youngsters (anyone under 60 years of age) have no time for them.

At the age of 50 years, still able to squeeze into 30″ waist jeans, should I care about Uncle Beelzebub?

Err, yes I am bothered, not for his fine anecdote delivery or for my own reality of growing into 32″ waist trousers.

I don’t know what will happen to me when I am old so I avoid considering it. I think about the reality of care for the aged today and cannot imagine myself in their place.

I’ll ponder my circumstances seriously in a few years when it is too late to change anything.

15. white trash

13: “We are totally unprepared for the reality of old age.”

“The majority of people who now reside in care homes have very complex mental and physical health needs”

I agree.

My father became extremely disabled while still comparatively young, in large part due to his unhappy life and stressed lifestyle, and he went into a home at a relatively early age compared to most nowadays after being cared for my mother for a number of years, with increasing difficulty.

Of course he would have preferred my mother to keep slogging away caring for his needs, and when he went in he said “I won’t be around more than a couple of years more” and he was correct.

My experience of seeing that and my grandfather before that suffering with early onset dementia has helped me to understand that being forced by societal norms to suffer and linger around in this degraded state is cruel and wasteful.

We don’t treat animals so badly, so why do we do it to each other? A year or so ago our much treasured dog started having minor fits occasionally. We didn’t want to lose her so we kept her hanging on. With hindsight, that was wrong and I now wish we’d given her euthanasia a bit earlier.

When I go I want to go quickly, and not too far beyond the point where I’m packing in and no longer able to look after myself.

Since I have no children and no pension that shouldn’t be too difficult, as I fully expect that over the next 20-30 years, as I move into my 60s and 70s, that resources will get ever tighter, and young people will revolt against the idea of paying what little they have over to us oldies so that we can spend it all on ourselves.

The “care crisis” is only one small part of the wider socio-ecological crisis engulfing our society.


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