When my grandfather was in his last week of life I was sitting by his bedside in the local community hospital as he dozed peacefully in a morphine assisted haze.
Suddenly, all hell broke loose next door. I stormed into the other room to see a small group of care assistants throwing pillows from one to another and loudly humming the theme tune from Star Trek.
“Do you mind?” I said: “there’s a man dying in there”. An instant spokeswoman apologised unreservedly but went on to point out gently: “It’s hard for us too and we have to have a bit of fun and let off steam sometimes”.
Much has been made of a report about the neglected dignity of the elderly but am I alone in feeling a little uncomfortable about an array of well-paid people from the media, pressure groups and politics gathering to point the finger at care assistants who do their job for a pittance and without any career status? Of course low status and poor pay are no excuse for treating the human rights of the elderly with contempt but they can set a context for why things sometimes go so badly wrong in care settings.
As someone who has visited many homes as a relative, as an Age Concern advocate and worked in them as a dementia reminiscence worker I would say the following:
1. Most homes and hospital wards survive on neutral care. There is little (but alas some) deliberate cruelty, but many staff simply do not go the extra mile and just get by. Staff ratios do not allow the level of human contact patients and residents deserve.
On one 24 person unit where I worked one lady continually (all the time she was awake) called out threatening to self-harm. With five staff it was simply impossible to sit with her all the time and comfort her. All the elderly people on that unit were vulnerable, most had dementia and one was dying. In order to give everyone a reasonable level of care that lady’s needs sometimes had to be ignored. It was a numbers game, a constant weighing up of different risks and cries for help.
2. The very elderly are almost never seen as citizens or customers with a voice. Go to a budget hotel and within moments of returning home a feedback form will pop into your inbox. Most local authorities consult on most things to the point of consultation fatigue. But with older people no-one asks. Where is community politics for the elderly? Even people with advanced dementia can give you some idea about what they like and dislike.
My husband and I have both worked with older people and we sometimes joke that in our 90s we too will get “Roll out the barrel” and Vera Lynn’s greatest hits at the day centre (rather than theBowieand Britpop of our youth) because the model of care is so static.
3. It is dishonest to pretend that this is not about resources. The coalition has updated the last government’s dementia strategy with lots of improving thoughts about people’s “dementia journey” but it remains a menu without prices.
Liberal Democrats are right to honour Lloyd George’s words that we should judge a society by the way it treats its older people but let us also spare a thought for the carers changing the sheets, doing the enemas and taking the flak all for a miserable £13,000 a year.
* Ruth Bright has been a councillor in Southwark and Parliamentary Candidate for Hampshire East
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9 Comments
Ruth,
what an inspiring and though-provoking post. We had a brief discussion on another thread
Job guarantees
as to whether the young employed (16-24 old’s) can be effectively trained and deployed to provide transitional support for social care needs . What would your thoughts be on this?
Thanks Joe. That’s an excellent idea. Many very elderly people are deprived of the company of the young and vice versa.
Bluntly, ageing is a growth area so the jobs and placements are recession proof. I am so glad I worked with people 60 or even 70 years older than me when I was in my 20s; it has shed light on so many policy areas that interest me in middle-age!
It is certainly true that the quality of care for elderly people, especially those with dementia, is not good enough in many settings. But it doesn’t have to be like that – and the solution is not one that requires cash thrown at it.
My mother died of Alzheimers last year and she spent the last three years of her life very contentedly in a specialist home run by my local council, Kingston. Everyone involved in the home had taken part in an American training programme called the Eden Alternative (http://www.edenalt.org/) – and by all, I do mean everyone, cleaners, cooks, care staff, relatives and residents themselves. The whole focus was on respecting and understanding the needs of the residents and remembering always that this was their home.
One little cameo: One day I went into the lounge and the cleaner was holding the hand of one of the ladies who lived there and they were telling jokes to each other. In any other setting she would have been reprimanded for not getting on with her work – here that was considered to be part of her work.
During the last year of her life my mother was virtually bed-bound, but people called in to chat with her at least every 15 minutes and often stayed for much longer. My only fear was that she would have an accident and end up in hospital, where the culture of ‘care’ is so different.
Yes, care staff are poorly paid and something should be done about that. But this approach to care had its own rewards. Many of the staff said how much they loved coming in to work, and were proud of what they did. They are now sharing this vision by training others in care homes around the country. (And, yes, it is a Lib Dem run council, who have said they will never pass this specialist home for dementia into the private sector because it is too important)
Mary – it’s wonderful that you found somewhere so special for your mother. It’s certainly true that even in the late stages of dementia people can make new friends and enjoy creative activities. None of us need end up spending our final days slumped in front of the TV in a smelly commual sitting-room – but many still do.
I have been an unpaid carer for three years and i have experienced at first hand how broken the ‘system’ is.
The poor treatment i have received have spurred me on to become a campaigner for carers rights and as a former trade union rep i have focused on the terrible working conditions of workers in social care.
In my time as a carer we have had a variety of ‘home helps’ from three different companies all very low paid and under terrible pressure from the employer to fit too many calls into their shifts.
These firms are employed on a contract by the council but with one exception [our local involvement network] all my attempts to highlight the obvious failings have fallen on deaf ears.
I do wonder sometimes if we are losing sight of what being a Liberal Democrat is all about.
As a son of a Dementia sufferer in nursing care can I say you are absolutely spot on..
It is not just care assistants, my wife, an RGN, stopped working on the wards and in care homes as she felt the opportunity for her to give “proper” nursing care (her terminology) was no longer there due to manning levels.
My father is in a great care home, with lovely staff who try their best but just cannot always give all they want to.
some things don’t cost anything. An elderly lady that I visit sometimes is upset that the home she is in call her “duck” or other such endearments. She wants to be called by her first name. Doesn’t cost a penny, or a minute for simple things like that.
Suzanne – agreed that “small” things like the way one is addressed matter when it comes to dignity.
Steve – agreed that many great staff burn- out or opt-out because the environment does not allow them to give the level of care they would wish. Mary’s example is a very good one – stopping to chat should be seen as part of the job.
Dave – I sympathise. Discontinuity of care is one of the most distressing things about the system as it stands.
Thank you for this thought provoking piece. Older adult continuing care is one of the most challenging environments to work in as a nurse or carer. You work with people with a variety of conditions and healthcare needs who need high levels of nursing, personal care and psychosocial support, yet care homes and care of the elderly wards in hospitals are chronically understaffed. One of the hardest aspects of working in care homes for older people is that you develop strong relationships with residents and their families but you also have to accept (to put it bluntly) that many residents will not get ‘better’ and will only deteriorate and eventually die.
I’ve undertaken nursing placements in care homes with vastly differing experiences and have seen (and reported) poor care but thankfully there is some really good work going on in many care homes. Not sure if you’re aware of the My Home Life programme http://myhomelifemovement.org/ who are doing some great work. I’d encourage anyone with links to care home management to direct them to this website. It has some great resources for improving care for older people in care homes.