Dementia Care Homes

I am sure I am not the only person to watch Panorama yesterday, 23^rd April 2012, and be shocked and revolted by what I saw. This programme obviously focused on one dementia care home where the treatment of a particular patient was disgusting, indeed one carer deservedly received a custodial sentence.

Let’s not run away with the thought that every nursing home or care home is as evil and depraved as this one is, but equally, let’s not start to pretend that this is a unique situation. We have seen similar reports, though maybe not so graphic, probably every year, and from all parts of the country.

The things we saw on the Panorama show were not complicated, not in doubt, they ranged from incorrect procedures to mental and physical abuse, potentially, I believe actual bodily harm.

My concerns in this instance go so much deeper than the callous behaviour and violence of the so-called carers. Clearly the poor lady featured had bruises, was frightened and there were no lifting aids available in the room. A mechanical hoist was needed to lift her out of bed into a chair, a job for two carers, not one. Obviously the management would allocate two carers to visit, if they were following the procedures.

There was need for other basic equipment, such as a slide sheet, to move her in bed, again a job for two carers.

If this equipment is not available in the room, where is it? If it exists but is not where it should be, other carers would be aware, there was no evidence to suggest that was the case. The House Management are obviously aware if they have the equipment or not, after all they would pay for it, pay for the six monthly inspections of the hoists.

It is clear that the callous uncaring people who starred in the film are not the only guilty people in that particular home, yet again there was no evidence of others being involved in the disciplinary action, and no suggestion that the management were in any way penalised, which suggests to me that they will shake this off and carry on without changing, basing their complacency on the reports of the Care Quality Commission (CQC).

That brings me to a key point… the CQC. Just what do they do to justify their expensive existence. In my opinion they tick boxes for the government, and do precious little else.

In my Carer support role, we were invited to submit reports to the CQC about our experiences on the Acute wards, we did so, openly, and in a professional and constructive way. The report covered a number of pages, listed a number of problems in each of I think 7 different complaint categories. Each point we raised was a serious and disturbing failure, many jeopardised the dignity of the patient, most jeopardised the health, safety and security of either the patient or the carer… or both.

Imagine our surprise when the report came back, in our view whitewashing the wards and taking no action in terms of improving things. When we sought a meeting with the CQC, we were met cordially by three senior officers who waffled inanely through their story, but ultimately confirmed that when they do inspections they look at whether there are proper policies and procedures in place, and if the practice is to follow them.

They do not, and cannot, they tell us, inspect how well the procedures are carried out. The implication of this is that their reports reflect purely the theoretical performance of the unit rather than the actual performance, and do not pick up blatant incompetence or bad behaviour, such as we witnessed on the Panorama programme.

Is the example we saw simply a case of a few carers not delivering an acceptable level of care? I don’t think so, we have considered the existence of hoists, and their availability, if they are not available, the home cannot function, if they are available but not used, it is surely an endemic problem, which those in charge just must be aware of.

The CQC passed the home as being of a high standard… did they not notice there were no lifting aids? Were they not aware of patients with suspicious bruises? It is not possible to think this one poor lady was singled out for abuse and the other treated perfectly is it? What did the CQC actually inspect, and how? Clearly for them to have come away not condemning the practices, as they did at the hospital I was involved in, they have not checked things properly, they have in my view desperately let down the patients who have suffered so much, and their carers who have gone through so much heartache, upset and distress, as they have let down everyone who is involved with any hospital or care home that doesn’t deliver top quality care.

The things that come out of this are manifold… firstly the CQC accreditation means absolutely nothing.

Secondly, we are supposed to live in a civilised, advanced culture where we do all in our power, even pass laws, to protect our most vulnerable people. No-one is more vulnerable, in my view, than a baby or frail elderly person suffering from dementia, who has fallen victim to the condition through no fault of their own. Yet these are the very people we see abused in the care home. Alright, one carer, the one who repeatedly struck the lady, received a custodial sentence. Under the current health and safety legislation, if a worker, or someone on the premises, suffers an injury, the Health and Safety representative and indeed the responsible director can both be seen as guilty if there is any shortfall In standards responsible for the injury.

Clearly in this case the owners and management of the home can be seen to have failed to provide the correct level of care, and need to be penalised along with those who delivered the blows. The very least penalty should be to immediately bar them from any position where they are responsible for the care of vulnerable people. Will it happen, I doubt it. The law will allow them to continue making large sums of money from stressed, weary, worried people for the care of their loved ones, and repay them by cutting every corner and abusing their charges as before.

For anybody who, like me, is in the process of securing an appropriate care home for their loved one, how do we decide… what can we look at to satisfy ourselves the home is good… until the government installs inspectors with some bite, who will honestly investigate every aspect of the care, from policies to individual performance, as well as contingencies, there will be no way of knowing. It will remain a lottery whether we place our loved ones in a quality caring home or into the hands of abusers.

We cannot accept this situation any longer, we have to have guarantees of care standards in every single establishment where people are cared for, there has to be a procedure to remove and ban any individual not fulfilling their care responsibilities properly.

Until then, we hope, pray, worry…. And if we are lucky, if our loved ones are lucky, we find a good caring home for them. If not… we live with the regret and sorrow indefinitely.