News and Comment from Roy Lilley, 9th April 2018
How
much credibility can you attach to a study that involved talking to 14
people, outcomes for a handful of patients and four places?
Not a lot…
Why
would it take five people? I have no idea. How could it be so
complicated as to require a ‘mixed methods approach, incorporating
retrospective cohort analysis and semi-structured interviews conducted
with staff’.
Gawd knows…
Except, I’m pleased someone has done it. It’s the Nuffs.
It’s a vanity project commissioned
by the Barking and Dagenham,
Havering and Redbridge CCGs to evaluate their new primary care service,
piloted in four nursing homes who previously had difficulty accessing GP
services. They knew it was good and very similar to approaches elsewhere and a hoop-la evaluation was superfluous but…
The NHS struggles with a hidden problem. Something we don’t talk enough about.
Think
very carefully before you put yer granny in a care home. They don’t
want to be useless and they don’t set out to be useless but a
combination of circumstances conspires to make the whole care home
concept useless, worrying and in some cases unsafe. There was a time when there was an identifiable difference between a care home and a nursing home.
Not any more.
- Yer
granny goes into a care home because she needs a bit of help to rub
along. Before you know it, her daytimes are nowhere near meaningful,
one week blurs into the next. - Family
don’t pop-in as promised. She misses her neighbours. Her husband died
four years ago and each day brings its aching memories and loss of
companionship. - She is forced to live with people she doesn’t know, many of whom can’t remember who she is today, tomorrow or yesterday.
- Medication
management is lazy, she stops eating properly and retreats to a room
with a single bed and pictures of her memories on a shelf. The rest in a
box in the wardrobe. She knows she’s warehoused, waiting to be with
her husband. - Her
acuity drops off a cliff. She’s confused by staff whose first language
is not English and churn so frequently she has no idea what’s what and
who’s who. - By
then she’s on the cusp of nursing care but she is in a care home. When
the Nora Virus does the rounds the staff, untrained to cope, terrified
of liabilities, ring for an ambulance.
Don’t tell me none of this happens… I get ten emails a week about care home standards.
Somebody
wrote to me the other day. They work in a care home that, six times,
called for ambulances, for six different residents, in one day.
A&E admissions from care homes are up by 62%.
When
it’s time for yer granny to be discharged, because she lives in a care
home and not a nursing home, she’ll need a visit from the community
nurse, the community pharmacist, the chiropodist and a GP… don’t
expect a care home to do this. It’s a nursing job.
Then there is money-thing. There isn’t any. Local authorities buy
care home places, priced at the bone. If yer granny has to pay for
herself; she’ll be ripped off.
Quality of the care… forget it. A quarter of the big homes might be failing.
Really? I hate to think about the rest. One home a week going broke. The CQC are spectators.
Don’t
put yer granny in a care home. Go on a carers course, take leave of
absence from work, use yer granny’s money to replace your wages and look
after her yourself. If the government had any sense they’d encourage
this with tax breaks.
I
can’t think of a more fragile corner of health and social care
provision, policy that is so moribund, politicians so useless, society
so left gawping.
Twenty seven organisations
claim to represent the interests of the elderly and when push comes to
shove… what have they done? Care homes… do me a favour.
The Nuff’s dinkey-do report is right. Dynamite right, it tells us what we already know. But, we can’t say it often enough.
The Academy has examples; here, here, here, here, here, here, here, here, here of which these are just a few.
The
uniting theme, predominately, improvements arise out of frustrations
with poor care-home performance, third parties going in to sort them
out.
It
should not be like that. The industry and the CQC need to step-up, fix
this.
Care homes must up-their-game. There are no nursing homes, no
care homes, just safe homes.
The
real message; do not register a care home without a rock solid balance
sheet and a performance bond, 24-7 nurse prescribing on the premises,
weekly visits from on-call GPs and recognise…
…the clue is in the word, c a r e; comprehensive, available, robust and effective, not warehouses.
