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Sir Gerry,was on tv tonight trying to get so called care homes to work properly and to offer some sort of basic care for their residents.
While all the homes featured showed good careing staff,working for a menial wage,the management appeared to care less,only thinking about profit,and petty little things,like the night staff eating half a loaf of bread,and stopping free meals for staff working 12 hour shifts,with no canteen to go to.
The manager of one home had NO training of dementia care,and appeared to not know anything about the gradeing of the home.
Yet they charge £450 to £750 pounds per week.
Yes, I watched it. My father has dementia and is in a nursing home.
Our family visisted several homes before a decision was made. One of them was truly shocking.
However, I don't think we get the whole story with these programmes. One of the STW'ers was featured in one a while back and said editing certainly took place.
I did not watch the programme - I may watch the repeat
A subject dear to my heart as a dementia care specialist is how I consider myself. I have run nursing homes and dementia care units within nursing homes.
Unfortunately once again money is at the heart of shortfalls in care. In the 1980s / 90s a political decision was made to privatise care of the elderly and make provision in the private sector rather than the NHS. while this has some clinical justification the main aim was reducing costs.
The dementia care unit I ran was amongst the best - paying staff above the industry norm ( but still well below NHS rates) and charging suitably for it - up to £1000 per week. At that level of funding care can be adequate. Good care costs more that that.
At the £450 level of funding that is the state support level good care simply is not possible. Care staff will be paid the minimum wage and there will be virtually no profit for the private companies - I know I have seen the figures.
If you have low pay you get on the whole poor quality staff - and that goes from the cleaners to the senior management of the homes. a manager of a nursing home will be earning less than £30 000 pa for running a business with a turnover of a couple of million per year - and will have nothing but legal minimum terms and conditions.
Recruitment and retention of staff at all grades is really difficult - hence the reliance on overseas workers many of whom have been conned into coming then end up working ridiculous hours to earn the money they need.
simply put - you get what you pay for and decent dementia care costs at least £1000 pw.
some sample figures - all back of a fag packet.
120 bed nursing home Income if you accept the state funding of £450 a week is around 2.5 million pa. Wages for the staff will be 1.8 million. Payment for the building will be around £200 000 pa. That only leaves 0.5 million pa to cover food, energy costs, replacement of equipment, rates, staff training, etc etc. Not much room for profits and that is with all the staff being paid the bare minimum possible.
A grand a week!! my father my well end up in a nursing home soon, if my mother can not care for him. You can see why dignatis is such a popular choice.
Tails - Argue and fight for home care for him. Ultimately its your mothers decision but a lot can be done at home and often more than the local authority wants to because again of costs.
We're in a sad state when companies care more about profits than peoples standard of life in their care. I saw half the show last night and it really pissed me off. I'm going to watch all of them on catch up this weekend.
companies care more about profits than peoples standard of life in their care.
If I understand TJ correctly, it isn't about companies caring about profits, it is simply that they cannot exist if they do not make unpleasantly severe economies. An experienced manager taking home less than 30k is arguably someone who cares a lot.
An interesting post there TJ. It really is quite frightening food for thought. After all, an awful lot of us will be affected by dementia.
Gerry Robinson was surprised that the garden of one care home was not utilised. Where my father is, the garden is nice but probably not used as much as it could be. However, the actual logistics of taking just a few residents out there and watching them is a nightmare.
For example, around 6 residents were in the garden when one decided he wanted to put his chair in the middle of the flower bed that had a picket fence around it. Meanwhile, someone else needed toileting, another went wandering over to a gate to escape, another wandered off in another direction, another was getting distressed, another nurse was needing help with a difficult resident etc etc.
What does make a huge difference to my father though is music. The care home pays for a singer/pianist to visit now and again and it makes a huge difference to their lives. The enjoyment from the residents is immense.
tails - I'm sorry to hear about your father. It may well differ around the country but the "at home" care that my father could be offered was very little hence him being placed in a nursing home.
Interesting comments on this thread.
I've no direct personal involvement with anyone with dementia but I thought that this was a really thought-provoking piece of TV. Fair play to the Gerry Robinson for getting stuck into this issue and opening up the issues to a wide audience in an intelligent way. I must say that I couldn't help thinking how well-meaning some of the carers were but at the same time how they were just not up to the job of engaging in a meaningful way with the residents...
I know of good homes and bad homes. the bottom line is they should pass the "would you put your mum there?"test. I have recently whistle blown regarding a truly shocking care home.2 Patients have died who can't protect themselves throiugh neglect. the response of care standards/ local health board/ and the local social services were woeful and inadequate. It seems that lip service was paid to my concerns when IMO the home should be shut down. There was little point in whistleblowing as the people who are there to protect vulnerable adults couldnt give a toss.
I had better watch the programme when it is repeated.
The finances are incredibly tight in nursing homes these days - it is a competitive market and very much money driven. There are effectively two parts of the market. The state funded residents where you get £450 a week ( it varies) depending on the area. At that level of funding the care staff will be paid around £6 an hour and will get legal minimum terms and conditions. IE no sick pay / 24 days leave this year etc. Nurses will be paid around £11 an hour on the same poor terms and conditions. This is significantly less than the NHS so recruitment and retention of staff is very hard. The result is you have poor quality staff and high staff turnover. You cannot pay staff more without taking the home into loss. Therefore standards tend to the lowest common denominator.
The other part of the market is the homes for those who can pay. This is also a very competitive area as all homes want these paying residents as you can charge more. £600 - 700 pw is common and up to £1000 is not unheard of. However more is expected in terms of hotel care - basically the quality of the surroundings and this costs money. However this is also a competitive market and thus occupancy rates are lower. At this point in the market wages can be higher to easer recruitment issues - but still are lower than the NHS.
When wages are kept down by a lack of cash recruiting and keeping staff becomes very difficult and you often end up with a choice of poorly skilled staff or none at all.
I went into working in nursing homes 8 years ago to develop the skills to own my own home. However I quickly found that it simply is impossible to provide care of the quality I would like with the finances available.
I keep banging on about wages - but staffing costs are easily 50% of the costs of running a home. The minimum numbers of staff on duty are set by regulators - thus you get pressure to keep wages down.
doctornickriviera
You are absolutly right bar I would say there are adequate and inadequate homes.
around here I know of a couple of homes that have been closed by the regulators.
Again the issues are a complex. The NHS is under great pressure on beds and over delayed discharge. Many of the people with delayed discharge are awaiting nursing home beds. closing nursing homes = more delayed discharges. Homes are put under extra surveillance by the regulators and indeed closed tho.
Please don't think I am defending inadequate homes tho - I am not. I am merely attempting to show the causes of why these homes are inadequate.
This stuff is my bread and butter. It depresses me no end as I work with the most damaged of people over 65 with Dementia and mental health problems. In providing care at home we are limited to a budget of £300 per person unless we go to a special panel of senior social work managers who can authorise a higher spend. If the cost is going to be above what an accommodated nursing care bed would cost £540 (Scottish National Standard)(£464 for residential rate) then there is immense pressure to place someone in care. The sad thing is that with the behavioural problems that many of our patient/clients have, a lot of the private care homes locally (there are no Local Authority ones in our area) will not accept them. There used to be an enhanced funding rate for people with challenging behaviour or higher needs, but this has been stopped. We are left with people either at risk in the community, or people blocking acute assessment beds in hospital.
The urgent issue, from my point of view as a frontline worker, is do we, as a society, really care about the good social and nursing care of our older and vulnerable people, and if so, why are we not prepared to pay for it? Everyone seems to want everything for nothing, and the money is running out. Certainly in Scotland, I predict the end of 'free personal care' in not too long. It's just not affordable. People forget that the care has to be paid for from somewhere. It's a topic that keeps getting forgotten as people bang on about how we need to spend more on schools and hospitals and also forgotten about when Social Workers are branded social pariahs. We don't all take kids away/don't take kids away soon enough. Some of us are trying to make sure that your granny isn't left hungry and sitting in her own urine all day.
Mini rantette over!
We had 5 years of my father-in-law in a home, funded by us. £600pw is cheap, and we were glad we didn't have to depend on state funding.
What we really need to do is agitate for higher payments for the state funded patients. If the government does not want to run the homes, then it should adequately fund them so that staff levels and remuneration are adequate.
Those of you with parents hitting their 60s need to ask yourself, can you afford £30,000+ per year per parent?
Get heavily involved in this right now, because the alternative is to do what we did, and pay for it yourself.
So TJ so it seems that it's ok to dump old people in old inadequate homes as long as it frees up an acute hospital bed. Great that! I know that's not your opinion but if that's the system great.
Not quite Dr Nick - but for sure there is pressure that way.
However I know of 3 homes that were closed by regulators in the Edinburgh area in the past year.
Edit : - and a couple of others that were effectively taken over by regulators.
ok to dump old people in old inadequate homes as long as it frees up an acute hospital bed.
That's exactly what we're being pressured to do by senior management in Social Work. It's awful. "get them moved, they're over their 6 weeks" Never mind that there's not a vacant bed in a care home near the family, or a vacant bed in a decent care home.
surely £52000 pa is a very poor deal for a low or negligable quality of life ? I'd far rather peaceful euthanasia.
Indeed, Simon. People are living longer, but increasingly not living 'better' ie: free from illness/infirmity.
SFB - £1000 pw should and usually does provide decent standard of care. its the £500 pw end of the market that is poor
£1000 pw should and usually does provide decent standard of care
fair enough, but can society and individuals cope with the burden of all this care for clapped out wrinklies ? If they need looking after their quality of life must already be severely compromised 🙁
We're already demonstrating the low worth we place in older people by the poor standards of care we allow to continue.
We're already demonstrating the low worth we place in older people by the poor standards of care we allow to continue.
quite frankly unless I had a high expectation of being restored to full functionality I'd much rather be dead than submit to "toiletting" 🙁 Perhaps the valuation we place is realistic ?
simonfbarnes - Memberfair enough, but can society and individuals cope with the burden of all this care for clapped out wrinklies ?
Easily - but it needs to be paid for. Just a chunk more tax or a redirection of spending. We have the wealth we just don't want to spend it on this.
If they need looking after their quality of life must already be severely compromised
Sometimes yes sometimes no.
I have looked after people who still get a lot of enjoyment out of life and those who really are existing in a futile way.
Easily - but it needs to be paid for. Just a chunk more tax or a redirection of spending
while that may be true now, I suspect eventually the demographic age shift will result in an overwhelming number of dependent oldsters. I don't know what proportion of the elderly will require full time care
"The prevalence of dementia increases exponentially with age, affecting one person in 20 over the age of 65 and one person in five over the age of 80 (Hofman et al, 1991). Dementia currently affects over 750,000 people in the UK (Alzheimer’s Society). It is estimated that by 2010 this will rise to 870,000 people and by 2050 to over 1.8 million people (Alzheimer’s Society)." [Sourced from a presentation by our Old Age Psychiatry Consultant.]
Someone better with numbers than me, do the maths to find out the ££££s
Any country that can afford a war and not afford to look after its aged and ill people has its priorities wrong.
C.mon guys, the fact is that providing care via the public sector is no good, it's inefficient, the staff are lazy and incompetent, and the private sector is much better with people who can operate effectively in the real world.
Therefore the level of care recieved when driven by profits must be much better than if it was provided by the public sector - I know, I read it on STW.
My dad's in his fifth care home, not including any 'hospitals' he's had to stay in. Only 2 were half-decent. One was worse than you see in a horror movie. Brought me to tears every time. Yet they took their shilling and then some.
Such a cruel illness; thankfully he's unaware he's been ill for 7 years.
Its on again BBC, 21.00hrs, part 2.
Well im sending the woman moaning about the staff possibly eating half a loaf,a pound to pay for the loaf as she must be on her last crust.
Remember boys and girls,one day this could be us,our families or freinds.
Or is already,sadly.
Sorry wrong info, its on next Tuesday night.
Well I got a little extra from my Monday night shift in a private dementia care unit - a dose of the shites!
hmm care homes, i get to spend a fair bit of time visiting people in care home. A [i]very[/i] varied bag.
As TJ says a huge and complex issue.
Did i hear a couple of months ago that the gov were exploring amongst other options compulsory personal insurance for the social element of care?
Wonder how much Edinburgh's Community Rehab Service costs. Wife says it's ridiculously expensive. I would hazard a guess at a shed load more than a grand per week.
Per person?
Yip. It's a physio/OT type service though. They are trying to get rid of it because its too expensive.
I know ther one. Nothing like £1000 per week per person - and if it keeps them out of hospital its good value.
Couple of hundred per week per person I would have thought
The prog highlighted so many issues about management of Dementia. What concerns me is the fact that patients with dementia have to go into private care homes, council one's don't exist, yet it's the state that provides so much of the income. Privatise and the care ethos gets turned upsidedown, profits always come before care. Council or state run places are better regulated and the training and regulation is statutory and mandatory, staff turnover isn't an issue, care far better in my experience. So, if you need residential elderly care you have access to a good standard of care, if you have established dementia you have to go to the private sector, two-tier healthcare provision? Shouldn't all people who need care be offered the same standards within their chosen locality. Shouldn't the benchmark standards have parity within the 2 care sectors? Are they set too low for the private sector to achieve a ticked box?
With the growing dementia issue within our lifetime, I would never wish to see Dignitas etc anything other than what it is now. The attitude of some around here to 'get rid of nutty wrinklies' disheartens me, they all have a right to the best care for the remainder of their lives. I really feel families should do more (I know I'm over-simplifying) and the possibility of 'fostering' the elderly and those with dementia, maintaining their skills and encouraging abilities in small scale homes. On the BBC2 prog we saw the quality (and profitability) of that approach, encouraged by younger carers to do everyday tasks, dementia patients often go into care due to elderly spouses being unable to care, social support is grossly lacking. Needs to be thought differently.
Right that's enough, it's emotive and there's too much to sort out.
From very personal experience,
Incontinence pads rationed due to cost,residents left in soiled pads all day,
DR,S refused to be called incase they go above a certain quota of calls and it gets noticed they have a few to many ill residents,
no meals for staff,
Heating turned down or off,
Limited baths due to lack of hot water,
Child like portions of food,
Poor quality of food and cooking,
Poor cleaning,
Incompetent management,with no training,and a false idea of their own role,even lieing to residents families about their job description and responsibility,
Not haveing the ability or kindness to say SORRY,
The list goes on.............
I forgot I had posted here
Tails - Argue and fight for home care for him. Ultimately its your mothers decision but a lot can be done at home and often more than the local authority wants to because again of costs.
Yeah he should be coming home sometime (hopefully before xmas) just as he can no longer totally make his own decisions its very awkward as I think the social workers get the final call, which is some what of a piss take seeing my mother has known him for 40yrs.
As you may know the hurdles placed on us as well as health care workers are large ones (I have know idea how it works in europe??) but I'm aware Scotland is better than England. We have had a bed delievered along with this ****ing winch, i mean why can't they just lift him, oh no can't do that lets get a winch he's seven ****ing stone!!
Alongside this the nurses sometimes help him walk, now this is something I could do at home, no if I drop him BIG trouble despite the fact that in hospital he fell out of bed, plus his ward has now got a Cdif patient.
Anyway I'll stop for now as its clearly very frustrating for me kind of loseing my dad at 64, besides there is hope as it not alzheimers the docs at one of the worlds best hospitals are not really sure so they packed him back off to hinchingbrooke which is chronically underfunded.
Still at least he hasn't lost his sense of humour, my dear mother who has visited him daily since august recieved this beaut today 'Jenny, your ugly a total wreck' tickled her anyway.
Interesting subject
teagirl - Member............... Privatise and the care ethos gets turned upsidedown, profits always come before care. Council or state run places are better regulated and the training and regulation is statutory and mandatory, staff turnover isn't an issue, care far better in my experience.
Training and regulation are statutory and mandatory in the private sector - infact the regulatory regime is tighten than for council run homes.
You are not comparing like with like however - council homes are residential homes - no [i]nursing[/i] care provided. Social care only. Nursing care has never been the remit of the councils. Any form of nursing care - for mental or physical ailments is done mainly in the private sector with a little NHS provision.
Project - If you have seen that then whistle blow - clearly unacceptable. Much of that again comes down to the lack of money in the system. I have worked in a whole variety of homes including some poor ones and have never seen some of what you say although some of it used to be commen - less so now.
In Scotland the incontinence pads are provided by the NHS unlike in England - that is one clear area that could be lobbied for. The manager of a nursing home must always be a qualified nurse.
Staff ratios in the NHS and private sector are identical
Some councils do run their own care homes. Hampshire has some, for example, and they are modern and purpose-built.
My father is not in a council run home (no vacancies), it's a private one. Top-up fees are paid for by the local council. It is excellent and the staff are so kind and caring. They do a really difficult job and have my respect.
But I do feel that all of us could spare a little of our time to relieve the tedium for residents. For example, everyone has a skill of some description and to spare an hour just once a year in a care home would be so beneficial. After all, the chances are that many of us will end up in one.
Lots of people can play an instrument, sing, dance, draw, paint etc. Another example, the manager of my father's care home breeds dogs (Newfoundlands) and was due to take one in to show the residents. Recently a guinea pig was taken in, the residents really enjoyed holding it and it was quite calming for them.
I do however hope that in my lifetime I will be able to choose when I wish to end my life. In fact, it would make sense to put something in my will.
The current funding system is unsustainable. We all need to pay more, are we prepared to do that?
project - that sounds awful, there must be something that can be done?
Tails - I shall attmpt to answer some of your stuff.
tails - Member
Yeah he should be coming home sometime (hopefully before xmas) just as he can no longer totally make his own decisions its very awkward as I think the social workers get the final call, which is some what of a piss take seeing my mother has known him for 40yrs.
Thats what the professionals try to tell you 'cos its easier for them. GEt advice if you haven't already from alzeimers society.
We have had a bed delievered along with this ****ing winch, i mean why can't they just lift him, oh no can't do that lets get a winch he's seven ****ing stone!!
I have a damaged back from lifting patients in the days before hoists. 7 stone lifted repeatedly will damage staff. Remember thay have more than just your day as a caseload. Before hoists I would lift and move a couple of tonnes a day. Sorry - that one is right
Alongside this the nurses sometimes help him walk, now this is something I could do at home, no if I drop him BIG trouble despite the fact that in hospital he fell out of bed, plus his ward has now got a Cdif patient.
Rubbish - dunno who has fed you that line but it is wrong. Smells of someone asscovering and not knowing what and why.
Tails - it is a very hard road you have - good luck
Cinnamen girl - you sure they are nursing homes not residential homes?
Other wise you are spot on.
TJ - I am sorry that you have not been able to fulfill your ambition of owning and running a care home. You seem to have so much compassion and genuinely want to do it for the right reasons. I would say it is Scotland's loss.