Dementia: Respite In A Care Home – No Thanks!

Fire at a care home, Cheshunt, Hertfordshire

If none of our local Care Agencies can provide staffing for a 72 hour period then an option would be to put Maureen in a Care Home for Respite.

The article below, which I have reproduced with the with the kind permission of Roy Lilley, convinces me that this is a rather risky option:

News and Comment from Roy Lilley
Did you watch the TV reports of fire ripping through the roof of the Cheshunt care home?
People have lost their lives, families have lost loved ones and 20 people have lost their homes.
I watched the evacuation.  Frail elderly people bundled into the street, wrapped in blankets.  Walking frames, wheelchairs.  They looked, to me, more like the residents of a nursing home than a care home.
There was a time when relatively able, senior citizens, would sell-up and move to a care home.  They would have the company of likeminded folk, meaningful daytimes and a bit of support if they slipped in the bath.
The tectonic plates of eldercare are shifting.  
As ‘care home’ residents lose acuity they often need nursing care and would benefit from being transferred to a nursing home.  They seldom are.
A transfer means upheaval, plus a change in status.  Nursing home placements are funded by the NHS and care home placements are means tested.  No one has any money hence there is no desire to make the transfer easy.  People get parked in care homes.
Anyway, there aren’t the nursing home places. The consequence; care homes look after people they shouldn’t or they do and pretend they can.
Desperate funding means, one care home a week closing and the sector at best fragile.  Staffing levels are generally, only just enough.
It emerged last week that nearly half of care workers leave the job within a year, there are 84,000 vacancies.
Often, dedicated staff, struggle-by on just-about-living wages.  Many struggle-by on with just-enough-English, with no prospect of their employer providing skills enhancement.
More significantly they just-manage vulnerable residents with next-to-no-nursing-skills.  Skills that should be at the very heart of all elder care.
In some parts of the country it is left to the NHS to sort out the problem.  It is no longer unusual to find frustrated Trusts, trying to stem demand on A&E, recruiting community matrons to train and develop care home staff.
See here how the Vanguards are getting the hang of it!
The costs? It’s cheaper than the Trust grinding to a halt.
The care and nursing home sector is stuck in the ’80s and is long overdue a reboot.
Too few operators can claim to provide end-to-end care, too many operators provide thread-bare care.
The sector depends on private families paying over-the-odds for a placement, subsidising the pitiful amount local authorities can pay for citizens in their care.  
We need more places with the skills to see us through an elegant retirement, joyful days, secure nights and a peaceful end.
According to Quality Watch;
‘… care home residents aged over 75yrs are three times more likely to be admitted as emergencies than over 75s in the general population.’
This has to stop.  Admission from a care home should be a last resort.  Who can blame under-skilled, under-resourced care assistants ringing three nines.
The CQC has to get busy and recalibrate licensing requirements.  Here’s nine ideas on the back of a fag-packet for starters:
  1. No care home should be licensed that does not have permanent, qualified, supernumerary nursing care, available on every shift.
  2. An on-call pharmacist that visits once a week…
  3. …and a nutritionist once a fortnight.
  4. All the residents of the care home should be registered with the same GP practice.
  5. The practice service should include a weekly surgery visit…
  6. …and rock solid OOHs.
  7. All care homes should have a qualified end-of-life specialist nurse available to provide hands-on care and as a training resource for care assistants.
  8. All care home staff should undergo regular dementia care training.
  9. A specialist continence nurse should provide regular training to all care staff.
If you think that’s tough or costly, ask yourself what an unplanned A&E admission costs, how much a three week stay in hospital costs and the damage it does.
Nine ideas that will work and Becky Malby has the proof.
Our nation was built by old people, who entrust it to the young to take it into the future, run it and hand it on, better than they found it.   They should not have to fear the future by feeling they are a commodity or a burden.
What is a government for if it can’t take care of the youngest, the poorest and the oldest…

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