SUGGESTED POLICY FOR LONG TERM CARE OF ELDERLY PEOPLE IN THE UK
INTRODUCTION (appeared on other website in July 2011)
Long term care of elderly people has become very high on the national agenda. This document sets out some of the issues concerned with long term social care within the UK. It also addresses some suggestions as to how standards can be improved and how we might assist our elderly population.
1 Priority - Living with dignity & desired standards
2 Care plans
3 Type of care available
4 Staff training
5 Funding
6 Elderly people in society – the concept
1 Priority
Elderly people and all those in care should live with dignity whether it be in their own homes or at the appropriate time within a hospital, nursing home, care home or supported living setting. How we care for people as a society is intrinsic and conveys much about us as a society. There are examples of living with dignity in old age:
Key factors:
Research shows there are eight main factors that promote dignity, all of which contribute to a person's sense of self-respect.
- Choice and control - Enabling people to make choices about the way they live and the care they receive.
- Communication - Speaking to people respectfully and listening to what they say; ensuring clear dialogue between workers and services.
- Pain management - Ensuring that people living with pain have the right help and medication to reduce suffering and improve their quality of life.
- Personal hygiene - Enabling people to maintain their usual standards of personal hygiene.
- Eating and nutritional care - Providing a choice of nutritious, appetising meals that meet the needs and choices of individuals, and support with eating where needed.
- Practical assistance - Enabling people to maintain their independence by providing "that little bit of help".
- Privacy - Respecting people's personal space, privacy in personal care and confidentiality of personal information.
- Social inclusion - Supporting people to keep in contact with family and friends, and to participate in social activities (1) http://is.gd/YSKr1T
2 A CARE PLAN
Care plans should be prepared by a key professional who has links to the caring professions/support networks. The person requiring care should be involved in any care plan whenever possible, along with a close family member or registered carer if family member is unavailable. The key professional should be decided by the GP and the local Social Care Manager. This will encourage a joint working relationship to the benefit of the patient/client.
3 TYPE OF CARE AVAILABLE
At present the care available is either or a mix of support at home, supported living in sheltered housing, care home, respite care and nursing home provision. Unfortunately many elderly people have extended hospital stays for various reasons but mainly due to lack of facilities/funding negotiation. This prevents acute hospitals/wards from admitting acute patients resulting in the term commonly known as bed-blocking. This can be a distressing situation for both the patient and their relatives and adds to the problem of waiting lists.
Clearly long term care is now very much on the national agenda, unfortunately very much due to bad press in recent weeks. The recent broadcast of the Panorama programme caused us all to re-examine the issue of long term care (2) http://is.gd/Jtkqey.
There are various guides online that can help relatives or indeed the person requiring long term care to seek a good care home. Checklists are available but how often are the checklists ticked? Some online guides:
Spot checks should be undertaken by local authorities at private care homes. I would like long term care to be provided by the state but accept that this requires planning.
4. TRAINING OF CARE STAFF
Whilst we are examining the issues about standards of care for those we love, and indeed for ourselves as we grow older, perhaps we should also consider the standards of those who will be caring and what their qualifications might be.
Trained/qualified nurses are often employed in Nursing Homes where residents require specialist/nursing care but what about care homes? What qualifications can be expected in care homes and from those who provide care in the community by staff sometimes known as ‘care assistants’? On undertaking some minor research I gather that little training is often given, sometimes as little as one week’s training. I really question this as being sufficient and must be worrying for those receiving care and also for those providing it. How confident are these people that they are doing a ‘good job’?
Long term care is here to stay and I believe that we have reached the stage, indeed many of us reached this stage decades ago, where quality of care should be provided for those requiring it.
I would like to suggest that a proper career structure in the caring services is provided by a formal training course. I strongly believe that this would raise standards of care and also raise morale within the caring profession.
This could be introduced into the sixth form apprentice curriculum. All provision of adult care would be covered – for young adults through to elderly people. Such a course would ensure that good standards of care are provided and maintained to anyone receiving care whether it be at home, in a day care setting, residential care, at home etc. This would cover all types of care for different ages with different module options for various disciplines e.g. people with various conditions e.g. severe autism, young people with disability, adults with special needs and elderly people requiring support and maximum care. Some understanding of chronic conditions should also be part of a module, e.g. diabetes, Alzheimer’s disease, so that specific awareness and care can be given to those residents. The course should also cover some minor nursing care e.g. changing dressings, bathing & hygiene, etc.
On completion of training for perhaps a one year full time or two years part-time study, a qualification would be given – The Care Diploma. This would be accepted in all areas of adult care including a hospital setting where nursing assistants are employed. Maybe this should be the minimum requirement for anyone entering into the caring arena. Mature students should also be accepted onto the course.
Private care home operators could enter into a contract with their employees to provide training perhaps one day per week plus online training for a period of two years. I’m sure some care home owners will dislike this suggestion but if they wish to reap the benefits of providing such a service, they should also accept responsibility for staff and residents. Training fees could be shared by the employer & the employee. If training is undertaken in the sixth form then this would be covered by the state.
The course would cover all types of adult care with different module options for various disciplines - people with various conditions e.g. severe autism, young people with disability, adults with special needs and elderly people requiring minimum support, and those who require maximum care. Some understanding of chronic conditions should also be part of a module, e.g. diabetes, Alzheimer’s disease, so that specific awareness of and care can be given to those residents.
How refreshing would it be to give credibility to staff working in this area where such standards are required? Staff would also attain knowledge, confidence and pride in their work and hopefully be valued by society at large. The days of casual labour working in our care homes would no longer be acceptable - indeed it is unacceptable by many of us now!
5. FUNDING OF LONG TERM CARE
As I write this article the Dilnot Report has been published (5) http://is.gd/4zhmVx and here is a guide to that report (6) http://is.gd/5KfVIk
Recently we have witnessed the business ethos that is behind several care home organisations e.g. Southern Cross, leaving many of us feeling uncomfortable. As that business appears to be in trouble, that model cannot be deemed sustainable. The Private Care Industry needs to be re-examined and certain clauses placed into contracts of care with the priority focussing on care. The average salary at Southern Cross is just over £13,000. I wonder how much the salaries are at other care establishments and how much of the residents’ money is spent on salaries, residents’ food etc. and how much goes into the bank accounts of those big corporate companies who so often are supposed to be providing the care for our loved one’s ?
Although The Dilnot Commission has provided some answers that will now be debated, there are many other questions outstanding… as outlined above and which leads me to…
6. ELDERLY PEOPLE IN SOCIETY – THE CONCEPT
The elderly population in the UK is growing and we are told every day that we are all living longer. That, of course, does not apply to everyone – we do not all live into our 90s and beyond – but many more of us can expect a longer healthier life.
When we are young adults we often move away from our parentsto study. We then set up home, start a family, have careers – very busy lifestyles. By middle-age some of us have more time and maybe moved back nearer to our loved one’s as our own children came onto the scene. Also by middle-age we have parents in their 70s/80s that require and, indeed, should be able to expect our attention. None of us like to think that we are cast onto one side just because we become less able.
However, when people do become less able It is at this time that we need to examine our lifestyles. Sometimes caring for our relatives can be the easiest solution especially when respite care is now available - perhaps that provision needs to be extended. Surely this is the way it has to go? When we were young and perhaps not so young, who was there for us? Isn’t it time to examine our own attitudes as a society, re-adopt the values that we once had and that we often witness in other cultures – pay-back time?!
Perhaps as part of a building programme, more bungalow-type accommodation could be considered in neighbourhood areas.
I know that many of us do care for elderly relatives but there are many who do not. We can’t always leave it to others… only when it’s really necessary, surely, should we do so.
This document is merely a suggested way forward in addressing some of the problems that we currently witness and encounter in the provision of long term care.
Bibliography
(1) Community Care
(2) The Guardian
(3) Age UK
(4) Revera
(5) The Dilnot Commission
(6) The Guardian
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