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In Defence of Dementia Care in Care Homes
Care homes took another shocking blow this week with the expose of a small number of individuals, acting independently, in a small number of care homes, shown by the BBC in the Panorama programme Behind Closed Doors: Elderly Care Exposed, broadcast on Wednesday night. The outpouring of indignation in the press however has given way to something more realistic – but equally just as disturbing, as the week closes. I want to break off from my weekly blog themes this week to take a closer look at the revelations, the power of portraying these isolated cases and the tremendous good work and progress in caring standards that is exhibited by thousands of dedicated staff day in and day out with not a BBC camera in sight
Are we blameless as an industry for the care failings of the individuals we employ?
The simple answer is of course no, just as we are not, as an industry, responsible for the incredible dedication of thousands of care workers. But we do carry responsibility for the care delivered in our name. We have a duty to offer training, supervision, support and good, effective leadership. We have a duty to follow discipline procedures if these are not achieved and we have a duty to invest to ensure safety, dignity and choice – for residents, families, friends and visitors and for our staff group (you will remember my triangle of the conditions necessary for person centred care)
But this is the care industry and the basic requirement for any business is to make a profit, the same capitalist ideology now grips our NHS. But making a profit is not wrong and it’s certainly not a bad thing if the profits are mostly reinvested to keep improving and making conditions better, but I fear in many cases the shrinking (in real terms) of funding for older persons care, has led us to a scenario where costs are having to be minimised simply to keep many businesses afloat. When this happens everyone suffers.
But we all know of single home or small number of care home portfolio providers who are themselves choosing to go without the good things of life, just to keep these running costs from affecting the care their services deliver – and they are loved and admired by the staff, the families and residents they care for and are the real unsung heroes of this industry – where are the BBC exposes of these guys? We all know of staff who will spend as much time unpaid at their place of work as they do paid time because ‘my residents need me’ where are the cameras then?
And yes, we know of the big groups too who are investing millions of pounds into training, who are keeping the costs down and who are employing senior teams worried sick about how they can keep the reputation of their company safe when employing thousands of people, sometimes across hundreds of sites, and hoping upon hope that they are doing enough to keep every resident safe and every family happy. I don’t see all of the above paraded across prime time TV with a programme entitled behind closed doors: in praise of care homes!
We do not always get it right
There are four hundred care homes not meeting some of the essential standards in England, many of these are breaches in managerial practices, paperwork and recording etc., some are staffing levels and some are to do with training. These are all hugely important areas but they do not paint a picture of a deliberately abusing industry, or deliberately brutal, uncaring care staff?
The home that featured the appalling failings in the programme by the way had actually been given a clean bill of health by the inspectorate just a few months ago, despite their being a number of whistleblowing allegations which now appear to have been supported by the programme?
This may once again prove what we already know ‘you cannot inspect quality into a service’ (W Edwards Deming) Quality is a culture, it arises from within.
From where I sit, I see government, providers, researchers, policy makers and world leaders all providing leadership and guidance as to how to care for people living with a dementia, their family, carers and friends. But I also see organisations with minimum staffing, time strapped, time pressured employees and poor, worn out, unsupported leaders and managers.
Until we understand that the former depends on changing the conditions of the latter we will be hear again, and again, more BBC exposes, and poor credit if any for the industry workers.
But when we do
But, and here is the kicker, despite all of the above, sometimes in spite of it, I have seen amazing care in care homes, I continue to see amazing care in care and as long as we can continue to attract the right staff I will go on witnessing amazing care in care homes.
Don’t be put off by programmes such as that on Wednesday, learn from them, take solace that this does not happen at your site and that you would never let it happen and then step back and do something amazing for someone today – there is no camera there – but that’s not why you do it is it?
We have a long way to go to make living in a care home a perfect experience, we have a tarnished image and a less than perfect funding system and living in a care home is not right for everyone. When it is the right choice however, and when it is good, then it can be a much better way to spend your later years than being forgotten in your own home, not coping, not mattering.
Care homes are for living in, not dying and next week we return to our theme of making sure the environment makes that living better.
Till next time
Paul Smith – Dementia Care Expert