I heard the screams as soon as I entered the home. The manager greeted me at the door with an apology. “Sorry about the noise, the staff are giving Annie a bath”. Annie was a small but surprisingly strong woman in her early 80s, suffering from dementia. She was confused, anxious, uncooperative and screaming for help.
It wasn’t hard to locate the bathroom. Annie was sitting in the bath and, while one care assistant tried to keep her there, the other was trying to wash her with a flannel. There was a lot of water on the floor. Both care assistants were speaking to Annie in a soft, coaxing voice, but she was having none of it. As far as she was concerned she was fighting for her life against two unknown assailants.
Wednesdays were bath days on the dementia unit. The care workers had four more to go before lunch; each one to be entered into the ‘bath book’ so that the late shift knew who had been bathed.
The days of the degrading bath book may be long gone, but attitudes towards elderly people and those who care for them have not changed. Working with older people, whether in their own home or in a care home, is challenging. It requires skill and patience, especially when the majority these days, like Annie, are suffering from dementia.
The care services minister Norman Lamb said at a recent care conference that providers who pay their home care staff less than the minimum wage should be named and shamed. But are the providers to blame? In the care business, the biggest cost is staffing. If a provider is to get business from a local authority or NHS trust, it needs to be cheap. Commissioners are faced with a budget that can’t keep pace with the growing number of very elderly people, so they want the money to stretch further and more people to be supported for the same amount. The result is a high proportion of care staff paid on or below the minimum wage.
It is far too easy to blame providers, but that is ignoring the failure of commissioners to negotiate fair contracts. It is ignoring a government that underfunds care services. And it is ignoring attitudes towards older people in a society that views them as a burden we cannot afford.
Blair McPherson is an author and commentator on the public sector with a special interest in management and equal opportunities.