by Adam McCullochGerry Robinson's illuminating analysis of the dementia care home sector showed the need for far better training and standards (BBC2 Tuesday 9pm).
As he says, the business model for care homes is not too challenging for any half decent businessman or woman: it is akin to that of a hotel where the number of guests remains relatively constant and occupancy is continually high. He says homes are often making a 30% profit.
Care home improvement has recently been highlighted in Community Care, through coverage of the My Home Life project (p30, 12 November).
One owner was interviewed in his £4m stately home, although, admittedly he was facing financial problems and was looking to sell.
The programme linked the failure of homes to make money with a failure to provide high standards of care. Dementia care mapping, in which residents are monitored on an almost minute-by-minute basis, and constantly engaged one-to-one, was presented as good practice. It is an approach similar to that employed in good pre-school establishments where children have their own keyworkers ensuring that the child is involved in activity throughout the day.
Penny-pinching
Care home owners were often seen to be shortsighted. They appeared overly managerial, focusing on reducing costs, often through measures like withdrawing free snacks for nightstaff. Robinson described this kind of penny-pinching approach as serving only to threaten staff morale and reduce care quality, which had a knock-on effect on standards and ratings, and thus, profitibility.
Unhappy staff
The staff in one of the 'failing' homes told Robinson of their unhappiness, one young woman telling him that kitchen staff sometimes became carers without any training. Again the lack of free hot food for staff on long shifts, up to 12 hours, was cited.
Overall, Robinson highlighted the lack of trained staff in the dementia care sector as its major problem. Care home owners by implication were not always able to recognise this as a threat to quality and profitibility.
The home where dementia care mapping was used appeared a far happier environment.
High staffing levels
There were no lounges full of slumped older people resigned to boredom in front of a TV. An abundance of activity involving residents was taking place. But there appeared at a glance to be very high staffing levels, yet Robinson said this home's fees were no more than many. It would be interesting to find out how homes can manage this quality and still generate the same returns. Perhaps this is a topic part two will return to.
Useful links:
Critical, but informed review from The Guardian
Anchor Trust's Victoria Metcalfe on dementia mapping
National Dementia Strategy
Joseph Rowntree Foundations' guidance on best practice in care homes
Judith's story - a typical tale of the dementia route through hospital and, inevitably, a care home
Dementia patients discharged from hospital with bags full of drugs
The need to match the care home to the severity of the dementia
Fighting Monsters blog on Gerry Robinson programme
One owner was interviewed in his £4m stately home, although, admittedly he was facing financial problems and was looking to sell.
The programme linked the failure of homes to make money with a failure to provide high standards of care. Dementia care mapping, in which residents are monitored on an almost minute-by-minute basis, and constantly engaged one-to-one, was presented as good practice. It is an approach similar to that employed in good pre-school establishments where children have their own keyworkers ensuring that the child is involved in activity throughout the day.
Penny-pinching
Care home owners were often seen to be shortsighted. They appeared overly managerial, focusing on reducing costs, often through measures like withdrawing free snacks for nightstaff. Robinson described this kind of penny-pinching approach as serving only to threaten staff morale and reduce care quality, which had a knock-on effect on standards and ratings, and thus, profitibility.
Unhappy staff
The staff in one of the 'failing' homes told Robinson of their unhappiness, one young woman telling him that kitchen staff sometimes became carers without any training. Again the lack of free hot food for staff on long shifts, up to 12 hours, was cited.
Overall, Robinson highlighted the lack of trained staff in the dementia care sector as its major problem. Care home owners by implication were not always able to recognise this as a threat to quality and profitibility.
The home where dementia care mapping was used appeared a far happier environment.
High staffing levels
There were no lounges full of slumped older people resigned to boredom in front of a TV. An abundance of activity involving residents was taking place. But there appeared at a glance to be very high staffing levels, yet Robinson said this home's fees were no more than many. It would be interesting to find out how homes can manage this quality and still generate the same returns. Perhaps this is a topic part two will return to.
Useful links:
Critical, but informed review from The Guardian
Anchor Trust's Victoria Metcalfe on dementia mapping
National Dementia Strategy
Joseph Rowntree Foundations' guidance on best practice in care homes
Judith's story - a typical tale of the dementia route through hospital and, inevitably, a care home
Dementia patients discharged from hospital with bags full of drugs
The need to match the care home to the severity of the dementia
Fighting Monsters blog on Gerry Robinson programme
From Victoria Metcalfe, Anchor Trust’s Dementia Specialist Team Manager
Two hours after Can Gerry Robinson Fix Dementia Care Homes? (8 December, BBC2) I was still fuming.
How can it be that a man with next to no care home experience could so quickly understand the changes needed to improve dementia care, while so many of the “experts” were too focused on ticking boxes for the regulator to notice the effect they were having on the people in their care.
The depressing picture of care home life painted by the programme, which concludes next week, is all the more depressing when you know that it’s not so different in many hundreds of care homes across the UK. But Sir Gerry, former Chief Executive of Granada, understood that simple changes can make residents happier.
At Anchor, all our dementia specialists have been trained in care mapping, the technique demonstrated by Bradford University’s Paul Edwards in the programme. By focusing on individuals, the person and not just the disease, it is possible to connect with people and improve their lives. Sir Gerry referred to an Alzheimers’ Society survey featured in the Home from Home report which revealed that, apart from care-related tasks, the average resident has less than two minutes of meaningful interaction with staff in every six hours. That has to change.
The keys are leadership, proper funding and a critical mass of change agents. And it is harder for smaller providers such as those featured to make the commitment to training and development that larger providers can make.
At Anchor, we now have more than 500 Dementia Champions. We’re committed to providing truly person-centred care across all our homes. What it boils down to is motivated staff who care about their residents and make the time to learn about their life history.
If there’s one thing anyone who works with people with dementia should do today, it’s to talk to three people in their care and find out three different things they didn’t know about them. It’s only by seeing the person, and not just the disease, that we can truly tackle dementia.
The programme made sad watching. It seemed to me that the care owners saw their residents as commodities, just a means to gaining a millionaire lifestyle. The lack of training and expertise was unforgivable. It proves the owners only want to employ carers at the lowest end of the salary scale to boost their profits The low morale of the care staff was worrying. Happy carers = happy residents. The care owner who held a postmortem over half a loaf of bread seemed to me to be the employer from hell. Who in their right mind would want to work for her?
Mapping care looks like the only way to to improve conditions for the residents, because unfortunately these people have lost the power to speak up for themselves. They have, like many adults who have severe learning disabilities, through no fault of their own, become the Cinderellas of our social care system.
Some years ago Donal MacIntyre went undercover to expose the awful cruel treatment of some learning disabled adults in a care home. I only hope lessons were learned then, but I doubt it. The difference in this situation is that we all collectively have the potential to be one of those people with dementia and it is in our interests to get it right, whereas people with a severe disability, who have never had a life, are always someone else's problem.
I thought the person-centred approach shown (which we already use, to great effect, with our customers with learning disabilities) is the obvious way forward for people with dementia. The concept that they should be encouraged to live in their 'homes' in an interactive way - cooking, painting, setting the table, doing the laundry etc - was clearly life enhancing (not hard when the only other option is to sit in your chair for hours on end). Our customers with learning disabilities, who are given more independence and choice each day (and not pre judged with regard to their abilities), communicate greater happiness.
It was an inspiring program.
Thankyou Victoria and Pauline for your contributions. Very strong points made here. I'm impressed by Anchor Trust's commitment to best practice in this area. The question about staff motivation is crucial.
But there's another issue here. How can people easily find out which care homes in their area use care mapping? The vast majority of care homes I've seen are rated as '2' but almost all had lounges with big TVs around which the residents gathered without any interaction. (Needless to say, no one is actually watching the TV). When I chose a care home for my elder relative I decided that the garden was a key factor (my relative loves gardens and sitting in them). But after seeing Robinson's programme and how it brought mapping to life I realise there is so much more I should have asked and so much more is possible in terms of care quality.
From Helen Joy, CEO, Brunelcare
“Gerry Robinson’s investigation into dementia care homes has certainly helped to highlight some important issues. Yet, as the very title suggests, the generalisation made was vast – tarring almost the entire care sector with the same negative brush. Yes, dementia care has a long way to come and the need to embrace innovation and appropriate training, is vital. But it is my belief that we are no longer in the ‘dark ages of dementia care’ as suggested by Robinson.
“Many organisations around the country have long ago abandoned the task-based approach for caring for individuals with dementia, as depicted within Robinson’s documentary, and adopted a person centred care approach. This approach treats all behaviours, challenging or otherwise, as communication. It promotes dignity and independence by empowering those living with dementia; enabling them to regain control in many small yet significant ways, such as deciding on what they’d like to wear or when they want to eat their meals and go to sleep.
“But it’s also about empowering staff – providing the right training and the right support to help them to perform their roles to the highest standards. It’s about placing a value on carers and the amazing job they do. This, combined with a person centred care approach and ongoing research, will improve the lives of those living in dementia care homes and remove the associations of ‘hiding people away to stagnate in empty lounges’.”
To my mind, the star system is a joke. I have seen appalling practice at so-called 'good' homes and through investigating with the (as was) CSCI found out that they had been subject to 'desk-based' inspections for a couple of years. That destroyed any faith I had in the systems which seem to be about presenting things positively. I think we need a lot more unannounced inspections in all care homes, not just the 'adequate' and 'poor' ones. Also, the poor quality homes need to be closed sooner in the processes. The difficulties are the contracts and the fees that local authorities are tied into. They are committed to paying as little as they can get away with paying and although, as the programme indicated, quality care doesn't have to be simply about money - it is a factor.
I think a lot more of the care homes should be brought back 'in-house' with council-employed staff working to very specific standards, but it will never happen - until then, we are at the mercy of 'for profit' enterprises.
I have seen some appalling practice in care homes and it still makes me angry, especially as some commissioners don't want to listen until an issue is so great it hits the local news.
Generally, though, I thought it was a good programme. It is an area that needs more publicity.
Incidently, in response to the above statement, I don't think the entire sector was 'tarred with the same brush'. There was some high quality care shown as well - it's just, in my experience of the sector (10 years as a social worker in over 65s teams plus 7 years as a care worker in residential homes - gosh, that makes me feel old!) the poor practice does outnumber the good practice - it's not to say there aren't wonderful care homes, there really are, but they are a very precious resource as it is so much easier, apparently, to run things sloppily.
But ultimately, for all the responses of various chief executives of care providers, the quality of care is absolutely reliant on the day-to-day usually minimum wage care workers who have the most scope for positive interactions. If they are not treated well, valued, paid and trained well at the very ground level, the care will suffer.
So did Sir Gerry fix dementia care homes? Well he certainly found a way that dementia care can be fixed and viewers of the BBC2 documentary all saw the beginning of the solution. But was there the will of the organisations and among staff to keep the momentum going? Was there an inspirational leader to keep people motivated and carry on the energy of the learning? Were the staff supported to carry on making the connections?
Sadly, the answers were not always positive. Did Ken, a retired paint-sprayer, one of the residents featured, continue to smile, feel the sun on his face, be engaged with life and living or did he return to feeling ‘’helpless’’ and ‘’stagnant’’?
My lasting feeling of the programmes, the concluding part of which was screened last night, reinforced how many services rely on the disease-based model of care because it is perceived as easier. If you don’t see the person you don’t need to make the connections with people so you don’t need to analyse the feelings behind the behaviour.
Yet this approach is so ill-conceived. Real change with true person-centred care affects everyone. It improves everyone’s lives; it is about caring and valuing each other and is something we all should have a right to.
So, if you work with people with dementia, remember today to talk. Talk all day, establish eye contact use people’s names every time you see them, and in every interaction and give a running commentary, talk out loud about everything that is happening to and around the person.
Can Gerry Robinson fix care homes? On his own, no. But, if we have the will and the commitment, everyone working in dementia care can and it is all our responsibilities to make sure that we do.
This is one of the best programmes on care homes i have seen.
Sir Gerry Robinson uncovered so much that it beggers belief.
They are human beings and not animals. The Spray Painter was such a dear gentleman, still full of life and intelligence.
Why were the owners of that care home not bought to account. 500K spent on doing the home up with no care for those staying there. The manager was too weak and Gerry hinted a number of times to the operations director. She put her friendship first. It is sad that they had to leave the home they had come so used to. But it was a postive that the profit making owners got their come uppences. All of the homes owned by that group should now come under scrutiny. Again it was shown its a business for profit, maybe the owners will wake up the day those dear to them have to go into care.
After working in a nursing home in various capacitys for fourteen years,i feel the main problem is social service inspectors.If they didnt set the staffing ratio so low [five care assistants and one nurse for thirty one dementia patients] nursing homes would have to employ more staff if social services reccomended it.The nurses in carehomes very rarely converse or take any part in the care of tha service users except to push pills at them,these are meant to be the educated members of staff and their wages reflect this yet i find them less caring than any other staff involved in service user care.Another problem is one of culture and language ,our homes are full of over seas staff with poor or very little english and totally different culture behaviour and manners,this leads to poor communication and little understanding of dementia patients needs.Most over seas careassistants see it as just a job and have no real interest in this vocation.
What totally shocked me was the lack of action to challenge what was going on. Many of the examples given should have been reported to trigger 'adult protection' investigations.
David Sheard and Gerry Robinson really showed where the difficulties are, i.e. lack of leadership from managers and/or care home owners, which leads to low staff morale and translating into poor care for individuals with dementia.
In the first programme, David was right to back out of the consultation due to lack of open-mindness of the owner of the home. Of the 500+ care homes locally, it would not surprise me to find a high percentage of owners and managers with very similar attitudes, who have no drive or idea on where to start.
I am a mapper and think it is a fantastic tool to improve person-centred ways of working with people with dementia. Again however, there are managers and owners who invite mappers to map but do not use the information mappers collate to improve care practices, though I offer to assist with advice and information. Instead the mapper's report ends up on the shelf ready to show the inspector as evidence of good practice.
Though the move was very traumatic, I truely hope the people in the second programme have found a better, more positive place to live!