by Adam McCulloch
Gerry 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 failureto provide high standards of care. Dementia care mapping, in whichresidents are monitored on an almost minute-by-minute basis, andconstantly engaged one-to-one, was presented as goodpractice. It is an approach similar to that employed in good pre-schoolestablishments where children have their own keyworkers ensuring thatthe child is involved in activity throughout the day.
Care home owners were often seen to be shortsighted. They appearedoverly managerial, focusing on reducing costs, often through measureslike withdrawing free snacks for nightstaff. Robinson described thiskind of penny-pinching approach as serving only to threaten staffmorale and reduce care quality, which had a knock-on effect onstandards and ratings, and thus, profitibility.
The staff in one of the ‘failing’ homes told Robinson of theirunhappiness, one young woman telling him that kitchen staff sometimesbecame carers without any training. Again the lack of free hot food forstaff on long shifts, up to 12 hours, was cited.
Overall, Robinson highlighted the lack of trained staff in the dementiacare sector as its major problem. Care home owners by implication were not always able to recognise this as a threat toquality and profitibility.
The home where dementia care mapping was used appeared a far happierenvironment.
High staffing levels
There were no lounges full of slumped older peopleresigned to boredom in front of a TV. An abundance of activity involving residents wastaking place. But there appeared at a glance to be very high staffinglevels, yet Robinson said this home’s fees were no more than many. Itwould be interesting to find out how homes can manage this quality andstill generate the same returns. Perhaps this is a topic part two will return to.
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