A committed, but not necessarily large staff,
and more autonomy for residents can make for better care homes.
Last week, a report, Keep Taking the
Medicine?, was published in which the euphemistic phrase,
“chemical management” was used as part of the charge that elderly
people are sedated to make the jobs of their carers easier. The
authors, Liberal Democrat MP Paul Burstow and his researcher,
Richard Stokoe, claim that two out of 10 residents are sedated for
non-medical reasons – which translates as around 35,000 people in
nursing homes and 53,000 in residential homes. Prescribing of
anti-psychotic drugs has doubled in a decade.
“Chemical management” is disturbing enough but
so, too, is straight-forward, unadulterated people management. In
Ageing and Later Life Julia Johnson describes the
different “group living” regimes in two otherwise similar
residential homes – both purpose-built buildings with a mix of 42
residents, from severely dependent to much less so.
Both buildings have a dining room and five
lounges. In “Park View”, the residents are segregated; the confused
in one lounge; the severely disabled in another, and so on.
Residents are brought by staff to the dining room four times a day.
The Zimmer frame rules.
In “Arden House”, a policy of “doing with”
rather than “doing for” prevails. So, at the end of each corridor,
is a dining area with a fridge and small cooker. Each area is the
“home” of four or five residents of mixed ability. They make
breakfast, drinks and snacks for themselves and one resident brings
main meals on a trolley from the kitchen.
Residents are encouraged to enjoy the privacy
of their own bedrooms and infantilised language is absent.
In Park View, in contrast, Johnson observed
one resident who arrived with a walking stick and was immediately
supplied with a Zimmer frame against her wishes. “It’s all too easy
to create dependence within the first few hours,” she points
At Park View, a staff of 31 work 700 hours a
week. At Arden House, 19 staff work 400 hours. Johnson makes clear
that what matters is, “a small, committed, well-trained and
supervised team” not a “group of inadequately paid, inadequately
supported and inexperienced staff”.
The issue of standards in older people’s homes
desperately needs a much broader focus. Autonomy and privacy also
matter crucially – as does the elimination of a professional
attitude which treats residents as “less than whole people”.
– Ageing and Later Life edited by
Julia Johnson and Robert Slater, Sage Publications £16 95.
Keep Taking the Medicine? free from Paul Burstow MP, House
of Commons, Palace of Westminster, London SW1A 0AA.