Training and tightening drug roles are key to tackling abuse, say MPs

The House of Commons health select committee estimates that
500,000 older people are being abused at any one time, but concedes
this is based on a 1992 survey.

Older people’s charities, social services and the care industry
suspect the figure is higher, while health minister Stephen Ladyman
believes that the situation is improving and that abuse levels are
lower.

Nonetheless, last month he announced government funding of
£150,000 to examine local authority information on the abuse
of older people to obtain an accurate figure. There is also extra
money for charity Action on Elder Abuse.

Health select committee chairperson David Hinchliffe says: “Much
abuse is not reported because many older people are unable to
report it.” Some are too frightened or embarrassed, he adds.

Abuse can be physical, sexual or financial, or take the form of
neglect, humiliation or over-medication. It most commonly occurs in
the victim’s home but is also widespread in institutions. Only 5
per cent of older people live in care homes but 23 per cent of
calls to the charity Action on Elder Abuse’s helpline are concerns
about residential care.

Evidence suggests that abuse in the home is rarely the result of a
family carer being under stress but usually occurs where there are
other risk factors for domestic violence.

MPs want elder abuse to be given the same level of recognition as
child abuse. Liberal Democrat MP Paul Burstow contrasts the anger
over Victoria Climbi”s ill-treatment with the muted response to
the case of 78-year-old Margaret Panting, who died after being
abused. Her injuries included cigarette burns and razor blade cuts.
“The difference between the two cases was 70 years -Êthat’s
the difference in attitude,” he says.

Gary Fitzgerald, head of Action on Elder Abuse, says: “It’s a
similar situation to child abuse 20 years ago and domestic violence
10 years ago. We need an investment in societal change. If we can
do it for domestic violence we can do it for this.”

– Health select committee report on elder abuse from
www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/111/11101.htm

Abuse in care homes: better monitoring by GPs of the use
of medicines

The report says that concerns about fees, standards and the
closure of care homes have led agencies to take a “light touch”
towards the protection of vulnerable adults. 

But urgent action is needed to tackle the widespread use of
powerful medication for the purposes of sedating care home
residents. The report says: “In many cases medication is being used
as a tool for the easier management of residents.” 

Gary Fitzgerald from Action on Elder Abuse says: “We find that
people store medication and then use it on people it was not
prescribed for. And drugs have a greater impact on older people.
When we are talking about doping people how can you talk about
inspecting with a light touch?” 

Twelve per cent of the 1,500 care homes for older people
completely failed to meet the national minimum standard on
medication, and a further 43 per cent partially failed to meet it,
according to a report in March from the National Care Standards
Commission. 

But doctors are also to blame, the report says. Under the
National Service Framework for Older People, GPs are supposed to
review medication annually for patients over 75. But a recent
survey found that only 29 per cent of GP practices had achieved
this. The report wants GPs to meet the NSF standard and also review
medication for older people in care homes every three months. 

Some GPs disagree with this, however. Dr Chris Dunstan, a GP
adviser to the government on older people’s care, says: “In nursing
homes, three-monthly reviews are necessary. But in residential care
homes where patients are more stable it is not so useful
medically.” 

Dunstan says that GPs can be encouraged to conduct reviews under
schemes run by primary care trusts. 

But the situation may not improve because the care of older
people is not a quality target that gives GPs financial rewards
under their new contract.  

However, the Commission for Social Care Inspection and the
Commission for Healthcare Audit and Inspection are developing
inspection methods to detect abuse by medication. 

The report also calls for an end to the custom of nursing homes
paying retainer fees to GPs for their services as everyone who is
registered with a GP should have free access. Consultants should
also play a greater role in monitoring what goes on in a nursing
home. Hinchliffe says that when he was in social services he would
invite geriatricians into accommodation. “That does not seem to
happen now.” 

The inquiry into Dr Harold Shipman’s crimes is also expected to
make recommendations on medication and has prompted the Home Office
to review the certification of deaths in care homes, ending the
practice of a doctor signing a death certificate without seeing the
body.  

These changes were backed by the select committee, which also
recommends that GPs who own or manage a care home should not
certify deaths in their own care home. Also care home residents
should have regular reviews, which is a practice accorded to
children in care.

Abuse in the home:registered staff more likely to spot
problems 

The report criticises as “unacceptable” delays in the
registration of care workers as this is where the risk of abuse is
highest.  

It rejects the government’s argument that domiciliary care
workers ought to attain NVQ level 2 before they can register with
the General Social Care Council and says that signed-off induction
training should suffice (news, page 6, 22 April).  

“We are concerned that introducing such pre-requisites will
ensure that a large proportion of this workforce remains
unregistered for the foreseeable future,” the report says. However,
there are concerns about the lack of places to train the estimated
25,000 domiciliary care workers every year up to NVQ level 2 (news,
page 8, 22 April). 

Nonetheless, the select committee’s arguments may be accepted.
GSCC chief executive Lynne Berry says: “Our own risk assessment
found that service users in their own home or using outreach
services were particularly vulnerable. This will be key to
informing our approach to rolling out registration to other care
workers.” 

But ultimately it will be Ladyman who decides and Hinchliffe
says there is a “difference between the minister and officials on
the approach”. 

The report also calls for domiciliary care workers to be trained
in detecting signs of abuse. It criticises the national minimum
standards for failing to require domiciliary care agencies to
report adverse incidents, such as accidents, despite it being a
requirement for residential care homes.  

Care workers hired under direct payments should also be
encouraged to register with the GSCC, says the report. Although
disability groups oppose compulsory registration, there are
concerns that abusers could switch to providing services via the
direct payment system to avoid detection. 

The government also comes under fire over the delay to the
Protection of Vulnerable Adults register, which will finally start
in June.  

Preventing the financial exploitation of older people should be
a key responsibility of council-led vulnerable adult protection
committees. These ought to be mandatory like child protection
panels, the report says.  

Sue Fiennes, the Association of Directors of Social Services
lead on the protection of vulnerable adults, says: “There ought to
be a statutory duty for all agencies to contribute to the committee
and an equivalent grant to that given for child protection to
support its work.” The committee could arbitrate disputes over the
mental capacity of vulnerable adults, she adds.