Solihull case raises questions over support for self-funders

Concerns about the lack of support for self-funders have been raised in a serious case review into the death of a 96-year-old woman, two days after her “distressing” move to a nursing home.

The review, for Solihull Adult Safeguarding Board, said that the residential care home where she had lived since 2004 had found it increasingly difficult to manage her deteriorating mental and physical health and this would have been picked up far earlier had she been a social services client. This could have seen her moved to an appropriate nursing home far earlier, avoiding the stressful move before her death. But the review found the death from vascular disease last February of the woman, known as Dorothy, was neither predictable nor preventable.

Dorothy only came to the attention of Solihull adult social services in January 2009, three weeks before her death, when an adult safeguarding investigation, triggered by an NHS continuing care assessment, found she needed nursing, not residential care.

It said because she funded her own care, she was outside the “positive safeguarding framework” provided for social services clients through the system of assessment and regular care reviews.

A National Care Forum survey in January this year found that more than 40% of care home residents are self-funders, a rise of a third since 2002.

Gary Fitzgerald, chief executive of Action on Elder Abuse, echoed the review’s concerns about the lack of support for self-funders.

However, Fitzgerald added that providers should still be conducting an assessment of need and had a responsibility to pick-up safeguarding concerns.

The review recommended that Solihull Care Trust, which is responsible for social services, should consider how it will provide social work support to self-funding residents in care homes and promote the availability of care assessments for self-funders.

It also said the trust should look to voluntary sector partners to help provide better advice and support to self-funding care home residents.

The review also expressed concern that the results of a June 2008 inspection of Dorothy’s care home by the Commission for Social Care Inspection, which led to a zero-star rating, had not been shared immediately with Solihull Care Trust, which only found out in September.

It said at the very least that care home residents needed an immediate assessment when poor care was discovered to see what impact it was having on them.

The Care Quality Commission, which replaced the CSCI in April 2009, told the SCR panel that there was no obligation to share initial judgements from inspections with commissioners but admitted better communication was necessary.

The review recommended that the CQC inform commissioners of poor quality services before the information was published to allow them to develop risk management strategies.

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