The struggle to support an increasingly frail older couple to stay at home was the subject of this evening’s second episode of Protecting Our Parents, the BBC’s documentary on the care of older people.
While Kathleen and Leonard Price are determined to stay at home, their increasing needs – manifested in multiple 999 calls and hospital admissions – lead professionals to raise the question of Kathleen moving into a nursing home.
The programme raised issues about the resource limits placed on funding care at home, the health-social care divide, disputes about capacity and what happens when family members are not around to support older people.
Community Care hosted an online discussion on the programme, which you can replay below. You can also replay our discussion on the first programme.
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I have to say I found this second programme extremely oppressive. The questions asked by the Psych (what is the day, month) had no connection with making a decision with regards to a change of accommodation or her care needs. making a sweeping statement that the lady lacked capacity was totally wrong, we all know capacity is situation and time specifics, under what decision was he Implying she lacked capacity? A decision to manage her own diary?!!
I appreciate the lady had a cognitive impairment but I totally disagree that she lacked capacity regarding a change to her accommodation.
The case conference meeting dominated by Dr’s attempting to make best interests decisions on behalf of the lady which they were not going to fund the decisions they were attempting to make was a total mockery. Social Care should be taking the lead there, not health. Social Care wouldn’t make a best interests decision for someone to have an operation, this would be lead by a Dr, therefore let the Social Worker do their job and make a decision regarding the ladies social care needs!
There was a total lack of support and advocacy for this ladies husband who was faced by overbearing professionals railroading him into what was best for his wife! How oppressive.
A maximum care package of 4 calls a day! I was unaware that there was any legislation which states this? If we were to look at this lady as a Working Age Adult would she be more likely to get Night Care? The answer is probably yes, this does beg the question on how we look at equality.
The Dr who took it upon himself to discuss what Social Care would provide was not his place to do so. NHS professionals need to realise you can’t offer people services you ain’t going to pay for or promise people things your not going to deliver. Social Care would not be promising people operations and medicines so let’s have some mutual respect of professional capabilities, specialisms and two differing models we work from, Social Model vs Medical Model.
I highly recommend that all professionals involved in this case reflect on the cases and as a bear minimum re-train on the Mental Capacity Act and Anti Oppressive Practice.
My last note is; if this lady does lack capacity with regards to change in her accommodation, knowing that she has already made her wishes clear prior to losing capacity that she wishes to remain in her own home come what may and her husband / next of kin has expressed her wish is always to remain at home, is it in her best intrets to move into Residential Care or is it the best interests on the health and social care budget?!
I really agree that this episode showed some very oppressive practices towards this couple. I am glad the SW involved did her job and challenged the ‘capacity assessment’ that wasn’t actually a capacity assessment! How such a large and intimidating meeting could be described as in anyone’s best interests is beyond me, the Mental Capacity Act does not stipulate that a meeting needs to be held but that the wishes of the incapacitated person before they lost capacity should be taken into account. Given that Kathleen had always said that she wanted to remain at home then how could it be in her Best Interests to leave her husband and go elsewhere!
Just because Kathleen presented a problem to the ambulance service doesn’t mean that her rights can be taken away from her.
Th evidence taken by the House of Lords Committee on the Mental Capacity Act shows up many serious problems with concerns about its misuse and application by health professionals and social services workers.
This programme highlighted this very well. There was conflation between mental capacity, behaviour vis a vis 999 calls, wishes to remain at home and ability to keep twopeople, likely to deteriorate and die if pushed too far into a service they do not want.
I do not think either the medics or social workers come out as less than patronising, with an inability to put themselves in the ‘life shoes’ of this couple.
I have personal experience of the same with a parent being bullied by social workers to go into residential because they did not gather information or have understanding of some family matters. It was the several medical mental capacity assessments that parent ‘passed’ that allowed a very very old parent to self discharge against the advice of the ignorant ‘professionals’ . I was proud and remain proud of parent for this. As relative I was ignored / sidelined and treated disgustingly.
The system is disgusting and Dignitas here I come.
I found this whole programme very distressing, there is a definite lack of respect for the elderly, i am not criticising any of the caring staff involved , as I am sure they all try hard within this system which is clearly failing. It should be apparent when you are old and very ill it is not the time to be making life changing decisions, like leaving your family home . Surely people should be encouraged to think and plan their lives for when they get old and what might happen to them , not have it thrust on them when they are old and incapable of looking after themselves. The government should advise people to consider their lives as they age. There has always been a taboo in this country about getting old and dying at least the BBC are talking about the issues. I am of the opinion that many people do not even consider getting frail and old or think about how they will cope.
Is’nt it about time governments take some responsibility , as It is clear that care in the community is never going to work as it is arranged at present The government should be investing in providing some form of elderly care community, where people retain some freedom of choice, where they can live together but still retain some independence and where all services for the elderly are in one place not leaving the elderly frail, out in the community on their own , feeling lonely, sick and dying or leaving dementia patients in a & e for hours with no specialist care, we have children’s hospitals for vulnerable children so where are the hospitals for vulnerable old people. Not giving them random piecemeal care when they are old and desperate.
We should be respecting the elderly not making them feel bad about asking for help and support.
The Government could be promoting communities for the elderly, helping people plan for their old age, investing money and services so that the elderly are not seen as a burden to the community. They should be asking all of us how we would I like to be looked after when we are old,giving people choices, consulting with the caring professions and listen to concerns , encourage people to downsize into more appropriate properties ,own or part own homes where they can be with other elderly people, but still retain some freedom and independence and at the same time being cared for and having a say in the services provided . People should, not be taken away or forced into something they do not want, when they are too old and frail to be able to manage those decisions. After all, we will all be old one day , we all hope to die in our sleep but the reality is many more of us will become too frail to look after ourselves and I expect most of all of us will want to remain in our own homes given the present grim care home alternatives. I was shocked and saddened by the programme and the way these people were treated.
The professionals seemed to have little understanding of the problem for which Kathleen was seeking help when she called 999, which a mobile support team might have been able to meet. Sliding into a position in which one cannot breathe properly, which appeared to be happening repeatedly, is a pretty unpleasant experience (and disorientating – not surprising that she did not remember fully what happened afterwards, if she was struggling to get enough oxygen). Rather than classifying her as lacking capacity and putting pressure on Leonard so that she could be moved, supposedly in her best interests, it would have been better to admit that there were insufficient resources to address her need. At a broader level, it is time for society to confront the human (and sometimes financial) cost of heavily rationing support to older people, including the obstacles to receiving NHS continuing care even when there might seem to be a compelling need.
I am the author of the book Behind Those care Home Doors and sadly agree with both of the above comments. People want to stay at home as long as possible, surely it would not cost more than a weeks care home fees to have a live in carer? District nurses can do their calls to do many medical bits and pieces. One thing I can tell you from my 16 years in a senior care role is that people would have much better care from 1 on 1 carer than in understaffed care homes.
Hi Clonust, I don’t know what area you live in but I suspect that you could easily answer your question with a few phone calls. In my area the cost of a live in carer is at least double what the local authority would pay for a care home.
As a health care professional myself I completely understand the difficult decisions that need to be made in regard to patients safety and well being, however this episode really saddened me. Two elderly frail people being pushed into a corner threatened with having to leave their own home. Mr price completely overwhelmed sat in a multi disciplinary meeting with 8 or more professionals all singing the same tune. I disagree that Kathleen price lacked capacity in regards to knowing where she needs to be. This whole situation has nothing to do with that its to do with a limited budget and funding and their local authority unable to pay for an extended care package. Disgusting. Mr and mrs price worked hard all their lives and deserve to be able to be cared for at home. Perhaps the government may consider cutting benefits of people to bone idle and lazy to work, take the money from mps expenses claims and such like to be able to keep vulnerable elderly people at home. I’m so glad they fought to stay at home and didn’t just give up fair play to them. The 999 calls obviously is a problem I would suggest getting a panic button installed where they can press it when they are frightened or need help. Alternatively the care company’s emergency line should be on speed dial where they can be easily contacted instead of the emergency services.