On Friday 7 August the Old Village School Nursing Home in Bedfordshire was stopped from providing services with immediate effect. The Care Quality Commission had taken urgent legal action to close the home after finding serious failings in the care being provided to residents.
The sudden closure led to some residents being moved to new homes in the middle of the night. Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission, explained why this had to happen in her weekly blog.
But the closure and subsequent transfer of residents also sparked a debate on Twitter about whether it was ever justified to move residents in the middle of the night. In this piece, Action on Elder Abuse chief executive Gary FitzGerald explains why he believes such moves are never justified and what can be done to prevent them:
If a care home was just a hotel and it was suddenly closed one evening without warning, it would no doubt be inconvenient for some people. Guests would have to find other rooms at short notice, and their new hotel might be in the wrong part of town or not have the right mix of amenities. Annoying yes, but certainly not life threatening.
Care homes are not hotels. But they are more than businesses. Their trade is with very frail, often highly dependent people who frequently have multiple needs and vulnerabilities. Closing a care home is more than merely ‘inconvenient’; it is risky and dangerous. Ageing already weakens the immune system of older people. Traumatic events weaken it further. And there is nothing more traumatic than a sudden, unplanned and enforced move of home.
And it is this contradiction that has not been addressed by legislation or by regulation. If a care home closes, residents are moved because the property is in private ownership. But we don’t do that if a train operator goes bust. No one suggests taking up the track, or throwing commuters out of the rolling stock. The name of the company might change and the colours of the carriages might change. But nothing else.
The urgent cancellation of a provider’s registration, shutting a home with immediate effect, is not a situation that happens often. And it only happens in circumstances where an immediate and significant risk to residents is likely to re-occur. But it is morally wrong to take action to stop abuse by engaging in actions that are, in themselves, abusive.
Moving older people in the cold, in the dark, at almost no notice – when they are confused and disorientated by what is happening – is institutionally abusing them. That is certainly not the intent, but it is the end result.
So we need a change in the legal status of care homes that are subject to urgent cancellation, enabling them to be temporarily (or permanently) taken over by new management – and that could be a local authority, a clinical commissioning group, or another commissioned provider. This would give time and space for appropriate assessment of each resident’s needs and allow for more long term planning, ensuring their safety and security. We don’t let railways collapse, or banks, or hospitals. This has to be equally true for care homes.
I have written to the care minister, Alistair Burt, to call for a change in legislation to enable this to happen.
Until then, we need to ensure that ‘urgent’ cancellations are planned so that the timing of a court order and the arrangements between agencies for resident transfers to other accommodation are coordinated to avoid action being taken in the evenings or at night. We need to maximize the time available for residents (and their families) to come to terms with what is happening. And if that is not possible, then we need to provide sufficient ‘link’ people for residents and their families – to brief them, to consult them, to support them.
Queues of ambulances outside a care home and moving residents in the night should be avoided at all costs.
Whenever the State intervenes in the lives of adults there is a balance of risks; are the proposed actions more likely to improve the situation or make it worse? In many adult protection interventions that is a complex balance, involving intricate relationships and dynamics. In these situations, however, the issue is more stark.
If the abuse or neglect in a care home is so severe that the residents are at immediate risk, what is the optimum time period in which they can be moved without causing a more, or an alternative, abusive situation? And what alternate provision might be made to hold it all together to facilitate that optimum time?
In December last year Merok Park care home in Surrey was closed under urgent action and the 26 residents were moved at night in the cold. The transfer arrangements collapsed into confusion and chaos. An 85-year-old man died of pneumonia barely 48 hours later, and a 91-year-old woman died from hypertension a few days later, though Surrey Council has reported that the coroner was clear that the deaths were not attributable to the move.
Lord Justice Munby once famously said, ‘What good is making someone safe if it merely makes them miserable?’ The consequences of rushed care home closures go beyond misery.