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.
‘Morally wrong’
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.
‘Coordinated arrangements’
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.
‘Rushed closures’
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.
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Mr Fitzgerald, I couldn’t agree more with your comments on this website. As a relative of one of the affected residents at the Old Village School care home, the treatment that the residents and relatives received was despicable.
To give you a little background. I visited the home with my wife and son on Friday afternoon – the first that we heard of the home’s closure was at 3.30pm, when a resident’s family approached us and questioned where my dad would be going, we were shocked to say the least. They then informed us that the home would be closing….a further shock.
On returning to the home later that night, we found out where his new care home would be and for us, it was a little closer to home. However, some poor residents were being moved further away – as far as Peterborough in some cases. We were also informed that a magistrate made the decision at 5pm that the home would close at 12am and that all residents would be moved that night.
Backtracking – no-one from CQC, CCG or SEPT contacted us concerning the home’s closure. Had we not have been at the home that day, we’d never have known where he was going. This wasn’t only the case for us, but for many other families and this is totally unacceptable. My mother received a letter from Beds CCG on Tuesday the 11th August to say the home was closing. The letter was dated the 8th August (Saturday), a day after the home closed and posted on the 10th August (Monday).
The fault lies in many areas:
1) The home – their care should have been up to standard. However, our personal experience was that it was totally up to standard and we’re still unaware of any reason why the home should have closed.
2) The Magistrate – how someone can have absolutely no idea what the situation is with regard to the elderly and (as my dad is) brain injured who reside in these homes, is unbelieveable. Making a decision on their lives in an instant was a ridiculous situation.
3) CCG/CQC/SEPT – Their actions in not informing the residents and their families was beyond belief and completely unacceptable. They have not made any attempt to explain the situation in any more detail, nor have they had the courtesy to issue any form of apology for their lack of action in contacting the relatives. This is totally ridiculous. In fact, the head of Beds CCG was quick to praise the actions of her colleagues in making this a ‘smooth transition’ – quite what planet she is on, I have no idea.
There should be some form of legislation to prevent this kind of thing happening in the future, but in all honesty, I can’t see it happening. If care homes have to be shut, the courts and the local CCG will just do it, but quite how these people can sleep at night once their decisions have been made, is quite beyond my understanding.
Hello Robin
Would you email me direct, I would like to follow this up further with you and any other residents garyfitzgerald@elderabuse.org.uk
Gary
It is without doubt abusive. There should be emergency teams available according to the number of closures that happened in a year in this country. Some of these homes have already been inspected and deemed to be a serious concern. Ibelieve that the CQC should have teams that go straight into any home requiring improvement or with serious concerns, paid for by the care home provider, to improve the quality. No CQC inspectors should walk out and leave vulnerable people in a potentially abusive situation. The new inspections are much improved but we need to go to the next stage to properly protect our elderly
It will be interesting to see if the Care Act provisions for provider failure enable different outcomes for residents in these situations.
More evidence of incompetence by the CQC. I have lost confidence in the CQC. Someone should point this out too the Government, and they in turn should explore closing the CQC! soon…
Imagine how the C.Q.C staff would feel about vacating their desks at short notice…