It was inevitable that the government would extend ‘special measures’ to failing care homes and home care agencies having used the regime with some success for hospitals.
While special measures may make some care providers improve, it does not address the fundamental and growing problems in the care sector. It also ignores the differences between hospitals and care providers.
The recent Panorama and Tonight exposés of appalling neglect and abuse in care homes and by home care providers has forced the government to take action. The regulator – the Care Quality Commission – will now have to implement ‘special measures’ in the care sector, but it is not clear yet how it will do so (even though CQC already has powers to close failing care services).
What is clear is that the TV exposés are just the tip of the iceberg. An analysis of the 4,000 most recent reviews posted by families on the Good Care Guide site shows huge concerns about the quality of care for some of the most frail and vulnerable older people in Britain today.
These reviews highlight some key concerns about care homes, such as incorrect medication, poor communication and failure to respond to calls for assistance as well as examples of physical abuse and restraint.
Underlying most of these reviews are concerns about staffing – the lack of staff, their inadequate training, the high turnover of staff and the fact that they do not have enough time to do their job properly.
These concerns are compounded by the increasing needs of care home residents, with the majority having dementia and many being extremely frail and requiring high levels of support. Without sufficient staff (there are no minimum staffing levels for care homes), these problems will only get worse as more residents need one-to-one support for eating and two care workers for toileting, washing, dressing and getting out of bed.
There are big questions for government, centrally and locally, about the funding of care, the inspection of care, the training of staff and the way care companies are run.
Unlike hospitals, most of these care providers are in the private and voluntary sectors. When care providers are put into special measures, how will they be supported to improve? Will they be funded to invest not just in staff and management training and development but also in improving staffing ratios?
Will families and commissioners use a care provider identified as being in special measures? And, if not, will this exacerbate a cycle of decline? Hard-pressed local authorities have squeezed the fees they pay care providers over several years to such an extent that delivering quality care is already an almost impossible challenge.
And what will happen to older people if their care provider fails to improve and is closed by the CQC? Are other care providers ready and waiting to step in? And what about the well-known dangers of moving a very frail elderly person from their (care) home?
No doubt special measures may make some care providers improve – just as hospitals and schools have responded to the threat. But it is a last resort.
Would it not be better to invest in the training, supervision and leadership of care staff and their pay? And to support advocates and families to speak out when concerns arise and provide early warning signs, rather than wait until things have gone seriously wrong?
If we value older people, then we should value their care. This is one of the biggest challenges facing not just the next government but all of us.
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Stephen Burke is director of United for All Ages and Good Care Guide, www.goodcareguide.co.uk, where families can find, rate and review care providers
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we should start with the fact that over 600k are in sheltered housing and would wish to end their days there
but the withdrawal of wardens is leaving them lonely afraid and unsure.
this is why we need increasing care homes, so the first step should be to reverse the policy of cutting cost to save wardens who are a vital part of our first line in elderly care
an average of £7 per week would fund one persons cover with wardens on a 8 hour shift per day per site and could cover unto 80residents of mixed needs.
this would give families and residents the confidence to remain outside care homes and die where they wish to at home.
the very frail will still need care but we need to consider a new model sheltered plus care on same site
this would mean a watchful eye by the relatively fit could be kept on the weaker residents care.
this would have to be outside the private sector to ensure the care was delivered not on a profit basis but need it would have the advantage of no major trauma associated with moving at their age.
I agree with your sentiments above, and the MPs notes are also correct, as far as they go. I would personally like to see [families] of older folk play a bigger role in their parents/grandparents/aunts/uncles etc well-being and safety, as their parents showed to them in the first 13 or so years of their own lives as dependent children. That is a quid pro quo arrangement I would love to see legislators enact in Parliament. Its all too easy to send an elderly person to a nursing/old-age home and leave the welfare and care to [a barely trained](sic) overseas staff member [in a lot of instances] who are total strangers to the ‘client’. Add to this the owners of the ‘home’ who in 9 cases out of 10 are an offshore management outfit who report to their company’s board of Directors [in [?] Switzerland, who kmows where?] who have recently been seen to be mismanaging care facilities and services to an appaling degree – in more cases than there is space to note down here. They seem to be, I contend, more interested in their Balance Sheet’s health and care than they are with their ‘client’s basic food and cleaning. This subject goes beyond party politics and should be discussed on in an open forum. We all get old. Dignity for the elderly and infirm is being trashed and forgotten on a massive scale by this Tory and Libdem coalition,