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By Debbie le Quesne

Archive for August 2013

Tasty care is on the menu for dementia sufferers

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It’s Friday, the sun’s out as I’m scribbling this blog and we are not at war with Syria. All good, considering the other options that may well have emerged.

But just to put the icing on the cake, I have stumbled on a lovely story about a care setting where a series of “Come Dine with Me” themed evenings are being held to help people with dementia and their carers enjoy the experience of eating out together.

Staff at Bield’s Whitehill Court in Kirkintilloch have set up “Mary’s Kitchen” where carers and people who use service can come and eat from a special menu in the complex’s dining room.

The TV programme-inspired monthly evenings are being created in memory of Mary Abel who worked at the Bield day support service for 18 years as an assistant manager.

For those with dementia, eating out in restaurants can often be a difficult and challenging experience for them and their carers because of the unfamiliar environment.

It is hoped that by providing a dining out experience within recognisable surroundings, they will be able to relax to spend quality time with their loved ones.

This is so heartening. Already my head is buzzing with ideas.

Rhona Forrest, service manager at Whitehill Court, is quoted in the Care Industry News online magazine: “People with dementia can’t always go out to restaurants as it can be a very stressful and sometimes an embarrassing experience for them.

“We wanted to take away this stress by creating a special restaurant within the service so people can come and relax because they know where they are. Our staff will also be on hand throughout the evenings to help with any difficulties and ensure everyone can enjoy the family experience of eating meals together.”

“The venture has been created in memory of Mary Able who worked here for 18 years. She knew about the project before she passed away and absolutely loved it. She was always keen to get the service users involved and wanted families to spend more time together, which hopefully will happen with these evenings.

“Mary’s family are delighted that we have created the evening in memory of her as we all know how happy she would be to be involved in such a positive initiative.”

Whitehill Court was awarded £20,000 of funding from Shared Care Scotland which will pay for the “Come Dine with Me” service to run for one year and an additional service where two evenings a week, five residents will get to go out for dinner as an extension to their day care.

This is truly the kind of care that enriches lives and supports both carers and those they look after. It’s worth? Priceless.

Enjoy the weekend. Golf beckons.

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Prevention Matters model gets my vote

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The old saying “prevention is better than cure” has a ring of truth, but the application of that wisdom is critical for the wellbeing of our elderly.

The adage not only applies to our seniors living healthier and fulfilled lives, but also to – and probably more importantly – to cost. If can keep our elderly independent that’s not only a great ethos, but also avoids costly crisis situations.

In the care and support of vulnerable adults, the evidence has been building for decades that taking measures to keep them healthy pays big dividends in the long term.

The Care Bill seeks to implement new models of working that allow this to happen.

Using some of the funding from the grant transferred from the NHS to local authorities to help social care budgets, Buckinghamshire County Council has created a Prevention Matters programme.

Launched last month, it has brought together the county council, the health service, the district councils and the voluntary sector in a joined-up approach to catch vulnerable adults in need before personal health or social problems become critical.

This is a great idea and an ideal that needs rolling out nationally.

Health secretary Andy Burnham accepts that research evidence presents a powerful and persuasive argument for making prevention a priority in social care services.

The figures show that for every pound spent on preventative social care, the NHS in providing emergency beds saves £1.20.

The mechanics of the Buckinghamshire model uses GP surgeries as the primary referral point. A network of community practice workers managed through specialist voluntary sector organisations work directly with the clients to assess needs, develop support action and assist the client in making it work.

Simultaneously, a team of community links officers is tasked with identifying, enhancing and informal community-based services and social opportunities.

I can see this being rolled out as a template after all of the audit work has been completed.

In the meantime, Buckinghamshire seems a good place to be if you’re elderly.

Challenging the ‘entertainment’ stereotypes in our homes

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I love art, it’s creative and varied expressions and the power it has to communicate across all language barriers.

West Midlands Care Association was recently approached by community interest company Creative Health, the independent Arts and Health organisation for the Black Country and the West Midlands, with a proposal that thrilled me.

Incorporated in February 2009 and formed by the Black Country Arts and Health Commissioning Partnership, the body, along with ourselves and other associations is bidding for an Arts Council grant to challenge the stereotypes of entertainment and activities delivered in care homes.

If the application is successful, a wide range of artistic expressions will be presented in residential settings, which according to the grant application will turn “the everyday into the extraordinary.”

The thrust of the project is to integrate artwork into care where professional artists, performers and residents are all encouraged to interact. Key to the project’s on-going success will be the training of activity coordinators in the homes.

Some 30,000 older people in residential care settings and more than 4,000 care workers would be targeted.

The “Living Room – Turning the Everyday into the Extraordinary” application explains: “We all pass time in our living room: somewhere to chat, undertake activities, rest, welcome visitors or watch television, together.

“Creative Health CIC and partners are proposing to use the idea of the family living room – where we feel at home, comfortable; surrounded by the people we love and also the everyday objects that mean something to us – to inspire a ‘Living Arts Room’ . . . a living, breathing space that stimulates warmth, emotion, sharing between residents. Families, providers, staff [and] artists.”

In tandem with the project would be an online presence, support mechanisms, exhibitions and a robust training programme for care managers, carers and activity co-ordinators.

I am delighted to be part of this bid and the ethos of the Living Room project ticks all the boxed for the association.

The first time I came in to contact with anything similar to this creative expression was when the association was working alongside the European Parliament two years ago to assess the creative synergy of care and art. I was so impressed with what I saw that when I was approached by Living Room I was happy to endorse the application.

It was interesting to see first-hand how, particularly in the Czech Republic. Arts in their many and varied types are central to culture and care for the elderly – especially those with Alzheimer’s. We discovered a similar model was also in place in Rome and Slovakia.

Living Room also aims to carry out a feasibility study into a Quality Mark for Arts in Care Homes. Together, residents, care staff and artists would benchmark arts activity in care homes.

Fingers crossed we will find favour with the application.

Consequences of care on the cheap . . .

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If you work in the care sector, have had a decent Bank Holiday break and are prone to uncontrollable rages at one-sided media coverage, don’t search on line for social care.

I wanted a quick catch-up after the weekend and stumbled on an offering from the Daily Mail online. It dealt with the recent CQC annual report and the findings are shocking.

Equally shocking is the fact that the newspaper has not attempted to present the reason why so many of these failures have occurred.

Here’s snipped just to raise your blood pressure: “A record number of care homes and hospitals were issued with official warnings last year after the health watchdog uncovered ‘unacceptable’ standards of care for the most vulnerable.

“Inspectors issued 910 ‘warning notices’ prompted by examples of pensioners forced to sleep in dirty beds, use dirty commodes and live in unheated rooms over the winter.

“Warning notices are issued when care is so bad that the law is not being complied with. They order institutions to improve on pain of closure or prosecution.

“The Care Quality Commission’s annual report reveals the number of warnings leapt by 43 per cent in a year to more than 17 a week.”

I’m not knocking the Commission here. They have a job to do and part of that is exposing bad care.

But the Mail seems to have missed a vital piece of information in its article.

A catalogue of failings included: Pensioners forced to sleep in unheated rooms over the winter; residents ignored when they were in visible pain; broken call bells meaning residents could not get help with going to the toilet; residents forced to sleep in dirty beds and use filthy commodes; staff falsifying medical records; unexplained injuries not investigated by staff and allegations of abuse not reported; and medication being given at the wrong times and doses being missed.

It doesn’t get much worse.

But why is this happening? If the Mail wants to shoot down the care industry, let’s see a bit of proper journalism at play first.

Yes, I know the CQC 2012/13 report is newsworthy, but the question has to be put why the care is so bad.

I cannot and will not defend bad care.

Details of the warning notices contained in the CQC’s 2012/13 report reveal 910 warning notices were issued, up from 638 the year before.

Of these, 818 were in adult social care – meaning care homes as well as care in pensioners’ own homes.

The remaining warnings were issued to other healthcare institutions, including hospitals, GP surgeries and ambulances, the Mail reports.

“It is not known whether the rise is down to an increase in poor standards, or the fact that the CQC is getting better at rooting out poor care,” the report adds.

This shaming, I believe, is primarily the result of an abandoned and chronically funded social care system. We perpetually battle for better bed payment deals from local authorities, man of which actually agree their fees should be higher. But their plight is much like ours – funds from central government have been unrealistically hacked to the bone.

I agree there are bad care proprietors, but in a lifetime’s experience within the care industry, I find most are good but are not paid anywhere near the amount of money needed to deliver care without some kind of compromise and the problems emerge when those compromises compromise care.

Many of my members survive only because of their private, fee-paying service users.

Their top-ups are being used to subsidise the care of those who do not pay such fees and sustain the level of care we all should expect.

The Mil headline reads: The shaming of UK care homes . . . but by whom? The operators – clearly they are culpable, but also I believe a series of governments, which have not given social care its proper value. Sadly, the care-on-the-cheap pigeons are now coming home to roost.

Safeguarding: A new way of sharing information

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I have long said that the Welsh know a thing or two – I seem to spend a lot of time in Wales doing family stuff.

So I’m not in the least surprised that Caerphilly council’s Protection of Vulnerable Adults (POVA) team have come up with a new tool in the way we protect vulnerable adults.

The mechanics of sourcing information and, in particular information exchange with other agencies, has been a problem for decades.

Accurate assessment of risk is critical. However, there is a “lack of consistency” when it comes to information sharing between agencies, The Guardian reminded us recently.

It is no longer acceptable for agencies to keep information pertinent to risk to themselves. Risk management is a multi-agency approach.

This question has formed the premise for a new piece of work, which has led to the development of a new tool – the adult safeguarding chronology, a timeline initially based on social services’ records and added to at strategy meetings by agency partners.

The Welsh Social Services Improvement Agency – a group aimed at equipping leaders to improve practice – has supported the scheme.

Up until now no clear means to document complex history of acts of abuse existed. The Guardian says.

The people at Caerphilly are piloting the new model and I’m sure this initiative will empower all concerned. It will be nothing short of comprehensive, including actual referrals and concerns that have not met the threshold for a referral.

I applaud the idea: Signposting for other organisations is critical and this certainly ticks the boxes. Information really is power in often-difficult safeguarding circumstances.

It will be interesting to see if this records model is rolled out nationally. For sure, if it wins high praise in Wales it ought to be given an airing in England.

Zero hour contracts: Between a rock and hard place

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The issue of zero hours contracts in the care sector raised its head again yesterday – this time care of The Guardian’s social care online columns.

On reading the report from Roger Kline research fellow at Middlesex University and an associate with Public World, I find myself between a rock and hard place.

He observes that when Robert Francis QC reported earlier this year on the shocking treatment of elderly patients at Mid Staffordshire Hospital, several of his recommendations explicitly applied to adult social care.

Why? Because, he argues, it was clear from numerous reports from the Care Quality Commission and others that the care of the elderly in all settings – including residential and nursing homes, and in their own homes – was troubling.

Kline then adds: “There is plenty of evidence linking the treatment of staff to the safety and quality of care the elderly receive. Above all, good care relies on competent, trained, supervised staff having the time and continuity to build relationships with vulnerable adults.” That is wholly true.

What I find most disturbing is the fact that according to Skills for Care, 307,000 social care workers are now employed on zero hours contracts.

This accounts for one in five of all professionals in this sector and the numbers are growing rapidly.

Kline’s economic analysis is simple (and again true). “This is happening for two main reasons. Firstly the immense squeeze on council finances (notwithstanding the recent transfer of some adult social care funding from the NHS) has led most councils to adopt commissioning models for home care that fund providers for fixed and often unrealistically short time slots. . .

“ Secondly, ‘personalisation’ has led to a growth of a section of the homecare workforce with virtually no employment rights at all – often on bogus self-employed terms – as well as raising serious questions about support, quality, training and supervision,” he writes.

There is a huge push from local authorities to contract out both residential care and home care provision, but as Kline points out, it comes at a time when council funds are being slashed.

It’s a bizarre contradiction of logic that as the elderly population rises to record levels, funding to care for them and the resources and staff required to do just that are being withdrawn.

I see first-hand the current stringent economies in play as my members desperately try to deliver care with little financial rewards. Morally I cannot support the zero hours contracts and most definitely, good care needs to have relationships built between carers and their charges. But I understand too that zero hours contracts can be the only way forward for some care operations. It would be easy for me to judge, but only if I have evidence of compromised care in such circumstances,

Sometimes I wish we lived life in primary colours – it would be much easier then.

Kline adds: “As personal budgets proliferate and block contracts decline, because councils cannot guarantee set volumes of work to providers, the uncertainty of funding and contracts is passed on to staff, in the form of zero hours contracts and other ways in which they pick up the funding slack.”

Is this really the way ahead?

Charity social researchers The Resolution Foundation argue that social care is not the place for such contracts; the Social Care Institute for Excellence agrees and advises commissioners and providers to ensure staff have set-hours; and Secretary of State for Business, Innovation and Skills and President of the Board of Trade Vince Cable has promised a review on such practice.

Government movers and shakers, who sit on the fence with their ears nailed to the floor, have long beset the care sector. Could we please have a proper decision on the zero hours soon, please.

Boots at the ready for Memory Walk

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The Great Gatsby actress Carey Mulligan has spoken candidly about her grandmother’s dementia on BBC Breakfast this morning.

Why? To urge people to join the fight against the condition by signing up to Alzheimer’s Society’s fundraiser Memory Walk next month.

She spoke affectionately about her grandma, ‘Nans’, now 87 and living at a care home in Wales.

Twelve years ago, she recalled, along with other family members she noticed her memory was failing.

“I was about 15 . . .16. I started to realise she was forgetful about things that I knew she would be passionate about and remember.

“She was a geography teacher and so she was always really interested in my education and what I was studying.  I remember picking my A-Levels and I told her what I was doing and she started not remembering what [the subjects] were and I thought, you love education and you are really excited about what I’m going to do, and she couldn’t remember them,” a report in Care Industry News says.

There was a refreshing honesty in the interview with Mulligan recalling the awkward moments while visiting her ‘Nans’ in the Pontadawe care home.

“The first time I went into the home and I sat talking to Nans, she had trouble communicating. I could talk to her, but often, other people in the home would try and talk to me or try to start a conversation and I would feel immediately nervous and think am I going to mess up this conversation because it’s slightly difficult sometimes.

“It can be a little bit challenging talking to somebody with dementia if you’re nervous – you don’t want to be patronising and I think a lot of people feel that,” the actress is quoted as saying.

There’s still a kind of awkwardness in talking to some people about the memory-loss condition and Mulligan rightly points out that the more people talking about it and raising awareness the more people will feel less scared of addressing the subject.

So many of the elderly people whom my members care for have some kind of dementia. It’s growing problem with an ageing society and the walk initiative is well worth a day of anyone’s time.

There are long and short walks and they are taking place next month all over the country. Visit http://www.memorywalk.org.uk/?gclid=COK85KP1jbkCFS3HtAod8mQAbA choose a walk in your area, try to raise sponsorship for a minimum of £50 and gets your boots ready.