By Debbie le Quesne

Archive for June 2014

Care reforms in danger of ‘screening out’ needs

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People living at home with dementia could be “screened out” of the care loop, Caroline Abrahams, director of charity Age UK, has warned.

She said that those with dementia and who needed daily help to live at home could become victims of the care reforms.

In particular, she was concerned that the criteria for accessing care was “far too restrictive.”

She added that those who struggled with day-today tasks such as dressing, washing, going to the toilet or preparing food were at risk and explained that “from now on the inability to do just one of those fundamental things will not be enough to qualify for support.”

Age UK is concerned that some older people’s needs will escalate and “undermine their ability to live at home.”

The report, to which I was referred, appeared in the Western Morning News, but has not seen this story anywhere else. I find it worrying that these kinds of alerts are not getting more exposure and the fact that the historically very measured Age UK appears to becoming more political also sets alarm bells ringing.

Home Group, one of the UK’s largest social care providers, has also called for an “urgent amendment” to the rules, so that those with moderate as well as substantial needs can access support packages.

Rachael Byrne, executive director of the operation, was reported as saying: “Many people who have relied on care from their local council will find themselves squeezed out.”

Mencap also gets a platform in the Morning News with charity chief executive Jan Tregelles saying the bar has been set too high and fears for the future wellbeing of those afflicted with mental illness.

I quote: “We know the huge difference support can make to people’s lives and how devastating the consequences when they don’t get it – needs can quickly escalate, pushing people and families to crisis point.”

I really do wonder for what this coalition government will be remembered most.

As the Care Bill progressively makes its presence felt, we wait with bated breath to see how it will standardise the criteria for care across the UK. Presently, we still have in place a postcode for care delivery.

Recently, our Worcester Care Association director Rakesh Kotecha  (left in the photo), gave a talk to a briefing at a Colliers International event in Birmingham for financial,  legal and care industry representatives.

We were all in awe of the task the Act is trying to cover. There are consultations aplenty as none of the parties really know how it can all work.

Part of the event was also an interesting presentation from Nicholas White of Colliers (right in the picture) on the key performance indicators financial institutions use to calculate what is happening in the industry – a real insight


Guilty until proved innocent – how the law works with residential care

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The care industry is getting very twitchy over the new raft of regulatory demands and possible inspection outcomes that can now be deemed criminal offences.

High levels of corporate accountability that could end in the courts have racked up insurance policy bills and according to Caring Times editor Geoff Hodgson’s blog insurers seem to “rank care homes with paragliding and rodeo work.”

At odds with all of the UK justice system, the biggest problem is that provider are assumed guilty until they can prove their innocence.

Geoff point out, quite rightly, that we rarely hear much of lack of accountability of the public agencies involved in the investigation of safeguarding incidents.

Let me quote this incident he highlights in his blog: “In a letter published in the June issue of Caring Times, Paul Simic of the Lancashire Care Association recounts the sorry saga of Palatine Lodge in Burnley where a patient died in early 2012.

“The home had been cleared of any fault by the Coroner, the police, CQC and the local authority, but as a consequence of the safeguarding investigation, all the residents were moved and the proprietor of the home, its reputation in tatters, was compelled to sell the business at a substantial loss.

“In his letter Mr Simic asks: ‘How can it be that all this time on – with what happened to the other residents, to the proprietor, to the manager, to the staff, to any family and friends of Mrs A who also may have had to travel this unhappy road to the Coroner’s verdict – that no fault is found in a provider with an established good name, those who made such consequential judgments en route are subject to no independent review or scrutiny or consequence?

‘Where is the justice or fairness in this instance? Without the right checks and balances in place, the SME provider sector is too easily a secondary level victim.’”

I know too of another case where a male career was accused anonymously of sexual assault with a client in a nursing home. A massive, often hostile, police inquiry followed. The carer was suspended for months, his domestic life fell apart, the home’s manager was devastated and the owners distraught. Outcome: No case to answer – the letter believed to be sent by a former disgruntled employee.

Issues of a legal nature in safeguarding sometimes have catastrophic consequences, which, as these cases show, are not always fair.

Geoff quotes 
“All are punished,” – the Duke in Romeo and Juliet after the lovers’ joint demise’ and notes well it’s not so in the safeguarding scenario. I have a quote to add here too: “The law is an ass” – Charles Dickens (Oliver Twist).

Unveiling the myths about care

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That great advocate for those pressing on in years, Age UK, has recently made headlines saying social care in this country is in crisis and is calling on the government to implement much-needed change.

But care is a mystery to many of us, the organisation says, and has examined five key areas that are commonly misunderstood to try and help explain the social care system better.

So here’s their piece and I would advocate all over-55s should be reading this.

1. The costs of care

The common misconception: It’s free isn’t it?

The truth: Care isn’t free and it’s easy to confuse healthcare services (which are free of charge) and social care services.

Social care is means-tested which means that, if you have income or wealth, you may be asked to contribute or pay in full for services.

Many people pay for care privately by directly arranging support with a provider organisation. People who receive support through a Local Authority may also be charged.

In England, if you are moving into a care home and have more than £23,250 in savings or assets (including your property, if no one else lives there), you will usually have to pay the full cost for the care home fees.

If you have less than £23,250, or your spouse or another dependent still lives in your home, you may qualify for council-funded care. The rules setting out how these payments work are set nationally by the Government.

You can also be charged for home care services, although the value of your house is not taken into account in this case. Local Authorities use national guidance for charging for home care services, but they are allowed to use their discretion and local charges and capital limits can vary.

2. Home help

The common misconception: Councils can provide home helps

The truth: Many councils now provide care only to people who have high levels of care needs. This is because in many areas demand for services outstrips the available funding, and so people with higher needs are the first priority.

People with lower needs can arrange to have help with domestic tasks such as washing and cleaning, but it’s likely these would have to be arranged privately rather than through a council.

3. Care workers’ skills

The common misconception: Care staff are unskilled

Caring is a skilled profession, although, unfortunately, many care workers receive low levels of pay. Providing care is a difficult job and the sector is full of excellent care workers, social workers, advice workers and care coordinators.

Social workers and care home managers are required to have specific qualifications before they are allowed to practise and many other workers need to have on-going training to develop their skills.

However, it’s not all about paper qualifications: the best care workers are those skilled in listening and engaging with older people so that they understand their needs better and can provide tailored support.

4. Paying for care

The common misconception: My home will be taken away from me if I need care

The truth: For some people the value of their house will be taken into account when charges are made for care services.

However, there are many people who will not be affected by these rules. For example, someone’s home is not taken into account in the means test for home care services.

Likewise, if there is a partner or dependent relative living in the property it remains outside of the residential care means test.

There are also other options available to people who do need to use the value of their property to pay for care fees.

Local Authorities are able to offer people a deferred payment, where the council agrees to provide funding as a loan, which is repaid when the property is sold at a later date. This helps residents who do not wish to sell their former home immediately.

Alternatively, some people choose to rent out an empty property, using the income to support with the care home fees.

5. Choice of care

The common misconception: There is no choice of services – you get what you’re given

The truth: Councils are increasingly designing services so that individuals are placed at the centre of the care arrangements, with full choice and control about what services and support they use to meet their assessed needs.

People who are eligible for support are allocated a ‘personal budget’ and can receive it as a cash payment, or ask the council to arrange the support that they want.

This is known as personalisation. It means that individuals work alongside the professionals to set up a care package that they are really happy with.

Dashboard: Missing the mark by a country mile

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I note that Geoff Hodgson, editor of Caring Times, has waded into the debate on web-based self-assessment system, the ‘dashboard’.

He notes that a “few questioning emails “established the following, and I quote:

  • Nursing home operators had not been involved or consulted in the development of the ‘dashboard’
  • Nursing homes will be contractually obliged to use the ‘dashboard’
  • While there was one testimonial from an apparently happy nursing home owner on the NHS Arden Commissioning Support website, the East Midlands Care Association says its members are finding it to be a “struggle, hard work and time consuming”.

As Geoff points out, it’s a fine example of care home providers having things ‘done’ to them without any real consultation.

Certainly, West Midlands Care Association was not invited to the development party and I’m sure none of its member got an invite.

You’d have thought by now the developers of Care Homes Dashboard – NHS Arden Commissioning Support in partnership with Wyre Forest Clinical Commissioning Group (CCG), Redditch and Bromsgrove CCG and South Worcestershire CCG – would have known better than not to involve the very people who are now obliged to use it.

It this was a policy decision, it’s a pretty cynical.

As Geoff says: “The arrogance of these people awesome.” Indeed!

Dashboard’s aim is to provide self-assessment. I strongly suspect at present, it’s missing this mark by a country mile.


Experts show the way forward over wall of silence on references

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Left: Jenny Jones, barrister with Harrison Clark Rikerbys Solicitors, addresses the workshop

Right: CQC manager Jane Rumble explains what to expect with future inspections

West Midlands Care Association has hosted a successful workshop looking at the thorny issues of employment law and its interaction with CQC compliance demands.

Staged at the Portway Lifestyle Centre, Sandwell, employment law barrister Jenny Jones of Harrison Clark Rikerbys Solicitors shared the podium with Care Quality Commission manager Jane Rumble, who outlined clearly the emerging compliance issues.

In tackling the issue of care worker references which employers are often reticent to offer, both speakers agreed that new ideas needed to be developed so that those offering observations on workers did not feel legally compromised.

We had a very focused session and achieved a lot in a short time– that’s great news for the care sector!

The workshop has resulted in the Association now working with both parties to offer guidelines and support mechanisms to its members on what can be included in these essential references.

With help of both speakers four ways were agreed to tackle the problem:

  • Care providers should take all practical steps to get current references, including sending forms and follow-up phone calls. Each action should be and applicant requested to make a self-declaration. Once completed, providers can employ someone with other references and evidence.
  • The Association will work to get members to support fellow members in supplying necessary references.
  • The Association will work alongside Harrison Clark Rickerbys to create a reference form, which will give guidance about what care providers can safely say.
  • And together we’ll do our best to ensureg care providers understand that a ‘well led’ organisation would indeed give valuable information to fellow care providers to ensure good carers remain in the industry and bad one leave.

It was pointed out from the floor: “Everyone is scared to give references in case they get taken to tribunal and there are a huge number of requests in this industry.

“This means that people have to remain on the dole and providers have to manage with less staff by getting people to do more hours, or agency staff are used, who are very expensive and do not know the residents or clients.”

In a PowerPoint presentation, Jane gave a comprehensive overview of what care providers can expect from CQC over the next two years and how its strategy aims to rebuild public confidence in the sector.

I spend quite a lot of my time in conferences and workshops and this was simply one of the best meeting of minds I have seen for a while. I’m only sorry that some WMCA members were unable to attend – such was the demand.


Worcestershire CCG quality monitoring initiative under fire

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A web-based self-assessment system aimed at helping 58 private sector nursing homes across Worcestershire meet ever-increasing legal compliance standards has been branded “hard work and time consuming.”

Residential nursing providers already using the tool in neighbouring Warwickshire and Coventry have claimed it is a “struggle to use.”

And now it’s been rolled out in Worcestershire fears have been raised that data entered online may be used for punitive measures if it shows homes are not meeting the quality assurance mark demanded by clinical commissioning groups.

The package – known as Care Homes Dashboard – has been developed by NHS Arden Commissioning Support in partnership with Wyre Forest Clinical Commissioning Group (CCG), Redditch and Bromsgrove CCG and South Worcestershire CCG, to “monitor, manage and improve standards of care.”

But so far it has failed to win universal support in pilot areas.

Criticism has also come from the regional Care Association for Worcester with many managers and owners feeling it’s yet another hurdle that the industry would have to jump for no additional rewards.

Some of the homes in Warwickshire and Coventry have been using the Dashboard tool and frankly, have found it to be hard work.

In a blame culture, homes are concerned, that despite the CCG saying it would not use the data for punitive methods, it wouldn’t be the case

I’m concerned too that my members are already swamped with Care Quality Commission ‘must-do’ tasks, and while I appreciate the Dashboard is aimed at being proactive, it’s yet another tier of data management that managers and owners are expected to fit in to their already overcrowded work schedules.

Sadly, although West Midlands Care Association represented a huge swathe of providers, it had not been involved with the development of the Dashboard.

The Dashboard claims to provide assurance on a range of local and national clinical key performance indicators, such as infection control, falls, pressure ulcers and hospital admissions.  It also includes a confidential ‘Serious Incidents’ and a ‘Never Events’ reporting portal, where providers can alert a local patient safety team of an incident in their home.

My Worcester colleagues sum it up admirable: More work – no extra pay.

National Care Home Open Day – let’s do it again!

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The first ever National Care Home Open Day was such a huge success it’s going to happen again., The event on June 20,  2014 is about connecting people; it’s about enriching the lives of the UK’s care home residents; it’s about reminding people that those who are residential care are unique,  often intelligent and charming characters; and it’s about the special people who do the caring..

A whole raft of ideas to mark the day is already in hand,  including open days,  coffee mornings,  special entertainment,  memory events,  celebration meals,  theme days and much more.
Each participating home really has a blank canvas to create their special Care Home Open Day., For far too long the care home sector has been marred by the negative press associated with a small number of badly run homes and rogue carers.
This is a golden opportunity to show people what care homes are really about. It’s a chance to make some positive noise – and I for one,  desperately want you to.
The care industry is unique and no-one bothers about it until either they need its services or examples of bad care are beamed into their living rooms in some TV Panorama documentary.
This event has the potential to showcase to the public the hugely positive contribution which care homes make to their communities and excellence in care.
Believe me,  the only people who can change public perceptions are care providers – no-one else is interested.
Be bold,  be brave,  be different in promoting your home. If you have bed vacancies,  put up a large banner promoting the home’s open day events. Get people through the doors and let them see what we are all about. It’s not about hard-sell, it’s about allowing an insight into our invaluable care sector.
On the issue of promotion,  Geoff Hodgson,  editor of the Caring Times,  says: “Considering the cost of advertising,  whether in local papers,  radio or by leaflet,  it seems a no-brainer that for the price of a couple of banners which could be used year on year.”
Go on,  go for it . . . please!