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By Debbie le Quesne

Posts Tagged ‘care in the community

Eye test may hold clue in Alzheimer’s diagnosis

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Changes in and around the eye may be able to detect cognitive impairment and Alzheimer’s disease at an early stage, the Alzheimer’s Association International Conference was told.

The Toronto gathering heard there was a strong association between thinning nerve layers in the retina of the eye and poor cognition, suggesting the potential of retinal imaging as part of early Alzheimer’s testing. It would mean a low cost pre-symptom test could be carried out.

Today, it is only possible to clinically detect Alzheimer’s relatively late in its development, when significant brain damage has already occurred.

Researchers at Moorfields Eye Hospital in London conducted a type of eye scan called spectral domain optical coherence tomography (SD-OCT) in 33,068 people aged 40–69. They measured the thickness of the retinal nerve fibre layer (RNFL), which is known to decrease with age. Participants also took part in tests of memory, reasoning, and reaction time.

A thinner retinal nerve fibre layer was strongly correlated with poorer performance on any one of the cognitive tests, as well as with the number of tests failed overall. For each additional test failed, the RFNL was thinner by 1 micrometre.

Eye tests are fairly common for older people, so there must be great potential to incorporate additional tests into their regular check-up. These tests could help to identify people at risk of dementia.

This is all very scientific and my eyes are becoming glazed over just writing this blog.

However, the information is worthy of putting out there.

The cost of dementia is staggering and our care homes are full of people – some not diagnosed – who struggle with memory loss.

The overall economic impact of dementia in the UK for 2015 was £26.3 billion. This works out at an average annual cost of £32,250 per person and consists of:

  • £4.3 billion of healthcare costs
  • £10.3 billion of social care of which:
  • £4.5 billion spent on publically-funded social care
  • £5.8 billion spent on privately-funded social care
  • £11.6 billion of unpaid care
  • £111 million on other dementia costs

Having had a personal journey caring for those with Alzheimer’s, a cure can’t come soon enough. I understand current research is looking at new treatments which could alter the course of the disease and if a predisposition to the condition could be diagnosed easily let’s hope some preventative therapy could also be found.

 

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Discharge delays again: New measures needed to fix problem

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The Government body for scrutinising value for money on public spending has concluded “patients and the NHS have a right to expect better” on the issue of hospital discharge delays for the elderly.

The recent Public Accounts Committee report challenges the Government to address the scale and cost of the problem.

It urges new measures to tackle discharge delays, which are bad for both patients’ health and the financial sustainability of the NHS and local government.

I have campaigned long and hard on this issue and clearly made known my views that in many cases hospitals are really not that switched on to getting the elderly back into the community or care homes. Discharge managers need to have a good understanding of how care homes deal with admissions and how care packages are processed.

The Committee found there was a poor understanding of the scale of discharge problems, with official data substantially under-estimating the range of delays and the number of older patients affected.

There is unacceptable variation in local performance on discharging such patients, said the Committee, finding that while good discharge practice is well understood, “implementation is patchy across local areas”.

It concluded poor sharing of patient information is a significant barrier to improving performance, while “the fragility of the adult social care provider market” exacerbates discharge difficulties.

All this is true, but there is I believe a bigger problem. Care costs money and the sanctioning of care packages becomes, it appears, more and more protracted. It’s not just a case of finding a step-down bed or a care or nursing home, the big issue is getting it funded.

However, while the Committee recognises there is pressure on funding, it does not accept this necessarily blocks efforts to make further improvements and urges a greater commitment to step up the pace of change.

It concluded: “NHS England shows a striking poverty of ambition in believing that holding delays to the current inflated level would be a satisfactory achievement.”

Harsh words.

Those regions which are doing best are the ones where “all the local system owns all of the problem” but this practice is all too rare. NHS and social care sing off the same hymn sheet, but who’s going to be choirmaster to create some harmony here?

Here we go . . . the reports adds: “The Department, NHS England and NHS Improvement have failed to address long-standing barriers to the health and social care sectors sharing information and taking up good practice. The result is unacceptable variation in local performance.”

West Midlands Care Association is available to help resolve the discharge problems. Getting the right people to talk to us . . . now there’s another challenge.

Local health and social care organisations need to work together effectively, in fully integrated systems, to make this work.

The National Audit Office (NAO) has estimated a gross cost of around £800 million a year for the NHS of older patients delayed in hospital when they no longer benefit from being there.

 

GPs a gateway to social care and more

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The role of GPs is changing. No longer are their practices just treating medical conditions and referring patients to hospitals.

Primary care is at last being driven by an integration which seeks a greater level of collaboration across frontline services – everything from companionship advice for the isolated to social service and end of life referrals.

This is the new face of primary care service, but it’s not everywhere – not yet.

Increasingly, patients are able to access GP-led hubs offering a range of services, or are given a social prescription that provides them with access to non-medical support, such as social clubs, peer networks or arts therapy.

However, even with growing evidence that these models of care can reduce long-term demand on acute services, we have still not yet seen a major national shift in this direction.

An NHS report – the General Practice Forward View – endorses this broader remit and as well as setting out detailed plans for the recruitment of more GPs, argues for a refocus of the GP’s role on to prevention rather than cure, and the promotion of community-based care and support.

Social care is getting NHS backing. Am I dreaming?

The report calls for more areas to incorporate the multi-specialty community providers (MCPs) model of care – a programme of integrated primary, out-of-hospital and preventative care that is being piloted in 14 regions of the UK. Social prescriptions should also be more frequently used, it adds, to provide patients with access to organisations that can provide advice on employment, housing, debt and other support services.

For me, this is an exciting breakthrough, and could mean GPs become the gateway to social care.

Mmm . . . which pot of money will be used to fund this?

 

New PM downgrades care minister’s role

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Theresa May has an unenviable challenge. We have the Brexit issue, the unstable British economy, welfare issues, immigration problems . . . and social care all clamoring for her attention.

What’s going on, I ask. The minister of Care responsibilities have been downgraded and are now the remit of a parliamentary under-secretary. It’s the first time in eight years this has happened and I’m hugely disappointed.

The news appears to have caught the imagination of only a few journalists, but not surprisingly, the ones at the Guardian.

“This downgrade comes at a time when there is acceptance that social care is in crisis and there is unprecedented demand on care services,” I read in the paper’s online columns.

And the article points out the obvious. As we live longer and have more complex needs in later life, it is crucial that social care remains high on the political agenda.

The downgrading appears to suggest otherwise – this is now a post on the bottom rung of the ministerial ladder. I was hoping that things would be so much better with Mrs May.

According to the Association of Directors of Adult Social Services, to maintain care at the same level as last year would require more than an extra £1.1bn. But the National Audit Office, says the Guardian, has previously reported that councils increasingly pay less than the actual cost of the care provided.

Here we beat the same old drum: It is not a financially viable a situation.

Additional pressure on care provider budgets comes with the Living Wage and the fact that demand for care is only going to increase.

Jane Ashcroft is chief executive of Anchor, England’s largest not-for-profit provider of care and housing for older people, writes: “With a rising population and longer life expectancy, the number of people over 65 is set to rise by more than 40 per cent in the next 17 years.

“This will take the number of older people in the UK from 11.4 million to more than 16 million. This demographic change is welcome; it signals improving living conditions and advances in medicine. But if the funding of services is not updated for these new demands, we are undoubtedly heading towards an age of suffering and loneliness for older people.”

Rightly so she calls for a minister of state role – “someone with the power to make real change.”

I fully understand that good social care reduces the financial burden on NHS care. It cuts hospital admissions and heads off expensive health troubles with our vulnerable and elderly. Critically, it can also cut hospital bed blocking.

According to Ashcroft these combined woes cost the taxpayer £820m a year.

Can we have our minister back please. I think we need one, urgently. The downgrading of this portfolio is a huge step in the wrong direction.

 

The haves and have-nots: Bizarre economics of care

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The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .

 

Exceptional success at the double for care workers

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Brum care awards

Above: Nicholas Nolan and Cherry Harvey, centre, with ITV weather presenter Emma Jesson, left, and Jag Khatkar

 

Many of us in the care sector recently attended a glittering evening to celebrate the best of caring at the Edgbaston Cricket Ground. It was a great night that celebrated excellence in care and a night I was pleased for West Midlands Care Association to be part of.

Out of that event, one story has been prominent in my mind. Two newcomers to the care sector were honoured with an industry award for their outstanding commitment to the job after judges failed to decide on a clear winner.

The selection panel was so impressed with the nominations for support worker Cherry Harvey and community carer Nicolas Nolan it decided they both deserved the Exceptional Newcomer’s Award. The couple were shortlisted from hundreds of entrant across the city for the Birmingham Care Awards.

Support worker Cherry, who is part of the Precious Homes’ Kings Heath team in Birmingham, had no idea she had been nominated and was thrilled when her name was called out.

Judges commended Cherry’s dedication, commitment, compassion and loyalty, specifically in a first-time role within the care sector.

The awards ceremony was a joint venture between Birmingham City Council, West Midlands Care Association, Skills for Care and the Care Consortium. A regional event, its aim was to celebrate and reward excellence in social care.

Joint winner Nicolas, a community worker with Trident Reach The People’s Charity, caught the judges’ attention for his “rapid learning ability and willingness to better himself.”

With no previous domiciliary care experience, he joined Trident’s Birmingham Home Care team based on Hagley Road, Edgbaston, in January.

Already he handles a customer base of varying needs, working alongside people with learning disabilities, mental health issues and the physically disabled.

His award nomination said: “Nicholas’s understanding of all his customer needs and the nature of how domiciliary care services work is highly admirable, given he started with no care experience. He is a valuable member of the service who is always willing to help customers achieve, always puts customers first and applies a personalised approach to every customer he works with.”

This pair represent everything what good care is about and I thoroughly endorse the decision that both have been declared winners. Birmingham Care Awards is about celebrating care excellence.

They are the kind of role models the industry needs and proof that quality care is out there, valued and right on our doorstep.

 

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Smart thinking, but ‘care bots’ can’t replace carers

Creating the ideal home is big business – in fact there’s a world stage out there for exhibitions that can both temp and puzzle. From the practical to the bizarre the evolution to help make us more efficient is rolling out rapidly.

In the home of tomorrow our front doors will be able to ‘talk’ to your smoke alarm, lights will flash when the fridge door is left open and, according to reports emerging from the Mobile World Congress in Barcelona, Teddy will put your child to bed.

Other features include at smart lock that unlocks the front door when the home owner is near, televisions that show notifications and can warn when a child is using the web when they should be asleep, and a system that lets you change all the clocks in your home at the touch of a button.

The vision of the future is restrained only by our imagination.

But this model, that’s also invading the care sector, is not without some serious pitfalls, as reported in the Telegraph online by Science Editor Sarah Knapton.

Last month’s article said these so-called ‘care-bots’ are “emotionally dangerous”. The warning comes from an artificial intelligence boffin Maggie Boden, professor of Cognitive Science at the University of Sussex.

She warned that machines would never be able to understand abstract ideas such as loyalty or hurt – essential in responding compassionately to those needing care.

“Computer companions worry me very much,” Prof Boden was reported as saying.

I understand her concerns, but one does not have to be a professor to comprehend that the elderly really do need real people to respond to their needs.

I read that last December the University of Singapore introduced “Nadine” the ‘care bot’, who, according to its manufacturers, will eventually provide childcare and offer friendship to lonely pensioners.

For those who know the care business well, loyalty from careers to their patients is something that is hugely appreciated by those receiving and those managing care. All excellent care on a personal level will have loyalty as a cornerstone.

I really don’t think ‘care bots’ can replicate that just yet, and even if they could, would I want to confide in a machine? Of course not.

Technology has its place and, fortunately I’m not one of those afraid of it. Telecare is a prime example where technology in the care sector can be helpful. It has been designed for people with social care needs and allows the remote monitoring of an individual’s condition or lifestyle. It aims to manage the risks of independent living and can include automatic movement sensors, falls sensors, and bed occupancy sensors.

But computer companions are very different. The simple act of sharing a cup of tea or listening to an elderly persons’s story can never be replicated by ‘bot’ science – well, at least not yet. Humans not only respond (we’re aware computers can do this too), but can respond in an appropriate emotional way (and it’s where, critically, the care-bots fail).

Smart technological thinking can help with being creative on stretched budgets, but even with all our faults, cannot replace that which makes us quintessentially human.

A robotic revolution to replace carers . . . Not on my watch.