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By Debbie le Quesne

Posts Tagged ‘elderly care

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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This is music to the ears

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Barbara Martin hasn’t played the piano for over 50 years.

Arthritis had crippled her fingers and tinkling the ivories seemed only a distant dream. That was until she received support from a student occupational therapist.

I caught this story in the trade press and it truly brightened my day.

A music lover from a young age, Connors House resident, Barbara, used to enjoy all things symphonic from playing the piano to singing in choirs.

With family life keeping her busy, she stopped playing years ago, and now, after two strokes and developing arthritis, she never thought she would play again.

Care Industry News, the online trade magazine, reports: “Barbara has recently been working with an occupational therapist student called Corin, who is on a placement from Canterbury Christ Church University. Together, the pair has been working on strengthening Barbara’s hands and fingers, through a range of activities and tools.

“Music is my passion,” Barbara says, “I can clearly remember singing around the piano as a family when I was younger, my children and grandchildren were all musical too. My first date with my husband, John, was to the BBC Proms! Corin and I got talking and I told him about my love for music and the piano.

“I honestly never even dreamt I would play the piano again. I always used to play Beethoven’s Für Elise and now I can’t believe I can play it again. Corin was so patient with me and has really helped my confidence grow, although I’m not ready to play for other people just yet. When I’m sitting in that big empty room and I can feel the sound coming from my fingers, it really is music to my ears. I can barely believe it is me playing it, it’s a real sense of achievement.”

How wonderful is this story! It’s a delightful antidote to so much gloom in the sector and again a great example of care excellence. Good care does exist. It tends to be only the media that fails to find it.

 

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 . . .

 

Still waiting for the Care Act to deliver

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I was reminded that it’s been more than a year since the Care Act was implemented. Last month saw the milestone pass by quietly . . . except for a report by industry big-player accountants KPMG, who offer advisory analytics to the care sector.

The paper, entitled “Reimagine Local Government – Time for the Care Act to Deliver, pulls no punches and is a timely wake-up call.

KPMG Director, Andrew Webster, outlined the promise of a better future in a Guardian article. He wrote: “It is now more than 12 months since the implementation of the Care Act, a legislative success many years in the making.

“The act spoke of fair and equal access to support services, vibrant and diverse care provider markets and of people having information about how and when to access services. It was to be a fundamental change in the foundations of social care.

In the run up to its implementation, local councils focused on what the act would mean for them. Directors and professional leaders sought to ensure their colleagues understood how services would need to change and momentum built behind the changes.”

But something seems to have gone wrong. In his words there is a “real risk this momentum has stalled.”

Significantly, he writes: “Instead of surveying a diverse care market, we read headlines about providers considering an exit from the sector.

“Council websites are filled with pages about getting recycling bins or parking permits, but little about how to have a grab rail installed so you can stay in your home safely. For now, the vision of the Care Act largely feels just that: a vision rather than a reality.”

He adds: ”The idea of councils as responsive organisations, guiding people to the best care, is the correct one. It is not only right for the wellbeing of our population, it is right in today’s financially constrained public sector.

“Fewer resources are forcing councils to consider making more radical changes to care, in the same way as they have already changed other services.”

He advises: “Councils should strike a new deal with local people, making it clear both sides have a responsibility to maintain independence and wellbeing. That means everyone acting quickly when long-term care starts to be needed. People have to raise the issue before reaching the point where they need care at home, and councils need to respond with accurate advice about local services.”

With a call that councils should raise their digital game to get simple, but still put comprehensive information ‘out there’ on social care, he acknowledges “all of this costs money.”

Added into his mix is a suggestion that all major local care providers should be brought together into one room; “not to drive prices even lower but to work out how to help providers thrive, support new services coming to market and create a digital platform offering access to these new services.”

These initiatives would then be supported by councils investing in training for specific staff groups, building investment in health technology into their economic growth plan, or working with schools to develop better ways to keep young people healthy.

The possible “foundation of the new era promised by the Care Act?”

Great ideas, but I suspect currently out of reach for too many people. One of the major problems we have as an Association is persuading people outside of our membership to talk to us and each other.

What a difference that would make. Not perfect, but a start . . .

Written by debbielq

July 4, 2016 at 11:54 am

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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.