Eating is (to nurses) low priority for older people in hospital

Not only in Britain. This is the results section from the abstract of a newly published article about a study of nurses and nutrition in an Italian hospital:

Although nurses perceived malnutrition as a significant issue, it was often considered of secondary importance compared with other aspects of care. Food choice, although available, is often limited to very few options, diets are standardised and monotonous and patients must choose ‘sight unseen’. Time constraints and understaffing were the obstacles for the identification of the need for nutritional care. Organisational and managerial decision-making did not ensure the provision of high-quality nutritional care. Patients’ nutritional status was often not assessed, and tools such as the Mini Nutritional Assessment were not mentioned by the participants.

One thing about this is the way in which the basic aspects of daily living seem less important to the professionals in a hospital than in normal life: washing, eating and drinking.

But also the relationship aspects: eating is a social matter, it should be done with people you enjoy being with: it's not just a filling station for nutrition.

I'm also doubtful about the argument that you hear sometimes that this arises because nurses are over-educated nowadays, so they're concentrating on the things they're trained to do, rather than on some idea of basic caring that education takes away from you. No, I think it's about discipline and self-discipline. When I was first in hospital in the 1970s, the whole place was regimented by a terrifying ward sister. But the regimentation meant that the basic caring as well as the training and treatment activities went on in a well-ordered routine. When I've been in hospital recently, it's all more relaxed in style, but that also means that people hang around yattering in scruffy clothes, thinking about their own affairs rather than running the place well.

The link to the article in the Scandinavian Journal of Caring Sciences

Social care white paper: we don't know a lot and we're not doing a lot

 A Guardian Professional report on a House of Commons Health subcommittee reveals that the government has really 'oversold' the improvements offered in the social care White Paper. Asked about the details, these were the answers:

Will they actually be banning home care visits as short as 15 minutes? Well, actually no: they'll be 'spreading best practice'.

Will they be getting rid of the postcode lottery by setting a national minimum standard? Well yes, but it will be at the totally inadequate 'substantial' level that most local authorities operate at anyway.

How is the 'universal deferred payment scheme' targeted at 2015 going to be different from what local authorities do anyway? Well they're still 'modelling' that, but not all local authorities do it. How many don't? They don't monitor that, so they don't actually know. They'll have to get independent research to find out.

So the reality is they don't know a lot, and, in the absence of a decision on social care funding, they're not proposing to do a lot either.

Link to The Guardian report.

Citation for the social care White Paper: Department of Health (2012) Caring for our future: reforming care and support (Cm 8378). London: TSO.Retrieved 24th July 2012 from http://www.dh.gov.uk/health/files/2012/07/White-Paper-Caring-for-our-future-reforming-care-and-support-PDF-1580K.pdf.

Claims for a luxury care home should just be normal standards

The BBC reports on a new Anchor housing association project to provide a 'luxury' care home, targeted at 'baby boomers' like me, who are property rich but income poor. They accept that it will not be for people paid for by local councils or many people who are self-funding.

Why this should be seen as a novelty I am not sure, since there are many such luxury care homes that exclude the poor by their prices? Except, I suppose, that it comes from a housing association more strongly associated with a charitable motivation. We have all got used to people paying for luxury, and perhaps I would want it for myself when I get there, although if they are targeting baby boomers, they are probably a couple of decades too soon.

But the question has to be asked: why should council funded or self-paying residents not also get a good standard of provision? The claim here is a magnificent advance to a 1:5 staff ratio, rather than a more typical 1:8 or 1:12, and everyone gets 12 weeks induction training, including stuff on dementia. Why should this be regarded as luxurious? Surely a reasonable level of staffing and training for the staff should be regarded as normal.

BBC News Report: is there a future for luxury care homes?

Images of ageing - video: older women explore their body images in an ESRC project

Last week at work: how soon will this ten years be forgotten?

Now I actually have retired, and after a busy period of a family event (grandparents -us-, children and grandchildren at Center Parcs) and an international conference, I am looking back at the actual last week at work. I’d planned to be there all week, switching my three days a week around to be available, but I was unneeded.

Because the boss was on hols, the leaving do was on the Friday before I left, so it rather spread out leaving over the following week for me. The usual St Christopher’s scones and cakes, and a good speech, from the chief executive, as she usually manages on these occasions. Themed on me as a ‘one-off’; flattering, do I underestimate, or am I right that I will be forgotten as soon as I pass over the threshold? Past experience of leaving jobs suggests the latter. And it has been ten years of my life.

Because we were going on to a church event, we had an elderly member of the church with us, who counted it a privilege to hear about my work life: ‘We only hear about this at funerals’. True, and also only if the funeral is not too long delayed so that everyone has forgotten you. I always think if you want a lot of people to turn up and give good eulogies, you have to be young and in work for your funeral. I, on the other hand, am hoping for a while to do stuff for myself.

Then there was a lot of clearing up – when she came to the leaving do, M was quite impressed by the amount of stuff that has shifted from my office, mostly taken in phases to home. I got used to this in previous job changes. You take a bag or two of books every night, and occasionally a carful.

Then the librarian had a lunchtime sherry party, and I provided nibbles on Wednesday, which was a treat for some of the volunteers and others in the education building.

Other than that I worked on some articles (still unfinished business for early retirement) and met some people about problems. Taking it easy and it was a nice week weatherwise, which makes it pleasurable to enjoy the St Christopher’s gardens, so a nice pic of them for this post.

Retirement day feelings: my loss is that work is no longer my place in the world

The retirement day.

I could feel myself being a bit weepy walking away from work for the last time. Not actually tearful but certainly filled up. I couldn’t quite see why.

Thinking about it, I’d not had any emotional farewells on the day; just handed in my keys and laptop, deleted everything from my computer – I’ve been progressing through that for weeks - went through some routines, put some office stuff in my bag and set off early for the station.

It wasn’t about loss of the job. I’m not massively committed to St Christopher’s, it’s been a good billet, nice people, interesting work, but I don’t totally believe in palliative care and the hospice movement. Probably that’s evident from my St Christopher’s blog over the years, and certainly will be in my new end-of-life care blog. I’ve wound down in a classic way over ten years, so I’ve been progressing towards retirement for ages, I’ve got used to it, I don’t have worrying health, care or financial problems, I’ve got family support and family things to do, I have continuing work and personal interest things to do.

So why the tugged heartstrings? For one thing, although in many ways I have the security of no major change in other parts of my life, I feel uncertain, perhaps insecure. It's because I don’t quite know how it’s going to be. I’ve been busy with work, and often too much of it, for forty or more years. What is my place in the world going to be now? And does it matter? I don’t know yet.

Link to my St Christopher's Hospice palliative care/social care blog archives

Link to my new Social Work and End-of-life Care blog

Do older people want a fun night out?

I saw this sign today at a local hotel. 'Clubbing for the over 30s'. Why not clubbing for the over 60s? At last week's conference a lot of people over 60 really enjoyed what for many of them was a rare chance for a dance. Is it another of those ageist assumptions that older people won't want a fun night out?

Older people will lose independence if council services are squeezed by rising social care costs

I'm back in action after a period of doing personal things, of which more later.

And in the meantime, this Report has come out, which is really important for the future of services for older people. The Local Government Association has published a modelling of local government funding trends, from 2012-20. Look at these two diagrams. Chart 5 shows you how the cost of social care increases up to 2020, and squeezes all other local government expenditure. Chart 7 shows you how many people actually use local government social care services – a very small proportion of the population, compared with people who use the services that are going to be squeezed. Will political support for social care disappear, when everyone’s services begin to vanish?

What will be the consequences for attitudes to older people if all the mainstream services of local councils are drastically squeezed to sustain social care.

And what will be the consequences for most old people, who do not use social care? All the services that keep them independent, leisure, transport and libraries will be squeezed, which means bigger expenditure for social care, because older people will lose their independence sooner.

Citation: Local Government Association(2012) Funding outlook for councils from 2010/11 to 2019/20: Preliminary modelling. London: LGA.

See the report on the web:

http://www.local.gov.uk/c/document_library/get_file?uuid=01a7770d-ed32-4bac-ae43-8fb4090e5d65&groupId=10171

Grandparents should always be part of official action on families

I looked at the Ofsted (the government’s children’s services regulators) consultation on how it was going to inspect residential family centres. These are places where families are helped alongside their children to care for them better. No mention of grandparents. I think families would probably always care for their children better if grandparents were involved, and very often grandparents are important care resources. So why are they not involved?

Link to Ofsted Consultation on inspection of residential family centres