Are women and ethnic minorities getting protection against deprivation of their liberty in hospital and social care?

Older people should be interested in the Deprivation of Liberty Safeguards (DOLS), because most of the people affected by official decisions to deprive them of their liberty under the Mental Capacity Act 2005 are older people affected by dementia, as you can see from this chart, published in the annual report on DOLs by the Health and Social Care Information Centre.

What this bar chart also tells you is that the rates of application are the same for men and women (the rates are per 100,000 in the population), but I think they shouldn't be because most applications are about older people and most older people are women: are men getting a disproportionate amount of protection from being deprived of their liberty?

And if you look at ethnicity a lower rate of white people are  affected by applications than the total rate of all other ethnicities, when white people are massively predominant in the population. Are agencies more prepared to make applications for the depriving non-white people of their liberty?

The law on DOLS is a bit hazy and the procedures are confusing, so it's not surprising that DOLS applications are still not hitting the expected rates, even after several years of the Safeguards being in operation. Numbers of applications are going up every year, although the rate of increase has slowed. That suggests that there are probably quite a lot of people who are being deprived of their liberty (although restriction of liberty is OK, so long as it's not continuous and heavy - that's one of the confusing thing about the law), and who are not getting the protection of the assessments that the Safeguards require. You can get some clue to this, by looking at the reasons applications were not granted. By far the most common reason was that nobody had done an adequate best interests assessment, so health and social care agencies weren't really looking too carefully at the best interests of the people they are supposed to be caring for.

Most of the people affected will be in hospitals and care homes. The Safeguards require health and social care organisations, that are depriving people of their liberty as part of caring for them, to carry out an assessment of the decision (or lack of decision) to do this. Mostly this is hospitals and care homes preventing people from leaving or pursuing their normal lives, mainly because there are fears for their safety where people cannot make decisions for themselves. The Safeguards require a 'best interests' assessment to be made by the professionals involved (is it in someone's best interests to be derived of their liberty?) and an independent element in the decision-making.

It's obviously still not working too well, and I'd be worried about the covert reasons why a decision is made or not made to apply for a DOLS authorisation. On the one hand, I think care homes and hospitals get themselves into deprivation of liberty situations trying to do their best in caring for people without thinking too clearly about people's rights and liberty. The affects mainly older people often without a lot of support from friends and relatives. On the other hand, I think they may be choosing to make applications when they are worried about being criticised or gong through a bad time with a particular resident or patient, rather than consistently thinking through whether their care for someone actually deprives them of their liberty.

Link to the HSCIC Annual Report on DOLS.

Big care services can be human, even if they are not small and local

I I'm always irritated by articles by top people in commercial organisations, when the main purpose of publishing it seems to be to promote how enlightened they and their organisations are without of course doing anything vulgar (and expensive) like actually advertising (the puff for the writer's organisation is about halfway down this one). However, this recent article on The Guardian's website makes an interesting point. It suggests that social services departments in commissioning services find it too easy to contract with big providers, rather than smaller, local services that might be a bit more human-sized and responsive to local circumstances. I actually think that it's possible to over-egg the argument about local is best. Expertise, flexibility and responsiveness is best, and professional services can do that if they're well-run, big or small. 

 Link to Guardian social care article

Moving to a care home with dementia

This is a post on the Demention blog, about a male carer and family looking after a mother with early onset dementia. This is about moving into a care home, the doubts, decisions and eventual success. It shows what can be valuable about care home care, although it does not discuss directly some of the disadvantages of a move with dementia that professionals might raise. However, here it is being done at a fairly early stage of the patient's progression, and it shows what efforts were made to connect her with her life history.

Link to the Demention blog post.

Private care home: rust-stained extended old houses are a reversion to the past

Another of my occasional pictures of facilities for older people, in this case, a care home in south Sutton.

It is typical of many private care homes both in its location and in the building. South Sutton is the formerly classy area of this suburb, on the southern border of London, merging into Surrey stockbroker belt. Some of this area still contains giant houses worth from a half mill to £2m or so, with extensive grounds. When we moved here ten years ago, an estate agent looked us over and said: 'Well, you'll be wanting to look in south Sutton, won't you?'

But nearer to the town centre, the big Edwardian houses are multi-occupied, or knocked down and replaced by larger blocks of flats, or simply converted into flats or, the concern of this blog, translated into care homes.

Here is an unprepossessing example, with the off-putting rust stains on the outside cladding and the bizarre design presumably cramming more rooms into the site than the big old house that previously occupied it. Looking at the side of it, it seems to have been extended both front and back. Domestic scale and Edwardian style are lost.

Because of its building, this is not a care home that can make nostalgic claims of connection with leisurely Edwardian gentility, or of convenient modernity. Local authorities, when they ran residential care, gave up the inconvenient and mobility-inhibiting conversions of large gentlemen's residences and went for newbuild on grounds of efficient service provision and convenience and independence for residents. A lot of the large-house converted private sector care homes are an uninspiring reversion to the past.

The aim of active retirement is only to put off deterioration. Discuss.

The niggle has become a clarity.

I’m now approaching the anniversary of my retirement; it’s been a year. I was planning to write about how I was experiencing retirement regularly, but I haven’t, because I haven’t had anything to say.

When I got to the six-month mark, I started to write, but did not think it worth publishing. This was it: ‘The new time structure that I remarked upon at three months is quite ingrained: daily organ practice, daily work on writing or blogs, with greater pressure on the writing as deadlines approach, and occasional ‘real’ retirement days of going out etc. Of course, I’ve just experienced Christmas and New Year, which connects us up with the wider family.’

And there I ran out of things to say. Thinking about this, I had the vague feeling that there was something hanging about in the back of my mind about ‘the next change is when I die’. But that seemed overly dramatic, I couldn’t grasp the niggle that was twitching there, so I let it be.

Then Margaret fell out of the loft and broke her collarbone, the electronics on the church organ phutted and the ‘ingrained’ routine deroutinised. I spent a few weeks chasing round over treatment for Margaret and her two nights in hospital after A&E and for a titanium plate being inserted in her shoulder. I’ve spent most of the last six months doing more in the kitchen and around the house because she has had residual back problems, and is improving only slowly.

 

What this has made clear is the risk that as physical things happen to us in old age, the outcome is an extra bit of incapacity. And you can see the incapacity inexorably leading to less mobility, more problems until, perhaps ten of fifteen years hence, fading away towards exclusion from the active world and death.

So I want to defend myself against events, such as falls and illnesses, that will move that process on. And I feel I want to keep on walking rather than busing, doing things rather than relaxing, continuing to write books and articles rather than staying with the easier stuff like blogs.

Is the objective of an active retirement only to put off deterioration and death? I’m now clear that is the question that is creating the niggle, but I don’t know the answer - yet. I wonder how others feel about it.

After the grandchildren...

'And the little one said...' The spare room after some of our grandchildren visited. Why are our dolls so elderly and decrepit? It's not a metaphor for the stage of our lives, we're grandparents. That means our dolls are from the previous generation or charity shops.

Inequality care or luxurious workhouse: high end care and support

 Another of my series of local older people's care facilities. This time we're at the very luxy end of the market - this place is renowned as the posh place to go. And you see they have a 'special neighbourhood' for the memory impaired - you can either see this as tactful or twee. And should we really encourage a public perception that dementia that requires care is really about being 'memory impaired'?
  

The main entrance is hotel like - although a lot of it seems to be flatlets. I've not been in, but one imagines smart communal accommodation, and as you can see the selling schtick encourages a hotel lounge sort of approach.

But the place is gigantic - there are several wings; or perhaps I should say 'neighbourhoods'. In fact it's workhouse-sized; and quite a large workhouse at that, although in this case, I imagine the taxpayers are not making any sort of contribution. This is really social inequality red in tooth and claw.






Another workhouse feature is that it's on the edge of town, so, as in the workhouse era, people are excluded from general view, and residents have little chance to go to shops, nice and Surrey-like though they are, under their own steam, unless they can still drive.






However, luxurious, then, is this the, possibly isolating, kind of living most older people really want, when research suggests that it's family networks that are most important to them?

Equipment if you need help with a little decrepitude

You see here a perching stool in our kitchen - this is a new acquisition; it makes life easier around the kitchen, indeed anywhere you need to stand when you have a bad back. Searching the the catalogue from OT Stores in Malvern (we were given it by an occupational therapist friend), we see an amazing number of things you can get for easing any number of practical difficulties as you get less able to do stuff. It's encouraging that there are so many possibilities, and perhaps discouraging that we know so little about it.

This is very solidly built, adjustable, cleanable but (question) does it have to be so institutional in style? Or is the definition of institutional something useful?

Has your room got its own mood? The latest silly decorating trend?

The National Trust magazine tells me (in passing in an article about planning your garden) that I need a mood board for each room in my house - I suppose I'm supposed to think what mood I'd like to be in in each room and adapt accordingly. I learned when we had a new lighting system in the church that it was adjusted according to moods in the services and in each area of the church; it brightens up when the service starts, for example, and when the choir's singing we get brighter lights.

Presumably I'm supposed to think about lighting schemes for my house, according to mood. When I'm depressed, the lights are lowered and black dogs reflected on the ceiling. Or do I just have to have the news projected on the wall? Do my happy family pics revolve like the portraits in the Murgatroyd Mansion (you have to have a background in Gilbert and Sullivan to know what this means), replacing cheerful snaps of weddings with family funerals?

Bur mainly I'm depressed that such a nonsense is being foisted on us as an innovation. I don't want my house to reflect my mood, and I don't want to move from room to room according to the mood I'm feeling. I suppose I might want the mood to be upbeat to keep me cheerful. And do people visiting stop looking at the decoration and the gadgets and instead do psychological assessments of the mood?

I'll consider a mood blog. Or it occurs to me perhaps I already have one - my more or less daily self-positioning blog probably has different photos and questions according to my mood. Look and see if you can assess it...http://self-positioning.tumblr.com/. But don't look at my less frequent end-of-life care blog, probably most people find that project depressing... http://sweol.wordpress.com/.

Inspiring story of living with dementia - Arnold Peters obituary

The Guardian today has an obituary of Arnold Peters, the actor who has been playing a character in The Archers, the long-running radio serial, which I've been listening to on and off since childhood. The character, Jack Woolley, has had dementia for some years. So, apparently did Peters, who recorded his part in his care home from 2008 to 2011, thanks to the BBC - good on them. An inspiring story about how you can live a good life with dementia, and also how, like the BBC, we should all be trying to help people live creative lives with dementia.

Link to the Guardian obit of Arnold Peters.

The permanency of paper against the temporality of a blog

I suppose I should say something about when you get a gap in my blogs as in the last few weeks. It's sometimes when I'm away: people know where I live and can burgle the house if I tell them in advance. Do burglars read blogs? But most often, as in the case of the end of April, it's when deadlines or publisher's pressures get heavy and I have to write academic papers and edit books and so on instead of write blogs.

Should that have priority over my blogs? Probably more people read my blog than read my books, and certainly more people see them than read academic papers. But then if they do, they probably forget it instantly, and there's something more satisfying about holding something made of paper in your hand, although people probably forget those instantly, too. But that's probably an old-fashioned view, and won't survive my generation.

Although I suppose paper's not that permanent, so the distinction is probably senseless...

Skill-building for older people, so that they can take control

An experienced social worker in the US (you may be confused that it's about Rochdale, but it's a Rochdale in New York somewhere) talks about how he became interested in working with older people. This is important because a lot of social workers (who of course train when they're young) are mainly interested in working with children and young people. Older people, as a result don't get their fair share of the good social workers - although he makes the point that you have to earn trust, it doesn't come with a degree.  He emphasises supporting and not competing with older people's community organisations and recognising the issues that are important to them - crime in this instance even though most professionals think concern is over exaggerated. Nevertheless, it's a real concern for many older people, and it's important to take it seriously. It's also good to help people feel they can do something about what's happening to them, so they gave observational skills training to the older people, so they could be good witnesses when crime affected them.

A positive skill-building approach to working with older people, which recognises they can take control and can build their own contributions to the community; they don't have to have things done to them.

Link to the article.

Granny pods - keep older people in garden sheds

I'm intrigued by the American Association of Retired People promoting the idea of granny pods in your back garden. Yes, it allows older people to 'age in place' as the American jargon has it, but however luxurious this means keeping your older relative in a garden shed. Even more than with a 'granny annexe' it makes them very clearly subsidiary to the life of their younger relatives.

Domestic or institutional care homes - pokey vs non-human?

One of my occasional pictures of facilities for older people. This is one of our local residential care homes. Note the emphasis on family management - a claim for more personal care than a big chain. That is supported by using an extended detached family home. But very often the conversion and extensions required lead to a maze of fire precautions and corridors, whereas bigger buildings are less atmospheric. made more so because there is likely not to be family management. Does this provide choice in the market?

The domestic (and pokey) or the institutional (and nonhuman) - which should we prefer, for what purposes? And can the domestic be non-pokey and the institutional human?

Prevention: free older people's opportunities

You might be interested to see a 'less than 10 minutes' SCIE 'Social Care TV' film about various projects for promoting well-being for older people. There is also some talking-head stuff from Julien Forder at the Personal Social Services Research Unit about what constitutes prevention.

My comment is: we need to think carefully about prevention, because government tends to think of it as being about preventing them coming in for extra expenditure. But what it should be about is helping people attain the right lifestyle according to their own wishes. Is having lots of older people's clubs the right approach? It all looks a bit institutional here. It might be all right for some, but not for all. For some people, promoting involvement in the local pub may be more right. We're still thinking about organising things for people, rather than making it possible to free older people's opportunities.

Link to SCIE 'Social Care TV page on promoting well-being for older people

Sassies (single sexy and sixty or over): plan for the future as well as pulling the men

Trying to sort out my Clipboard site (where I post the odd comments on news of the day) I was reminded of this old Daily Mail article on Sassies: that is single, sexy and sixty (or over). Apparently, in 2010, women of this age were seeking lots of sexy fun.

My comment: I wonder what plans they're making for their possibly less active late-seventies and eighties. I don't want to pour cold water on the Daily Mail's opportunity to publish loads of attractive photos of beautiful women in their sixties, but this is a period when you can be zapping life and also planning for your future.

I recommend lasting powers of attorney, a funeral plan, a will and settling into an adaptable home where you can live well with a greater degree of disability. You can still go on pulling the men for a lot longer than your sixties, as any care home owner knows.

Link to my Clipboard site.

How to steal someone's identity: read the widely available care home reports at your local hospital

My wife fell down the stairs, so we went to the Urgent Care Centre (what used to be called Accident and Emergency) at our local hospital. 

While waiting by her trolley, I read with interest a report left on the counter. It was from a care home, sent in with a previous patient, giving full details of his and his nearest relative’s name, address, date of birth and information that would allow me steal his identity. It included his medical details and symptoms of dementia, so you could probably steal his identity without his knowing.

I thought about mentioning this to the computer-users studiously avoiding any eye-contact with the rest of us in the room, but I didn’t because my wife and I have a policy of being nice to everyone involved in caring for us. This is the most likely tactic for getting good service from harassed professionals in the NHS. So they had no opportunity to cease revealing the personal details of one of their patients to all and sundry arriving at the counter because our ‘be nice’ policy prevented my handing the report back.

It’s an example, though, of how easy it is to be careless about making sure that patient information is not routinely left around for anyone to gawp at. It’s lucky I am a registered social worker who keeps things confidential and carefully forgot the things I saw; they might not be so lucky next time.

Your medical information from your GP for commercial interests? - Lexology reblog

A post from a lawyer with severe doubts about the confidentiality of patient information, now that the government is proposing to collect GP information, aimed to be with the aim of evaluating GPs. But the information will identify patients, and the government has made a big thing about using NHS information to help commercial companies to compete in the international marketplace.

So who will rally be using your information and why? And will they ask you for permission and tell you how they are going to use it? Seems not.

This is the link to the legal commentary.

Link to the government proposals.

Children's community services should always include grandparents and the older generation

Ofsted (the people who inspect children's facilities) has published a good practice example of a community and children's centre in Lancashire. No mention of grandparents though - a whole lot of stuff about building community networks.

My view is that it should be a matter of principle that children's lives should include older people. And a good practice example should show how the community and family resource of the odler generation is being involved in the lives of the young. It's good for the children, the parnetal generation and the older generation.

Think about it, Ofsted.

Link to the Good practice example.

Department of Health needs a broader non-health view on older people's needs

One of the good things about the Department of Health's new Director General for Social Care and blah blah (Jon Rouse) is that he has good experience of social housing - this is a really important link for the Department of Health to make for services for older people. The DH is far to health-oriented - it needs to have a broader view about what is important for older people in the whole range of public services.

Link to Department of Health announcement.

Care for older people is everywhere - but paid for, not a social service

I thought it was just another pizza delivery leaflet through the door, but this was something I haven’t seen before, a leaflet offering ‘Care visits at home’ assuring me that this organisation cares passionately and explains all the services that they might offer.

When a grandparent had difficulty living at home in the 1970s, it was really quite hard to find an independent service for her, or a care home that was not public sector. Even ten years ago, door-to-door publicity for care services could not have conceivably been worthwhile. Yet now, a publicity leaflet has been pushed through the door, presumably of every house in the district, so widespread is the presumed need.

Another sign of this is these pictures that I took locally recently of the offices of just such a care service. Its name and advertising emphasise how it meets what the need is assumed to be: CareFirst24 indicates a 24 hour service and the advert says 'putting people before profit', an implied criticism of other services. Having this on the average high street is a mark of how the care world has changed in the last few years. Care is assumed to be like any other paid for service; the result is that care provided by local social services is for those who cannot pay, rather than the normal service for everyone.

 

Just because you can make gadgets do complicated things is no reason why you should

Having recently bought a new telly, I can only endorse my son's view, expressed in his blog, that the plethora of information about technical products that you don't really understand makes it hard to make decisions about what to buy. I'm not surprised that older people feel they just don't want to know about all the new gadgets they might buy. My wife said we should get this telly with all the things it can do that make it so much more than a telly, because in a few years' time our grandchildren will not want to come to see us if our equipment will not meet their assumptions about the world. Already, our grandchildren are unable to comprehend why our telly can't just show everything they might want to see just when they want to see it.

Stuart Payne's blog on logistics.

It's a feature of old age that one's children's professional activity in completely incomprehensible worlds begins to eclipse one's own feeling of general social competence; I was never sure what logistics (you see it on the sides of lorries) was in general before my son got a job doing it, and I'm still not sure what he actually does; my mother had the same problem about social work. But I see from the blog that the old Sony telly that we used to watch a quarter of a century ago has formed his retail decision-making, so obviously parental behaviour does have long-term implications. It seems that modern domestic equipment, marvellous though it is in so may ways, is just too complicated even for younger people nowadays to keep up with. This is a sign of the rigidities of old age strike ever younger because today's world is so unnecessarily complicated.

I might worry that this why I've had to take so much stuff back after Christmas. But no, as I said to the young man who said he could help me with my wife's new gadget, it's not that I don't know how to make it work, because I can make my own work. It's just that because modern technology can, modern technology does and then it's made itself too complicated to work

Fuel poverty kills vulnerable people, including older people

I came across an intriguing report about fuel poverty among older people (and other vulnerable people), written in 2011 for Friends of the Earth, the environmental charity, by Sir Michael Marmot. You may wonder why FoE are doing stuff on fuel poverty: their website connects this with energy efficiency contributing to a good relationship between humanity and the environment. You may also wonder how Marmot (a public health medic) comes to be writing all this stuff: of course he doesn’t, he has a team paid for by sucking up research grants from organisations which very broadly fit within his main research theme that tackling health inequalities is a crucial part of improving health nationally and internationally. Presumably, he looks at what they are doing and so his signature on the report gives it added credibility.

Link to the FoE report by Sir Michael Marmot’s team. 

Link to the FoE website on fuel poverty and energy efficiency. 

It’s mainly a literature review, and it collects up some very interesting figures. Among them, is this graph, which shows the excess deaths in different years from 1999 to 2010 due to cold. The point is that, particularly for older and other vulnerable people, cold is a real health hazard, and therefore fuel poverty is an important issue. The NHS spends a lot of money treating people for disease caused by poor heating in private sector housing, according the a quotation from the Chief Medical Officer of the Department of Health in the FoE report.

You are in fuel poverty if you spend more than 10% of your disposable income on heating and lighting. There are three reasons for getting into fuel poverty. Obviously one is how rich your household is; the rich can afford their fuel. The other two are the cost of fuel and how well-insulated your house is.