Business ethics is important to social workers, who have to deal with the consequences of self-interested behaviour in business

This article appears to be about economics and business, but it's important to people interested in social work, because holding businesses and governments to account for how they spend their money helps to avoid corruption and devious excuses for self - interested behaviour, which benefits us all and especially people who rely on the state to protect them from oppression.

The Economist | Corporate transparency: The openness revolution via @theeconomist

The openness revolution

The Economist

HOWARD SCHULTZ, the head of Starbucks, said last year that “the currency of leadership is transparency.” If so, bosses should be feeling ever more qualified to...

Adult social care spending rising: but what about the impact of this on local government in general?

Interesting that crude figures show that adults social  care spending rose by 8% in real terms over the last 10 years: what, I wonder, does this mean for financial pressures on other local government spending?

Link to Integrated Care Today article

Working into later old age - the financial markets' interests are more important than older people's needs

Another Telegraph article making it clear that the pensions system dominated by financial markets rather than people's needs is not working for many people.

Link to Telegraph article

Academic study concludes that savers have 'grasped the harsh realities of the 21st century pensions world'

'Bed-blocking' comment really reinforces the need to respond to older people's complex social needs in the community

It's a pity about the headline name-checking bed-blocking in a Gloucestershire health chief's comment on integrated care. That's because the point being made is a good one, that health and social care services have to work to resolve complex social needs as well as treat medical problems if they are going to succeed in providing worthwhile  services.

 

Link to Integrated Care.com article

Feelings and frustrations of caring for an older parent and your young family well-expressed

A woman (American, as it happens, but the feelings and frustrations expressed are universal) is a 'sandwich carer' (she has a frail elderly parent and children and family to care for) talks to her father who is having a bad day at the same time as coping with her family's needs. Impressive piece of writing,

Link to the original article

Pensioner bonds and top-ups to state pensions start soon - info

A news report on the new pensioner bonds and the arrangements for existing pensioners to top up their state pensions, all part of the government's response to the ill - effects of low interest rates on people with fixed incomes. 

Steve Webb tells 'livid' pensioners: give us your money for a better interest rate - Telegraph

The Case For The Bus Pass | Greener Journeys

The Case For The Bus Pass | Greener Journeys


Any older person will tell how important their bus pass and senior railcard is to maintaining and building their social network. And it's good for the environment too, if we encourage people to use collective means of transport. This link is a useful discussion of the arguments.

It's good that younger people take older people out

Another of my street photos, taken at Osterley Park, a National Trust property near London.

Isn't it great how often younger people take an older person out for a good time?

Would flats in tower blocks suit older people better than special housing?

A newspaper report tells us that a tower block in North Lanarkshire has been designated for use by older residents. The argument is that it's close to the shops and other services and the flats are the right size for older people. Others can live there, too, however, so it's a bit different from the usual housing flatlet or bungalow scheme for older people. For myself, if in later years I'm left on my own, I'd certainly fancy a smaller property with a view and the maintenance taken care of.

What do other people think?

Link to the article.

Older people need to learn to text in emergencies: young people can help by sending texts to older relatives

You may realise from some of the content of this blog that one of my retirement activities is taking street photos. You can see the results in my Flickr photostream. If you're not familiar with Flickr, either scroll through the stream or click on 'Albums' and look or search for albums that say 'people'.

Link to my Flickr site.

This is a picture that I took in Wimbledon recently. In one way it is commonplace and in a related way unusual. Can you see why?

The answer to the first question is that the young woman at the bus stop is using her mobile phone, and this is a characteristic of many, if not most, street photos I take nowadays. Young people are mostly holding, and often using, a mobile. The answer to the second question is that the older man is also using his mobile, and this is very unusual - most older people in my pictures are talking or walking without the mobile.

Which tells you something about the generations. Most older people do not see the need to be continually connected in the way that is natural to younger people. But this means that they lose out in emergencies. If an older person gets admitted to a hospital or faces some other major change in life, they often have no way of contacting people for social reasons or to call on help, because they have not become accustomed to using their phone.

In particular, they lose out because they have not learned to text, and their friends do not text, so they have no convenient way of sending and leaving a message. And their friends, even if they have a mobile phone, never look at texts because they're not accustomed to getting them.

Texting on a mobile is so natural to younger people that they do not realise and cannot believe that their parents and grandparents cannot and do not do the same, and this means that they're not practised enough to use texts in emergencies. One of the best services young people can provide for their older relatives is teaching them to text and encouraging them to practise by sending them regular texts.

Aren't-we-good corporate videos waste of NHS and social care money

I often wonder why NHS and social care organisations feel the need to spend money on  corporate videos. I looked at one from Lanarkshire, about the local 'partnership' of voluntary and statutory services as they 'swing into action'. I'm keen on what they do: mainly stimulating activity and personal development, I liked the singing group, football for older men (not just sitting around in day centres playing bingo). And I was pleased to see texting (but not sexting) for keeping in touch with people.

But I resent the unremittingly positive 'isn't it wonderful' message and the current professional jargon. Who is this for, other than saying 'we're doing a good job here'.  I'd rather see information videos which give useful information or educational resources for older people to help them develop their activities.

Link to the video

The more you do the more you risk falling as you age

Anyone involved with social work knows that, as you get frailer in old age, falls can lead to all sorts of difficulties that prevent you from leading an independent life - loss of self-confidence can limit your lifestyle. So my eye was caught by the report of an American study by a social work academic found that African Americans were more likely to experience falls than non-Hispanic white people; this is possibly because they were less active so they were less at risk. Certainly, in general, physical limitations and health problems put you more at risk of falling. I must say that I step a whole lot more carefully than I used to, even though there's not yet a lot wrong with me. For one thing, I find I judge distance edges on kerbs and staircases less well than when I was younger.

Link to the academic article: Racial/Ethnic Predictors of Falls Among Older Adults: The Health and Retirement Study by Emily J. Nicklett and Robert Joseph Taylor.

Link to a more popular article on the study.

 

Information about personal development opportunities for older people is an important service: Men in Sheds is an example

Another Isle of Man event is an information day for older people. This was basically an exhibition of organisations for older people, including Men in Sheds, the Stroke Association, the Diabetes Centre, the Older Persons Mental Health Team. Offering information in an interesting way for older people is good for building their rights to have access to opportunities for  education and personal development.

Men in Sheds was a new one on me, but I see from Age UK websites that it's widespread and based on an Australian idea. It provides a hobby workshop for men to pursue interests that they might not otherwise be able to afford to equip themselves for.

Why not women? The success of the Great British Bake-Off and the...Sewing Bee on the BBC suggests that making a good kitchen and sewing equipment might also work well.

Link to Isle of Man information day report

Link to Age UK Nottingham Men in Sheds website

The first world war is a past that is current in our family histories for all of us

A recent event for older people at a resource centre in the Isle of Man illustrates how an imaginative programme for older people might cover both current and past events. Older people currently alive did not live through the first world war - it was before their time - but their parents and other contacts in their earlier lives will have had a personal connection with the privations suffered in the first world war. So there will be a personal link to remembrance. And remembering the war is going to be very current for all of us who may be discovering new understanding of this war. Even if it's almost history now for most of us, our improved understanding of and response to the life of a families in the past is not history but present currency.

Link to the Isle of Man article

Better deprivation of liberties safeguards for older people after Supreme Court decision is implemented

I didn't cover the Supreme Court 'Deprivation of Liberties safeguards' decision in the 'Cheshire West' case six months ago or so on this blog, but on my more professionally oriented 'Social Work and End-of-Life Care' blog, which you can look at for more details.

Link to deprivation of Liberties safeguards posts on 'Social Work and End-of-Life Care' bog.

Link to the Supreme Court decision.

But there's a fairly recent professional commentary on the Community Care website for social work professionals which demonstrates the aftermath, that local councils have been inundated with applications for Dols authorisations. This means that older people (and others, but older people are a substantial group affected) are having their rights better protected.The writer makes the point that the decision enshrines social work values in the law.

Link to Community Care article

There are now quite a lot of commentaries on the effects of the decision. A particularly good one is on the mental health law online website, which also has loads of links to previous relevant legal decisions and to good explanations of the law, including a video of Lady Hale, the supreme court judge, explaining it in Court.

Link to Mental Health Law online. 

The MHLO summary of the effect of the decision is also helpful, as follows:

 (1) The 'acid test' for deprivation of liberty is whether the person is under continuous supervision and control and is not free to leave. (2) The following are not relevant: (a) the person's compliance or lack of objection; (b) the relative normality of the placement (whatever the comparison made); and (c) the reason or purpose behind a particular placement. (3) Because of the extreme vulnerability of people like P, MIG and MEG, decision-makers should err on the side of caution in deciding what constitutes a deprivation of liberty.

Link to Lady Hale video.

Excellent film on dementia not always taking away identity, love and social connection

Really good film on dementia, provided by the Social Care Institute for Excellence. Focuses on four people talking about their experience of dementia, with their relatives also telling something of their stories. It's striking how even quite disabled people are able to express their personality and identity, and relatives their continuing loving and social connections.

Link to the film

The commentary says: This brutally honest film reminds us that although dementia causes the loss of some abilities, people's feelings remain intact. The people in this film talk about their emotions: fear, guilt, embarrassment, isolation and powerless. They give a deeply moving and personal insight into an often overlooked aspect of the condition.

It also offers practice points:
1. People living with dementia can still be alert and aware of their condition
2. It is important to know the person with advancing dementia as an individual and support them to maintain their own identity
3. Although dementia causes the loss of some abilities, people's feelings remain intact; it is essential to empathise with people's emotions
4. Caring and supportive relationships help people to cope with the difficult experience of living with advancing dementia.

What makes older people happy?

The Age Demands Action campaign is having a social media campaign inviting older people to say what makes them happy. You can make statements or provide videos, photos etc, using a hashtag (#). Examples on their website.

Link to 100 days of Happy Older People website

EU regulations - you have to give allergen information if you provide food

A worrying bit of advice for people who run care homes or deliver mobile meals: there are new EU regulations that require you to provide allergen information to customers, users and residents; it's very detailed and covers a lot of types of food that you might not have thought of.

Link to legal advice note

Returning to an important place is forward-looking, because it's a trip with a purpose

I could not resist this starting sentence in a news report: Do memsahibs take a phaeton ride to the ghats of Sovabazar?

What could it be about? It's about older women who are widows, being taken to visit the town or area where they grew up. One woman describes being given the 'cold shoulder' by her in-laws (presumably living with her former husband's relatives); a voluntary organisation looking after a thousand widows plans to offer them the chance to take a tour to a major town that many of them originated from during Durga Puja (I had to look that up, it's a Hindu festival).

You can see nostalgia and wanting to see the old places as too backward-looking, but it's forward-looking to plan a trip with a purpose, rather than an idle holiday.

Link to the original article. It's on the website of the voluntary organisation, the 
Sulabh International Social Service Organisation

Retirement: avoid supermarkets at the weekend

A study for the Oddfellows supports the government's 'mental well-being' aims (my last post was  about the quality standard for mental well-being in care homes) more broadly. A survey of their retired members found that maintaining and building friendships, keeping active and avoiding the supermarket at weekends are both important advantages of being retired.

The Oddfellows is a friendly society that provided financial and other benefits for working people: it still does this through various mutual insurance schemes, but also provides local social clubs, one of the ways of making friends if you're feeling isolated.

If you're a joiner type person, rather than a keep yourself to yourselfie; in which case, you probably don;t have problems with finding things to do in retire,et anyway.

Link to report of the survey

Link to the Oddfellows. If you're ever wondered where organisations with strange names like the Oddfellows come from, try looking at 'About us' on their website. It's also a good example of how organisations change their functions over time.

Care services for older people should help them feel good and keep their minds in trim

A 'Quality Standard' aimed at social care services, and particularly care homes, published in 2013, focused on older people's mental well-being in care homes. If you're familiar with these things, you'll know that quality standards are a list of things that services should be achieving, published by the NICE (the National Institute for Clinical Excellence), which researches the best standards which services and professionals are encouraged to pick up on. There are six statements in this one:

1  Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.
2  Older people in care homes are enabled to maintain and develop their personal identity.
3  Older people in care homes have the symptoms and signs of mental health conditions recognised and recorded as part of their care plan.
4  Older people in care homes who have specific needs arising from sensory impairment have these recognised and recorded as part of their care plan.
5  Older people in care homes have the symptoms and signs of physical problems recognised and recorded as part of their care plan.
6  Older people in care homes have access to the full range of healthcare services when they need them.

Link to the guidance for care homes.

It's good to see this sort of thing being done: older people should be able to feel good, and keep their minds in trim; basic care that only permits existence rather than personal development is just not good enough.If a care home is doing this stuff, their residents should not be sitting round (or marooned in their own room) watching telly.  Instead they should have the chance to take part in useful and interesting activities, which means much more than periodic sessions of bingo. I was disappointed to see in the film that accompanies the publicity about the publication of the standards that a bingo session was used to illustrate activities; bingo requires quite a large audience to be interesting and this means that lots of people get dragooned into it, and don't get their minds stretched by a variety of arts, sports, or creative activities.

The standards come about because a lot of research says that older people are depressed, lonely and unstimulated in care homes and in their own homes if they receive care there because they are frail. Because they are receiving care services because they are unable to manage their own lives fully, they also don't get the kind of detailed attention to their routine healthcare needs, such as dental, hearing, sight and podiatry services that would make those lives more comfortable.

There is a film about the quality standard (see the illustration in this post), but although the principles are well-expressed, it officialdom in video: it starts by telling you how wonderful it is that NICE has done this and how the inspectors are going to use the standards, but mostly has people wittering on at a conference to promote the standard to people in the field. This was held in the wood-panelled splendour of the place where the Chelsea Pensioners live, and they took part in their scarlet and bemedalled uniforms, telling the participants about their experience of older people's services. But most of the film is preachy platitudes from senior people in social and health care, so the whole thing is not incisive or practically helpful either for people trying to operate the services or trying to improve them as residents. An opportunity missed in a rather expensive way.

Link to the film.

More useful for professionals are the resources intended to support services trying to do something about it: they cover research studies on issues on mental well-being of older people in care and more information on what you can do about it. Print wins our again: you really have to be very thoughtful about what your audience is for a video: it takes time to watch a video, and you can't skip the boring stuff as you can in a document. every second needs to be clearly focused on the needs of your audience and puffs for NICE and nice people pontificating platitudinously just encourages you to turn it off.

Link to useful resources.

Only marketing in social care is suspect: a critique of austerity pressures is crucial

It's a pity that the present home care system's financing relies on commercial attitudes and a marketing approach, rather than a total focus on older people and their needs. A Guardian blog by someone who had a good experience of her mother's death and wanted to work with older people to give something back, presents caring principles (hour-long visits by her carers, good use of technology for efficiency) in the service she set up. But actually the blog post is an unashamed advert for her service and says nothing about what she charges for this luxury provision. The criticism of services that do not meet her principles does not look critically at the cost pressures on services that may have to provide care in austerity England. An approach to social care that is focuses on marketing is always going to be suspect.

Link to the blog post.

Disappointing conference report on portraying ageing without visial reference materials

You can see the contributions to a British Library conference last April on 'Portraying Ageing: Cultural Assumptions and Practical Implications'. An interesting topic with top speakers, including stuff on the arts, photography and creativity, but only with videos of the speakers' whole speeches with interpolated bullet point PowerPoints. You would have thought on these topics and with the BL's resources, they could have curated an interesting collection of visual reference material.

Older models and care home leaflets: starting Greyamble blogging after a gap

A friend is thinking about a care home, so we are looking at leaflets. It occurs to me that the proliferation of need for care homes is going to be a bonanza for older photographic models for the pics that all their leaflets need for grey-haired and slightly wrinkled but lively-looking and positive residents. All looking, I must say, more with-it that most care home residents I come across.

You'll have gathered that I've taken a gap from Greyamble blogging to do other things for a while, but I'm starting up more regularly again now.

Christian care home/bungalow scheme preserves scale and environment

 Here's another of my occasional pics of care homes in the locality. This one is (from the front) a well-preserved Edwardian house, and run by a charity for Christians. Note the in-keeping handrails for the stepped entrance, but this is not the crucial point, there's a flat entrance at the side and the steps preserve the Edwardian style at the front. This is a very attractive environment, although you might not fancy the care home rooms  with the side view that you can see on the left below.

Another desirable aspect of this scheme is that the garden has been changed to provide a series of bungalows.So there are more and less independent aspects to it. It also fits the scale of the area much more than the overlarge luxy private scheme I blogged about a while ago. Because it relates well to the area, and it does not seem so keen to make money, it looks a more attractive prospect for living. I wonder how hard you have to work at being Christian?

Search 'care homes' to find previous posts on care provision in the Sutton area.

Older people should have a stimulating life even if they need care

An interesting case study of the misuse of a Deprivation of Liberties Safeguards (DoLS) authorisation, which demonstrates the importance of good practice. Care homes and hospitals have to take out these authorisations if they're going to stop you doing things that normally you would be free to do, for example go out on your own if you're unsafe. My view is that it's not good enough just to comply with the safeguards; here you have a man who was legitimately deprived of his freedom, because he was at risk when he was living on his own with dementia. But once admitted to a care home, they did not work at trying to give him as much freedom within the constraints that were necessary, and so lumbered him with a more miserable life than they needed to do. I can't say often enough that just caring for older people won't do, you have to give them a worthwhile life. Even though someone has their freedom curtailed in some respects, it's still possible to give them freedoms in many other aspects of their lives. Social workers should be supporting care staff to do that, even if the managers of the care homes isn't good enough to manage it on their own.

This comes from the annual Care Quality Commission review of the operation of the Deprivation of Liberty Safeguards. The development of these safeguards has been going very slowly, and it is suspected that a lot of care homes and hospitals are breaking the law. It seems that, while there is some good practice, there are still a lot of people who do not know about the safeguards, and so cannot operate them correctly. Although there is confusion about what deprivation of liberty is, what the DoLS scheme does is force you to think it through. The CQC review provides a lot of interesting case studies and citations to recent legal cases, and comprehensive links to guidance.

Link to the CQC review.

Why people with dementia should be involved in worship

An interesting leaflet from MHA (the mainly Methodist organisation for housing and care for older people) and the CCOA (Christian Council on Aging) which I picked up while passing through a Methodist Home (this is what they call themselves; they seem to have dropped the word that the 'A' in the name originally stood for).

It is about worship and people with dementia, and is one of a number of leaflets about spirituality; the CCOA has a huge variety. The point is that although people with dementia may not have the same sophistication of appreciation of their Christianity that they once had, they can often appreciate the involvement in ritual that has been present for important parts of their lives. Worship for people with dementia, according to the leaflet, should be fairly brief, involving, use familiar materials and use well-known symbols, such as candles. Don't close your eyes when praying - it makes people feel cut off. the leaflet suggests suitable hymns and readings for particular themes.

Link to the leaflet on the MHA website (scroll down for downloads).

Governments don't collect data about older people, so they can't plan for their needs

This interesting map (drawn from UN population data) compares the proportion of the population in different countries that are and will be older people in 2012 and 2030. The proportion is rising almost everywhere. It comes from an interesting Global AgeWatch information briefing which says that governments and others are not collecting data about older people. They concentrate on younger people, so older people get missed out of the planning for policy and services.

Link to HelpAge download site, so that you can look at the briefing.

Statistics on grandparent care

It’s always interesting to look through a pile of statistics. The organisations Grandparents Plus and AgeUK dug through various reports on grandparents providing childcare. Here are some highlights:

• The value of grandparental childcare in the UK in 2010/11 was £7.3 billion, up from £3.9 billion in 2004.
• In 2011, 28% of families where both parent work used grandparent childcare, 25% of lone parents, and 14% of non-working families.
• Nearly two thirds (63%) of all grandparents with grandchildren under 16 are providing some childcare, with one in five (19%) grandmothers providing at least 10 hours a week.
• Employment rates are lower for grandmothers than for women who are not grandmothers. While grandparents generally view providing childcare as a positive choice, there is some evidence of women giving up work to provide childcare.
• European data indicates that the grandmothers most likely to provide childcare are those who are younger, fit, healthy, and with young grandchildren.

The organisations say:

most informal childcare is provided by grandmothers aged 55 to 64 who are not working, because at the moment there are many more grandmothers in this group. However a significant minority of grandmothers are already combining work with childcare: and grandparents who are working are more likely to say they look after their grandchildren than those who are retired, reflecting the fact that working grandparents are generally younger and their grandchildren are also younger. As the proportion of working grandmothers increases, it will be of growing importance that they are able to combine work with supporting families through providing grandchild care, to avoid the emergence of a care gap.

Robot cleaners will lead to cuts in human contact in care homes and social care services

A Guardian article about robots to do the cleaning in care homes in Denmark sounds like a good idea. the person promoting the idea (which is presented a bit cautiously by the Guardian) suggests it means that staff have more time to give to interpersonal relationships with residents. But the rest of the article is about worries about Danish cuts in the social services.

Which suggests to me that it will be a bit like having computers supplied to social workers over the last 20 years. Claims that it will lead to a reduction n paperwork proved to be nonsense. It just meant that the social workers had to do all the administrative work that was previously done by clerical workers. This led to extra stress for social workers and time taken from working with people and passed across to working with computers. It also led to cuts in the availability of routine clerical jobs for people with ordinary qualifications.

Robot cleaners will be the same.  Once they're efficient and cheap, they will be used to cut routine staff from care homes, who provide a bit of extra humanity and human contact. And eventually they'll be handed out to older people in their own homes, so they will lose one of the little bits of human contact that they get from people doing their housework. And of course they'll also have to buy them or contribute to the cost, and won't have the alternative of opting for a human being, because that will be more expensive than a robot. And then, nobody will have a list of human cleaners, so the possibility will be lost anyway.

Link to the Guardian article.

Older people should be encouraged to plan ahead for their care

This picture (it's called a 'wordcloud) shows important words in a consultation about new regulations setting out standards of care in care homes and hospitals that the Care Quality Commission (CQC) registers. That's the regulator for health and social care services. There's a lot of stuff about communication, informing and listening. My view is that planning should be bigger: a lot of problems for older people in care homes and hospitals can be avoided or minimised if people are encouraged to think about and plan for the future, and if care home operators and healthcare providers are also planful. This is because they will ask questions which will encourage older residents and patients also to be planful.

The Consultation follows up on a previous starter consultation about setting up the 'fundamental standards' expected of organisations that register to provide care. This follows up on various committees of inquiry and events that have led people to say that everyone's ideas of what is basic about good care should be written into the regulations.People have suggests that the rules are too complicated and what's needed is a simple statement. You can use this link to see various versions of the consultation and the draft of the regulations.

Link to the consultation website.

Because the idea is to make a fairly basic statement, the proposals set out the blindingly obvious, but it does seem one needed to say that to at least some managers and proprietors of care services. And having basic standards of this kind, the consultation claims, allows a broader approach to regulation - you look at whether the place is caring in general, rather than going into lots of professional or legalistic detail. The questions the CQC is moving towards asking are:

• is the care safe?
• ...effective?
• ...responsive?
• caring?
• well-led?

Maybe. It seems to me that there's always a balance between being detailed so that people know where they are and not being too detailed, so that people drown in guff. But a lot of that depends on the quality of the people doing the inspecting and their managers. And my view tends to be that the best people want to do the job, not inspect how others do it.

If you want to reply to the consultation, you have to respond by 4th April.

Here's the main list of standards proposed (Chapter 4, page 15):

(a) care and treatment must reflect service users’ needs and preferences;
(b) service users must be treated with dignity and respect;
(c) care and treatment must only be provided with consent;
(d) all care and treatment provided must be appropriate and safe;
(e) service users must not be subject to abuse;
(f) service users’ nutritional needs must be met;
(g) all premises and equipment used must be safe, clean, secure, suitable for the purpose for which they are being used, and properly used and maintained;
(h) complaints must be appropriately investigated and appropriate action taken in response;
(i) systems and processes must be established to ensure compliance with these Fundamental Standards;
(j) sufficient numbers of suitably qualified, skilled and experienced staff must be deployed to meet these standards;
(k) persons employed must be of good character, have the necessary qualifications, skills and experience, and be capable of performing the work for which they are employed.

Citation: Department of Health (2014) Introducing Fundamental Standards: Consultation on proposals to change CQC registration regulations. London: Department of Health.

Help in controlling blood pressure - it's a right that should be available everywhere

Controlling high blood pressure is really important for maintaining older people's health, and avoiding heart disease. Like many older people, I take the statins every day, and it keeps my cholesterol under control, and I take blood pressure tablets also. I know there's controversy continually mediating people in this way, but at least it's right that controlling blood pressure is available. But, according to a recent survey, it's not available in many countries.

Link to the HelpAge report - scroll down for the survey presentation.

Do we exploit family carers by expecting too much? The New Zealand funded family care system

It's always fascinating to see how they do it in other countries, and I was intrigued by a set of New Zealand documents setting up a system for the state to pay family members of disabled people to care for them (including presumably older disabled people, since many disabled people are so because of increasing frailty in old age). It arose from a court action in 2001 by Susan Atkinson (and other in a similar position) against a policy not to use state funds to pay members of a family who lived with them to provide care for them, on the assumption that such care is a natural part of family life, so the state would not pay for it. The action used New Zealand human rights legislation to argue that this policy discriminated against family carers; the government's position was that their policy allowed family carers to appoint substitute paid carers, respite care and information and support to assist the unpaid care that they provided. Ms Atkinson and her co-complainants won.

The government reconsidered, and eventually made provision for family carers to be paid for in certain circumstances. Simply allowing for all family carers to be paid would have been very expensive and, it was thought, might undermine family relationships (apparently, it is ok for people - usually women - in families to be exploited by being required to provide care for all its members). Eventually though, the total number of hours to be paid for was capped at 40 hours a week, and the eligibility was limited to situations where there providing care in other ways was difficult (for example because the disabled person lived in an isolated rural location) or where the care was best provided by a family member resident with the disabled person because of the complexity of the needs.

You can see the rules and also the process by which the appeal led to the change in policy through a sequence of Cabinet minutes and public consultations, by downloading documents from the government website.

Link to the NZ government website on funded family care.

The point of principle that we all need to think about is how far and in what ways should the state support family care? How far is it exploitation for family members to save the state money by providing care for their loved ones? You might take the view that the primary responsibility should be with the family and not the state; in reality most states could not afford to provide total care for everyone. But in expecting too much, do we destroy family relationships and support? What do you think of the NZ compromise?

Dementia-friendly financial services are needed: a new Charter could help

I have often commented about the complexity of financial services for anyone, and particularly for older people, who have to rely on financial services rather than work for their income. Even more so for people with Alzheimer's disease or other forms of dementia which affect their capacity to cope even with honest banks and insurance companies, leave alone the devious and self-interested extractors of profit from vulnerable people. So a recently published 'dementia-friendly financial services charter', telling banks and the like what they should be doing to respond better to the needs of people with dementia is very welcome. the main aim is to train and encourage staff to be more aware and be able to help people with dementia, remembering that many will be out and about using services over several years in the early stages of the disease.

Download the charter from this link.

Of course, whether this will be any use depends on how financial services companies tka eit up, but local organisations could encourage their local ban branches to be aware of the charter and start training their staff. The actions to be taken are graded - and most are very easy, so there's no real excuse.

Value the character and life experience in the faces of older people

Two pictures of older people on the Soller tram in Mallorca; I took them on holday recently. Aren't they full of character? Aren't these people who are engaged and involved in their local community? Why take only pictures of the young with their life and character still to form?

Involve carers in older people's care for the best outcomes

Older people with dementia are often living with frail husbands or wives; sometimes both have dementia. A Local Government Commissioner's Report (done with the Health Service Commissioner) on a case in Kirklees (in West Yorkshire, it covers the towns of Dewsbury and Huddersfield and smaller towns in between) shows how difficult it may be to deal with such situations, but how supporting the family's involvement is crucial.

In 2009 the husband (with dementia) was admitted to hospital with acute glaucoma, probably caused by a blow from his wife, whose dementia was also showing up. There seems to have been a safeguarding investigation, but it was never followed up, and the husband was shot out of hospital with no protection. This is not a big surprise to anyone familiar with health and social care: hospitals dealing with in-hospital decisions, especially if they need a bed for someone else, often know nothing about and therefore take no account of the home situation in their decision-making. If they employed or even liaised with social workers, they might know more about what's going on in their patients' lives.

The wife's symptoms worsened, and she was admitted to hospital: her husband went into respite care. Their son, a doctor, fixed up a private care arrangement for a nurse to provide home care, but the health trust and the local authority decided this was inadequate (without consulting him) and issued a Deprivation of Liberties order to authorise themselves to keep the husband in respite care without his consent. The health trust also took it upon themselves to write to the son telling him he should put them in separate homes, and sent a copy of the letter, presumably following the usual transparency guidelines, to the mother, causing her great distress.

The Local Government Commissioner said:

...the couple were denied the chance of living at home together in a settled lifestyle for longer than they did. The couple suffered a needless loss of dignity, while their son felt ignored, undermined and excluded from any decision about their care.

and the Health Service Commissioner said:

Involving their son could have led to better outcomes for the couple. Families and carers can have the key to understanding the needs of their loved ones. That’s why public services must, in law, involve families and carers in making life changing decisions for vulnerable people.

Utterly reasonable, and in addition to apologies, reviews of their practice and financial compensation, the trust and the local authority also agreed to review how they implemented their complaints policies, so presumably they told the family to buzz off when they complained, too.

Link to the Local Government Commissioner's (Ombudsmen) Report.