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.