Interesting legal post on new crimes that care providers can commit; similar to corporate manslaughter

http://www.lexology.com/library/detail.aspx?g=4109767b-f9d4-4287-851d-ed04a9414d6d&utm_source=Lexology+Daily+Newsfeed&utm_medium=HTML+email+-+Body+-+General+section&utm_campaign=Lexology+subscriber+daily+feed&utm_content=Lexology+Daily+Newsfeed+2015-04-29&utm_term=

The first care home to face a corporate manslaughter charge under new legislation for its care failings

http://www.lexology.com/library/detail.aspx?g=02298556-8787-40fc-827a-bc9ebcbb58e0

Infographic on practical care for people with dementia

Six Tips for Dementia and Alzheimer's Care at Home (full article) #Alzheimers #dementia #caregiving ... - http://pinterest.com/pin/538391330430176096/?s=4&m=blogger

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.

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?

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.

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.

 

Plan in advance and tell people if you want to control your dying

A Dr Schillerstrom, writing on a news blog, makes a good point about the psychology and ageing and end-of-life planning. He says:

Perhaps some elders’ reluctance to engage in end-of-life planning stems from knowing that perfectly thought-through wills and living wills do not necessarily decrease death anxiety. It may even increase it by forced confrontation with one’s mortality. However, end-of-life planning may decrease the anxiety of those we love, and it may give some sense of control over the process.

My blog on social work and end-of-life care often puts the case for planning for care at the end of our lives. And the questioning doctor is right, this is often not an easy thing to do.  But if we want to be in control, or a bit more in control if it's at all possible, good advance planning and telling people what we've planned gives us the best prospect of having it like we want it to be. If we don't plan and we don't tell anyone, how are they going to know what to do when we're clog-popping.

The link to the article on the psychology of ageing and end-of-life planning.

Link to my social work and end-of-life care blog.

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

Dignity in care websites listing

I'm working on dignity in care: you might find my list of websites on dignity in care issues useful; it gives lots of connections to resources and reports.

Listing of useful websites on 'dignity in care'