As I sit researching the facts
for this article I find myself asking the same questions
1. Care
Providers record their profit in various forms – The profit from properties, the
profit from individual services operating under their umbrella and profit from
capital. Where’s this profit going?
2. How
much of this profit is reinvested back into their business?
3. How
much of this profit goes on the purchasing of company cars and other perks for
Directors or other staff?
4. How many care providers advertise are you
seeking a care home or nursing home where people receive high-quality care in safety,
comfort and a welcoming atmosphere?
5. Or state claims that their personal activity coordinator
ensures the people living here can follow the pastimes and pursuits they know
and love. And they also encourage new interests inside and outside the home?
6. How
many of those residents are involved in their own care?
What is in fact the true value
of Care?
In the 1990’s many of you will
remember Councils sold off their Care Homes to private purchasers for example
FSHC, Avery, BUPA and Excelcare.
I worked in a Care Home during
this transition. Prior to the purchase of
the home by a Private Purchaser my local council completely refurbished the
premises. New beds were purchased, brand
new Oxford Hoists were purchased and special Hydrotherapy baths replaced the old-style
baths. Carpets were replaced and fresh
paint adorned the walls.
My local council spent an
absolute fortune, admittedly the care was still of a poor standard but the home
looked amazing!
When we were purchased, literally
as soon as they took over, our brand-new beds were replaced with old style
hospital beds, the brand-new hoists were sold or moved off site and the
hydrotherapy baths were again removed from the premises and possibly sold. But how much of the profit from selling these
assets was put back into the service?
None? How many other homes was
this done to?
The manager who happened to be
one of the few who cared was fired and replaced by “a company man” who I think
had been an accountant manager at a supermarket prior to his placement as the
Manager of the Care Home. Now a Manager’s
qualifications should be relevant to the care services your home provides, like
health and social care, nursing, occupational therapy or social work but back
then this wasn’t as regulated and DBS and CRB were still to happen. Our new manager did not know Care and did not
care.
After the purchase, and the
selling off all the assets by the new Provider, care standards slipped to an all-time
low, safeguarding once again became an issue and abuse within the home was apparent
and those who reported this found themselves with their P45 and a UB40 card.
After I left, I went to work
in Adult Social Care and was placed within the Safeguarding Department. This was at the time a new department, and
still in it’s infancy. In my first year
in Safeguarding this same home and horrific cases of abuse passed over my desk
at a ratio of 1:4, for every 20 cases on my desk 5 were relating to this
Service Provider and this care home.
Lessons were always “leant”,
outcomes were always recorded and recommendations were always made. But nothing ever changed, staff were never
dealt with appropriately and the standard of care was still below any decent expectation.
Moving on nearly 20 years and
I still find nothing has changed. And I’m
still asking the same questions.
How can we improve care in residential homes as the needs
of older people intensify?
In the next 20 years, the
number of older people in England will rise significantly.
As we all live longer, the need for more
places in good quality homes will intensify.
Value-based care isn’t a new
concept, true value-based care: fully capitated payment contracts in which a
lump sum of money is available to treat a patient over the course of a year. No penalties or incentives, simply ownership
of the total cost of care and the total cost of outcomes. The better the care, the more money the
organisation bearing the risk receives. This is how to best reward exceedingly
efficient, effective health care.
But to create the value, you
must first invest. Invest back into the
services, the staff and the Users who are purchasing their care. Policy and Procedure needs to be re-evaluated
and encompassing of the needs of the many not just the needs of the service or
solely the profit margin.
Partnership working between
district nurses and care home staff still appears largely to occur by default
at present. There is opportunity for a
more strategic approach to providing nursing support in residential homes.
There is considerable debate
about the relationship between quality of care and quality of life, but why should
these be competitive? Should one not
work with the other?
There is clear evidence of
unmet needs amongst older people with dementia, poor quality of life, and inappropriate
use of psychotropic drugs.
In other clinical conditions, staff training appears to
produce improvements in residential homes, but seems unsustainable by the
Provider. What about other areas of
training (e.g. infection, rehabilitation, preventive care). There is some literature on improving the
nutritional status of older people in residential care, but how many care homes
have implemented this?
There is a clear need for
better management of medication in nursing homes. Appropriateness of drug use is an important
indicator of the quality of care.
Older adults who are
hospitalised can decline in a matter of days, emphasising the importance of
timely hospital discharge. Evidence suggests that stroke patients in nursing
homes are less likely to receive physiotherapy or occupational therapy than
those in hospital-based extended nursing care and that patients discharged to a
nursing home have a greater risk of dying. Placement in nursing homes after
stroke discharge needs to be better understood to manage length of stay and the
cost of acute care.
Together we can improve upon
care in care homes as the needs of older people intensify.
With aims to clarify the
agenda for policy-makers and practitioners.
Better integration of services
for older people which has long been promoted as improving quality of care and
potentially reducing costs.
Quality improvement
interventions include monitoring quality of care, strengthening the care-giving
workforce through training and regular Training Audits.
Person-Centred oriented care
focuses on quality of life. Factors
considered include resident activities, social contacts and staff knowledge and
evaluation of individuals. This approach
can reduce care gaps, particularly in psycho-social aspects of care. It can also have a positive impact on staff
e.g. lower frequency of sick leave.
We can promote independence
and trust based relationships between care staff and residents.
Management and leadership
style have an important impact on quality improvement initiatives, change must
begin with owners and managers building new relationships with all stakeholder’s.
Stakeholder’s are (in a
pictorial diagram): but also, includes CCG’s, NHS, Associated Organisations and
Local Authority Commissioning Services
New work practices may be
insufficient if adopted without investment in training or a commitment to
continued Training and Practice.
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