“Will you help me, please?”

These are the heart-breaking words of 98-year old Yvonne Grant, calling for someone to help her to the toilet in secret filming captured by her family and aired by Panorama ‘Behind Closed Doors: Elderly Care Exposed’.

In this hour-long programme, viewers are shown older people in care homes being neglected and abused, call bells being ignored, verbal and physical assaults, and staff who are either completely unsuitable for the job they are doing or, as a few glimpses of footage show, some very good staff who - whilst overstretched - are caring people who want to do their best for the frail older people who are depending on them.

For me, having been by my father's side through 9 years in social care (punctuated by spells in hospital), I saw things then that didn't represent good care on more than one occasion, and as I have already written about, I had cause to call in CQC when my father's care deteriorated (‘From care to catastrophe’). Whilst I have never seen the type of physical abuse depicted in the programme, it's important to remember that many aspects of poor care aren't any less abusive just because they don't involve physical violence. 

You will struggle to find anything in this programme that represents what most people would want care for their loved one to look like, defined in the current overhaul of CQC’s inspection process as ‘The mum test’ – namely asking if a provider is delivering care good enough for our mums and dads, grans and granddads, siblings, cousins and wider network of loved ones. New key-lines of enquiry for CQC inspectors will ask if a service is safe, caring, effective, responsive and well-led – everything that is absent in this footage.

In the consultancy work I do now I've seen practice that wouldn't pass the 'mum test' for me. Providers don't always get it right, sometimes through failings they want to learn from and make long-lasting improvements because of. However in other cases, as we heard in the Panorama programme, there are some providers who are ‘content’ to bump along the bottom, treading the fine line of previous inspection regimes that defined a provider as being either compliant or non-compliant.

As members of the public we expect that regulation of care providers will root out all poor practice, but as the Panorama programme clearly showed, regulation alone isn't enough. From my personal perspective, it certainly wasn’t enough to prevent my father from aspirating on his own vomit five times and being admitted to hospital with aspiration pneumonia and pressure sores.

The overhaul of the CQC inspection process that is currently out for consultation  – including looking at the issue of cameras in care homes -  gives me some hope for the future, but however robust inspection becomes, and however much quality and innovation is made an intrinsic part of the regulator's role, CQC alone cannot ensure that every service is good enough for our loved ones.

Inspection is but a snapshot of a service. Done well by a team that includes a well-trained inspector, an expert by experience and (where necessary) a specialist expert (for example in dementia, palliative care or pharmacy), against key lines of enquiry that focus on what good should look like, it will expose most services that require improvement or are inadequate.

For me, however, the real key to unearthing insidious poor practice (and equally excellent practice) comes from intelligent monitoring. In other words, whistleblowing staff, relatives and visitors, including visiting health and social care professionals - the people who see what happens on all the days of the year when the CQC team aren't present. 

In an ideal world we would all be the eyes and ears of CQC, but in practice whistleblowing has become a concept that instils fear whenever someone considers it, as I described in ‘Putting your head above the parapet’. Fear in professionals that they will be ostracised and deemed unemployable, fear in relatives that their loved one will be victimised because they have spoken out, and fear from those receiving care that they will be silently killed for complaining.

In that climate, poor care and abusive practices can proliferate and this must change. We need the culture of whistleblowing to be encouraged and respected. Confidentiality, alongside a proper weighting of evidence - rather than a previous attitude of ignoring what hasn't been corroborated over a long period of time by numerous others (who may be too frightened to speak out) - is vital.

There are other suggestions too. One of the most innovative ideas I’ve read is that care homes should have boards of governors in the way that schools do. Private sector care providers are offering a service in the same way that private schools are, and both exists to nurture vulnerable members of society, just at different ends of the age range. Governors that are drawn from a cross-section that includes representatives of those receiving care, relatives, friends, health and social care professionals and wider community leaders could rejuvenate every aspect of social care.

It cannot be the case that we rely on TV programmes to occasionally shine a light onto the plight of a minority who receive a service that is so short of being caring it shocks the nation. Families resorting to installing cameras to prove what is happening to their loved ones, and then watching in tears as the full extent of their suffering is revealed, proves that we woefully short of a culture of open accountability.

As a nation we have to demand better for our loved ones. As professionals we have to find a way to deliver better care. And as the majority of good social care providers would say to the minority who are failing: If you can't deliver a service that is safe, caring, effective, responsive and well-led then go into another sector, far away from the care of vulnerable people. 

As Yvonne said: “Will you help me, please?”

Until next time...

You can follow me on Twitter: @bethyb1886

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Caught on camera

CQC’s launch of their document ‘A fresh start for the regulation and inspection of adult social care’ has created a barrage of debate. Amongst the raft of changes and proposals to overhaul the inspection and regulation of care services for adults are some ideas that CQC want to discuss with the public, including the “Potential use of mystery shoppers and hidden cameras to monitor care”. Concerns have been raised about whether hidden cameras are ethical, if their use would be legal, and whether we even need them.

To begin to illustrate my views, I want to pose a scenario to you:

A man of 84 is living in a care home. He has advanced dementia, and requires all of his needs to be met by a skilled team of care professionals, assisted by his family. His family are not present 24 hours a day, so much of his care is provided by different care professionals. His family become concerned for his welfare when the ownership, management and staffing of the home changes . The home is frequently short-staffed and running on agency staff (who don’t even know who each resident is). The man becomes more frail, has more infections, begins to develop pressure sores and is being kept in bed more than normal. This is also true of other residents. The few remaining regular staff, including the man’s keyworker, express concerns about the way that they are being instructed to care for the man and how new staff are caring for him. The man is eventually admitted to hospital with pneumonia after aspirating on his own vomit five times. The hospital are so concerned about the condition of the man that they make him the subject of a safeguarding order. He never fully recovers from the pneumonia and passes away four weeks later, less than two weeks after his 85th birthday.

That man was my dad.

I repeatedly raised concerns about my father’s care with the care provider after the changes in ownership, management and staff. Eventually I had to resort to phoning CQC three times before they would take my complaint seriously. They inspected, but then took two months to produce a report. It was too late for my dad. His keyworker, a wonderful care professional who had diligently looked after my father for eight years, was as heartbroken by the way in which the care deteriorated as we were. Indeed that care professional, and his colleagues who had  assisted with looking after my dad for many years, found alternative employment and left the home: they simply could not stand to deliver care in the way that the management wanted it delivered.

On the night my father aspirated on his own vomit, we believe he was put to bed too early and given a milky drink in bed without being properly upright – all of those actions going directly against our wishes and the recommended advice for his care from doctors (the management made their own care plans without our consent). The doctors treating my father at the hospital didn’t believe he would pull through the night – aspirating on your own vomit is a bit like pouring acid into your lungs they said. Imagine how that felt.

We will never really know what happened that night, because despite asking the staff on duty, no one could explain. I dearly wish we had had a hidden camera in my father’s room that night, and indeed in the months leading up to that fatal incident. I know it would have proven the poor care my father was subjected to, and it would also have proven some of the good care people like his keyworker provided, often fighting against the management to do what was best for my dad.

Do I think cameras should be routinely installed into care homes? No I don’t. But potentially they do have a value in certain specific circumstances when there are grave concerns for a person’s welfare that only indisputable footage can prove. Currently surveillance is limited to the few families who have installed hidden cameras to prove that their relative is being abused, or places like Winterbourne View that needed Panorama cameras to expose the appalling treatment being meted out.

It must be remembered that some people don’t have a family to monitor their care. People with dementia, learning disabilities and other conditions cannot always articulate what is happening to them. Proving how injuries are sustained can sometimes be one person’s word against another’s. Poor care many only really come to light following a crisis point when a person is admitted to hospital in a condition that no amount of treatment can cure, or it many only become evident on investigation after death.

I want to pose another scenario to you:

A lady living with dementia in a care home, almost completely deaf and blind, begins to lose a dramatic amount of weight and is always thirsty when her family visit. The family suspect she isn’t being fed enough. They often find drinks that have been left out of her reach, and suspect that staff aren’t communicating with her appropriately. She eventually passes away at a weight that would be considered severely malnourished.

I knew this lady, and her family agonised over what happened to her – a camera would have given them answers, and potentially ensured she received better care.

Dignity, privacy and respect are all vital in any care setting, but there is nothing dignified or respectful about elder abuse or premature death from negligence that hides behind a veil of privacy. Such practices – that are in the minority - must be rooted out: they taint the vast majority of wonderful care that is being provided. A hidden camera can prove or disprove allegations and suspicions, and it could potentially work in many different ways. For example: It can prove that a care worker is acting inappropriately. It can prove when a provider is negligent in not giving their staff the equipment or training needed to perform a task or to keep a person safe. It can assist a care provider to root out poor practice that they suspect an individual employee of but need to prove. It can show if a person receiving care has had a harmless accident or is self-harming. It can provide evidence if a family are being abusive, either towards their own relative or towards staff (yes, it does happen).

Cameras could also be helpful in certain specific circumstances in people’s own homes, where they are receiving home care or care from a family member, friend or neighbour.

Consider this scenario:

Two elderly sisters live alone at home. A neighbour ‘befriends’ them. That neighbour manages to persuade them to sign a Power of Attorney and then gets control of all of their money. She tells them that they are now so poor they cannot afford heating. Professional carers often come in to find these ladies cold and hungry. One of the sisters develops hyperthermia. Eventually they end up in care, virtually penniless.

I knew these ladies – could a camera have helped them, and brought the person who prayed on them to justice?

Clearly there are huge ethical, moral and legal issues with the use of cameras in any setting, particularly if those cameras are hidden. Whether a policy allowing the use of hidden cameras in adult social care will ever be created and implemented isn’t yet decided – this is merely an idea that has been put into the public domain for debate. Personally I welcome healthy discussion on any proposal that could help to safeguard our most vulnerable people and stamp out elder abuse. I don’t believe sensitive use of such cameras in a minority of isolated cases would undermine the morale of social care professionals. In my mind, those who are providing good care have nothing to fear.

Until next time...

You can follow me on Twitter: @bethyb1886

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Why, oh why, oh why?

Incensed. Appalled. Outraged. Indeed there are a plethora of words to describe how I felt on hearing reports of a rise in suspected cases of elder abuse in England, but I’m not sure any of them accurately do my feelings justice.

What I cannot, have never been able to, and will never be able to comprehend is what motivates anyone to commit such abuse. Of course you could equally argue the case for the abuse of children, women, the disabled and indeed any person, or any animal, in a vulnerable position – it is never, ever justifiable, and the perpetrators should be held to account for their actions.

Why we have a rise in possible cases of elder abuse is, I fear, about more than just a growing older population or the opportunism some may see in that. I would suggest it has as much to do with the societal approach to ageing, mostly because I see and hear so much in everyday practice that constitutes the foundations of elder abuse. The demeaning of older people, the view that they are a drain on resources, complaints that they are a sector of society that doesn’t ‘contribute’ and that they are simply ‘in the way’.

One of the great arguments against legalising euthanasia is the concern that it would lead to many older people being pressured into ending their lives simply because they are at a stage of life when they need more from ‘the system’ than they are currently putting in. This of course conveniently ignores all the years they did ‘put in’, worked hard and contributed to the defence and prosperity of the nation, not to mention parenting and grand-parenting the younger generations we have now.

In our desire to measure so much in monetary terms, we lose sight of the priceless contribution that our older generations bring to their communities – their wisdom, their experiences, their link to our past, their guidance in the present, and their observations on our future. It may be really simple stuff, but it is incredibly important if we are ever to regain the community spirit that we’ve lost, and to teach our younger generations about humility and respect.

I was bought up within an environment that steadfastly instilled in me respect for my elders. Perhaps this was because my parents were older when they had me (my mum was 40), or because we had strong ties with older relatives throughout my childhood (including the great sadness of my grandmother passing away). Or maybe it’s a simple case of engendering a system of values – to speak when you are spoken to and for children to be seen and not heard (my dad’s favourite).

It probably sounds really old-fashioned, but it worked. Knowing your place as a child within your family means that as an adult you have a grounding that no amount of money can buy. I’m a staunch defender of our elders not because my dad lived with dementia for 19 years and became one of those very vulnerable older people, but because my mum and dad taught me about the value of generations and the place of each generation within the overall tapestry of life.

We will all be old one day if good health prevails upon us, and how do we hope to be treated? As a piece of dirt on a younger person’s shoe, or as a valued and respected member of the community? Moreover, for anyone with children, how do you want them to be treated when they get older? Would you be prepared to tolerate them being neglected or physically or mentally abused simple because they cannot fight back?

Ultimately the point about elder abuse is that it could happen to any of us. It isn’t something that only happens to other people. None of us know what care and support needs we may have as we grow older. We may hope to never rely on other people, either within our own family or professionals who are otherwise strangers, but we just don’t know.

Amongst the majority of wonderful care that my father received, he was subjected to treatment which in my mind was undoubtedly abusive, a view backed up by doctors when he was admitted to hospital with aspiration pneumonia (he had aspirated on his own vomit five times) and pressure sores. My dad became the subject of a safeguarding order, and that was despite having an actively involved family who tried to stop the dreadful treatment meted out to him. He never fully recovered and passed away four weeks later.

We know from the scandals at Mid Staffs and other hospital Trusts that abuse isn’t just confined to care homes, and the exposé TV documentaries on bad care only highlight certain individual organisations.  I don’t believe that the cases of abuse in people’s own homes that hit the headlines tell the whole story either. My greatest fear is the abuse we don’t hear about; the people who are in pain, soiled, sworn at, neglected or isolated. The people who are fearful of having enough money to pay their bills because someone has conned them. The people who are being told they are worthless and should just die.

Every single one of those people needs us. They need strong voices to highlight their plight, a person to talk to who will help them, effective whistleblowing procedures, a robust system of regulation from CQC to ensure that they are safe, well cared for and happy, and from everyone who lives in their community, respect. It costs nothing, but if it was engendered within all of us, elder abuse and indeed all forms of abuse would never exist.

Until next time...

You can follow me on Twitter: @bethyb1886

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UK readers can get more information on Elder Abuse from Action on Elder Abuse: http://www.elderabuse.org.uk/ or call the Age UK helpline: 0800 169 6565