Care in our care homes

Various regulatory measures have been introduced along side heavy duty ‘monitoring’ bodies. All these have been welcome by the consumers and health/social care professionals.

With a steady decrease in NHS beds over the recent years pari passu a great increase in the number of clients needing such longer term low-tech care, there has been an explosion in the numbers of privately run care/nursing homes throughout the country. These are now essential parts of the health and social care delivery system. And to be fair, most of them do a fantastic job providing a very important part of the service.

All that said, problems do exist. From time to time we hear and read about ‘scandals.’ Only recently in Bolton, a fairly well known long running care home was the subject of the newspaper head line. Lack of care, evidence of neglect and poor standards were the main criticisms. Such incidents are not infrequent; but may not be very common given the fact that there are many more care homes being run these days.

The question, however, is why should there be a single case of such incidence? Even if it is infrequent, why should there be even one. How many air crashes or train accidents should be accepted as ‘within normal limits’. Care of human beings, irrespective of their age, gender or race, is not for any compromise; exactly the same way as airline services. These must be zero-risk areas.

Now let us have a look at the problems. In health care, ‘caring’ is the most expensive entity — looking after a dependent person for weeks or months makes that patient a very expensive one, much more than a heart transplant or proton beam patient.

Most ordinary people do not realise that. And quite often those who run the service attempt to reduce the overall cost of care. Care cost just doesn’t mean the staff salary or cost of food, there are many other vitally necessary things. One important requirement is ‘training’ and ‘space for thinking/contemplation.’ Even in those so-called low-tech areas, the staff must be kept updated with new developments and understanding of disease and medications.

Most of the time very well trained staff do not offer themselves to work in care homes; these places are not challenging or attractive enough for a young nurse or a social worker. On top of that rewards are not good enough, work seems to be boring and thankless. The consequence can be easily worked out. And when the scenario is dull, boring, unchallenging and totally thankless, things tend to go wrong. Senior monitoring, supervision, help and guidance are often inadequate and the ‘customers’ never complain – too ill or infirm to do so.

One way to improve things may be to run the care homes as an integral part of the NHS; regular visits by specialist doctors and general practitioners. More routine involvement of general practitioners are now being recommended by the authorities. Better and more intensive training and more integration with the rest of the NHS care systems. All nurses and doctors should remain involved in the continuing care sectors in the community.

Their overall attitude will change a little and the isolation of outside care home staff will be alleviated. Standards will definitely improve. A more critical handling with some changes is urgently needed and within the available resources, it can be achieved.

Arup Banerjee