Home From Home is a timely, readably short and punchy report which deals with the growing number of people with dementia in care homes and looks at the quality of care they're receiving. The Alzheimer's Society figures on the increases look intuitively about right, roughly matching the Bupa survey from about a year ago - and merit some consideration.
One of the most worrying trends the report identifies is the fact that 40% of people with dementia are being cared for in homes that aren't registered for their care, homes where staff have no specialist knowledge, training or support. Five years ago that wouldn't have been possible - the Commission for Social Care Inspection (CSCI) were onto homes offering care without proper experience like a ton of bricks. They'd make it explicit in reports that individuals with dementia in standard care would have to be moved on or homes would lose their registration. This could be useful in terms of pressuring care managers or health personnel to take supportive action but often meant people with relatively mild dementia had to leave a home they were settled in.
CSCI relaxed these rules a couple of years ago, partly to prevent unnecessary moves - and partly, as all professionals knew, in recognition of the fact that the residential system was swamped by people with dementia who needed care somewhere (anywhere) and that local government didn't have the money to pay for specialist environments. Note the gap the
report identifies between a £445 a week and a £627 a week fee for non-specialist and specialist care. Effectively, CSCI allowed the mess that the report identifies to develop. Now we're all going to have to dig ourselves out.
A key issue, of course, is money. It's right and proper for the report to suggest that training for staff would be helpful, that a proper career structure for care workers based on training would help even more and that commissioners ought to be commissioning properly for high quality services. But that's not going to happen without more resources and the kind of shift in priorities that the Wanless report identifies and which, to be fair, government is currently considering. Don't hold your breath, though.
There are some truly terrifying statistics in the report. The suggestion that "a typical person in a home" spends "only two minutes interacting with staff or other residents over a six hour period" sticks unpleasantly in the mind. Based on my own experiences of managing specialist care for people with dementia I have to say I find it hard to accept. I would have thrown a blue fit (not to mention handy crockery) at any member of staff who didn't regard spending time with the people who we cared for as the centre of their day and find time to do it by involving residents with domestic tasks, sharing meals, coffee or strong drink and as many laughs as possible. Any home failing to work on similar strategies is bound to be a disastrous environment for dementia sufferers (who get lonely and depressed easily) - and certain to lead to staff disparaging residents and neglecting personal care in the way the report suggests. That's a function of ceasing to see the people you are caring for as human beings and beginning to regard your working day as consisting solely of mindless, repetitive and unpleasant drudgery.
Under those circumstances the report is only too right in asserting that "the bar is set too low" for dementia care and its suggestions for remedies - more activities, more external specialist input, a focus on life histories for care planning and more recognition for staff are spot on. Not mentioned is the need for greater involvement of relatives and friends, however. It surely isn't possible either to provide services as dysfunctional as those the report identifies - or to
fail to offer some kind of reward for dedication and the many areas of good practice in care work also identified - if you have relatives actively involved in talking to managers about quality and change. Let's ensure they get a chance to throw some crockery, too.
