The continuing story of the dire state of care homes for the elderly

Oliver Wright’s piece today in The IndependentDire state of care homes for the elderly is only going to get worse, says top inspector – has left me scratching my head. Some of the statements made by Dame Jo Williams, Chair of the Care Quality Commission (CQC), astonish me.

She seems to approve and accept without question, almost as a fait accompli, that ‘service providers’ will cut corners, will not provide suitably trained staff, will continue to scrape the barrel when it comes to staffing by paying the minimum wage.

One of the Essential Standards is that ‘you can expect to be cared for by qualified staff’.  So the CQC cannot allow service providers to cut that corner.

You can expect to be cared for by qualified staff

  • Your health and welfare needs are met by staff who are properly qualified.
  • There will always be enough members of staff available to keep you safe and meet your health and welfare needs.
  • You will be looked after by staff who are well managed and have the chance to develop and improve their skills.

She says that more needs to be done to recruit, train and retain good staff, but in the same breath she condones the fact that “many staff are already on the minimum wage so there are not many savings there”.

It is the function of the Care Quality Commission (CQC) to ensure that service providers don’t cut corners.  To ensure that staff are suitably selected and trained for the job they are required to do in care homes.

Dame Jo seems not to have made the connection between the appalling standards of care provided in some parts of the care home ‘industry’ and the ridiculously low wages paid to staff, resulting in problems with staff recruitment, retention, quality and loyalty.  The care ‘industry’ needs to pay a living wage, rather than a minimum wage, in order for things to improve.   Then Dame Jo might find that in the South-east the workforce might be less transitory.  Didn’t the Mayor of London set up a Living Wage Unit a while ago?  How on earth can anyone expect decent standards of care when little respect is shown for those who provide the hands-on day-in-day-out care?  If they are undervalued, they will undervalue the people they are serving.

If only the care  ‘industry’ cared enough to guarantee staff training – especially dementia training – and to make available a decent career path, the right quality of care could be found more often by those of us who have no choice but to arrange for our own older people to move into residential care.

Whose side are you on, Jo Williams?   Has the CQC become the Trade Union for Service Providers?  I read little of Dame Jo’s empathy for people in care paying an absolute fortune (to them) for sub-standard care.  The CQC is there to regulate and to guarantee that a good standard of quality care is provided to those vulnerable people who need care.  The CQC is there to ensure that the Essential Standards are met, without short-circuiting.  The CQC and the local authorities and the care home providers all need to be reminded of the fact that nobody moves into a care home unless and until they have to do so.  It’s not a flimsy lifestyle choice – it’s a necessity.  All care home residents deserve respect and deserve to be valued.  They must be at the centre of thinking.

Is Dame Jo Williams serious when she says “Quality in our terms is making sure a service is safe – but it is also about how you’re treated.  It’s about staff remembering your birthday, calling you by the right name and engaging with you as well as maintaining your dignity.”

A birthday comes but once a year.   The remaining 364 days of the year in care are equally important, if not even more important.   Calling you by the right name?  That’s not rocket science, so it should be fairly easy to instil that quality into the staff.  Of course dignity is essential, but it hasn’t been present in the world of care for far too long now, so forget the birthdays (the chances are there’s a piece of software that will ping out a birthday!) and concentrate on the quality of care.  That quality of care involves the setting, the building, the decor, the provision of good nutrition, medication, care planning, monitoring and supervision …. … to name but a few of the essentials of care.

She talks about “looking at those services that are risky and are likely to put the public at risk”.  It’s the residents who are at risk, not the general public.  I hate constant references to ‘services’ and ‘service users’ and ‘institutions’.  It de-personalises, it removes the person and the personal from the debate.  By all means use those terms in your own offices, if you really must, but remember the people first.  It’s almost as if the word ‘service user’ gives permission to the profession to forget that they are dealing with real people, people who have a lifetime of experiences, people who have contributed throughout their independent life.  And without whom we would not be here.

A person who moves into a residential care home becomes a resident.  They reside in their new home.

A person who provides care in a residential care home is a care provider, a provider of care.

Sort out the language of care, Dame Jo, then we might all be able to understand each other better.

But ‘nursing home’ seems to be creeping back into use, just to confuse us even more when trying to navigate the CQC website!  There used to be only two types of care homes: residential care homes (without nursing), and residential care homes (with nursing).  There are care homes with a nursing section/wing/unit/floor.  There are care homes with no nursing at all.  Some people talk of EMI homes.   Are they the same as care homes registered for dementia?  Are they nursing homes?

I’m intrigued by this security-services style software that she mentions.  Scanning the thousands of reports the Commission receives each month looking for ‘trigger words and anomalies’.  Anyone who has ever approached the CQC or its predecessor the CSCI – by phone, by letter or be email – to draw attention to a particular concern in a care setting will know only too well that software isn’t required.  The CQC just needs to listen, to note, to reflect and then to act promptly.  You don’t need software to alert you to problems.  That’s what we’re here for – real people.  All you need to do is to listen.

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