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Elderly 'written off' to care homes

A government health adviser has warned that older people are being moved unnecessarily into nursing homes where they do not have adequate healthcare.

Professor David Oliver, clinical director for older people at the Department of Health, said not enough effort was being made to tackle “perfectly reversible, treatable problems”.

Speaking to the House of Lords select committee on public service and demographic change, he said when older people entered homes, access to certain treatments was worse than “you might get in prison”.

“Certainly, when older people are in health services, primary care or secondary care, they need a proper diagnosis, they need proper assessment, and currently we are failing to address reasons why they are becoming immobile, or becoming dependent, and writing them off,” he said.

“We are normalising disability and frailty in older people when often it is reversible; that is a real cultural challenge for the professionals.”

He said there was evidence that common problems associated with growing old were “relatively neglected in primary care” and that older people got “much worse treatment” than somebody who was middle-aged with the same condition.

“Why are people going into care homes, and why is there so much variation? Partly it is to do with capacity locally, but many people who have perfectly reversible, treatable problems like immobility or confusion are not having proper investigation of those syndromes, and sometimes end up going straight from hospital beds into care homes because they have not been properly assessed and we have not done everything we can to try and get them better,” he said.

He added that support around medication, GPs, rehabilitation, chiropody and dietetics was not being delivered adequately in care homes.

“It is probably worse access than you might get in prison, for instance, and that is something that we have to sort out,” he said.

Readers' comments (27)

  • we need more rehab beds, we've been saying this for years since hospitals began closing down in the 80's. no-one listened then, no-one is listening now.

    we also need investment in home-care and relatives who are willing to look after their elderly parents. many people choose to move into sheltered accommodation or a carehome.

    where I work we have an excellent rehab team but patients don't always have somewhere to move onto, people should not and do not want to stay in hospital indefinitely so what are we to do?

    hence the phrases 'bed blocker', 'winter pressures', which used to be called rehabilitation, long-stay, geriatric wards but it's the same thing.

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  • After looking after our father (with Alzheimer's, but otherwise physically fit) at home for 4 years, we have had to place him into care because his safety is at risk. The only time we could not be there was when we were at work. Otherwise, we did all the care, (including overnights every night), outwith our working hours. We've spent a fortune on private carers to shore up the lack of care available from the local day care places, limited resources and a complete lack of 'joined-up' approach to my father's needs.

    In the first month in care, my Dad lost 11kgs in weight, had two infections (UTI and bilateral conjunctivitis) and that was with a family who were there daily voicing our concerns and finally taking the decision to move him out of the home. This was a home the Care Commission were giving good reports. The staff were very polite and nice, but there was definitely a "Well, he is an elderly man with Alzheimers, what do you expect?" attitude. My husband brought Dad home for the afternoon one Saturday and he had a temperature of 39.6! We took him straight back and had to insist that a Doctor be called, as the staff were adopting a 'wait and see' approach. Someone even said that it was probably due to the heat in the dayroom!

    He is now in his second day in a new home. As a family, we have been rattled by my father's decline in so short a space of time. The decision to place him into care in the first place, has been heart-breaking. To move him again, so soon, has increased his confusion even further. We feel let down, anxious and not at all confident that my Dad will be properly looked after in a care home setting.

    Yes, it does need to be sorted out.

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  • Florence

    I have worked as a Nurse in care homes and various areas of the NHS as a Nurse.
    I have to agree that I have seen less that satisfactory specialist care for older people in care homes. Sometimes GP'S are dismissive of problems that arise despite Nurses raising their concerns. And unfortunatley it is harder to access Community Allied Professionals such as Physio.
    I agree that the senario described by Anonymous in the previous post is an example of very poor care. It must have been a very difficult situation clearly they recognised that their Father needed full-time care. And you place faith in the care home that they will provide it.
    I remember working in a care home and being '' Reprimanded'' by our GP, who covered the service, for asking him to review a Lady with new rectal bleeding.
    In my current role as a Hospital Nurse, where I have worked most of my career so far, I look after Older People recieving rehabilitation.
    The challenges we face can be broken down as follows;
    1. Due to closure of acute beds our rehabilitation beds are not used appropriatley.I don't need to state the implications of this.
    At one point our Trust decided to close our Isolation ward and use our side rooms as Isolation beds. That fell apart after a few months.
    2. We don't have enough rehabilitaion beds anyway. We always have a '' waiting list'' of about a dozen patients for our ward.
    3. Patients who are fit enough for community services, such as rehab community beds or rehab care packages at home are not identified readily enough on the acute wards. Often they are missed, pick up an infection in hospital and have an extended stay due to this.
    4. Our social services are totally over stretched and the waiting time for care packages and community rehabilitation beds is unacceptable.
    5. The governemt has known that our elderly population has been rising for decades and adequate provision has still not been made.
    The head of our social services teams recently commented to me that she felt that Older People were not given adequate time for assessment and rehabilitaion in our Trust. Although I believe our area is very good,I mean we were having board rounds and MDT meetings on a daily basis before it was stipulated we should be doing this more regularly, I have to agree she did have a point.
    This is not down to apathy, ignorance or lack of caring.
    The pressure on beds is unacceptable.
    The system still does not take into account the complex needs that older people have.
    We have addressed our concerns, and continue to do so at the highest level in our Trust.
    When it was announced some months ago that some of our rehabilitation beds may be closing. I asked our Matron what provision was being made for this. She simply replied ' Community services''. I suggested she spend some time with our socal services department to look at the poor provision of community services we have.
    I wasn't being unkind, and theres no point in '' shooting the messenger'' . However, someone along the line obviously seen it was a bad idea and the beds won't be closing now.
    We simply have a social care and NHS that is full of great individuals who are for the most part caring and innovative. We all have a vision of how the service could be shaped to meet the needs of our Older people. As it has been said before clinicians have lost all say in shaping services.
    Our Ward Manager raises her concerns regulary and we do similar. We also offer suggestions and solutions.There is no way Senior Managers could ever say we have not tried to be part of the solution.
    However we have a government that is hell bent on minimising our NHS and taking clinicians out of the picture when it comes to shaping the services.
    We have just had Band 6 posts advertised for our unit.At one time I would have jumped at the chance as it gives you the opppertunity to shape and improve your area and be a stronger advocate for patients and colleagues.
    Now it just doesn't seem to make any difference as clinicians are largley ignored.
    Although there are great staffour NHS and social care system doesn't allow us to do our jobs properly.
    I will be voting for the new NHS party next time around.

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  • it's not just the elderly - those with mental health needs, disability needs, the homeless, substance abuse - everyone is suffering because of lack of beds and lack of community care.

    Those who decided to close beds back in the 80's should be asking themselves some very basic questions -

    - where did they think people would go
    - who would want to come into nursing when it was so obvious it was going down the pan
    - who did they think was going to look after vulnerable people

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  • It's the Goverment's fault. Geriatricans are almost a thing of the past and Geriatric hospitals have been close one after the other, along with convelescent hospitals and most community hospitals. 40 years ago a brand new one was pulled down for housing investment and all the inmates transfered to Nursing Homes-many having to pay for their unwanted transfer. A very obese wm had to wait a very long time for a placement becasue Care Home owners did not want to invest in an expensive hoist, just for her. Now the chronically sick elderly have nowhere to be transfered to. Makes me wonder if this has been the intention all along and so now it is deemed kinder to put them out of their, so called, "misery" (and save NHS funds) by putting them on the LCP.

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  • sally - 'geriatricians' are certainly not a thing of the past, it is a very valued speciality nowadays and there are plenty of doctors wanting to work in this field.

    why do you refer to people as 'inmates' - was it a prison that was closed down?

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  • Anonymous | 27-Nov-2012 8:59 am

    "why do you refer to people as 'inmates' - was it a prison that was closed down?"

    I know. What an insult to prisoners! Let's face it, they are looked after better than a lot of our elderly.

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  • tinkerbell

    in my new role as a dedicated home link nurse for our area, i am saddened to see the old folk, sitting around a tv in chairs, not much else going on, telling me that life's not worth living.

    No wonder the majority of them are on an antidepressant, of course they are depressed.

    Is this the way we end our days 'waiting for God?'.

    I know they are kept safe and warm but sometimes i wonder if they would be a darn sight happier taking their chances in a risky world.

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  • when I was a student in the 80's I had my geriatric placement in nursing homes, residents were all just sitting around in chairs then.

    some care-homes are really good.

    do you have any experience of working in carehomes for younger people?

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  • there are many people who remain healthy most of their lives and live until advanced old age. many of these have paid into the NHS all of their lives and have been fortunate enough to have used the services very little whilst supporting those who have required a lot of care. that is fine as it is how any social system in a civilised society works but when the elderly may need their share of healthcare and modern medicine they are being denied access to it on grounds of their age. what sort of society is this that we now find ourselves having to live in?

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  • Yeah, i'm sure there are some bad places to work in out there, but dont slag off all community care. Just coz I work in private care doesn't influence the care that i give as a nurse. I have to say that the care home I work in is:
    a. able to provide better care than the local hospitals for elderly folk
    b. Better documentation/computer care planning (that is relevant)
    c. Has more activities than the hospitals
    d. Has a good GP link

    Just coz you work in the NHS (and I have) doesn't mean that you can hide behind the size of it and think that 'the community' is a write off. Sooooo many people discharged to us from the hospitals have pressure sores, zero documentation and bad communication that it is frustrating!
    Don't get me wrong, I'm not slagging off the hospitals but rather bring some balance here...It's not just a romantic view that I hold, but the more you people separate hospital Vs community, then the more you perpetuate a 'them and us' scenario. What ever happened to working together?

    As for relatives, I think sometimes despite all their fighting and struggling for care provision (which is right to do btw), people need to find some realism in it all..It's not that care providers can't or won't care, it's rather that they are not in a position to provide 24/7 care as most nursing homes & hospitals are stretched to such a point that they don't have the staff to be there all the time, because its all so FLIPPIN expensive!
    We should be looking after our own relatives with support, not just expecting other people to look after our own because of work commitments etc... If work commitments get in the way, then we need to look more at our Western lifestyles/cost of living/cost of housing/western culture/government etc...and see the root of the problem is the society we live in.
    I wonder if the government give a hoot anyway. Everyone is protesting about something and complaining how unfair life and their workplace is, maybe we should get to some root issues and change our society and what it is we actually care about.

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  • michael stone

    Anonymous | 26-Nov-2012 1:37 pm

    You ended with:

    Yes, it does need to be sorted out.

    I listened to a radio programme recently, and the presenter finished with something like:

    'I don't understand why this is so hard to sort out'.

    There are lots of issues within healthcare, where things clealry need sorting out, and I cannot fathom why it is so difficult to sort them out (and I'm excluding the problems that obviously would be hard to deal with - some things appear to be in a mess, merely because nobody is knocking the right heads together !).

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  • tinkerbell

    Anonymous | 28-Nov-2012 1:09 am

    You are absolutely right. This divide and conquer mentality helps no one.

    We are all hopefully nursing to the best of our ability with the resources provided, we are all under the strain of providing care with lessand doing the best we can with what we've got where we are.

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  • Anonymous | 28-Nov-2012 1:09 am
    Anonymous | 26-Nov-2012 1:37 pm

    This isn't about the NHS v Private Care. It is about the right care being available for the elderly. You should know that there are plenty of articles on NT citing poor examples of poor care within NHS settings, so there is a little over-sensitivity in your post. Poor care should be highlighted wherever it exists.

    "As for relatives, I think sometimes despite all their fighting and struggling for care provision (which is right to do btw), people need to find some realism in it all."

    Perhaps it is you who needs a reality check. Think about some of those in your care and consider what it might be like to look after this elderly person with complex physical and mental problems, which you are not trained to deal with (because you are not a health care worker) and where there is no shift change allowing you to go home to your life. Imagine that 24/7, 365 days a year with inadequate support from health and social care "professionals." That is the reality for many carers. Residents in care homes or hospitals, represent only the minority of elderly requiring care in this country.

    "We should be looking after our own relatives with support, not just expecting other people to look after our own because of work commitments.."

    What support would that be? You obviously aren't well enough informed about that particular reality. Finally, I would ask if you are in the position to give up your work and in doing so, your ability to support your own family; and become a recipient of the benefit system to look after someone full-time? I'm not.

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  • Anonymous | 28-Nov-2012 1:09 am

    ".....we need to look more at our Western lifestyles...and see the root of the problem is the society we live in....."
    One of the biggest myths being punted around, is that "other cultures" in the world somehow "look after" their elderly better than "Western society". The truth is that, often, the elderly are looked after by subservient women, who have little say in their own lives, whilst the men do f*ck all. Let's stop kidding ourselves that there is some ideal society getting it right. It simply isn't true. As has been pointed out, the vast majority of elderly in this country ARE being looked after at home by their own families, often in very trying circumstances. To dismiss their efforts and imply that their need to work is selfish, is shameful. Whilst you boast about documentation, activities and GP links, all of which are minimum requirements, I doubt if you have any idea what it is truly like to look after an elderly relative at home.

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  • Need help! 4th year project!

    If anyone here works with the elderly i would really appreciate you taking 2 minutes to fill out my survey about the future of elderly


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  • I am leaving the nursing home I work in. A charitable trust I am told over and over that is non profit....over and over again, one that made £26m last year. The CEO earns £275k a year with a 10% bonus and an £11.5k car allowance. The directors get paid £4.5k for each half day meeting they attend. But there is no money for activities or extra staff.
    I am leaving because our ladies and gentlemen are left sitting around a TV day in and day out, with activities maybe happening once a week. No matter how hard the staff work, there is no time allowed in the shift to actually spend quality time with these dear people- staff are too busy trying to get all the physical needs of all the residents tended to.
    When I mentioned the decline in care I was noticing, the manager told me she disagreed....I am the one responsible for their care, I am the one who sees the downturn in care, yet I can do very little about it. Yet I will be the one referred to NMC for safeguarding and I will be the one loosing my license when care standards fall so low, something life threatening occurs. I feel bad for the dear people I work with, both the elderly residents and my work colleagues, but I can not stand by and watch this continue.....I have brought it to the attention of upper management over and over again, during the past 3 months...They dont care!! People who are so far removed from hands on care.....they just don't BLOODY CARE!!

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  • Oh dear what is happening in this day and age. I am now seventy years old and I am lucky to be well enough to still work as a registered nurse. During my varied and long career, I worked with the elderly for 18 years. I first went into residential social care as it was named then back in 1971. I was appointed the Officer in Charge of a brand new large (53) bedded home run by a county council. There were several of these in the area and some were horrendous, run entirely for the benefit of the staff. Some were trying hard to improve but the majority of staff were stuck in their ways and therefore care suffered. I was adamant that the home that I was about to run was going to be the best. Before the home opened we had all the staff in place including the senior staff. Training was given to everyone as to what we were going to provide for the residents. Besides choice of menu daily, there was always help for those residents who could not get to the dining room for meals. The residents also were not woken at some unearthly hour and because we had shifts of carers coming in at certain times to provide care, everyone was well looked after. We had several small lounges where the residents had the choice of where to sit. We had a good OT programme,where something went on every day, such as handicrafts, games, walks to the nearby village, clothes shops who used to bring loads of clothes for the residents not able to shop outside easily, to choose for themselves. There was a hairdresser who visted twice a week. We also recruited a super band of volunteers who gave up hours of their time to do things with the residents such as painting,playing bingo,playing cards and many other activities. Some of our residents were suffering from confusion and we held remeniscence sessions with them and anyone else who wanted to join in. The laughter and stories that used to emerge was wonderful. There was a small shop where the residents could purchase small items and retain some form of independence. Our local surgery made a weekly routine visit where residents could go and see the doctor if needed. We held lots of fund raising activities to enable us to take the residents to the seaside and other visits. One of our 100 year old ladies expressed a wish to go to the fair and she had a ride on one of the roundabouts.
    This is how any care home should be run today. I am not saying that our resdents were all easy, they were not, we had a lot of very disabled people and a lot of dementia sufferers, but we managed to look after them all very well. We had an excellent reputation and the council homes officers used to bring visitors to the home just to prove that it could be done.
    I was proud to have started off this great residential home and stayed for five years. I unfortunately had to move on as my own Mother became ill and needed me.

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  • tinkerbell

    Anonymous | 29-Nov-2012 5:15 pm

    Hurray for people like you. Well done.

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  • Where I work, there are several colleagues who, with their families, look after elderly relatives with varying degrees of physical and mental illness. This is quite usual. One of them has dropped a band and her hours because the "community support" available is so fragmented and inconsistent. I have watched this nurse become crippled with anxiety and exhaustion, whilst trying to provide for her own family, fight for help with her mother's care and deal with her mother's deteriorating condition and increasingly challenging behaviour.

    Most people are not trained to look after the complex problems many of the elderly face. It is frightening, exhausting and isolating. Look at the appalling statistics about the health impact of being a carer. The resources to provide even adequate support do not exist in many areas. Some are faced with no choice but to place their relative in care. That sparks off another set of problems if the care home isn't up to standard. As nurses, we should be aware of this, rather than accusing loving relatives of "expecting other people to look after our own because of work commitments etc..." . I would think that my colleague would work even harder to keep her mother away from someone holding such an attitude. Such ignorance is indeed a problem. Whilst there are some good homes, there are others which most definitely are not.

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