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Residential care system is failing elderly and hard-pressed staff, warns union


Care home residents are being left in re-used continence pads, denied trips to the toilet and kept indoors for days on end due to severe staff shortages, according to a survey by Unison.

It found 83% of care workers said they were so rushed they were compromising the dignity and well-being of residents, despite 80% saying they regularly worked through their breaks.

“The care system is failing the elderly and the vulnerable – and those staff struggling to provide the best support possible”

Dave Prentis

The findings are based on survey responses from more than 1,000 care staff working in private and local authority care homes across the UK.

The union claimed they presented a worrying picture of residents being denied the most basic levels of care.

The survey found 89% of respondents blamed a lack of staff, with 27% not having the time to help older people eat and drink.

A similar percentage of care workers also reported often being too busy to take people to the toilet, or notice if a resident’s health has deteriorated.

“One of our wheelchair-bound residents will often sit for hours smelling of urine”

Survey respondent

Others said there was often not enough time to help residents wash their hair, or cut their nails.

In addition, care workers noted that they were rarely able to stop for a brief chat with the people they were looking after or take them outside.

According to the survey, 27% of employers were forcing staff to ration equipment like wheelchairs, wet wipes, gloves, continence pads and hoists.

Some staff said they were resorting to re-using continence pads on residents because of budget cutbacks.

A respondent said: “One of our wheelchair-bound residents will often sit for hours smelling of urine because she’s only allowed two (continence) pads a day.”

“Continence pads run out twice a month, wheelchairs are either broken, have missing footplates or are too small for larger residents. New wheelchairs are usually donated by the families of residents who have passed away,” said another.

Other issues highlighted by the report included a lack of safety checks on residents and not having enough time to do the necessary paperwork for care plans.

The union published the results to coincide with the start of Unison’s local government conference in Brighton on Sunday.

Dave Prentis Unison

Dave Prentis

Dave Prentis

It is urging councils and care home owners, in both the voluntary and private sector, to adopt a new residential care charter so standards can be raised.

It follows on from the union’s ethical care charter, which aims to raise standards of care for people living in their own homes, as well as enhance the treatment of homecare workers.

Unison general secretary Dave Prentis said: “The care system is failing the elderly and the vulnerable – and those staff struggling to provide the best support possible.

“Significant change needs to happen if respect and dignity are to be restored and standards improved in care homes,” he said.

“It’s shocking that some care home owners are being allowed to look after people when they don’t have enough staff to deliver quality care,” he added.

A total of 1,003 residential care workers across the UK responded to the survey, which was carried out 3 May-2 June 2017, with 69% working for a private care provider.


Readers' comments (6)

  • Absolutely agree with these reports.The whole emphasis is on paper work as well for the nurses.
    To be honest at present I would be hesitant to put a parent of mine in most care homes.
    What is the incentive for carers as most supermarkets pay a better starting salary.There should be a minimum wage for carers who are doing amazing work which is not very glamorous I should mention.

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  • The issue of "re-using" incontinence pads is exacerbated by the CCGs, who are responsible for providing pads for care home residents, failing to supply them in adequate numbers. If the local continence team only provide 2-3 pads for 24 hours, it's hardly surprising that the staff are struggling to cope.

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  • Regulation and checking senior NHS managers is long overdue and CCG managers, lead nurses and commissioning nurses who fail to ensure lawful care need taking through the Criminal Justice system and prosecuted.

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  • I've seen this first hand after working nights in a private residential home for the elderly. A lot of the problem, I think, also comes from residents being placed in the wrong settings, where they need nursing or EMI care after their health as deteriorated but the assessments don't get done, care staff concerns don't get listened to etc. Made worse by ridiculous staffing ratios (3 staff to 30 residents... ). My personal experience was also that the care home managers put too much emphasis on completing non-care tasks such as cleaning, laundry and food preparation, especially for night staff. It's truly heartbreaking for the residents, their families and care staff that the time and resources just aren't there.

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  • There is a big problem in some regions where the self-funding residents are detained in a residential setting although they have conditions that have progressed to needing NHS funded care or even Continuing Health Care in accordance with the criteria set out in the Department of Health's "National Framework."

    Of course the outcome therefore is that neither the Local Authority nor the NHS pick up the bill for the care of the self-funded patient detained in residential care. But the ramifications are formidable. When unregulated, unchecked senior NHS managers who sometimes are woefully defunct in how to provide humane, cost-effective, person centred care to the elderly with complex needs, there is a massive problem with nurse retention and so agency nursing costs soar and/or staffing ratios drop resulting in the deepening of problems with nurse retention and dissatisfaction. Some regions even have had to offer to pay for travel fares to bring in nurses from other countries (who are probably easier to dupe as they are unlikely to have knowledge of the National Framework or Care Quality Commission standards).

    To Anon 3 July I would say that your concerns are well justified but it would be an error to believe that the resources just aren't there by necessity or innocent mistake. Fundamentally, resources are available. We are the 5th or 6th richest nation in the world. Resources do not get to where you/we need them because we all place too much emphasis on appearances, getting higher status and disposable incomes, and too little emphasis on self respect, a sound sense of purpose, teamwork and respect for others, I believe. We were not forced to vote in again a party that is obviously shutting down national health care in order to reduce the Gross National Product and reduce taxes, mostly for those who already have plenty of disposable income, even though the "trickle down" theory has been shown to be false.

    If anyone has genuine concerns about standards of care not being lawfully met, for whatever reasons, in an appropriate and timely manner, there is a duty of candour to report it but given the problems with persecution of whistleblowers then understandably people might be afraid to do this. Rather than doing nothing, it may be advisable to do this anonymously to the CQC if those who should be behaving responsibly have shown insufficient, practical interest in improving care. (Be wary of those who should have been awarded Diplomas in Lipservice.)

    It needs remembered throughout that unless care homes can attract residents, they will not be able to afford the money for better care. Also be aware that care home owners who are not compliant with poor managers in Local Authorities and NHS Clinical Commissioning Groups, could find themselves in a position where they could be forced into a situation which is untenable and not viable.

    If nurses looking for posts in care homes checked out the ratings given by the CQC then they may not get a clear picture as the CQC, I believe, do not have enough manpower hours either for their inspectors. So I believe that where no one has complained, homes get passed automatically almost.

    If the CQC got anonymous complaints, would they focus better on problem areas? They always give managers and owners plenty of time (too much time?) to put things right and they are one step removed and better able to be tactful over a period of time. Would the outcome then be that the better homes would be more viable financially? Finances are the main concern naturally, for the owners. Satisfied residents and staff speak for themselves in the way that homes, that is the people therein, look.

    Are there ways for all of us to promote the well-run, person centred and cost efficient care homes??? (To the detriment of the homes that do not care.)

    Videos, with all the necessary consents of course, maybe? Photographs can be rigged too easily and therefore must be declared as lacking credibility. But could videos showing contented and/or purposeful people help - providing that all consents are given for that specific purpose and recorded in a lawful manner?

    Can Nursing Times advise please on how this could be done and supply a template and instructions that meet lawful requirements?

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  • Sadly I see this every day in my nursing home. Residents are only allocated 3 incontinence pads for 24 hours, equipment is broken or not enough of it, there is little meaningful activity or interaction. I do think carers are undervalued by society and certainly not paid what they are worth. Some truly care but unfortunately I see many who are only in it for the money (as little as it is).
    Nothing will change as long as we have a government who wants to totally dismantle any kind of state apparatus and reduce taxes to ridiculous levels.

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