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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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