Care of the Elderly - My Reaction to the Panorama Report
Having worked specifically in the area of Elderly Care for over six years and as a Health Care Assistant in both hospital and care home previously, I have observed many types of practice, both good and poor over the years.
Following the news this morning about the appalling treatment meted out to care home residents in Essex by SOME members of staff there, I was prompted to vent on this Blog about it and my feelings surrounding looking after elderly people, many of whom have Alzheimers or Dementia. There are many sides to this story and I want to look at it from a few of them.
Firstly, health care assistants and carers are underpaid and undervalued. They have one of the most stressful jobs in the industry and receive the least amount of pay and recognition. When at work, they are frequently needed to be in five places at one time and have eyes in the back of their head. They have a limited amount of time to spend with patients who need time and patience to look after. Staffing levels are frequently minimal and shifts can be long. Care Assistants go home with bruises, scratches and aching bodies. These Care Assistants frequently have families to look after, and often have more care related jobs to do when their paid job has ended for the day. Do they burn out? Yes, of course they do. Do they realise it? Possibly not - and, if they do, what can they do about it? They need to earn a living so they carry on, burned out or not.
Secondly, but of premium importance, the patients or care home residents. These are people, yes, real human beings, who had jobs, marriages, children and grandchildren and have lived through war, who now find themselves in an environment with little or no control over their lives. Thanks to the cruelties of Alzheimers or Dementia, many do not know where they are, have no control over bodily functions and have no clue who these people are that keep coming in, manhandling them and examining their personal areas. They often cannot hear or understand what is being said to them by people speaking to fast, too quietly or in an unfamiliar accent. They are woken up, spoken at and next thing have their clothing removed, get rolled from here to there and lash out as they believe they are being attacked. They are then labelled as aggressive.
In the meantime, there is an elderly person, without dementia, who has mobility problems and is desperate to go to the toilet. That person often tries to go on their own, rather than "be a nuisance" and has a fall. They would rather risk that than have the indignity of wet or soiled bedclothes. To an elderly person, being told they have to wait for the toilet is often an impossible task as when they need to go, it is now! Physically, they cannot hold on. For them it is a priority and they cannot see why others are telling them to wait.
I was a "guinea pig" once for a manual handling session. I have arthritis and a bad back. The trainer who used me a demonstration object was so rough when rolling me that I cried out and told her that I hope she never had to look after me in my old age. Many of those in our care wake up with their limbs "set" from being in one position for a long time and suddenly straightening them out can cause awful pain. Once again, time is something that they need to gradually straighten out their limbs and something that is not always give and does lead to shows of violent reaction.
Patients or residents with Dementia or Alzheimers are very often not easy to work with. They can lash out, say very hurtful things to staff, other patients and visitors and it can be very wearing. It is not easy to keep up the standards of respect and politeness that should be standard procedure. However, that is without a doubt what should be upheld in all conditions, regardless. Elderly people are not necessarily nice just because they are older. We do however have a duty of care to treat others how we would like our family or ourselves to be treated.
Now onto management. Do they know what is going on? Do they answer a buzzer or cry from a room? Are they prepared to get their hands dirty? Do they know how their staff are speaking to patients/residents?? Would it hurt to be a "fly on the wall" and stop and listen to what is being said? Why is there a need for undercover reporters and hidden cameras to be in place to find things out? Management rarely seem to work a night shift. Why? How do management decide who would be good to hire?
Hmmmmm, we have facts about patients, facts about staff but a lot of questions surrounding management.
From my own experience, I know that it can take up to an hour to give a patient their meal and a drink. Half an hour to get them to drink 50mls. It can take half an hour or more to persuade a patient to wash and dress and that is sometimes impossible if the patient does not trust whoever is trying to help them. We have already covered at least two hours on one patient in those last sentences. How many patients can someone care for at one time? For patients like my example, three hours a day is spent on meals. Obviously not all would take that time but there is a need to supply the right amount of staff to patient need. If patients or residents wander, hours can be spent ensuring that person's safety in a day. Time management is often raised in interview questions. Unfortunately, when it comes to elderly care, there can never be specific answers as to how one can manage their time. It is all dependent on the type of person being looked after. Obviously, efficiency is great but that is where team work comes in. There is nothing worse than being a care assistant struggling with a resident or patient in your own "zone" when you know that others are standing around in their area doing little as they have "easy" patients.
Returning now to the issue of the "Panorama" case, and the obviously rough and uncaring attitude of certain members of staff, why have they got away with it for so long? Obviously whistle blowers brought it to the fore but why are people not speaking up daily and in all places of elderly care? I think that those who bully their patients are also likely to bully their coworkers and that possibly prevents people from saying anything.
I have thought for a while now that there should be some form of job rotation to prevent burn out and apathy from taking place. In a hospital setting, that would not be too difficult as ward rotation would be possible and staff could pick up new skills by working in different areas of medicine and with a variety of patients. In a residential home setting, I am unsure how that would work but maybe different teams could be formed, that could be rotated.For example, a nutrition team for a week or two rotating into a manual handling team (getting people out or into bed and to day rooms), then a personal care team to take care of cleaning and toileting needs with some office time and personal development time to find out how everything runs. People then may have a chance to develop skills they did not know they had and advance into new areas if they can. Studies could be created around the different blocks of work - for example, learning about kidney function and health on the personal care rotation. Could people move between care homes and nursing homes run by the same company in the area to provide variety of workload and scenery?
Can daily routines be changed to lessen the monotony? Do staff get on together or do they battle with each other? Is a "happy team" a priority for management?
Are people taking jobs in Care because those are the only jobs they can get? The demand is high and most places seem happy to train staff. Do people stay in jobs too long because they feel they have no other options? Do they quit from burn out before they have an opportunity to advance?
The demand for elderly care is on the increase, wages for carers aren't exactly improving, Dementia is on the increase so are we going to have a series of Panorama broadcasts highlighting the issues within the system or are care providers going to actually look at what is going on in their own areas and help carers to manage their jobs and eliminate those who will not respect the standards set for care? What support and monitoring needs to be given to people caring for relatives in their own homes, another potential for catastrophe.
These same issues have been raised over and over from all sorts of care settings but still the stories come and still we are shocked. At least we still have the ability to be shocked, let's hope this situation never becomes the norm!