Paul

Coronavirus/COVID-19

We have continued to provide high-quality homecare to our customers throughout the lockdown period. All our carers have all been trained in Coronavirus infection control and our operations policies and procedures are continually reviewed to deliver the latest Government advice. The safety and well-being of our customers and carers is always our top priority.
For latest guidance, information and updates on the Coronavirus visit GOV.UK Public Health England.

Everyone Should Tell Their Story

Joan’s Story

Joan was born in London in 1933, where she lived with her mother and father in a flat in Putney. She remembers the outbreak of World War Two being announced via a town crier who rushed through the streets. Joan’s mother accepted the dangers of living in London, but she couldn’t bear for Joan to be evacuated to an unknown place to live with strangers. So, she took matters into her own hands and made enquiries with a family friend who worked in a vicarage in Hoby, Melton Mowbray. The vicarage agreed to host Joan for the duration of the war and so she went on the train to Melton Mowbray aged only six!

Joan reminisces about her time in Melton Mowbray with fondness noting that the tiny village only had one shop, a small junior school, a church and the vicarage. There was no running water, electricity or toilet facilities there despite these amenities being common in London at this time. Water had to be gathered from the well and a cart came round to collect the sewage. But despite this Joan admits she really enjoyed life there and her 5 years away went by very quickly. She saw animals and fields for the first time and even helped the Land Army girls pick potatoes – they were glad for her help! She got involved with the church, learning lots of hymns and helped pump the organ for 50p.

After the war, Joan’s family moved to Maidenhead in time for her to start secondary school. Joan admits she didn’t always concentrate at school, but she’s always been very artistic. After leaving school aged 15, Joan worked as a sale assistant in Marks and Spencers in Maidenhead High Street and then for British Railways. However, her favourite job was as a wedding photographer, where she often photographed 2-3 weddings every Saturday. She would develop black and white prints in her bathroom for her friends. For Joan, it’s photography that has shown the biggest change during her lifetime, she can’t believe the quality of mobile phone cameras now! Or that mobile phones even exist as she only got her first one about five years ago.

Another one of Joan’s talents is her French language skills. After studying French at school, Joan continuing teaching herself using records. When she met a French lady on the train to work and struck up a conversation with her and they remain friends sixty years later. Joan’s first holiday outside the UK was in 1956 when she went to see her in Paris.

Looking back on her experiences, Joan thinks the most important lesson in life is to always listen. She was taught the importance of listening when she sent to etiquette lessons in London aged 6 and this lesson has stayed with her throughout her life.

Since retiring aged 60, Joan has remained happily living in Maidenhead. Her hobbies now include reading and listening to her favourite singer, Susan Boyle.

£2bn Rescue Package or Sticking Plaster

So, the Chancellor has heard the clamour that social care for the elderly is in crisis by offering a ‘rescue package’ of £2bn in additional funds over the next 3 years. Obviously, it would be curt to dismiss this effort but will this really make a difference? The questions to consider are
• How much of this money will actually make its way to front-line care activities?
• Will we see an increase in the numbers of elderly people receiving care?
• Or even an increase in the rates Councils expect providers (and our staff) to work for?
• Will Councils still expect providers to charge self funders extra to make up the difference between costs and Council rates?

The size of the problem is that while the headlines in this budget are for Council funded care, they only account for 22% of the elderly population over the age of 65 that are estimated in needing assistance with care. On another point, if you didn’t catch it this rescue package is not solely for the elderly care needs but it’s a pot to be shared across both services for the elderly, and younger adults with disabilities!

Any Help Whatsoever for self funders?

I am disappointed that there was nothing in this budget for people who have to pay either fully or partially for their care; Nothing to the 1.5m people that are cared for by family or friends; and nothing for those estimated 1m people that struggle by with little or no help. There was also nothing for providers who face increased costs in pensions, living wages and a huge hike in CQC Registration costs!

Sadly, I fear the elderly care crisis will continue with the most obvious signs being on the viability of providers (and their underfunded care staff) and on the NHS. I’m not even sure that the distance to the potential cliff-edge failure of social care has been increased! I very much welcome the possibility of a Green Paper from the Government later this year but any Paper must consider the whole issue and not just be dominated by Local Authority self interest. We repeat our call for the Government to appoint a Minister for the Elderly for ensure all the elderly in England are considered and that a comprehensive, integrated approach is arrived at.

Lets encourage good eating while I’m on my diet

The recent spell of hot weather brought the familiar debate over whether my shorts and T-shirts had shrunk over the winter months, or it was time to recommence my annual and largely unsuccessful fight against flab. It is a familiar story for many of us, with fears about obesity and the associated health risks dominating.

Unfortunately, while being overweight is clearly a health issue, which receives much prominence in the press, at the other end of the spectrum we have those suffering with malnourishment. This is often forgotten, yet recent researched shows that in 2015 there were around three million people in the UK that were malnourished or at risk of being malnourished. A million of these being over the age of 65. Elderly people living at home on their own may have a tendency not to eat wisely or drink enough

. Our appetites appear to diminish as we get older. Some of our customers have said the lack of sociability of eating alone and the effort of preparing a balanced meal for one person sometimes makes them lose their appetite. One of my lovely lady customers always tells me “Why worry? It’s not like I’m at the size I was when I was a young woman.” For others it can be a reduced sense of taste or smell or the recognition that they’re doing less exercise. There has also been research that suggests malnutrition can be linked to poor mobility, where older people are unable to stand or reach meaning they cannot use their kitchen safely. Furthermore, those living which dementia frequently miss meals due to their lack of memory. Meanwhile, doctors tell me that as we grow older, our kidneys become less effective. Our older bodies are not as good at hydrating and then conserving water making it easier for us to become dehydrated.

Why should we worry about good eating and drinking habits for the elderly? Statistically, malnourished older people visit their GP twice as often, experience more hospital admissions and have longer lengths of stay. People that don’t eat and drink well also have an increased risk of infection and urinary tract infections and have longer recovery times from illness. In short, the easiest way to avoid regular periods of hospital confinement is to eat well and take on sufficient fluids. So, if we can save on the number of visits to hospital we may yet save the NHS!

When considering eating and drinking well Halcyon carers are trained to follow these “rules” and I recommend you adopt when dealing with an elderly loved one.
1. Present a meal which is appetising. Don’t forget the setting of the table or tray and think like you’re serving to a customer in a restaurant.
2. Consider whether by joining someone at the table while they eat may result in more food and nourishment being taken in. It can be lonely eating alone but don’t make yourself an unwanted guest!
3. Let’s provide appropriate sized meals. Many older people came from a generation where leaving something on a plate was socially scorned. So let’s encourage people to have the satisfaction of finishing their meals and agree to abandon the “no clean plate, no dessert rule”.
4. Serve a drink with every meal and leave a drink within easy reach when you go.
5. We strongly believe as in all elderly care that there is a principal of “Use it … or lose it”. So, please do encourage safe participation in preparing the meal.
6. Variety is good for diet and appetite. Let’s abolish the mandatory cheese sandwich for lunch and offer imaginative alternative suggestions.
7. Don’t accept “ I ate earlier” without searching for evidence that some eating took place, for example, dirty dishes and foods still left out.
8. If someone really isn’t hungry make a “deal” to leave something out but agree you’re going to check it’s been eaten when you come back!
9. If you have suspicions about fluid intake levels use a jug that has a measure down the side to fill glasses and celebrate when it gets emptied.
10. If snacks are a normal part of a diet try and avoid products with too much sugar or salt.

Let’s Expose the Big Secret …. ‘They’ expect you to pay

Last week’s papers brought us the story of the NHS introducing a system of warning letters to try and stop ‘bed-blocking’ by medically fit elderly patients. Other recent reports have shown that over 220,000 days of hospital delays are being caused annually due to elderly patients not moving through and out of the hospital system quickly enough; an increase of 25% in the last two years with numbers still rising.
According to reports, some NHS managers have decided to threaten families of elderly patients with legal proceedings, if they do not move out of the hospital within 3 weeks of being declared medically fit. This particular report clearly blames the families, as it concludes the problem of ‘bed blocking’ is significantly reduced if the elderly person resides in a care home or receives home care funded by their Local Authority. This is contrasted with the higher number of elderly people remaining in hospital who are classified as ‘self-funded’. These ‘self funders’ and their families are apparently taking too long to find a suitable provider and need the encouragement of the threat of legal proceedings to make their decision. Toby Lewis, the CEO of Sandwell and West Birmingham said that the warnings helped to ensure families get their heads around the ‘responsibility to pay’ for care before making a decision about where relatives should live.
While some campaigners responded with concerns about the quality and availability of care, to Mr Lewis the key issue is getting families to the point where they accept that the responsibility to pay for care will fall to them if after financial assessment they are considered ‘self funding’. What a situation! People that have made savings over their working lives and are of little burden on the State (and probably still paying taxes) are now open targets for name calling, legal action and it’s all their own fault!
In our experience, being informed you are a ‘self funder’ is a key and often very difficult moment for the care recipient and their families. We receive calls from individuals recently informed that their relatives need care in Maidenhead in order to be released from hospital, but with no idea of what is required. In many cases the only assistance offered has been a list from the Local Authority with ours and every other care provider’s contact details …. And a deadline. Furthermore, the social worker will have inevitably said that it’s policy that they’re not allowed to recommend a care provider, despite their obvious experience in dealing with care providers. So that’s really helpful! The family is left to differentiate between providers, with no guidance on how to determine who will be best for their loved one’s needs; They are fearful of the costs; stressed at the responsibility; and equally fearful of the concept of strangers regularly coming into their home and giving personal care.
None of us have had any preparation for this situation. We have been misled to believe the NHS is ‘from the cradle to the grave’, and the pensions industry only encourages retirement savings with pictures of Round the World cruises. Where are the adverts preparing us for possible care provision costs. It’s not helped by a cultural belief that it is our role to ‘pass on’ our savings to our survivors and guilt that we may be eating away at their inheritance.
It’s so clear that we need an urgent and honest discussion to discuss how families are meant to cope with caring for ourselves in old age. Let’s expose the big secret that those in the know, like Mr Lewis, are already expecting us to “get our heads around the responsibility to pay” and are impatient that we haven’t already done so.
Why wouldn’t someone in Government think this is a simple strategy to implement and it is their responsibility to provide thought leadership on? Because that would mean them having to admit the inadequacy of the current arrangements that have gone on for too long? Whatever reasons, it’s time for a change. We need to stop sleep walking into this family crisis and then having our loved ones labelled as bed-blockers.

Loneliness is not just for Christmas

The usual features about loneliness at Christmas and how we all need to be a little more neighbourly will shortly join the John Lewis advert to tell us what time of year it is. However, it seems a pity that a large effort to combat loneliness only appears at Christmas. Although exclusion from the celebrations can certainly amplify the feeling of loneliness, sadly for many elderly people isolation can be a continuous feeling. Like many human emotions there are different kinds of loneliness that affect people to different levels. Some experience loneliness as a vague feeling that something is not right, while for others it is a very intense deprivation and deep pain.
To confuse the matter, loneliness is not the same as being alone. A person may be living in a care home surrounded by staff and patients yet still experiences deep loneliness. Certainly, one type of loneliness for many elderly is related to missing a specific individual because they have died or live far away due their domestic circumstances.
A study carried out by relationship charity Relate in 2014 found 1 in 10 people felt they didn’t have one close friend and that 19% had never or rarely felt loved in the two weeks before the survey. The statistics regarding loneliness for the elderly in the UK are sombre.
• 17% of older people are in contact with family, friends and neighbours less than once a week and 11% are in contact less than once a month (Victor et al, 2003)
• Over half (51%) of all people aged 75 and over live alone (ONS, 2010)
• Two fifths all older people (about 3.9 million) say the television is their main company (Age UK, 2014)
Loneliness is a bigger problem than simply an emotional experience. Research shows that loneliness and social isolation are harmful to our health. 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often. This shows the importance of conquering the challenge of loneliness, but for the elderly this can often be tricky.
The feeling of loneliness is considered a passive state, that unless we make changes will lead to further helplessness and depression. For many people, overcoming it involves increase their level of social contact with others. Unfortunately, for many elderly people, transportation issues and personal mobility concerns make increasing social contact something that they are unable to initiate.
At Halcyon we believe that almost half of the value from our visits, is in the social contact we provide. As anyone who has met our carers will testify they are very capable communicators, interested in and more than able to converse with all our customers. This is crucial as studies have shown that a conversation or even just saying hello can produce a positive chemical response in the brain for most people helping them feel less alone.
It seems clear that the only way to challenge the loneliness epidemic is simply for more us commit to speaking with elderly people. I understand that this might seem daunting to some people, wondering how to start a conversation and worrying about what response we might get. Some people wonder what they might say to someone 40, 50 or 60 years older than them. But it can be done. I truly believe older people are younger people but with more birthdays to their name.
We know from studies with socially challenged children that initiating and holding a conversation is a skill that requires practice. Our tone and physical presentation in a successful conversation is every bit important as our choice of words. How we respond to a simple hello is part of a social convention that without regular use we forget. Therefore, for an out of practice person their response can appear awkward or even rude. But that does not mean that they are not benefitting from the exchange. So, there may be challenges but to borrow the words of Nike “Just Do it!” and not just for Christmas.

Waiting for the Inevitable Collapse in Homecare Provision?

This week the Chancellor released his ‘Spending Review’ and ‘Autumn Statement’, which once more failed to even start to address the crisis of care for the elderly. This left me to question what will it take before the politicians see what is obvious to the rest of us? Once more a sticking plaster will be applied to the NHS, which fails to get anywhere near resolving the burden of the elderly on hospitals. It is only a matter of time until the effect of inadequate home care provisions results in Hospitals being used as poor elderly care providers.
Last year I wrote to our local MP asking for her support in appointing a Minister for the Elderly. She replied that this was all covered by various departments and wasn’t necessary. But I believe the absence of such a cabinet minister has allowed the Chancellor to ignore the consequences of underfunding in the care sector. This is already beyond deterioration in quality of care provided and is now affecting recruitment and even the financial viability of many care providers. The proposal that allowing local authorities to increase council tax by up to 2% to meet the cost of social care simply won’t undo the damage from rates stationary for the past 8 years. Some have estimated that it won’t even cover the increased cost from the imposition of the Living Wage by the very same Chancellor!
There are over 9,000 registered homecare providers across the UK, over 75% of which are independent businesses, the vast majority of which are less than 25 employees. About 70% of homecare visits are funded by the state (usually by local council social services departments) but delivered by independent providers working under contract. Last week the Chartered Institute of Personnel and Development predicted a shortfall of 200,000 care workers by 2020 and a potential gap as high 1,000,000 in the next twenty years, as the number of people aged over 80 is expected to double and demand increases significantly. We need to attract recruits. I personally don’t see the solution as lots of cheap foreign workers. This is a skilled job requiring higher communication skills.
After a thorough commercial examination, Halcyon reluctantly made the decision this year not to accept further work commissioned by local authorities. For us, there was no choice between paying our excellent workforce a decent rate for a difficult, essential job or to continue working on social services contracts. We realised that the consequences of this decision might mean a reduction in choice for people in Maidenhead, who might now need to move into residential accommodation. But we concluded that the reality of being unable to provide staff for these commitments produces exactly the same result as not accepting the commission in the first place.
Whether elderly are supported by social services or funding things themselves, our customers know we need a healthy homecare sector with good, well trained and supervised staff. So I listened with despair at the lack of imagination and application from politicians to help improve the situation.
There were no shortage of suggestions for him to consider, it wasn’t just about giving more money to local authorities.
My favourites include:
-We know that people receiving homecare are monitored for food and fluid intake and other personal care issues that reduce the number of hospital visits, so why can’t they have tax incentives to assist with the funding of their own social care?
-Why not change the VAT status of ‘welfare services’ to ‘zero-rated’ enabling care providers to reclaim VAT on the costs they incur?
-Why not “encourage” insurance providers to seriously consider the introduction of elderly care insurance products?
Really, Chancellor, how much longer can you and other politicians ignore the elephant in the room? Do we really have to wait for a collapse in homecare before you understand that it’s time to do something?

Superstars, Not Bed Blockers!

Returning from a short spell in South Africa I am in awe of the number of older people ignoring the current perceptions that try to define them by their number of years on Earth.
As I wilted in the heat of a queue for the Table Mountain cable car, tired from the overnight flight and simply trying to stay on my feet in the ferocious wind at the top, I was comforted by the grace and good humour of my fellow traveller. Many were well past the flush of early retirement in their late 80s but their capacity to withstand the ardour of an 8 hour wine tasting trip was impressive. If the heat, sun or coach travel didn’t “get you”, then our inability to only “taste” the gorgeous wine in preference for finishing each glass might have been considered punishing for adults of any age. They was no difference in capacity, although jokes about toilet stops suggested more personal management issues.
By any tabloid headline these people should have been blocking beds in hospitals, slowing down queues at busy ATMs or hogging their 6 minutes allocated with GPs, preventing doctors from serving the needy in the community. Instead, I found them very interesting and entertaining, hearing their ambitions for the trip (and the next one after this), while also learning of their families and their own slices of history. These were fabulous people to spend time with!
I accept that most elderly with ailments and financial resourcing issues could not afford either the rigours or the fare from the UK to Cape Town but those that do state quite clearly that we should only ever define someone by their capabilities. In the land still inspired by Mandela this truth rings particularly true to the ear.
But on returning, slumped in a chair in front of the television, the message was amplified as I watched Prunella Scales with her husband Timothy West. Despite acknowledging she was suffering from Alzheimer’s disease, Prunella went ahead with filming a TV series Great Canal Journeys, in which her illness is often addressed with humour between the couple who have been married for over 50 years. Although Alzheimer’s develops at different rates for each individual, and is clearly an individual journey for each person affected, her willingness to share her enjoyment of life and how they manage the increasing impact on her capabilities was a reminder to care and enjoy older people for what they bring and can do.
So, as an alternative to the usual warnings about NHS bed management failings and politicians pointing out scapegoats for their failure to manage and prepare our society for the demographic and health advancements predictions of over 50 years ago, let’s celebrate our older superstars for what they bring to our society.

The Case for Introducing Technology to Social Care Operations

We’ve had an exciting time recently, implementing strategic improvements for the business after reviewing what has been successfully and unsuccessful in the way we do things.

Social Care has a reputation for being backward, lacking in innovation and resistant to change. Therefore, a proposal to move to handheld technology to organise staff schedules and record our visits with customers was considered highly ambitious by some of my contemporaries in other care agencies.

Our analysis showed that rescheduling happens frequently, due to customers being affected by illness or accidents, and running an operation based on paper instructions meant the rescheduling system wasn’t that effective. When we looked at the care information we gleaned from a visit, we concluded that we couldn’t expect to be highly responsive when we had to wait for paper copies of the reports to be brought in by the carers. Obviously, critical incidents were reported by phone but this was dependent on the experience and initiative of the carer to deduce that an emergency call was required. We also realised that reports submitted on paper remain on paper unless we transcribe them. Furthermore, without a contact system handwritten notes go into a file and rely on the person that put them there to remember or tell others or to be prompted at that moment when things go wrong!

Our solution has been to reorganise our operations (and our supervision of the team) to reflect the fact that we are a mobile workforce and not an office based team. With new software to design and implement, new phones for the carers, 3g technology, training for all the staff in new ways of working and all in an environment where we simply don’t have the option to fail to make visits to vulnerable elderly customers…. What could possibly go wrong??

But we managed it! We have already received some great ideas for improving the system but it works! And the benefits are already beginning to be realised…

Collecting digital data on the care visit means that the management have a view of the care situation from the time of the last visit. It allows us to proactively respond to a developing situation, either to get more clarity from the carer, to contact the family or health professionals in a timely way. Our next development is to share this data on-line with the families of customers who are often remote from the Maidenhead area offering reassurance of our care management.

The back office benefits of having real-time information on carer progress enables us to answer queries for customers when traffic or acute customer needs have caused delays. We are also able to answer directly requests from families asking for confirmation that the carer has been when their loved one, when they have been confused as to whether a visit has taken place or not.

Mobile technology and the use of 3g enabled tablets has also presented the management with the opportunity to take a lot of their work with them out to the customer’s home. We see this as entirely consistent with our aim to be there to support carers who often spend most of their day working alone with customers.

So, backward? Resistant to change? Not us! It may be challenging to do new things but if the prize is improved care, more effective operations and efficient back-office jobs how can you not manage the risks and make the effort?

 

Time to talk about funding

I was recently asked to consider writing to my Local Authority to respectfully ask them to reconsider their responsibilities under the Care Act, and consequently to increase their fee rates for homecare work.
For me, there is an obvious and predictable direct link between inadequate pay rates and poor quality care. A high percentage of public sector savings are being made at the expense of vulnerable elderly people. This is clearly wrong, but I do not believe that asking the Government to allocate more money to Local Authorities for care will solve this crisis.
Local Authorities have already taken choices over where to allocate funds and clearly they have failed to prioritise elderly care. Cynically, I fear that even if the money was “ring-fenced for social care” the percentage of funds that ended up actually spent on elderly care would not make a significant difference. Social Services Directors would still line up to justify flying 15 minute (or less!) visits and select providers solely on price without reference to quality of care.
But there is another reason why I don’t support asking the Government for more money. That is because I believe that this type of initiative reinforces the misconception that homecare can be defined as that type of service funded by Social Services. It clearly isn’t! Homecare needs are not mitigated by a nominal line in the sand drawn at assets of £23,500. Elderly with more than this figure still need care and still want to remain at home!
Sadly, Halcyon Home Care have experienced more than one exhausted 85+ year old who has been abandoned by the system. After “failing” the financial evaluation, they were left to contact and arrange care (normally from an out of date list of providers) for their spouses at a time of extreme emotional distress. They call us without any understanding or experience, uncertain what it will cost or where they will find the funds, or even what service to expect. Simply, they need someone to assist them through the process.
I believe a lack of understanding of the scope of who might be affected and the costs involved is one of the key reasons that the crisis in homecare has been allowed to develop. Too many people think it isn’t going to affect them and if it does, then, social services will look after them. By the time they find out the truth it is too late.
If things don’t change it will only get worse and the scale of the failings of the system will become a catastrophe in our own society. We do need a discussion about funding… and one part is about social services funding … but the bigger debate is about funding for care for all our elderly regardless of the £23,500 assets cap… and it needs to happen now!