Policy

Dementia Alone Cannot Dominate Ageing Debate

The Prime Minister’s latest strategy, picked up extensively in the news media, is a drive aimed at pharmaceutical companies to focus their efforts on dementia drugs with a hope that, by 2025, significant inroads can be made. There is a plan to build on G8 commitments and further rally all the world’s major powers around the need and importance of this work.  With neither of these things do we disagree – but there is much, much more to this problem.

Dementia does not equal Ageing

Dementia is frequently treated in the news as an illness which is effectively analogous with ageing. That is wrong: it is not an inevitable consequence of age even though its incidence correlates to a high degree.  Neither is it not the only issue which accompanies ageing, which has a range of effects on our lives, as well as bodies.

The number of people in the UK aged 65+ is projected to rise by nearly 50% (48.7%) in the next 20 years to over 16 million, and they will make up a higher percentage of the population than they do today (22.4% by 2032, versus 17.2% today).  Consider this: just 1% of those over the age of 65 are likely to suffer from dementia, while 100% will experience other difficulties of ageing, such as declining general health and mobility.

Broader Ageing Research Required

More money absolutely does need to be put into dementia research. The question is where that research should focus, and what priority is placed on it relative to other aspects of ageing.

I would like to see as much focus, research and effort into understanding the causes of dementia , in pursuit of prevention, as well as pharmaceutical management of the outcomes. However, I believe we must additionally extend all kinds of gerontological research – and, if we understand how to manage the full breadth of aspects of ageing better, we may well directly improve our dementia management.

Dementia Home Care is Critical

Much of the recent news agenda around ageing has been overtaken by stories around residential care home practice and failings, and it has crept in to dominate much of the accompanying political debate around the Care Bill.   It is a worrying distraction – because there is simply no practical or economical way that residential care can be the dominant model going forward. Home care, in close alignment with health and community care, must and will become the main environment within which we help people manage the challenges of old age. That means that dementia care in the home will be vitally important.

The Bradford Dementia Group has made a number of important research contributions in the area of helping and caring for those living with dementia, and those who must support them.  I would like to see much more research of this kind, focused on caring for those with dementia who remain at home.    There needs to be recognition that caring for someone in a specialist care home environment is very different from care at home. The care skills and expertise required for good dementia home care are specialised, and all carers need better researched practical exercises and advice. They need help in shaping the home environment to facilitate the lives of those living with dementia.

This is the most important challenge that exists today – and it will continue long after drugs to alleviate the symptoms have been developed.  We must not let the focus on dementia distract us from the bigger challenge that awaits. We have a vast ageing population issue approaching which will create a tidal wave of pressures on our economy, our communities and our families.

I sincerely hope that there ARE huge steps forward in dementia drug treatments and, in particular, those drugs which can delay onset or minimise the symptoms of dementia for those who need it. However, the stark reality is that no drugs, no amount of righteous politicking, can hold back the tide of ageing health and welfare issues which faces Britain and many other countries.

Sources: Alzheimers UK and National population projections, Office for National Statistics, 2011

15 Ways That 15-minutes Aren’t Enough: Insanity of 15-minute Elderly Care Visits

We spotted a big stream of twitter responses to a question posed by the Guardian Social Care http://gu.com/p/3ppv2/tw    “should 15-minute care visits be banned?

Evidently we aren’t alone in having strong views on this. We reject the constant requests made by Local Authorities to deliver care in 15-minute slots – and would love the whole idea of 15-minute visits to be dismissed once and for all.

Check out these points that we think get the point across not just once but 15 times:

  1. Rushing through personal care such as toileting, washing and dressing for a frail, elderly person turns vulnerable, needy citizens into objects to be manhandled  – doing it all in 15-minutes would make a  sadist stop and think.
  2. If you only have 15-minutes to do multiple tasks then completing those tasks will always be prioritised over the needs of the individual – and their wishes must inevitably be ignored.
  3. 15-minute visits force elderly customers to choose whether they want to eat, go to the toilet, or stay clean. Which would you choose?
  4. Councils don’t fund travel time between care visits but often takes >15-minutes of unfunded travel time to attend a 15-minute call. It’s uncommercial for agencies, unacceptable for the environment and, above all, it’s totally ineffective at caring for those who need help.
  5. A significant benefit of a homecare call is to deliver relief from isolation and loneliness. Pausing for social interaction is impossible in an overloaded 15-minute call. The rush simply emphasises to the individual the lack of social interaction in their lives.
  6. Care workers hate 15-minute calls. They do the job to help, and give care – they get very upset by a customer asking them to stay longer: “but, you’ve only just got here – surely you can spare a few more minutes?”
  7. It can take the majority of a 15-minute call to microwave and lay out a meal for someone – there’s certainly no time to say and make sure it is eaten. Meal preparation isn’t the part that is vital to well-being and health.
  8. Carers would like to know where they find the “Go/Stop” Switch on an elderly person… so they can ensure they use a commode to order in the 15-minutes available.
  9. At least 4 minutes of the 15 are taken up with getting into and out of the premises leaving just 11 minutes left for “care”
  10. For an elderly person with (or even without) arthritis, it can take over 10 minutes simply to descend the stairs aided by a carer, and many do not have handy stair lifts.
  11. Care clients with dementia can be confused and require calm reassurance each time that the carer is familiar – a precious 5 minutes or much more may disappear reassuring them. What is a carer supposed to do, just forget a few of the essentials so they can leave on time?
  12. 5 minutes washing upstairs, 5 minutes washing downstairs and 5 minutes jamming a frail elderly person into clothes before running out of the front door does NOT constitute care.
  13. It is very hard to find carer recruits, especially those with the right practical and empathic qualities for this tough job. Many last a matter of days if forced to focus on processing tasks in a 15-minute rush, rather than providing caring relief. A nagging conscience does not make for job satisfaction. It’s not why they chose a caring career.
  14. 15-minute calls are always the result of attempts to cut budgetary corners and costs. The model is implemented as part of a local policy and therefore irrespective of individualised care needs – and with zero input or advice sought from professional home carers. Local Authority managers commissioning care should prioritise care for the individual over budget considerations.
  15. Rushed, multi-task 15 minute visits are unpalatable for everyone involved. The most significant barrier is sometimes the elderly care recipient themselves, who may actively obstruct the rushing through of tasks. Who can blame them? This is iniquitous – it puts them in the position of being ‘the problem’ and they can be reported as such, putting their care in jeopardy as a result. That’s unacceptable and extremely unfair.

We would love for some Directors of Adult Social Services Departments to be forced to follow this degrading routine for a week – they would very rapidly see how unreasonable, unworkable and unkind it is.

We are angry and confused as to why the insanity of 15-minute visits seems so hard for policymakers (at any level) to understand.  It is akin to state-sponsored human rights abuse: because demanding 15-minute care visits effectively encourages actions and attitudes that are entirely devoid of respect for the individual and have nothing to do with delivering real benefit.  It fails to deliver it’s most basic purpose.  This should have been addressed, along with putting Local Authority care activities under CQC scrutiny, via the new Care Bill, but it was not. What a disgrace that is.

It is long past time that the 15-minute care model was put to bed, firmly, and without regard to whether it wants to sleep yet. That is, after all, what we do to millions of our elders – every day.

Dementia Week: Dementia – Tip of the Ageing Britain Iceberg

The realities that highlight an increasing need for a Minister for the Elderly

This week is Dementia Awareness Week, and a great time to reflect on how to help those with Dementia. It is a distressing and debilitating condition which we care about very much, yet, feel that this week carries with it some dangers. Focusing on this one issue in isolation — while it can help communities and individuals step up to help — can create a smoke-screen which masks, or pushes to the background, some very serious associated issues. Perhaps Dementia Awareness Week should not be viewed just as a time to focus on the challenges of now, but should be a time of reflection and vision. Britain faces a very scary future scenario when it comes to its ageing population and that is intimately tied up with the challenges of dementia.

Even the simplest facts should be giving us all pause for thought:

  • One in three people over 65 will develop dementia in their lifetime, according to figures from the Alzheimer’s Society.  This is a startling enough likelihood that we must face, not only for our ageing relatives but as we look towards our own future.
  • The number of UK citizens over the age of 65 is already more than 10.5 million, and this figure is set to increase steadily and dramatically for the predictable future in Britain and around the western world. There will be over 16 million in that age bracket in the next 20 years.
  • Not only will there be more of us in the ‘elderly’ category, we are also living longer, on average. That means that there will be an increasing proportion of the population at the older end of the 65-plus spectrum. The number of those aged 85 and over is predicted to double in the next 20 years – and triple in the next 30. There will be a significant number of people over the age of 100. Where in the past it was exceptional to find the extreme elderly, it will become increasingly common.

Everything must adapt. In such an ageing society, dementia will be only one of the impacts and implications that we must face – yet, to date, remarkably little has been done. Efforts to rationalise (and ration) care through major legislative exercises such as the Care Bill can only, in reality, focus on part of the problem at any one time. The problem of taking a piecemeal approach to such a vast issue is that as you change one part of a system, you can create myriad unforeseen outcomes and still fail to effect positive change.

Who’s Responsible?

There is, currently, no minister with specific responsibility for the Elderly population that exists today or which will come to exist in the future. Instead, it is bundled under the vast responsibilities of the Secretary of State for Health and the Minister of State for Care and Support, who must also grapple with unrelated things such as prison care, and care for every other category of citizen. Not only is this unrealistic, but the problem is that the implications of our ageing do not lie solely in matters of how we deal with the illness that is dementia, organise elderly care, or arrange NHS resources.

The challenges that lie ahead touch on every aspect of Government responsibility, from housing and planning of our future communities and built environment, to the behaviour and expectation of businesses in dealing with older customers, to the provision of key public services like transport, to pensions. The list goes on, of course, and underlying it all is the question of how to fund and finance essential change, and negotiate and balance the demands of ageing Britain against all its other pressing needs.

We must stop being Ostriches

The UK Government has been steadfastly ignoring this issue for years now. The current administration did not act even after it was handed a clear call to action by a cross-party group of back bench MPs in June 2012 who launched a Commons debate after a concerted campaign by action group Grey Pride. Numerous petitions have been started, both by that organisation and others independently. A ‘tsar’ approach was tried under the last Government with veteran actress Baroness Joan Bakewell stepping in, but it wasn’t continued, and no real action was taken – not even her calls for the appointment for, at the very least, a commissioner for the elderly to help fight discrimination and promote awareness of elderly issues. In our view this was focused on the wrong part of the challenge; but even this ‘watered-down’ approach would go some way to equalising the disparity which exists, inexplicably, between the interests of the elderly and children, who enjoy (in effect) positive discrimination. While we would not want the interests of children to be neglected in any way, we believe that the same or more attention and support MUST be provided to the elderly.

To date, we have all been guilty of waiting for others to take action. The Government has said it will ‘consider’ the matter, but some spokespeople have raised spurious concerns around the risks of taking such a step – and ignore both the pressing need, and potential benefits. Public services have been content to deal with current problems, and paid insufficient attention to those which are coming down the line. Each administration has managed to hand off the problem to the next. This cannot continue.

Call to Action: Call for Change

This issue is not going to go away.

We call, firstly, on the elderly population, who are voters in their own right, to stand up and call for action on this vital issue. We call on all adults to do the same, in fact – because this isn’t something that will only affect someone else. It is going to affect you, and significantly so.

We also, most of all, call on the political establishment to wake up, and recognise the critical needs that exist now, as well as in the future. This problem sits above and beyond what any single administration can deal with, but we need someone to step up and start the ball rolling – soon. Every member of the Government, both in power and in Opposition, and every public servant in the UK must recognise this as their own problem – because, like everyone, they will age. If the current Government can be brought to recognise it, the next will still need to recommit. This is no small challenge, but postponing it does not make it any easier to address.

The enormity of the changes that our ageing population will force in our society means that ageing and elderly issues should be part of every policy decision. Failure to do so will mean inevitable needs for knee-jerk, after-the-fact, reactive change in the future, at far higher cost than would have been incurred had they been addressed ahead of time. Whatever it is called: a Minister for Older People, a Minister for the Elderly, or a Minister for Ageing Britain, we need one, and extremely soon.

We will be writing directly to the Home Secretary, Theresa May MP, in her capacity as our own local Member of Parliament, and would exhort any reader to do the same, to ask her to take action on our behalf, and join our call to arms.

 

Sources include: Alzheimer’s Society http://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200120

Halcyon Home Care is deeply committed to excellence in dementia care, and last year appointed a Dementia Champion. Read some of our other dementia articles. such as 6 ways to care for dementia in winter and Connecting to people with dementia 

Personal Budgets for Elderly Care – A better choice, or no choice at all?

New research by Coventry University has concluded that the obvious benefits of direct payments are being compromised by a lack of funding and choice, and was highlighted in a recent article in The Guardian. Unfortunately, there is no surprise in this.

Choice – a meaningless promise

The idea that elderly people responsible for their budgets would opt for a visit to the swimming pool over essential assistance with personal care, when the budget being offered for personal care for the elderly is often at a minimal level, is laughable.

Indeed, the very nature of managing your own personal budget as a direct payment means you can only spend the money on services or equipment that meet your assessed needs. In theory this is supposed to mean that you can choose the ones that best suit you and your lifestyle. If the amount of funds available only covers basic needs anyway, then there is no true choice, and the statement is meaningless. This is very likely to be the case in most local authorities, since all have had to cut their budgets significantly.  Furthermore, the move towards direct payments is so far outside the cultural assumptions under which social services departments operate that it would be akin to suddenly switching to metric units after a life time of imperial. Advising people to be more independent is a difficult concept for local authorities to think through, let alone implement.

Personal decisions – compromised

The Guardian points out that the research found that a quarter of older direct payment users said decisions about when they ate, went to bed or had a bath/shower were compromised. There was never enough money to allow choice over different care arrangements or leisure items and it is made worse as personal budgets have been frozen.

Local authorities have crowed about the savings to Community charge rates, while bleeding care providers through restricted pay rates, often arrived at with a complete lack of commercial understanding. Many local authorities, including our local Royal Borough of Windsor and Maidenhead, have frozen rates each year for domiciliary care since 2009. Although inflation was only between 2.2% and 4.3% in the past five years, the impact of inflation alone to providers is a cost increase of 16%. The impact of cost rises on care workers is even greater, with petrol price hikes and a stubborn, continuing refusal by local authorities to pay for any travel time.

The net result is a reduction in the number of providers that are willing to quote for Local Authority work. No wonder Coventry University discovered a lack of innovation among providers for personalised budget holders!

Elderly care needs – different from those of others?

Another issue raised by the research is whether personalised budgets which were driven by the younger disabled lobby — where the budget is sometimes managed often by fit, healthy adults on behalf of the care recipients —  is appropriate for the elderly. Among the younger disabled recipients there is a much more positive view of personalised budgets than amongst the elderly, who feel much less confident when faced with managing their own budgets.

The care situation for the elderly is likely to deteriorate further: most of the information about personal budgets for elderly persons can be a challenge to access for older people, since they are primarily placed on web platforms, and there is the administrative burden of Local Authority bureaucracy to deal with. However, the biggest difference may come from something that was not made explicit in the Coventry research at all: the vast difference between elderly care packages and those for younger adults.  The baseline for the elderly care packages is care visits based on a miserly 15-minute slot – for others, it is often from longer, person-in-attendance type of care calls.

Budgets – making things worse?

Outcomes of other independent assessments this year, as reported in Pulse, a publication for GPs, attest that the personal care budget scheme was not only inadequate but could actually make matters worse for elderly care. It states that: “The assessment by experts at the University of Glasgow and King’s College London finds that on average personal health budgets cost £4,000 more per patient than usual care, but that in some cases it had a ‘negative impact’ on patient outcomes.” This is in direct contrast to what the Department of Health believes and the line it takes publicly.

In my experience giving control back to an elderly person to manage their care, although it is in many cases exactly what they want, can be pointless or even counterproductive if it is not accessible, sufficient, and realistic in relation to their real needs.

Only the lonely…

… really understand the devastating power of loneliness.

Loneliness has a major effect on our wellbeing. It has been linked to the development of physical as well as the more obvious mental health issues. It can also start a downward spiral in self-esteem where our ability to communicate with others diminishes with lack of practice, making it more difficult to initiate and optimise contact.

Communication is key

Towards the end of a recent presentation I did on home care jobs, which had largely centred on hours, pay, training, and the like, I was asked why I was so insistent that Halcyon home carers are  good at communicating. And why I rated the ability to hold a conversation in clear English as the key skill I look for at interview, even over previous care experience in a care home. I explained that the main reason is to be found in the role we play to help combat loneliness for those people choosing to remain at home, by bringing a bit of the everyday world into their home during our visits. Obviously, while not an exclusively elderly experience, an inability or reluctance to leave the home, loss of a long-term partner, family living away or with very busy lives, all contribute to the growth of loneliness, which some, including Tom Watson, Mirror Online’s Labour political panelist, see as an epidemic. He points out in his article “Loneliness is a modern epidemic that shames our society” that there are currently 8 million people living alone, with the majority made up of those over the age of 75, and calls for action. But – what action?

Technology can help – up to a point

There is no silver bullet for this problem, but many things might help. I personally believe that technology can bring us closer to each other. Initiatives by organisations such as Housing Solutions in Maidenhead to provide free broadband in sheltered accommodation centres have seen a significant growth in the use of iPads and other devices to connect with family and friends using Skype and Facebook, and to share photos and short videos. It also helps bury the idea that the elderly can’t utilise technology after a little help. This is a far more productive solution than, for example, promoting more volunteers, often with no or only limited training. While this is one of the more popular political solutions to elderly care (popular, because it costs nothing) it will not produce the right results and do little more than mask the problem. That said, The Campaign to End Loneliness and other bodies that understand and support the issue, such as the Royal Voluntary Service, are carrying out valuable roles in raising awareness and garnering a caring society.

Home carers play vital role

Home carers know only too well about the impact of loneliness on people’s lives. Very often we are the only real person they will see in the day and it therefore needs to be a pleasant experience as well as a functional one. It is why we allocate our resources into customer “rounds” so we get to build relationships across a number of carers, each with their own personalities and life experiences. Our Care Plans are designed to take a person’s current level of social inclusion into account. It is why we refuse 15-minute “flying visit” calls and train our carers in the difficulties of communicating, especially with people hard of hearing or with other sensory difficulties, and to arrive with a smile on their faces. By choice, we have carers that are able to leave their troubles outside work at home and could easily talk for Great Britain and probably win Gold if it was an Olympic event! Communicating in a respectful way to help keep loneliness at bay is an essential part of their job and woe betide anyone reported as being “not very happy, today” when they visit!

Action requires leadership

The growing number of people reporting loneliness is an unwanted feature of modern living and we need to do something to improve the situation. But people move around more often, change jobs more regularly, change partners more regularly, stay single, choose not to have children or have children that have to live in a more globalised world. We cannot try ‘Canute-style’ to plead for a return to village-community behaviours without imposing controls on all these contributing factors.

At the least, we need a Minister for the Elderly that can raise the plight of loneliness in society at the highest level of political thinking. If we accept loneliness as simply a factor of ageing in a modern society, shame on us all.

Our growth news coincides with CQC Inspection update

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Good management of a domiciliary care agency takes more than just ticking boxes

The CQC inspectors have just returned our annual inspection report and we are delighted to announce that a great CQC report coincides with the news that we have just exceeded 400 care hours per week, and now employ 25 people  — a significant milestone we set out to achieve and are now surpassing.

We’d like to share some of the CQC findings with you. It just goes to show once again that boxes can be ticked, but to really come up to scratch you have to see the evidence in the comments behind the boxes. So we are happy to report that not only are we meeting all the standards, but have surpassed expectations in certain areas.

We were found to have met the standard for Respecting and Involving people, Care and Welfare of people, Safeguarding people from abuse, Supporting workers, Assessing and monitoring the quality of service provision — and we would expect nothing less. What really matters is what both our customers and their relatives, and our carers and their managers, told the CQC about us.

Here’s a summary of what they found:

From our customers:

“People were wholly complimentary about the quality of the service they received with one person describing staff as ‘really lovely’ and said staff went ‘beyond the scope of what they need to do.’

Other people described staff as ‘respectful’ and ‘very well trained.’

One person said the manager was ‘very particular about the staff they employed.’”

This is exactly one of our top priorities and it’s good to know it’s being noticed.

From our staff:

“Staff felt supported and one, who was new in the post, found the support helpful in making them feel comfortable in their role. Staff were also motivated and said they enjoyed their work.”

And here are some first-hand remarks that support our top priorities — the report highlights that we keep our promises.

Involving people in their care plan, giving them control and respect:  “We saw there was a clear schedule of support the person had planned with staff and the times this was to be delivered. The schedule was supported by detailed individualised care plans. People we spoke with said they had been involved in their care planning and were able to request changes and we saw these requests were acted upon.”

Treating people with dignity:  “Staff spoke with confidence about how they ensured people were treated with respect and dignity and gave examples of how they did this when supporting people with their personal care needs. People using the service, and relatives, said staff were always respectful and showed regard for people’s dignity and independence.”

Keeping people safe from abuse:  People who used the service told us they felt safe with the care staff allocated to provide their support. Staff told us they were up to date with their safeguarding training and we saw records of certificates, in staff files, to confirm this. The information provided, together with our observations demonstrated that people were protected against the risk of abuse.”

Regular vetting and training of staff:  “We saw that staff were regularly assessed. Managers carried out regular checks to assess staff performance and also to offer support and guidance to staff. Staff said they had enough time to carry out their duties effectively and we saw that staff always stayed at a person’s home for the allocated time to ensure they were providing the most effective care they could.”

It’s great when a homecare agency can be upfront about its operations; none should have anything to hide.

 

 

5 resolutions for Halcyon Home Care in 2014

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The end of one year and start of another are frantically busy times in home care. Not only do many families ask us to keep a caring eye on relatives while they are away or distracted by the mountain of tasks that this time of year always entails, but the needs for provision of social care are continuous. As we settle back into some semblance of normality, we now have time to reflect on what we want, and what we intend, for 2014.

  1. This year we will prove that we are up for the Dementia Challenge launched last year. We have already appointed a Dementia Champion, and will be continually and carefully redesigning and promoting our dementia services. We will look to meet more than simply the basic care needs of those with dementia, but also look to support them holistically and improve their quality of living every day.
  2. We will be watching the progress of the Care Bill as it moves through the legislative process, and are resolved to be vocal – giving credit where credit is due, but not being afraid to challenge areas and aspects of debate which we feel are not hitting the spot.
  3. In a similar vein, we will be proactive in sharing the great stories and examples of care excellence which are the mark of our agency. It isn’t simply to market ourselves but is, much more importantly, to counter the poisonous impact of negative elderly care stories which the media love, but which do such a disservice to our wonderful carers and to other people like us who strive to be different. Shine a light on bad practice by all means – but don’t assume all carers are the same.
  4. Continue to partner positively and proactively with the Local Authority, as we work together to try to meet more of the growing needs for elderly care among the aging populations in Maidenhead, Windsor and Ascot. As a company we’ll be increasing the number of Halcyon-trained care staff and ensuring that they live and breathe our care philosophy of delivering quality care with respect, and continuity.
  5. Lastly, we plan on having fun – with both our team and our customers. A little lightness can go a long way to helping our clients deal with what can sometimes be a tough decision to bring in a helping hand — and to help our carers cope in what is a very demanding job. Plus – it keeps us sane in the office, as we juggle an ever increasing number of care hours!

We’re looking forward to a great 2014.
Happy New Year to all, from the Halcyon Home Care team.

 

Attending the UKHCA Conference

halcyon-homecare-footerThe UK Homecare Association hosted its recent conference,
“Homecare — Meeting the quality challenge, today and into the future​,” at the Oval on November 26th. In the light of Jeremy Hunt’s speech on the national shame of large numbers of lonely old people, the gathering was testimony to the private home care sector’s commitment, energy and experience to do something about it.

I was not alone in expressing exasperation at the way the majority of care for the elderly is commissioned on a time basis by Local Authorities and their continued defence of 15-minute flying visits. “He who pays the piper calls the tune” was the repeated refrain from business leaders present. A common view emerged that this particular tune is the direct causal link to a limit on better wages for good carers, poor quality job applicants, reduced investment in training and cheaper management practices that all contribute to a downward quality spiral.

I was delighted that I was not alone in my concern over the way the sector is portrayed in the media and the inevitable consequence that some people decide not to engage a professional care firm but to struggle on inadequately.

One of the key problems facing the sector is the high proportion of social care commissioned by Local Authorities. How they treat care provision has such an enormous effect on the cultural assumptions of care providers that this becomes the way of doing things for all customers. It struck me that any inertia in the room was from those providers “waiting” for something to change in Local Authority practices. But what many private providers know, from experience with self-funding customers, is that a customer has choice, and if we don’t provide the agreed outcomes they will go elsewhere.

We deliver person-centred, Outcome-Based Care. We have learned that when they are paying, customers can be very clear about what is important to them and what is required. We have learned that not addressing those requirements in our care delivery leads to failure. Unfortunately, many recipients of care commissioned by Local Authorities don’t appear to recognise any choice; they might make a complaint about shabby performance, but with the commissioning arrangements as they are, they mainly receive what they’re given … and are grateful for it!

So, what can we do? One step forward might be to stop using the derogatory term of Service User, and replace it with the fullest interpretation of the concept of “Customers,” that is, individuals with personal needs, choice and preferences. Of course, another step may be that people, like me, need to have the courage of our convictions and strike out with care products for self funders that truly address the care needs and outcomes, rather than just aping care packages structured on a commissioned-by-the hour basis … watch this space.

 

 

 

Outcome-Based Commissioning in RBWM?

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Congratulations to the Strategic Commissioning team in RBWM for hosting a market dialogue event to discuss Outcome-Based Commissioning (OBC) for homecare services and (despite the cynics) there appeared to be a genuine interest in contributions from the providers’ market. Getting a room full of providers together and asking for their input to the challenges, implications and possible solutions should be applauded, not least for the recognition that it is in all our interests to find some form of solution to the challenge of growing adult homecare requirements and strapped social services budgets. None of us want to see the continuation of the 15-minute flying visits or the cacophony of negative comments about homecare. To be clear, we as providers want successful homecare services just as much as any pressure group currently complaining about the quality of care provided.

Not surprisingly, no clear solution emerged from the workshop but there was plenty of food for thought and the contributions to the discussions were high on practical, experienced insights. For me, learning the perspective of carers specialising in autism and learning difficulties on what is a “valuable” outcome with time scales measured in years were particularly provocative.

One particular point was well made: care providers do not need staff from local authorities to determine what is required in a care package and what the recipient of the care desires as an outcome. We already successfully define and agree care packages for all our private customers (the so-called “self-funders”) where the ultimate test for how successful we are is in the choice that a private customer has to stay with the provider or go elsewhere. We document these aspirations and our programme of work into individualised contracts of care and we deliver against them with our value reviewed every time we submit an invoice. In a pure OBC world the challenge for the local authority would be: how do they determine the value to be placed on a particular outcome and build it into their budgets? But I don’t think we’re there yet!

It is clear that there is no simple solution to the challenge facing local authority commissioners. It seems inevitable that dealing with that many local requirements (service users), the local authority staff will need to be more flexible, creative and collaborative with both providers and recipients of care to reach better solutions. But at least we’re no longer burying our head in the sand and waiting and hoping for Central Government to open the funding tap again.

 

CCTV and Elderly Care

Elderlylaptop250pxThe suggestion that the Care Quality Commission will investigate the risks and potential benefits of mystery shoppers and hidden cameras to monitor elderly care provision has become a major talking point. One social worker on Radio 5 Live commented that if a vigorous discussion into practices and standards in elderly care homes had been started simply by making the suggestion, then the CQC had done its job. That may be so, but there is another aspect of this suggestion that ought to be considered … and that is the use of technology to assist in supporting elderly care.

I believe that the potential for using technology to assist the elderly at home is huge.

For some time we have known that there are digital pill dispensers that will provide individualised prescribed medication to an alarm through the day; pressure mats, to indicate movement around a house or to detect falls, have been recommended for a number of years; pendant or wrist watch alarms provide an opportunity for an emergency response; and there is now talk of remote monitoring of blood pressure and heart rates over the internet. But these innovations are generally “preventive” or “medical responses” in nature and do not contribute towards enhancing the lives of the elderly or alleviating some of the reports of chronic loneliness.

I would like to see designers and developers applying their creative minds in this area of technological development. I am excited by products like the Care Messenger from i-Spy Digital that uses the television as a communication medium offering simple messaging into the home for care providers but also opening up the opportunity for elderly people to be involved in social media exchange with loved ones — all without having to learn new technology or leave their lounges!  Clearly, Smart TVs also offer the opportunity for Skype (or others) with the wonderful advantage of actually seeing who you’re talking to … an instant end to isolation! We welcome Jeremy Hunt’s support for more modern communications technologies in the NHS as a whole and the fact that GPs can start applying for funding to trial such use of technology.  However, we would always want to see technology employed mindfully, for example, elderly patients may be less receptive to Skype etc and not always find such transitions simple.

Of course, I see we need to manage any fears that this would lead to Big Brother care monitoring and strongly believe that technology can never replace the personal touch or indeed the training to complete professional personal care, but I can foresee a time where care workers will need to be capable of assisting in setting up modems, Skype, etc., as a part of a care plan that includes widespread technological applications .

However, hidden CCTV cameras to check on carers and the care provided? Well, it doesn’t make it into my vision of future care regimes for the elderly.