In a growing demographic, our elders, current and future deserve the very best. Can we agree on that? It must have no bearing whether they are without disability, or whether they have physical or mental health challenges.
As a former emergency response care provider, and having been a performance improvement project manager in primary care, I attended possibly thousands of elderly patients, in a number of settings. I have also have an unfortunate, yet privileged insight into some crucial elements relating to care, or lack of, for our elders.
I found the elders living independently and self-sufficient at home, who were generally much more content to those living in authority commissioned residential or care/nursing homes.
High Cost = High Quality
Right? It appears to matter not, whether a resident was paying £1,000 or £2,000 per month for their residency. The level of compassion, care and dignity provided was certainly, in the vast majority of my experiences, anything but commensurate with the funding, however provided.
In an Emergency
Well, at least when there was an emergency in the night, due to unconsciousness or fall there would be rapid availability for better care. That’s a major decision factor for why we help our elders decide this model of living isn’t it? Think again! The premise may be correct and worthy; the reality, based on my experiences differs.
Below is anything but an exhaustive list of problems witnessed affecting, emergency care attendees, and which ultimately affect the most basic of human rights for the resident-now-casualty:
- No clear resuscitation policy for staff discovering a resident in a collapsed condition. Just call an ambulance, but do NOT intervene with hands on CPR! (However, if a member of staff or a visitor collapses, they CAN get ‘hands on!)
- Poor access to ‘Do Not Resuscitate’ (DNR) and expressed wishes (Advance Directives) documentation. This means that invasive resuscitation often takes place, even if wishes have been expressly made to the contrary, denying the individual their most vital last wishes. (It may be worth noting that this has been even worse in the hospital setting where an inordinate amount of patients receive CPR – despite having had wishes recorded to the contrary!)
- Inadequate access to medication, lists, and previous medical history – in an emergency.
- Dangerously low staffing levels.
- Delays gaining access to patients.
- Staff made up almost exclusively of non-English speaking; out of hours, when time lost can make all the difference to the outcome for the patient.
- Lack of daily engagement – social, communication, interests, development, mental health.
What’s that smell?
One of the casual observational quality indicators emergency responders may self-initiate when asked to attend the care/nursing/residential homes was whether there would be a noxious odour when we arrived. This odour is well known in the profession and easily identifiable as that associated with urine. Particularly evident in those suffering from infection, or of course, where hygiene needs were unmet.
High ambient temperatures and dehydrated residents would lead to a common request for the transfer of residents to hospital care for urinary tract infection (UTI) management. In the elderly, this can be catastrophic.
You knew about this?
You may ask then, why haven’t I done anything to change this? This is a reasonable question. I have tried! I have challenged, in the strongest possible terms, the lack of adequate and appropriate policy relating to resuscitation. I have been involved in ‘whistleblowing,’ and covert data analysis which ultimately may have impacted on the authority to operate for premises. This however, created another challenge that only goes to further undermine any remaining dignity for the elders concerned.
Darn them ‘bed-blockers’!
The horrible hospital term ‘bed-blocker’, coined to describe an individual who remains beyond the time necessary in a hospital bed, despite needing no further therapeutic intervention.
They could not be accommodated elsewhere, due to social care inadequacies, made even worse by closure of the poorly performing ‘homes’, and subsequent lack of capacity – read ‘contingency’.
How has it become so bad then?
Have things become worse? I’m unconvinced they have! Yes, money is tight, but even where money is less of an issue, care and basic compassion are still often missing. There is enough evidence to suggest this has been the case at least over the last century or so.
Where might solutions lie for this growing demographic that will become you and I, and our children in the future? I would love to share your views and ideas.
What if the lack of care and dignity provided was due to things outside of profiteering and ‘efficiency’ measures? What if solutions were simply available with a change of attitude, delivery and culture?
“Elder Care Cooperative” – Care delivered for elders, by elders.
What if all elder care provision and management fell to another growing population, the professional retired or positions redundant? I wonder whether those who are capable might be more empathetic to the residents – and care less about profit; preferring to provide on a more humanitarian basis?
Hotels – The ‘Joke’
There is a caustic viral post that continues to do the rounds alluding to the choices between paying tens of thousands of pounds to the ‘care’ home – or book in to a ‘Holiday Inn’. The care received, due to customer service, is second to none because you are a ‘customer’! (What the heck are you in a fee receiving ‘home’ then?)
Will apportioning blame help?
I think it is unhelpful to ‘blame’! This has been ‘accepted by our society for so long, many of us are complicit. I think what could be helpful is to establish a humanitarian solution that encourages a paradigm shift in attitude and culture, one that will provide the dignity, compassion and fundamental care and respect that must be seen as the standard of which we strive to never fall below. It has to be outside of cost efficiency derived for the purpose of enhancing financial profit and return.
Performance management and appropriate governance will still be critical, but needs to be sufficient to encourage best practice rather than inhibit. It must be bureaucratically ‘light’, rather than that currently in place and which is weighed down in politics and finance wrangling.
Money, money, money…
We can keep banging the ‘where will the money come from’ drum, but surely this is more important than that. It really doesn’t have to be about money. Yes, it costs. But are current models efficient and providing to an acceptable level? Is money in the treasury appropriated to satisfy basic human needs – or is this reserve used elsewhere? I think we know the answer to that. If basic agreement could be found, so would the drive to make it happen.
This is it…
Now is the time to drive forward a shift from that which has rarely provided dignity, care and compassion to that which each and every elder human being deserves – after a life of sacrifice and service.
…or we can choose to do nothing, and nothing will change.
It isn’t solely the job of the NHS, the government, or any other agency. WE are empowered to create our own agency for change and there has perhaps never been a better time to make this happen.
How would you create a better now, for our elders? Stick your head above the parapet and share your solutions, because the challenges are clear!
Note: My comments and views expressed are based solely on my recollections of observations and experiences whilst a serving as an award winning paramedic in the UK, and relate to the time between the early 90’s to late 2011.
Images attributable to: http://www.freedigitalphotos.net