I BET many readers are currently involved in caring for an elderly parent, or have recent memories of its abject horrors.
And I’ll wager they won’t have been surprised by the news that Scotland’s £3 billion care network is in meltdown.
I don’t mean caring for an elderly parent is in itself horrific. In my view it is a role-reversal that it is not only our duty to fulfil, but is also life’s most precious privilege.
In my experience, however, reaching the sorrowful stage of relinquishing control of a loved one means having to engage with a dislocated, often hostile, system in efforts to ensure the best possible end-of-life care. A lack of joined-up thinking between doctors, local authorities and care services makes the process so prolonged and frustrating that you wonder if the term “elderly care” has become the cruellest of oxymoronic jokes. Botched assessments, delayed appointments, lost paperwork and sudden staff sickness are only a glimpse of how bad it can be in the painful early stages. And it doesn’t stop there.
It has taken two disgraceful revelations to give me hope that the situation I encountered may yet be salvaged. Last week it emerged that Southern Cross, the UK’s largest private care-home chain, with 31,000 elderly residents – 3000 of them in Scotland – is on the brink of collapse, with millions of pounds of debt. And in Edinburgh, two residents of the private Elsie Inglis care home have died.
Social Care and Social Work Improvement Scotland (formerly the Care Commission) says it had demanded the Elsie Inglis home make improvements to the way residents are helped with eating and drinking. Teeth weren’t being brushed and they were being left to eat mashed potatoes and stew with their fingers. The mind boggles at what else might have been going on behind closed doors.
But hang on. SCSWIS is supposed to be the regulator here, even in private homes. What is the point of its on-the-spot inspections if its reports aren’t followed through? It’s all very well ticking boxes and filling in forms, but old people need action. Instead, they’re falling between too many fiercely-guarded stools.
First Minister Alex Salmond has taken a sideswipe at the last Labour government’s NHS policy of using private companies in the care and health sectors. Meanwhile, the British Medical Association in Scotland described the country’s 32 Community Health Partnerships, which are supposed to bring together council and health service staff to plan services, as “bureaucratic monoliths” caught up in their own internal processes rather than helping to organise services to meet patients’ needs. GPs, said the BMA, long ago turned their backs on CHPs for failing to engage effectively with them.
This shameful shambles has been going on for years, not months, as Labour’s health spokeswoman Jackie Baillie would have us believe. Greed, self-interest and complacency, rather than compassionate care, have become the priorities for those in charge of looking after the vulnerable elderly. And we should all be worried: over the next 25 years the number of over-60s will increase by 70%, and the number of dementia sufferers will double to around 160,000.
Despite the vast sums being spent, the quality of care seems to be deteriorating. Care staff, mostly women, are treated as the lowest of the low and paid as such. Consequently it is the least attractive career option possible. Staff no longer have the autonomy to choose to spend five more minutes with a resident if they judge it necessary. They daren’t give in to the instinct of rushing to help an old lady who’s tripped over her zimmer, hitting her head on a side-table in the process; they must wait for the manager or doctor to check her over, because most of them are not trained nurses. And fewer still are trained in dementia.
More older people are being admitted to hospital as emergencies, yet in an average 900-bed hospital, approximately 150 patients will have some form of dementia and most NHS staff are not trained to look after them properly. Alzheimer Scotland launched a £1.5m fundraising campaign to place a dementia nurse in all 14 health boards in Scotland, but since 2006 only four positions have been secured. Why?
An influx of transient foreign staff is the result of paying the minimum wage. East Europeans with a minimal grasp of English can’t communicate verbally with residents, far less with families. A creeping erosion of confidence in the level of care being administered is endemic.
Such mean-spirited cost-cutting is inexcusable in private homes, where “hotel and accommodation” costs are upwards of £600 a week per “self-funding” resident – those whose monthly employee pension, and/or equity from the future sale of their home, is included in the local authority’s means-tested financial assessment of a resident.
Free Personal Care is paid by the Scottish Government to care homes at a rate of more than £200 a week per person to cover washing, dressing, hair-combing, teeth-brushing, toileting and in some cases nursing (though that’s another grey area). There appear to be no proper checks on how that money is used.
Private care does not necessarily mean good care. In some homes managers get away with allowing their appointed dentist to refuse to replace a chair-bound resident’s dentures after they’ve been “lost” a third time. They accept the local GP practice sending a locum to see a patient they have never met before, and blindly believe their flimsy prognosis to the point of arguing with relatives about what is wrong. They ignore the discomfort caused by the soiled nappy a resident has been wearing all day, preferring to turn the cushion on her chair rather than order staff to do their duty. And all this despite interminable care inspections.
If Scotland can reset its dislocated care system, the £3bn currently being squandered should go much further. But if it can’t, all is not lost. If we all get dementia, at least we’ll be oblivious to the horrors of our own old age. We might even forget ever having witnessed scenes that could be straight out of a Hieronymus Bosch depiction of the torments of hell.