Deaf, Daft and Demented: Improving Attitudes to Elderly Care

The woman on the radio sounded distraught. She was calling a phone-in show from the hospital where her frail, elderly Dad was being treated. Treated perhaps, but not being cared for. The caller described a ward full of elderly, infirm patients marooned in their beds trying to reach water jugs across the Grand Canyon of space between them and an impossibly far away bedside cabinet. Others pressed the call button repeatedly for commodes or help with moving up in the bed. Nobody came. 

The presenter Shelagh Fogarty suggested a shortage of staff. Apparently not. The caller described a large group of ward staff lolling around the Nurses Station chatting about Facebook. The phone-in took place on the back of a recent RCN report calling for minimum staff levels on elderly care wards. The RCN survey was itself a response to a catalogue of horror stories surrounding the care of older people. In the same week a Which? Magazine ‘secretshopper’ sting highlighted (yet again) serious failings in domiciliary care. It makes sad if not unfamiliar reading. Missed medication. Missed food and drink. Soiled beds. That sort of thing.

So what are the reasons for this constant torrent of bad news? There are plenty of ‘big picture’ factors involved, and others more eloquent than I have written about some of them elsewhere with the precision of front-line experience. But let’s look at one specific and rather uncomfortable area from my own perspective as a trainer.

It’s one of those elephants in the room that doesn’t get much of a public airing, and goes something like this. 

Care of the elderly is far and away the least popular of the health and social care specialities, and attracts the sort of staff who might just as well be earning a Gold Star for assembling Big Macs.

For as flawed as the bigger picture may be, it is still individual care staff leaving patients to dessicate or care home residents to sit in their own faeces. Whenever I hear one of these reports I imagine myself visited by The Ghost of Christmas Yet to Come, aged by forty years and placed in a nursing home by a family who have ignored my Living Will request to be shot at the merest suggestion of double incontinence. I have a memory span of thirty seconds, and I’m muttering to myself, probably because nobody else will listen. My Inco Pad fills with the end result of my soft diet lunch. A couple of care assistants haul me into a wheelchair and whisk me off to the nearest shower hose, deep in conversation over Kate Middleton’s choice in shoes. 

So in this Dickensian nightmare I’m quite literally at the arse end of the care sector, but back in the real world does it really follow that elderly care attracts the bottom of the pile in terms of it’s staff?

Speaking as a trainer working with hundreds of care staff over the years, most certainly not. But I do often see a demoralised workforce working long hours for poor pay and even poorer conditions. With the best will in the world it’s not hard to see how patients or clients eventually come to be seen not as valued individuals but as names on a job sheet spiralling ever downward  toward ever-increasing neediness and ultimate death.

So what do we do? Do we throw more centralised funding at our local authorities and privatised care providers?  Even if such fanciful thoughts had the slimmest of chances of becoming reality, I suspect this would achieve little in terms of progress beyond a healthier shareholding for their employers.

What about better training for care staff? For as long as I’ve been in the business training has been a luxury expense in an industry long governed by the bottom line of the profit/loss equation. ‘Stack it High, Sell it Cheap’ used to be the mission statement for Tesco but is now the essential business model for elderly care, where training is often seen as a costly irrelevance to short term profit. But could more and better quality training really improve the care and attitudes toward our vulnerable elderly? 
A few years ago I collaborated with some local colleagues on designing and facilitating a BTEC Short Course Award: Caring for the Older Person with Mental Health Problems. It was a fairly simple programme consisting of three classroom-based modules focussed on Dementia, Depression and Challenging Behaviour. We worked with a varied collection of staff from both nursing home, residential and domiciliary settings. Some of our candidates were managers, while most were front-line carers. Almost all were terrified at the prospect of taking a test at the end of each day although Exam Phobia faded quickly once our candidates realised how much they already knew and what they were capable of.

We looked at how depression, so endemically common among older people in care and yet so seldom tackled, can be quite easily identified by care staff using the sort of rapport and person skills that comes inevitably when helping a resident put on their socks every morning.  We looked at magnified images of protein plaques and discussed how these lead to memory loss. We looked at how awareness of the sensory and cognitive deficits of dementia can help us communicate much more effectively and reduce distress. Not only did our candidates earn a recognised qualification but challenged, examined and re-evaluated  how they worked with older people. Now let’s not pretend this was Dead Poets Society but the fact I’m talking about this award it in the past tense irks me more than Robin Williams. And that’s a lot of irk.

We were able to deliver the award only with the help of a generous funding pot from the now defunct Business Link Dorset. Once the funding dried up, so did the course, and we certainly didn’t have the resources to evaluate the shop-floor efficacy of the training. But on anecdotal evidence at least, investment in a reasonably cheap and effective project yielded greatly improved levels of care and support inspired by more positive attitudes and a greatly enhanced sense of self-worth among our groups. With potentially business-ruining CQC reports easily available online and a traditionally high turnover of staff, you don’t really need a degree in health economics to work it out. It’s just good business to have better trained staff.

In the meantime we’ll continue to hear an unending tide of bad news stories and radio phone-ins about staff who have become demoralised and dispirited when they could, with a little time and effort, be taking a fresh look at the work they do as something which is as skilled and satisfying as any of the ‘sexier’ areas of the care and support industry.  

It could certainly beat flipping a burger.
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4 thoughts on “Deaf, Daft and Demented: Improving Attitudes to Elderly Care”

  1. I feel quite sad reading this I worked as a Health Care Assistant some years ago. Clearly the situation has not improved. You are right it is a poorly paid role but not all staff are disinterested in caring but you do become demoralised. I left as there was lack of training and I hated the way clients were treated by some staff who were there for a wage and no other reason. More training is the way forward to instil a sense of value in the role being performed and this can only benefit those being cared for. Simply taking on the role because it requires no training for the most is not beneficial for staff or patient.

  2. Thanks Lorna. If anything the situation has deteriorated in recent years and staff now get only what is absolutely essential for CQC inspections e.g First Aid, Moving and Handling and of course 'Elf and Safety, and not to diss my colleagues who run these courses this isn't the sort of training to fire the imagination and change attitudes.

  3. The language is fairly strong, but Militant Nurse points out that it's quite difficult to distinguish who is a nurse and who isn't, when gathered round a nurses' station."Nurses stations are gathering places for all sorts of staff, all day long. These people may be in uniform but they greatly outnumber nursing staff. My ward is in a very central location. People [use the] nurse's station as their own personal break room, meeting area etc. They tie up our phones, our computers etc. They are not nursing staff nor are they employees of my ward so it's not like they are going to answer a call bell or see a patient. The clinical techs are the worst. They work all over the hospital and they travel in groups. They are NOT ward based. When they are not busy…they are feet up at MY nurse's station. If you look at the station at any random moment you will see occupational therapy, clinical techs, physios, dietitian, social workers, clinical techs sat on their arses, nurses from other wards who have stopped down to borrow something but are not allowed to touch a patient on my ward, clinical techs, clinical techs…, pharmacy techs and more clinical techs. I have to fight my way through this crowd of people to get my work done at the station.I know for a fact that relatives and visitors generally refer to this eclectic group as "nurses ignoring patients". "However, the wider point about improving elder care through appropriate training and recognition is well made.

  4. Thanks for the comment EMatters. I haven't been a ward based nurse for some years and then mainly in psychiatric secure units, but you paint a very familiar picture! I must confess that the BBC 5 Live quote at the top of the piece was indeed (according to the caller) about nurses standing around the Nurses Station, but I was just trying not to use the word 'nurse' twice in one sentence. Note to self: 'Must be clearer next time.'I took a look at the link you posted and have to say I don't really think the blogger nor the comments suggest a very professional picture of nursing at all. And that's putting it mildly. Phew, I thought some of my posts were a bit strong but Militant Medical Nurse is a veritable Viz-style Profanosaurus. Whatever lights one's candle I suppose ..

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