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.