Poor Care For The Elderly

Submitted by tonyplant on October 18, 2006 - 13:49.

The Times, amongst others, has a report on the poor state of home-care for elderly people. The 15 minute time slot came in for particular criticism.

In the first ever major study of domiciliary care services in England, the Commission for Social Care Inspection (CSCI) found that councils were unable to attract and retain staff because of poor pay and that both carers and the cared-for complained of being rushed, demoralised and unable to form meaningful relationships.

The "15 minute slot", in which a care worker is expected to visit a person, wash them and get them dressed and ready for the day, was identified as a symbol of a regime that will be unable to handle the growth of Britain's older population.

The 15 minute allocation is clearly a nonsense. Too many people don't receive the amount of care that they need at the time they need it, even if it would keep them independent and active for longer and delay the need for more intensive and extensive care.

However, it is all very well for Age Concern etc. to welcome the report but what we need is an authoritative and well-costed report on what it would cost to provide appropriate social and personal care.

There seem to be several reports about the deplorable state of hospital food and the numbers of elderly people who need assistance to eat in hospital but don't receive it.

There has been a persistent problem with patients not getting the nutrition they need while in hospital. The release of the figures, in a parliamentary written answer, follows a study by Age Concern into what it called "the scandal of malnourished older people in hospital". Nine out of 10 nurses told the charity's Hungry to be Heard survey that they did not have time to provide the elderly with the help they need at meal times. (Telegraph)

Dr. Crippen has some discussion about using volunteers to feed patients but I don't think that this is a practical alternative for a number of reasons.

It is an attractive idea but I wonder about the practicalities of organising volunteers to do something like help elderly patients to eat. If the volunteers were working with vulnerable people, then somebody would probably mandate that they should go through the enhanced disclosure process (Criminal Records Bureau check) first - something that deters a number of volunteers and is expensive and time-consuming for their sponsoring organisation. Should any such volunteers be screened to see if they are asymptomatic carriers for various streps, hepatitis or MRSA?

How many times would a volunteer attend in a day? Breakfast, lunch, dinner and snack-times for one patient or maybe 2? Would they stay at the hospital all day, or return for some of the meal times - and who then would pay for their parking costs (parking can be scarce and prohibitively expensive in some hospitals) and their meals (some hospitals have economised by no longer providing meals for volunteers)? Depending on the area, the expenses bill could run from £12-£30 per day, for one volunteer to feed 1 or 2 patients.

And all of the above is overlooking the questionable quality and attractiveness of the meals on offer in some areas. E.g., outside of a hospital setting, I have never known anyone to prepare boiled liver, and I think that there is a good reason for that.

It is unlikely that cash-strapped hospitals would be able to afford the cost of the expenses. I very much doubt that organisations such as Help the Aged or Age Concern could afford the cost of these volunteers. The estimate that I gave above was for the volunteer's own daily expenses. The costs of supervising them, putting them through their enhanced disclosure, various bits of training etc., the costs of implementing a complaints procedure and setting up all the extra admin. to cope with that level of expenditure on volunteers (and verifying their entitlement) would probably mean that the front-end training costs and overhead costs would be prohibitively high.

There are vast overheads associated with looking after volunteers and providing the expected structure and supervision. If you are one of the charities that accepts people who are referred by the courts as part of a Community Rehabilitation sentence, then the overheads of being involved with the Probation officials or other officers who oversee them, then the costs are almost beyond belief. Even the complications and costs of liaising with the Dept. of Work and Pensions if your volunteers are unemployed and claiming benefit have to be experienced to be believed.

I made a plea for better costings when I previously commented on the Wanless Report. Yet another plea for an intervention from a smart enconomist who can cost up the cost of appropriate provision in a transparent manner.

Copyright 2006, Tony Plant Happystance Project

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