Neglect of the Elderly (2) and Prevailing Attitudes....

I woke up this morning, cleared the sleep from my eyes, turned on the comp and read with interest  Dr Phil's and the good Witch Doctor's posts on the recent CQC report and my  thoughts returned to an excellent comment left by a&e charge nurse at Dr No’s Bad Medicine  in which he states ‘The tradition of elder abuse is well established in our culture - for example, many do not even have the wherewithal to eat properly, or heat their home in cold weather.

Isn't this report the same old lament we heard 10 years ago, and 10 years before that - if nothing has substantially changed then one has to assume, however painful it might be for us to accept, oldies are not loved sufficiently to receive the sort of service that would undoubtedly cost a lot more than we are presently paying’.

Sadly a&e charge nurse is spot on for the elderly are much maligned, much ignored and the ready butt of jokes in this society we presently exist in.  I was reminded of a recent event (whilst on holiday) when the resident comedian – as in paid entertainer – pounced on a trio of very elderly patrons who entered his domain and ridiculed them with no thought on how his disparaging remarks would hurt and humiliate them.   (I think it is a common belief that those who are frail of body are also frail of mind and therefore it is okay to ridicule, ignore and talk over them – for what does it matter as they are just old and are an unwanted burden on society and not worthy of respect).

Dr Phil’s anecdotal story relating to his grandfather also reminded me of the appalling care my (long since deceased) well demented mother experienced during hospital admissions.

I guess I was the interfering, pain-in-the-arse relative when I requested that she should not be nursed on her right side (pressure damage would surely ensue), be supported if sitting in a chair otherwise she would fall off as she could not maintain her position, need to be assisted with eating and drinking (as she couldn’t do this herself), was diabetic etc.

However these requests (of basic and necessary interventions) were not carried out and after all but one admission, letters of complaints regarding her (lack of) care were sent to those who attempt to appease but don’t care at all.

Her catalogue of harm (whilst in hospital) listed a non-diabetic diet (although it is probable that she did not receive many meals unless I was there to feed her as quite dramatic weight loss was always a dominant feature of her admissions), a dry, crusty mouth (“No we don’t do mouth care here – give her some of her water”), pressure damage, many small haematomas on her palm (where her fisted hand had become trapped in the cot side), black eyes (after she had ‘slipped’ off her chair – “No nurse, wrong place to have injuries if you slip off – she fell off as she wasn’t supported despite me informing you this was necessary!”) and so on into infinity.

Her final admission (of four days) was when it was obvious to all that she was in the process of dying and was breathing with her whole body – she was now in end stage dementia.  On her last night, I visited her in hospital (before I commenced my night shift) and it was obvious to me that this was part of her last twenty-four hours.  I informed the nurse in charge that I would go to work and sort out immediate cover (for myself) and requested they ring me immediately when she entered her ‘final hours’ and I would come straight there (if not already there).

Three hours later my cover had arrived and I phoned the hospital to inform I was coming in and to ask how she was and was informed that they ‘hadn’t looked at her yet' as they had just finished the handover (this was two hours after their handover) and they would go and ‘look at her.’  She was dead.  On my visit to my now dead mother I was informed that someone had sat with her all the time after I had left – what lies, what awful damned lies.

I guess the point of my story is to illustrate that inadequate staffing levels (so much more damaging when the skill mix is wrong) are an important factor in the neglect of the elderly as in all cases inadequate staffing levels were evident on my mum’s admissions.  Nurses (of the qualified variety) were stretched and rushed off their feet and showed impatience with me when I asked questions, and I can understand this impatience as I was yet another unwanted diversion from the required (and often life saving) tasks in hand.

Importantly, we must also ask ourselves why medical wards (which house mostly elderly patients) are so grossly understaffed despite I am sure, requests from nurses to those who manage in the higher echelons (and don’t care) for at the very least adequate staffing levels  Here I would pick up on The Witch Doctors post, and beg consultants to look at the whole picture and not swallow the only too convenient prevailing belief that  ‘Nurses are too posh to wash’ for if you do you are surely colluding with management.

We must also take a long and good hard look at attitudes towards the elderly and develop the mindset, the understanding and the damned truth and realisation that we will all be old one day.

When I interview prospective new carers at work I am uninterested in them as potential carers unless they answer questions in the way I want.  One of the questions is “when you look at a resident and think about how you would care for them – who would you think of?’  Mostly the replies are of “My gran/granddad” or “My mum/dad” and this is the right answer yet I take it further in that I suggest that they think of the resident as themselves and ask themselves “How would I like to be treated?”  This way of thinking, identifying with the resident continues through their induction and for ever more.

We all must ask ourselves (and this especially of those who exist in hospital management) “How would I like to be treated?” for if we don’t – we will never learn and change will not ensue, and sometime in the near future, we will yet again be reading of the disgraceful care of our elderly - who once were people worthy of the respect you receive and are still worthy of it now.

Remember that we will all be old one day!

Anna :o]

Neglect Of The Elderly

Today we have learned of the unannounced inspections by the Care Quality Commission (CQC) of one hundred hospitals and the disquieting news that one in five are neglecting elderly patients to the point of breaking the law.  (The report is here).                  

We hear of unacceptable hospital cultures where unacceptable care has become the norm, where the elderly are treated with a lack of respect, stripped of their dignity, are ignored, are talked over (by doctors and nurses), where basic needs (eating and drinking and going to the toilet) are not met.

How many times have we heard something similar or seen ‘undercover’ reporting on TV documentaries of the disgraceful care of the elderly this year, last year and the years before?  How many times will we hear and see it again – for we never seem to learn from it?

It appears to me that the blame culture firmly scapegoats nurses and fails to look at the real issues.  Of course there are indeed bad nurses as there are bad doctors, bad politicians and bad governments and I have come across some cruel nurses and doctors in my time but would add that they are few and far between.

The report notes that care has been broken down into a task-based culture where doctors and nurses are held to account for every box they have or haven’t ticked and I would agree that this is indeed the case.  Although not working in a hospital but a care setting there are so many boxes to tick (even the photocopier has to be risk assessed), so many authorities, agencies and professional bodies to which you are accountable, so much damn paperwork (often duplicated for aforementioned authorities, etc) that there is less time to offer patient/resident care.  These boxes have to be ticked, no ifs or buts or it is your job down the swanny.

Of course staffing resources play a part and the report states: ‘Many people told us about the wonderful nurses in their hospital, and then said how hard pressed they were to deliver care.  Having plenty of staff does not guarantee good care (we saw unacceptable care on well-staffed wards, and excellent care on understaffed ones) but not having enough is a sure path to poor care.’   (Bold type mine).

Understaffing does matter, more so when the patient group is more needing of staff input.  If you really want to know why understaffing matters read this excellent and frightening post by Nurse Anne at Militant Medical Nurse.  (It is important that you are aware that most of the nurses you think are nurses on wards are untrained healthcare assistants – that said there are many damned good healthcare assistants who cannot, I repeat cannot do the work of a qualified nurse).

I can only report honestly how understaffing affects the environment in which I work.  We have excellent staffing levels which are above those legally required.  If one member of staff has to accompany a resident to hospital during the night we are 20% down on staff and therefore 20% of residents will not receive the individualized input of that member of staff.  (Hospitals tend to ‘hang on’ to our staff member for hours on end (anywhere from 2-10) and are quite reluctant to let them go (as in effect they increase the hospitals staffing levels).   Staffing levels do affect care whether the DoH agrees with it or not.  (Oh what fine meaningless statements the DoH  make: “…. Ensuring that providers have sufficient qualified, skilled and experienced staff and patients are protected from the risks of inadequate nutrition and hydration.”)

However it would be foolish to pretend that all bad care is related to bad staffing for indeed there is a culture where bad care/practice is the accepted norm, that said if you work in an environment like this (and are good) it is almost impossible to effect change especially if bad practice is top-down.  I worked in a care home such as this (owned by a hospital consultant) and as my ‘whistle blowing’ to management met with indifference I and a residents relative informed the JIU (which has morphed across time into the CQC) and I had to leave and the nurse in question kept her job.

This is the lot of a whistle blower who are regarded as troublemakers and at best ignored and at the worst vilified and lose their job.

So the question needs to be asked “How can change be affected if nothing changes in that wards remain under resourced, staffing levels are in the main made up of healthcare assistants, bad practice is allowed to continue and whistleblowers are vilified?”

What say you?

Anna :o]