Balance needed

Stephanie Rose redresses the balance in the debate concerning care of the elderly and vulnerable

Over the past couple of weeks, here in our blog, we have published a series of articles and reports concerning problems in relation to the care of the elderly and vulnerable. Mostly they give depressing reading concerning an industry in turmoil and sometimes crisis; and the inability of government to resource the issue of an increasing number of people in society living into 'new' - old age. Yes, 10% of people in OECD countries will be more than 80 years old by 2050, up from 4% last year, and up from 1% in 1950. Clearly the systems of care, and paying for that care need to change. What barely works now will certainly not work in 40 years time.


Having said that, it is noticeable how well we can rise to the challenge. Day by day, new care services are being developed. A quick search on the web reveals many great new projects and businesses across the country that are designed to meet the needs of an ageing population. And perhaps that is where the answer lies.


What is manifestly evident is that central and local government are retreating from the responsibility of 'providing' care for the elderly. Even where financial assistance is provided, the emphasis seems to have entirely shifted from 'providing care' - to 'funding care in the private sector'. Approve or not, it seems that it is now up to the private sector care services to fill the gap in provision, albeit with decreasingly resourced services.


Within Stephanie's Bespoke Care Services, we estimate that home care can be provided at about 50% of the cost of residential care for those of the elderly who are not confined to bed or in need of round-the-clock care. Clearly, for those needing intensive levels of care and continuous presence of carers, the best and possibly most economic place to live may be a care home or nursing home. This group regrettably includes many who have advanced levels of Alzheimers and other forms of dementia. For the rest - the vast majority of the elderly who need care - the answer lies in the provision of bespoke packages: ones that have been carefully thought through by those receiving care, their families, the extended health care team and the designated social worker, if one has been allocated. And the care packages, by their very definition, need to be kept under active review. It is not enough to assess and prepare a care plan, then to proceed as if the job is done. Here within our service, we encounter individual cases that change day by day and where a failure to keep the care package under review would be unacceptable. Additionally, the bespoke care packages need to be supervised. Wherever possible, we prefer to work with our clients' extended families who are sometimes the best qualified to know what their elderly relative needs, or simply wants for peace of mind. How often have an agreed care package been put in place only to discover that the client asks for less intrusion, or a little more help within their home. In particular, with the low-cost availability of new services from existing carers, such as hand and foot massage, hair care, manicure and supported trips, clients are seeking small indulgences in what otherwise may be a very hum-drum existence.


Whilst all care comes at a price, it is becoming clear that many of the 'new' elderly are asking to remain in their own homes and keep a higher level of control over their lives, rather than commit themselves to private community care. And why not? After all, it makes practical and financial sense.

The ideas here are the personal ideas of the author and may not be reproduced without permission and attribution to Stephanie's Bespoke Care Services.




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Elderly care costs could treble, says OECD

Continue reading the main story

The cost of caring for the elderly could treble by 2050, according to a report by the Organisation for Economic Cooperation and Development.

The body, which represents the most industrialised nations, estimates that 10% of people in OECD countries will be more than 80 years old by 2050.

That is up from 4% in 2010 and less than 1% in 1950.

The OECD report said member countries are spending 1.5% of GDP on long term care.

It predicts spending as a share of economic output will double or even triple in the next forty years.

Overhaul

The report said countries must face up to the challenge of caring for ageing populations. It said a vision of long term care was needed and that "muddling through" was not an option.

Angel Gurría, OECD Secretary-General, said: "With costs rising fast, countries must get better value for money from their spending on long-term care.

"The piecemeal policies in place in many countries must be overhauled in order to boost productivity and support family carers who are the backbone of long-term care systems."

However, the report warns against relying too heavily on family members. It says low pay and hard working conditions result in a high turnover of care workers and that many countries were struggling to meet demand.

It says Germany, the Netherlands and Sweden had all increased retention by boosting pay and improving working conditions.

The OECD also said there was likely to be an increased need for migrant workers.

Cuts to care for elderly 'devastating warns Age UK

Town hall spending on social care for the elderly
has been cut by more than £600 million this year,
according to a leading charity,
which warned of "devastating" consequences.

By Stephen Adams, Medical Correspondent

6:30AM BST 27 Jun 2011

Some of England's most vulnerable people would be condemned to "a miserable existence behind closed doors" by the cuts, predicted Age UK.

It has calculated that local authorities have cut spending by 8.4 per cent since last year, based on data obtained from Freedom of Information Act requests.

Of 152 authorities across England, 139 responded to requests by Age UK, which calculated that net expenditure on older people's social care had fallen by £610 million in 2011/12, compared to 2010/11.

More than half (76) said they had either frozen or decreased the rates they paid for residential care home places for old people, leaving them and their families to pay the difference.

And at least 61 said they were making new charges for services like home help or day care centres.

Overall, net expenditure per older person who needed care had fallen from £2,548 to £2,335.

Michelle Mitchell, charity director at Age UK, said: "Funding for social care is already inadequate and the system today is failing many older people at the time when they really need help.

"The consequences of cutting expenditure further to 8.4%, indicated by our research, could be devastating.

"We are fearful that even more vulnerable older people will be left to struggle alone and in some cases lives will be put at risk.

"We anticipate these cuts will condemn many more older people to a miserable existence behind closed doors struggling to keep safe and well."

Labour accused the Government of damaging elderly care by bringing in deep local authority cuts too quickly.

Barbara Keeley, shadow communities and local government minister, said: "Tory Government cuts to council budgets went too far and too fast. We now have a crisis emerging in social care and Government budget cuts are making it worse."

However, Age UK's figures were disputed by the Government with Paul Burstow, the Care Services Minister, saying they "simply don't add up".

He said: "Council spending on social care is under pressure - that's why the Government will provide an extra £7.2 billion over the next four years to local authorities so that they can protect services that support vulnerable people.

"But Age UK's research does not give the full picture and they have seriously underestimated the amount of additional support for social care and older people in particular."

He added that the charity's figures forgot to include £150 million of NHS cash for "reablement" - supporting older people upon discharge from hospital.

"While some councils may simply be cutting care, others are working hard to get more for less with innovative ways of delivering better care, including using more telecare and cutting needless admissions to hospital and residential care."

The charity's research comes ahead of the eagerly-anticipated findings of the Dilnot Commission, set up by the Government last year to come up with proposals for the future funding of social care.

Increasing life expectancy is creating a multi-billion pound black hole in elderly care - due to reach £6 billion by 2020 - on which the political parties have so far failed to agree a solution.

Economist Andrew Dilnot is expected to recommend that the middle classes should pay up to £35,000 towards the cost of their care, and be encouraged to take out insurance to cover that cost.

Ms Mitchell said the Dilnot proposals must "turn around the crisis".

Failure to reform elderly care 'will be catastrophic'.

The system of care for the elderly will face
“catastrophic” breakdown if politicians are not
prepared to work together to back painful long-term reform, experts warn today.

 Photo: ALAMY

By James Kirkup, 

Political Correspondent

The Telegraph 7:00AM BST 27 Jun 2011

Leading charities and experts have written to The Daily Telegraph warning the current care system is “reaching crisis point” and must be radically overhauled, even it means making people pay more.

A panel of experts, led by the economist Andrew Dilnot, will recommend reforms to the funding of care and support for elderly and disabled adults in a report to ministers next month.

The review is expected to recommend that better-off people should pay at least £35,000 towards the costs of care, raising the money by taking out private insurance earlier in life.

Mr Dilnot has also suggested pensioners should be prepared to raid their pensions, down-size or even sell their homes and rent to pay for long-term care in old age.

Since the recommendations of the Commission on Funding of Care and Support are expected to be painful and controversial, experts and charities fear that politicians will come under pressure to avoid implementing them in full.

The signatories to today’s letter, who include the Association of British Insurers, Age UK, the Alzheimer’s Society and the National Care Forum, say that watering down Mr Dilnot’s plans would be disastrous.

“It would be catastrophic if the forthcoming report from the Dilnot Commission resulted in no action at all,” they write.

“We are reaching crisis point. We know there is no perfect solution. Care will always cost money and someone has to pay for it.”

The question of care funding has been the subject of bitter political rows in the past. At last year’s general election, the Conservatives depicted Labour’s plans for reform as a “death tax” on the estates of the elderly.

Hoping to avoid such rows this year, the letter urges politicians from all sides to “put aside party divisions” and “work together to prepare for the consequences of living longer”.

Insiders say the approach of the Dilnot recommendations has also strained relations between the Conservatives and the Liberal Democrats. Some Lib Dem ministers suspect the Tories will try to delay reforms for fear of a political backlash.

Underlining the case for change, new figures will today show that councils are cutting their spending on care for the elderly by almost 10 per cent, leading to warnings that more old people will be left to fend for themselves.

The figures were compiled by Age UK after Freedom of Information Act requests to councils about their budgets for adult social care.

Age UK said: “We are fearful that even more vulnerable older people will be left to struggle alone and in some cases lives will be put at risk. We anticipate these cuts will condemn many more older people to a miserable existence behind closed doors, struggling to keep safe and well.”

Depression in the elderly

Dr Trisha Macnair

It's a mistake to assume depression is an inevitable part of ageing. Depression is never normal, but many older people hide their worries and struggle alone when they feel low.

Dr Rob Hicks last medically reviewed this article in January 2008.
Copied from the BBC Emotional Health site.

Older people are more likely to blame their depression on events or social circumstances. But while the death of a partner or friends, or coping with a chronic illness are important contributory factors, there are real biological changes that account for depression.

Brain-imaging studies have shown that in depression the brain circuits responsible for regulating mood, thinking, sleep, appetite and behaviour all fail to work properly. The chemicals that brain cells use to communicate with each other, called neurotransmitters, become out of balance. This happens in young and old alike and is always abnormal.

Several conditions can lead to depression in the elderly, including heart problems, low thyroid activity (hypothyroidism), vitamin B12 or folic acid deficiency and cancer.

Many drugs also cause, aggravate or trigger depression, including beta-blockers, blood pressure drugs, heart drugs such as digoxin, steroids and sedatives.

Depression often occurs after a stroke, and getting it treated may be critical to restoring normal abilities.

Who's affected by depression?

Depression is much more common in the years after retirement, when people may struggle to adjust to a new role and routine in life.

It's then less likely for the next decade until people are in their mid-70s, when factors such as chronic illness, frequent loss of peers and friends, and increasing restrictions on mobility may be factors.

Depression symptoms in the elderly

Depression has a different pattern of symptoms in older people compared with the young. Anxiety is particularly common, as is the slowing of thought and activity.

Older people also tend to have more bodily symptoms, although it can be difficult to work out whether these are signs of depression or part of the increase in general illness seen with age. Older people are more likely to battle with weakness, for example, as well as headaches, palpitations, loss of interest in sex, abdominal or back pain, shortness of breath and constipation. Imaginary illness and hallucinations are also more common.

Deterioration in mental function can occur with depression at 18 or 88, but young people have greater mental reserves, so these problems often show up more in older people. However, it's important to separate the effects of depression from those of conditions such as Alzheimer's disease.

Treating depression

If you or a friend or relative has problems with bleak moods, get help from your GP as soon as possible or talk to the Samaritans.

Antidepressant drugs can help to restore the balance of neurotransmitters in the brain, while social support and psychotherapy can help to deal with many of the triggers of depression.

Studies have shown that over 80 per cent of people with depression improve when given the appropriate treatment with a combination of medication, psychotherapy and other measures. However, it can take longer for older people to respond to treatment - on average, it takes 12 weeks to achieve remission. In elderly people in particular, research has shown that a combination of psychotherapy and antidepressants is extremely effective in preventing depression from recurring.

Dealing with social isolation is another important part of treating depression. The health benefits of being part of a family or tight community are well known.

Self-help remedies may be worth a try but beware of interactions with prescribed or over-the-counter medicines - St John's wort, for example, is increasingly self-prescribed and may help with mild to moderate depression but it can interfere with other drug treatments.

Always talk to your doctor before trying any complementary remedies.

Increased health risks from rescribed drugs

Common drugs side effect link to increased health risks for elderly

24/06/2011 17:48:00

A major study of more than 13,000 people aged over 65 has linked a side effect of many commonly used drugs to cognitive impairment and increased risk of death. The findings are published in the Journal of the American Geriatrics Society.

Led by researchers at the University of East Anglia as part of the MRC’s Cognitive Function and Ageing Studies project, the study is described as the first systematic investigation into the long term health impacts of ‘anticholinergic activity’. This activity is a known potential side effect of many prescription and over the counter drugs. The activity affects the brain by blocking acetylcholine, a key neurotransmitter for communication between nerve cells.
In the two year UK study, around half of the 13,000 participants were found to use a medication with potential anticholinergic properties. Medications with the properties are commonly taken by older people for a variety of reasons; including treatments for depression, bladder or heart problems, as painkillers, epilepsy and asthma treatments, or as eyedrops for treating glaucoma.
By allocating the various drugs a score indicating the strength of its anticholinergic effect (from 0 for no effect, to 3 for severe), the study’s key findings were:

• 20% of participants taking drugs with a total score of four or more had died by the end of the study, compared with only 7% of those taking no anticholinergic drugs - the first time a link between anticholinergics and mortality has been shown.
• For every additional point scored, the odds of dying increased by 26%.
• Participants taking drugs with a combined score of five or more scored more than four 4% lower in a cognitive function test than those taking no anticholinergic medications – confirming evidence from previous smaller studies of a link between anticholinergics and cognitive impairment.
• The increased risks from anticholinergic drugs were shown to be cumulative, based on the number of anticholinergic drugs taken and the strength of each drug’s anticholinergic effect.
• Those who were older, of lower social class, and with a greater number of health conditions tended to take the most anticholinergic drugs.

Rebecca Wood, Chief Executive of Alzheimer’s Research UK said:
“This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription. Further investigation needs to establish exactly how and why drugs with an anticholinergic effect might be increasing mortality. This might offer clues to influence safer drug design. It’s important for people prescribed medicines with an anticholinergic effect not to panic, but to discuss with their doctor the best possible personal treatment plan.

“Large cohort research is essential to understanding what might influence the prevalence of dementia in a population. These broad studies can be invaluable in shaping public health policy, yet funding for such research remains shamefully low. With the 820,000 people currently living with dementia set to increase drastically, research is the only answer and we must invest more now.”

Commenting for Alzheimer’s Research UK, Prof Simon Lovestone, Director of Research for King’s Health Partners, said:
“Older people are prescribed many drugs, as this study shows. Yet again some of these drugs have been shown to have adverse effects, including an association with cognitive decline. This is an important and very large study and although we cannot assume that the drugs are actually causing the increased decline, there is good reason to think they may be. This study has important clinical lessons for all doctors looking after older people.”

http://www.healthcanal.com

Care home opens 1950's shop for elderly residents

By Hannah RichardsonBBC News education and family reporter

A care home for the elderly has recreated a 1950s-style Co-op shop to remind its residents of the happiest times of their lives.

The stall at the Birchwood Care Home features drinks, sweets, cereals and household products that were popular at the time.

The feature is such a hit that 91-year-old resident Spencer Tricker has taken on the role of shopkeeper.

He weighs up items for his customers using traditional scales.

'Special era'

Spencer said: "I am the son of a grocer so I know all about the job my father did.

"I made some suggestions about what to have on the stall, like the scales and what to put on the counter.

"It jogged a few memories and the other residents have been coming over to have a look."

Lesly Norton, activities co-ordinator at the home in Ilford, Essex, said: "The 1950s was a special era and our residents would have been in their youth at the time.

"The shop is a very visual way of bringing that period back to life. It has proved a great talking point among the residents, sparking memories of when they were young.

"They have really enjoyed seeing items in their original 1950s packaging again and pretending to go shopping."

It was also the decade when supermarkets first started popping up in Britain's high streets.

Mary Monahan, one 80-year-old resident who worked from her local store in Bow, east London, in the 1950s, said: "The Co-op was my first job and I loved working with the other ladies.

"It's been wonderful to relive those days and see all the old brand names and packaging.

"We have had a lot of fun pretending to go shopping and reliving the good old days. It's been a real trip down memory lane for me!"

Home care for elderly criticised

Click to play

Mark Easton's report - 20 June 2011 is well worth a listen on BBC News link

http://www.bbc.co.uk/news/correspondents/markeaston

What we can learn from recent events?

Stephanie Rose gives her thoughts on recent news items

What a very sad catalogue of events is revealed by the collection of articles posted yesterday on this blog. Whilst it is 'news', we must remember that they are also real lives - of real people, some of the more vulnerable in our community.


So, what can we learn from these experiences which, highlighted in a small number of research projects, are unlikely to be uncommon?


The main issue in relation to home care appears to be accountability. Wherever neglect occurs, it arises because those responsible for it (carers, supervisors and managers) are insufficiently accountable. Where was the monitoring in these profoundly unacceptable cases? Where was the supervision? In the absence of an articulate and vociferous client, who was in a position to deal with the issues that will inevitably arise and intervene on the part of the vulnerable?


Systems that allow issues like these to occur on anything but an exceptional basis, are flawed systems. The first principle of care provision is to ensure that both carers and their managers are accountable - not just following crisis, but on a day-to-day basis. (This is one of the reasons why we use video logs, which I will mention later). Coupled with accountability carers should have a proper level of supportive and directional supervision, one which does not result in carers concealing issues, but actively encourages discussion, problem sharing and problem solving within the care team. On this topic it should be noted that research suggests that an over disciplinary approach to supervision results in concealment rather than openness (Born Liars -Why we Can't Live Without Deceipt by Ian Leslie).


The second issue appears to be training, continuation training, and general guidance to deal with day-to-day problems for which new skills, knowledge and techniques are needed. Arifa Farrouq's piece shows how the lack of appropriate training, and the way that carers are often abandoned to 'get on with it', can cause real problems.


Third is the issue of care time and dynamic input. Both from Arifa's article and from Jo Carlow's commentary, it is evident that insufficient care time is allocated to the sometimes complex tasks facing carers, and usually virtually no time is set aside for emotional care. Many of the elderly living in their own homes may go days or even weeks without having outside contact. Here is a role for the carer - the contact that we crave which is as important as the daily tasks of feeding, cleaning and administering medication. Carers are failing in their role if they are timetabled to rush from one client to the next, giving little or no flexibility should a problem arise, and no time for those important moments of human contact - a brush of the hair, a massage of the hands, a hug.


None of the main issues are new issues; they have been evident for as long as carers have cared. They simply have been overlooked, probably because of financial resources and profit. Within our own service, we have developed a system of 360 degree collaborative support. Of course, we have the advantage of size - just three senior principal carers working collaboratively in a co-operative, each one of which brings to the service different skills and experience of care. We work on the basis that we will accept a limited number of clients, and each client will have a named principal carer who will take overall responsibility for them. All visits will be the subject of video log, accessible to relatives and other team members on the web.This addresses responsibility and accountability. The principal carer takes not just responsibility for the quality of care delivered, but for the funding of the care. This means that no principal carer will be directed as to resources, by a manager who may not know the practical details of the particular case. Furthermore, each principal carer will discuss the care issues in their case-load at regular monthly supervision meetings and fortnightly informal 'sharing meetings' at which all carers meet and discuss concerns and successes. These also form part of our process of on-going training - additional to gaining further qualifications and outside skills training.


Turning to the thorny question of resources and time, our service it must be said has a further advantage, in that we self-select our clients and give detailed direction on what we consider appropriate by way of care plan. Before taking on a client, we sit down with the client, their relatives and their funders to determine exactly what is needed, and then to look at 'extra care' - the important issues of emotional and social caring, including quiet time with a client, taking clients to appointments, attending when health care professionals visit, arranging visits by opticians, hairdressers, pedicures and dental care. Families are often surprised by the list of neglected care items, and frequently heartened by the relatively low cost of their provision. And intrinsic in our service is the timetabled opportunity for the carer to remain with a client after a scheduled visit. Yes, this comes at a cost, but then what is the alternative?...serial carers at short notice, clients being left or deserted by carers, and the sort of problems only too graphically described by the Equality and Human Rights Commission, and by Arifa Farrouq in her chilling expose.

The ideas here are the personal ideas of the author and may not be reproduced without permission and attribution to Stephanie's Bespoke Care Services.

Undercover probe

No food, water or medication: The grim reality of home 'care' for the elderly exposed in an undercover probe

By ARIFA FAROOQ

Last updated at 7:40 AM on 21st June 2011

BBC reporter Arifa Farooq went undercover as a carer for the 2009 Panorama expose Britain’s Homecare Scandal. Here she relives her experience and lays bare the horrifying truth about the industry.

The shambles of home care for the elderly was revealed to me in an appalling incident when I was sent to care for a terminally ill man who was doubly incontinent and in great pain.

The only way he could be moved was with a hoist, but I had received little training in the use of such equipment — indeed my only instruction in caring at all had been a few days of seminars and DVDs.

I was completely out of my depth as I looked at the poor man, surrounded by machinery and tubes. He really needed proper medical attention, not an inexperienced carer like me.

Neglected: Andrew Wilson was filmed in the documentary and told a reporter he had not had a bath for six months. The footage showed him being wiped with a flannel as a carer chatted on a mobile

I tried to treat him in the most dignified manner I could, but it was so difficult that I had to keep ringing the company office, asking for more support. Yet all my calls kept going through to an answering machine. It is an episode that haunts me to this day.

This incident happened while I was working undercover as a carer, doing an investigation into inadequate home care for BBC’s Panorama. The reality is that thousands of carers have no more experience or support than I did — and their elderly charges are equally neglected.

As a Muslim, I come from a culture in which the elderly are revered, and young people are taught to show them the deepest respect. But what I found during this undercover experience was shocking.

There was a constant state of pressure and crisis, so that the clients were not given the time they either need or have paid for.

While most patients have their care financed by the local authority — who outsource the work to private companies — some clients pay for private care.

During the making of the programme the level to which cost-cutting is the priority for local councils was painfully clear. An online auction decided South Lanarkshire council’s new care provider.

The company I worked for was the fourth largest in Scotland, yet there was always a sense of being short-staffed, of being rushed off your feet, of always desperately trying to cram in all our tasks, of not being aware of the real needs of our clients.

One of Scotland’s largest care providers, Domiciliary Care, won the auction — which saw bidders bidding down, not up. It agreed to provide care for just £9.95 an hour.

It was clear to me that the quality of care is massively compromised by the determination of commercial firms to make as much money as possible out of looking after the elderly.

Care is dominated by profit-making companies, with independent providers now controlling 70 per cent of the market. The sector is said to be worth at least £1.5 billion and is growing all the time, due to the ageing British population.

Shameful: Dementia sufferer Janet Finn, 89, was left on her own for 24 hours without food, water, and had to sit in her own excrement when her care visits were skipped for one day in June 2008

But the ever-more-lucrative nature of the market does not mean that the elderly are receiving a better deal. Far from it.

I should stress that all the carers I worked with were devoted to their jobs. They all wanted to do the best they could.

But, just as the Commission reported, they were up against a cash-orientated, corner-cutting system that meant that they could not do their work properly.

Nor was the logistic support adequate. For a start, we were given little training. Before I began my job, I received a few days instruction, which was hardly sufficient for the complexity of my clients’ needs. Then I was thrown in at the deep end, expected to cope with extremely vulnerable, sometimes very ill people. 

Many of our clients were bed-bound and needed intensive support, from the cleaning of their beds and changing their sheets, to feeding them and getting them dressed. To give a client a proper bath, for instance, could easily take half an hour, yet sometimes we had to be in and out of the home in five minutes, rushing off to the next client. The schedule was ridiculous, compounded by the lack of time allowed by the company for travelling.

There were other problems which made the system all the worse. One was the huge turnover in staff, which meant that the clients would be facing a bewildering array of new faces every week, hardly a way of establishing confidence.

And thanks to the chaotic rota system, these different carers would often know nothing about the needs of specific clients. We sometimes got into the ridiculous position of having to ask people what they required, which was hopeless if they were suffering from dementia.

This kind of difficulty should have been overcome by the official rule that every client was meant to have an individual care plan, setting out in detail all their needs.

Bad experience: Hayley Cutts was another Panorama journalist who worked in a care home - despite having just four days basic training

But these were often inadequate or even missing from the home of the client, which meant that we were operating in the dark. The casualness about the plans was indicative of the mess the system was in. 

I remember seeing a pile of them lying on the back seat of a manager’s car — despite the fact they were meant to be highly important and confidential.

But that was hardly unique. A fellow Panorama reporter, Hayley Cutts, also went undercover and her experience was as bad as mine. Again, she was pushed into a front-line job after just four days of training and, like me, she found that the amount of time set aside for visits was inadequate.

One of the firms Hayley worked for was Care UK, which had 15,000 clients and 48 contracts around the country when the programme was made. 

Yet one day in June 2008, her visits were skipped entirely. For 24 hours she had no food, no water, no medication and was left sitting in her own faeces and urine. She was found by her son in this terrible state of neglect. 

A graphic symbol of the appalling care provided by this firm was the case of Janet Finn, an 89-year-old woman from Hertfordshire who suffered from dementia and double incontinence, meaning that she required three home care visits a day, each lasting for at least half an hour. 

Partly as a result of the outrage over this case, Hertfordshire got rid of Care UK, though the firm still operates elsewhere. And the abuses continue.

In a civilised society, the impulse of compassion should be the driving force behind the care of the elderly. Those who have given so much to our society deserve to be treated with respect and dignity in their final years when they are at their most vulnerable.

Yet the recent scandals over abuses in residential homes, the maltreatment of older patients in NHS wards and now the home care revelations show that this is clearly not what is happening.

It is one of the tragic paradoxes of our society that our civic institutions and judicial system continually trumpet their commitment to human rights.

Indeed, the human rights agenda has become one of the central themes of modern civic life. Yet, when it comes to the rights of the elderly, they seem to have been forgotten.

Read more: http://www.dailymail.co.uk/news/article-2006022/Elderly-care-No-food-water-medication-And-caring.html#ixzz1PtrObkRP