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.