Life in a Lancaster Area Nursing Home for the Elderly

Michael Nunn talks to a Care Assistant in the Lancaster/Morecambe area

Care in the Community
In November 2003 the BBC broadcast a Panorama programme called A Carer's Story. This was a galling and appalling account of one woman's undercover experiences working for local authority domestic care services for the elderly at home. Moved by the programme, I subsequently had an exclusive interview with Chris (not their real name), a care assistant in a private-sector nursing home in the local area. The establishment and its location have not been named, and Chris's gender has intentionally been left unspecified.

I have been familiar with care provision for the elderly, mainly in Yorkshire, with both parents casualties of age-related illnesses and conditions. My former partner also worked in local authority home for a number of years. But it seems that locally, the descriptions and impressions of others suggest that what Chris describes is far from unusual, and possibly common practice. Indeed in some places it is even worse.

As with so many policies introduced by the last Tory government, social concern, equality, quality and care have been sacrificed on the altars of the free-market economy and profit. As with the railways and utilities, the service in general and care for the elderly in particular have been the casualties of capitalism and personal greed. It is a grim legacy.

Background
The home where Chris works provides residential care for some 50 residents, most of whom have their own single rooms. Many suffer from dementia and related illnesses, and they have varying degrees of self-sufficiency. Chris has worked there about two years.

During the day, between 8.00am and 8.00pm, Chris says there are 10 people on duty consisting of two specialist-trained staff and eight others with varying levels of experience and qualifications. The gender of the staff is, quite properly, roughly 50/50 male to female. During the night, however, only four or five staff are on duty.

Not all staff are adequately trained. "Only some"- about half the staff -- are working towards the nationally-recognised NVQ qualifications in care, and this is funded by the employers or others. Observation of Health & Safety and other legal requirements is "mostly good". Regular GP visits occur, and Chris believes that the premises are largely "suitable for their purpose".

"Not enough time"
That's the good stuff. The reality, inevitably, is different from the home's publicity material and the reasonable expectations anyone might have for the way their parent or relative is looked after. General and personalised one-to-one attention by key workers is severely limited by time. Time, after all, as Benjamin Franklin said, is money.

"The worst thing is that there is not enough time for one-to-one care or finishing jobs properly", says Chris. "This means cutting corners on, say, lifting and the use of the hoists". There is some provision of appropriate equipment such as hoists, slings and wheelchairs etc. But, Chris says, "One sling one hardly ever gets used because it does not lift them up high enough -- it is not adequate for the job".

Worse still, these shortfalls are also endangering the health and well-being of the staff. "Care plans detail the use of a hoist, but some don't go by that and just use under-arm [lifting] techniques", Chris continues. " Some workers just lift them and hurt themselves. It is a 'non-lifting home', says the boss". The reason: "This is because it takes double the time to use the hoist". Ah yes, of course -- profit margins again.

It is not just the lifting. "There is no time for exercising the residents adequately", feels Chris, such as ensuring they are walked and can get about. The knock-on effect seen in Panorama's expose of cramming in visits into an unrealistic schedule is echoed here. "If we look after one properly [ie ensure they are properly exercised], "the next one suffers because of time".

Key workers
All residents, as is common best practice, have a nominated 'key worker'. Chris acts as such to several residents. That responsibility, too, is difficult to carry out because of the overall constraints of time and money. "As a key worker I never have chance to talk to relatives about these nominated residents", says Chris. I questioned that, but Chris stuck to never, not sometimes, or rarely. "Everyone's too busy to see them [the relatives]".

Cleanliness is another problem. "Sometimes residents' personal hygiene suffers because there is not enough time to see to their needs properly, like if we are rushing to do lunch". All residents are supposed to have a bath every week, but "sometimes there is not enough time, and some go a fortnight without being bathed". When you consider that residents are paying hundreds of pounds weekly for this non-service, this is a shocking revelation.

Explaining how the work varies during a typical day shift, Chris says that "2.00pm to 4.00pm is usually a quiet time, but we still have to clean commodes, wheelchairs, sluices". This too erodes the quality of the personal care for which the residents themselves, the families, the residents themselves or the state are paying so dearly for, often from scarce or arguably plundered resources.

Yet in spite of all this, management has recently takes steps to reduce staff working hours, with "overtime bans and cutting the numbers of night staff". Why? "It costs too much", came the swift, clear and inevitable reply.

Management shortcomings
Chris and colleagues have other problems with the management. "It's not very often we see management in the home working", says Chris. "There is no 'Management By Walking About [MBWO]", Chris continues. MBWO is a useful and widely-established management and communication technique exemplified by industrialist Sir John Harvey Jones by which staff can both see and be able to talk to management. The managers are "aloof and difficult to approach", feels Chris. It seems that management by fear is the order of the day. "A lot of people are nervous about seeing the boss". Such a non-conducive and unhappy atmosphere cannot be in the residents' best interests, nor those of the staff.

Regular staff meetings are another concern. "Staff meetings are meant to be held once a month", explains Chris, "but often they don't happen that often. I've only been to four or five this year [in late November]". Summing it all up, Chris and the other staff reckon that "Management don't keep us properly informed".

Communication within the organisation is poor too. "Staff are not always told about new arrivals and residents' details -- there is not enough time to look properly at care plans to assess a patient's needs. We don't always get proper briefings about how to handle the new arrival, and we do not get chance to see care plans when they arrive".

Other problems
Fear and an all-pervading unwillingness to take responsibility are also an issue that worries Chris. "There is one resident with a long-standing injury and whose limb is so badly swollen with retained fluid that we cannot take [their] clothes off at night when [the resident] has been wearing [their limb support]. The attitude [among the staff] is: I didn't want to take them to the hospital or have them attended to because I didn't want to be held responsible. It would cause too much trouble as the resident is thought to have had the injury in hospital".

There are gaps between promises and delivery -- i.e. the reality behind all the bullshit. Recreational activities, particularly traditional seasonal celebrations, do not happen as promised in the home's publicity. "A lot of them I've never seen done before", said Chris, looking at the list of events with some credulity.

The staff are paid £4.75 per hour, scarcely more than the national minimum wage of £4.50. Time and a half is paid for bank holidays and overtime, but there are no 'unsocial hours' allowances for weekends or nights, unlike in other demanding and responsible sectors.

Staff turnover is, not unexpectedly, high, with an average of one new staff each week. Looked at over time, this means that the entire workforce changes twice every year. Chris explains that "Many leave for better-paid work". So much for consistency of quality, standards, care and maintaining long-term, caring relationships with the residents. Shareholders' dividends and cash in the till come first.

Workers' morale
Inevitably, morale in the home is poor. Chris explains that "It always feels as though no-one ever appreciates anything you do there". Whilst there are some employees of integrity who have a genuine care for the residents and their work, Chris, who is demure and given to a generous modesty, told me that morale is "varied". Common complaints among the staff are the poor wages, time pressures and lack of proper breaks. These are limited to a maximum of only twenty minutes for each break throughout the working day -- not much use if you need to go to the bank, do shopping or whatever, let alone grab a decent meal.

The way the staff are treated is unfair in other ways too, Chris feels. "The rota has been 'frozen' for the week an inspection is planned, and it seems that management has made sure all their favourite staff will be on duty". Sounds familiar? "Normally there is some flexibility for the staff" to cover for the unexpected such as sickness etc, and to give employees the chance of a breath of freedom when other commitments crop up.

Food for thought
Feeding the residents is another area that suffers. Whilst there is some choice of food, and individual dietary requirements are observed, breakfast is the same every day unless the resident requests otherwise. "Many cannot communicate adequately, and you can see that they do not like what they are served", says Chris.

The day we spoke, Chris said the lunch that day had been a choice of "tasteless" poached haddock, or turkey in a "sort of cream sauce". And Chris, who loves plain, well-cooked food, is neither fussy nor has extravagant tastes. These choices came with mashed potatoes ("every day") and two vegetables, and was followed by a "not very nice" lemon meringue. The evening meal had been crumpets, quiche and the like. Yummy, or crummy?

But this is an area which also suffers from the ubiquitous lack of time to do the job properly. "Sometimes we just tick the menu sheets if there is not enough time to ask all the residents what they actually want. Sometimes vegetarians end up with meat and potato pie".

As for the quality of the food, there is "Little care taken over preparation, things are just chucked into a pot and cooked". Even worse, there "never seems to be enough food there", says Chris. Meanness in hospitality is a mortal sin in my book: would you treat your parents like that? It sounds worse than the Victorian workhouse or something out of Dickens to me.

"I would not be happy … ended up with a bad back"
Chris is clear about what might happen should either a parent or a relative need specialised care in their dotage. "I would not be happy for any of my family to go there because they would not get the care that they deserve, or treated with respect as individuals".

Now Chris is an ordinary, cheery, decent soul with no evidence of hypochondria, and a good sickness record, but is distinctly unhappy as a result of the unreasonable, and possibly illegal, pressures of work. "I have ended up with a bad back now and then because of having to cut corners with the lifting and preparation tasks like raising beds". Survival of the fittest. Maggie's 'morality' again.

SOME COMMENTS

Panorama revisited
"There's anxiety, stress and a loss of dignity and I just don't think that people deserve that at the end of their lives", said Fran Baker, the reporter whose narrative was the focus of the BBC programme. Nor do those who are younger (Chris has yet to see 30). Many of the comments on the website from those who had seen the programme said they had been moved to tears by it -- and many of those so moved, significantly, were men.

For me, it recalled Tony Harrison's remarkable and moving television film Black Daisies for the Bride. That never fails to make me cry, with its agonising portrayal of "the monstrous adventure/Of Alzheimer's dementia". But it is not just the victim of old age who is suffers. "All life's brightest moments, filling hearts and heads", Harrison says, "Alzheimer's, like a blizzard, rips up into shreds".

The extension of this is that we too, surely all of us, family, friends, carers or anyone with a heart or vague political consciousness, suffer as a result of the disease and associated conditions. Worse, though, we are all touched by the appalling chasmic lack of gentleness, humanity or professionalism in standards in care and provision that this government continues to subject and expose those in need to.

But there are ways of tackling the problems Chris has described. The current UK economy, the lack or resources in the health and related services, privatisation and local authorities, as well as the less scrupulous private care home proprietors, undoubtedly are all to some extent to blame. Some responsibility must also lie on the friends, families and relatives of those who are in such accommodation.

A political issue
The grisly and evil spectre of Sir Keith Joseph, and the other ghouls whose sole mission in life was to exploit the less well-off, still stalks Lancaster even now, no doubt rubbing their grasping hands with Scrooge-like glee. Reflecting that Thatcher herself is now thought to be suffering from dementia, I wonder how she and her privileged like would cope in this particular home, or with living in socialist Sefton or blue-rinse Brighton as shown by the BBC.

Unfortunately, it seems that there is little prospect of this particularly inhumane aspect of Thatcherism improving under the present 'socialist' government. Private financing, 'foundation hospitals' and denationalisation look set to be pursued with even more vigour, rather than the state taking full responsibility, financially and otherwise. The state has largely abnegated its responsibility for ensuring everyone, particularly the elderly in this case, receives the care, respect and dignity they deserve -- when they need it and regardless of ability to pay.

Personal responsibility and advocacy
There are opportunities for those who visit their loved one in care home. Concerned relatives can demand to see a resident's care plan and to talk to a responsible member of staff. They can also keep a watchful eye open for things that are not right -- with the other residents as well. "These situations wouldn't arise unless relatives allowed them to", was the forthright view of one former social worker who spoke to me recently.

She is right to some extent; but often it's a case of 'what the eye doesn't see'. Of course, we visit our relatives not just because we love them, but we can also take the opportunity to advocate on their behalf to prevent such abuses, short-cuts and bad practice. "Vulnerable people will most certainly be neglected/abused in our society unless people advocate for them, not only en masse, but also individually, case by case", she feels.

"An absolute disgrace"
So many elderly people feel betrayed, especially those, like my parents, who fought in World War II and were genuinely convinced by the post-war Labour government that free care was for life. My own mother trained as a nurse during the war, and worked on the wards till she was forced to retire at 60. Now her house, all her savings, pensions and valuable possessions have been sequestered in order to pay for her care since she is no longer capable of looking after herself. Never a woman to mince her words, it was an "absolute disgrace", she felt before the lights dimmed too much.

How are your parents and elderly relatives, by the way? Are they comfortable, clean and well looked-after? You know what to do if there is any doubt in your mind.

Copyright © 28 January 2004 Michael Nunn

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