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Welfare Reform on the Web (April 2012): Care of the elderly - UK

Addressing the nutritional needs of older people in residential care homes

J. Merrell and others

Health and Social Care in the Community, vol. 20, 2012, p. 208-215

Malnutrition in older people is a significant and continuing problem in the UK and Europe. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutrition of care home residents are not always implemented. This qualitative study examined the factors that influence the nutritional care provided to residents in two different types of local authority care home in Wales. Data were collected from semi-structured interviews with staff, residents and relatives, observation and documentary review between August 2009 and January 2010. Results showed that policy directives and national guidelines regarding nutrition in care homes were not being implemented in practice. A need for further staff training on the nutrition of older people is identified and an enhanced regulatory focus on addressing nutritional needs in care homes is proposed.

The age old excuse: the under treatment of older cancer patients

Macmillan Cancer Support


The report found that deaths from cancer were reducing in most age groups, but were doing so at a slower rate in those aged 74 to 84 and were increasing in those aged 85 and over. Treatment options were too often recommended on the basis of age and not how fit the patient was. Cancer is more common in the elderly but was in many cases diagnosed late, further reducing the chances of successful treatment. Moreover, many older people decided to refuse treatment or ruled out certain options because they did not have the support at home or transport that would be needed for repeated radiotherapy or chemotherapy sessions. Few clinical trials involved older people so clinicians lacked evidence on the effectiveness of drugs and few cancer specialists had any training in geriatric medicine.


Can social care ever really co-operate with health?

J. Smith

Caring Times, Mar. 2012, p. 16

With acute hospitals failing to provide basic care for elderly patients, the author asks if the NHS and social care providers will ever be able to work effectively together. Social care remains underfunded compared to the health service, and the two are managed through totally separate lines of control, each with their own mandates, cultures and aspirations.

Care home safety standards 'getting worse'

J. Bingham

Daily Telegraph, Mar. 14th 2012, p. 13

A survey of about 600 nurses carried out by the Royal College of Nursing showed that one in ten believed that residents in their care home were not being well looked after. Nurses warned that care assistants, often without formal training, were regularly taking charge of homes and that facilities were not fitted with the equipment they needed. More and more people were being sent from hospital into care homes that did not always have the staff or resources to cope. Nurses blamed a drive to fill empty spaces in care homes and simultaneous efforts to free beds in NHS hospitals for the situation.

(See also Guardian, Mar. 20th 2012, p.7)

Delivering dignity: securing dignity in care for older people in hospitals and care homes. A report for consultation

Commission on Improving Dignity in Care

NHS Confederation, 2012

This report by a commission made up of Age UK, the NHS Confederation and the Local Government Association found that undignified treatment of older people in the NHS and social care was rooted in the discrimination and neglect they routinely suffer in British society. It said that age discrimination was the most common form of discrimination in the UK. It concluded that the government needed to take a lead by setting a positive tone for debate about population ageing, celebrating the contribution that older people make rather than casting them as a problem to be solved. The report calls for a 'major cultural shift' covering training and regulation of care workers and medical staff. Denigrating expressions such as 'bed blockers' which imply that older people are a burden should be outlawed, as should the practice of addressing them patronisingly as 'dear' or 'chuck' without permission. Among other recommendations are that universities should reject candidates for medicine or nursing courses who show a lack of basic warmth or compassion; that potential home care assistants should be observed working with older people before being offered a job; that all care staff should have a good grasp of English; that hospitals and care homes should introduce new whistle-blowing procedures and that managers should be more readily available to staff on the ground at night. The report also calls for family members to be directly involved in care, for homes to set up residents' associations to give occupants a say in matters such as choosing menus, and for Skype to be installed to allow residents to talk to relatives who cannot visit. Suggestions for hospitals include incorporating short biographies in patients' medical records to help staff understand them as individuals.

Dementia is a crisis on the scale of HIV, says Cameron

R. Mason

Daily Telegraph, Mar. 26th 2012, p. 2

In a speech in central London, the prime minister argued that dementia was a scandal being ignored as he announced a doubling of funding for research into the illness to 66m by 2015. As the NHS struggled to meet the 19bn annual cost of treating dementia patients, Mr Cameron said he planned to improve research on living with dementia and to fund an academic centre to investigate the causes of the condition. He also wanted to encourage people to volunteer for tests to help identify signs of the early onset of the disease.

Don't let us down on care funding reform, alliance tells Andrew Lansley

D. Brindle

The Guardian, Mar. 5th 2012, p. 2

Pressure was piled upon the beleaguered health secretary, Andrew Lansley with a blunt warning from groups representing millions of elderly and disabled people that they would not stand for "empty promises" on reform of care funding. In a joint letter to Lansley, the biggest ever alliance of charities, care home organisations and housing providers said the government must not duck its commitment to deliver reform when it published a social care white paper later in the year. The warning came amid reports that Downing Street feared the white paper could turn into a repetition of the government's NHS shake-up, the poor presentation of which was widely blamed on Lansley. Officials at No 10 were said to have stepped in to influence the policy process.

Elderly 'denied basic services'

D. Bowater and J. Bingham

Daily Telegraph, Mar. 7th 2012, p. 1 + 2

This article reports on the gathering campaign for reform of the system for care of older adults. Activities included a mass demonstration outside Parliament by 1,000 older people, a letter to the newspaper supporting a move in the House of Lords to protect the human rights of older people receiving care, and publication of a critical review by the Care Quality Commission.

(See also Daily Telegraph, Mar. 2nd 2012, p.18)

Elderly in care homes 'are losing out on basic health services'

J. Bingham

Daily Telegraph, Mar. 29th 2012, p. 10

Data were gathered by Nuffield Trust researchers from an analysis of health and social care records of older people in four areas. Most of those receiving care of some kind had been to a hospital in the previous year, either as an emergency admission, for an operation or as an outpatient. However, while 73% of those being cared for in their own homes had been admitted to hospital in that period, only 58% of those in care homes had. In more routine matters, those living in care homes had an average of 1.09 outpatient appointments in a year, whereas those not receiving any care had almost twice as many, an average of 1.99 appointments. This could be either because care homes were acting as a substitute for hospitals , meeting most of their residents' needs, or because residents had 'reduced access'.

Elderly may be forced to pay care bills up to 100,000

T. Ross

Daily Telegraph, Mar. 23rd 2012, p. 7

George Osborne hinted in the 2012 budget that the burden of funding services for Britain's growing elderly population should not fall on younger generations. Some officials were thought to favour a scheme that would see all but the poorest pensioners meeting the full cost of their care. The Department of Health was said to have modelled a plan under which the cap on payments would be set at 100,000.

Failing the frail: a chaotic approach to commissioning healthcare services for care homes

C. Carter

British Geriatrics Society, 2011

In March 2010 the Care Quality Commission (CQC) conducted an on-line survey of PCTs about their services for people living in care homes. CQC gave the data to the British Geriatric Society and the Society commissioned a secondary analysis to further inform its campaign about the quality of care in care homes. There are concerns about the standard of, and access to, healthcare enjoyed by the 375,000 older people in England who live in care homes, who typically have greater and more complex health needs than their peers who live in the community. Improvements in their access to healthcare would benefit this population and reduce unplanned and costly demands on the NHS. CQC's survey was the first part of a two stage review of healthcare in care homes and with the exception of the data on whether response standards were met, the data refers to the position on 31 December 2009. CQC used a basket of nine exemplar services that older people were likely to use to test the specialist primary care PCTs provided to people in care homes and to their counterparts in the community. One of CQC's concerns was unequal provision and differential access to services between those living at home and those of equivalent age living in care homes. They also explored whether PCTs provided enhanced GP services as they could not evaluate mainstream GP services due to the lack of data. As befits a regulator CQC treated 'don't knows' as negative answers.


Nurses too busy to help elderly patients with their basic care

R. Smith

Daily Telegraph, Mar. 20th 2012, p. 1 + 2

One in three respondents to a Royal College of Nursing (RCN) survey asking about care of older people in NHS hospitals said they did not have time to help patients eat or use the lavatory because of unacceptably low staffing levels. The RCN is calling for more nurses on geriatric wards because these patients often have more complex needs yet staffing levels are lower. Geriatric wards should have no more than seven patients per nurse and ideally five.

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