Poor Care of Elderly in UK Govt. Hospitals

Doctors, nurses, politicians, bureaucrats, patients and the public, in short, everyone in the UK, have been stunned by the results of two inquiries into dreadful conditions at a hospital in the Midlands.

A report in 2010 into Stafford Hospital found that hundreds of patients had died unnecessarily and that conditions were sometimes unspeakably bad. Some patients were left in excrement-soaked sheets and some had to drink from dirty flower vases because nurses failed to bring them water.

A second report by a leading barrister, Robert Francis, into the causes of this disaster makes depressing reading. He found that there had been a total collapse of the system at the Mid Staffordshire NHS [National Health Service] Foundation Trust, which is responsible for running the hospital. In the report, which was released earlier this month, Mr Francis writes:

"This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety. Patients were let down by the Mid Staffordshire NHS Foundation Trust. There was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed, and fundamental rights to dignity were not respected."

Mr Francis's brief was to identity the reasons for the breakdown in care. He made 290 recommendations to change the toxic culture at the hospital and to make sure that patient care comes first, ahead of financial targets.

Some of the more important recommendations are that failure to comply with standards should be a criminal offence if death or serious injury results; misleading patients, the public or regulators should be a criminal offence; nursing staff should be trained to give compassionate care; and a NHS leadership college should be established to ensure high standards.

The reaction of the UK government was entirely predictable. Prime Minister David Cameron denounced the enormity of the failure, apologised to patients and their families and promised root and branch reform. However, the scepticism of Mr Francis about whether this will actually happen is frightening.

"The experience of many previous inquiries is that, following the initial courtesy of a welcome and an indication that its recommendations will be accepted or viewed favourably, progress in implementation becomes slow or non-existent...

"Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated or that the risk of a recurrence was so low that major preventative measures would be disproportionate. The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction."

The reports can be downloaded at the Inquiry's website.

Mickey Rooney on Elder Abuse

Mickey Rooney, the Hollywood icon who testified before the US Congress about his experience with elder abuse, stars in an 82-minute documentary, “Last Will and Embezzlement”. It has a certain relevance to bioethics: the growing incidence of elder abuse has been flagged as an important reason why it would be dangerous to legalise euthanasia. ~ cross-posted from BioEdge

Watch this YouTube feature.

Elder Abuse and the Work of Marie-Therese Connolly

Marie-Therese Connolly

As she crafted her closing argument in a case against a Seattle area man who was charged with allowing his elderly mother to literally rot to death, prosecutor Page Ulrey struggled to find the right words. So she called Marie-Therese Connolly, a former Department of Justice lawyer who knew just what to say:

The role of caregiver comes with a legal and moral obligation.

And even though the son had said his 84-year-old mother, Ruby Wise, had wanted to die at home with dignity, not in a nursing home, there was nothing dignified about the way she spent her final days — emaciated at 72 pounds, covered in sores so deep that bone was visible through rotted tissue, in a bed stained with urine, feces and blood. Last year, Chris Wise was convicted and sentenced to three years in prison.

Connolly, who for years has been trying to place elder abuse in the national spotlight, will be a awarded a MacArthur Fellowship, the US$500,000, “no strings attached,” so-called “genius” grant given annually to a couple dozen artists, thinkers, social advocates and historians.

Connolly, 54, a senior scholar at the Woodrow Wilson International Center is the architect of the Elder Justice Act, a law passed by the US Congress last year. The $500,000 grant, which will be awarded on Tuesday, will aid her ground-breaking work.

Ms Connolly has also founded a non-profit, Long Life Justice, to fight elder abuse. Here are some facts and figures from the website:

7.6-11% of people 60+ at home are victims of elder abuse, neglect or exploitation.

47% of people with dementia at home are abused or neglected by their caregivers.

For every one case of elder abuse that comes to light, 23.5 do not.

50-90% of nursing homes are understaffed at levels that harm residents.

"Elder abuse includes abuse, neglect and financial exploitation. It occurs in homes and facilities; cuts across all demographic groups; and causes untold suffering and cost, not just for its victims, but also for those who care about and for them. Victims often live their last years--impoverished, injured, neglected and in fear--with little effective assistance, protection or attention from any system.

"Victims of elder abuse suffer more injuries and illnesses and are three times more likely to die sooner than non-victims. In addition to depleting the resources of already stressed individuals and families, elder abuse costs taxpayers billions of dollars annually in Medicare, Medicaid and other federal, state and local program expenditures.

"We are at the early stage of a hidden epidemic. As 77 million baby boomers age and caregiving shortages grow more acute, the problem will grow. Wealth and fame do not provide immunity, as the plight of Mickey Rooney and Brooke Astor show. A 2011 General Accountability Office (GAO) report documents the need for more funding and federal leadership. Yet, our response to elder abuse lags 40 years behind child abuse and 20 years behind domestic violence." ~ True Dignity Vermont, Sept 24
 
 
Related reading:  Elder Care and Abuse Prevention; UK Hospitals Criticised for Elder Neglect

UK Hospitals Lack Compassion for Elderly

A harrowing report on care for the elderly has accused the UK hospital system of lacking care and compassion and failing to meet even the most basic standards of care. Ann Abraham, the Health Service Ombudsman for England, detailed the treatment of 10 people.

"The investigations [she writes] reveal an attitude - both personal and institutional - which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care, in clean surroundings in hospital is not being fulfilled."

The stories do not make easy reading. Nine of the ten patients died before the report was published. Basic needs - cleanliness, sufficient food, nutritious food, water, wound dressing - were often neglected, especially if the patient was confused.

But Ms Abraham faults the attitude of the staff of the National Health Service more than its diminishing resources. "The difficulties encountered by the service users and their relatives were not solely a result of illness, but arose from the dismissive attitude of staff, a disregard for process and procedure and an apparent indifference of NHS staff to deplorable standards of care."

In the same week in which the report, "Care and compassion?" was published, the NHS announced that it was shedding 1,000 jobs at two London hospitals. This underscores the unsettling vision of what the future holds for the elderly which is painted by the report:

"These complaints come from a population of health service users that is ageing. There are now 1.7 million more people over the age of 65 than there were 25 years ago and the number of people aged 85 and over has doubled in the same period. By 2034, 23 per cent of the population is projected to be over 65. As life expectancy increases, so does the likelihood of more years spent in ill health, with women having on average 11 years and men 6.7 years of poor health. Nearly 700,000 people in the UK suffer from dementia, and the Alzheimer's Society predicts that this figure will increase to 940,000 by 2021 and 1.7 million by 2051. The NHS will need to spend increasing amounts of time and resource caring for people with multiple and complex issues, disabilities and long‑term conditions and offering palliative care to people at the end of their lives."

The unsettling conditions described in the report will certainly have an impact on the "dying with dignity" debate in the UK. If bad food, horrid nurses and soiled nappies are what Britons can expect in the final years, some of them will surely want to avoid the distress and humiliation. ~ Health Service Ombudsman

Elder Care and Abuse Prevention

Carolyn L. Rosenblatt

Carolyn L. Rosenblatt

The term “elder abuse” sometimes makes us think of a scam artist selling a bogus financial investment to older people. Sometimes we see ads from the local District Attorney’s office showing bruised faces of an older person, and we are horrified. What does the term really mean?

The National Committee for the Prevention of Elder Abuse defines it as “any form of mistreatment that results in harm or loss to an older person”. It is usually divided into the categories of physical abuse, sexual abuse, domestic violence, psychological abuse, financial abuse, and neglect/self-neglect.

Since elder abuse has been called “the crime of the century”, it is important to be aware that with elders at home, it can be a crime of opportunity for the worker. Financial abuse affects millions of seniors, as most of us know. Preventing it must include a consciousness of protecting elders at home from those who enter the home freely and who work unsupervised for long hours.

The resistance of the aging person himself or herself is just part of the picture. Getting past the resistance is usually the job of the adult child, who may be the first to see the need. According to Erin Winter, co-owner of Hired Hands Homecare Inc., in Novato, California, “about 75% of the elders we serve don’t think they need help when it is obvious to those around them that they do”.

One must gently push ahead, presenting the idea that the help is needed for the peace of mind of the adult child. It’s the “humor me” approach. It seems to work, for most, Ms. Winter reports. If the adult child is able to persuade the elder to try it, and the worker is consistent, kindly and respectful of the elder, the elder actually may be relieved to have the help.


Weigh the costs versus the care

Choosing the worker is a different challenge. Many people, worried about the ongoing expense of having help at home, which can be as much as $27 an hour and up, seek helpers through the newspaper or general internet advertising. Invariably, it is cheaper to go this route than to use a home care agency to find a worker. We suggest that it is far more dangerous to hire a worker independently.

If the statistics on identity theft and financial elder abuse are not enough to convince the consumer to use an agency, consider the economic times. Desperate people, even those whom you think you know, can do desperate things. The temptation to take money, valuables, or misuse a credit card can be overwhelming for a worker whose spouse has lost a job, or who feels economic pressure in this recession. A licensed agency offers several layers of protection for the consumer.

First, the agency doing its job properly will do a thorough background check of every worker. This should include a national criminal records search. Hiring on one’s own seldom involves checking anything more than the applicant’s references. Those, as we know, can be falsified. Next, the agency should be insured, bonded, and licensed. If a worker steals, at least there is a remedy.

If a worker one hires from a newspaper ad steals, it might just be too bad. Homeowner’s insurance may or may not cover the loss. The deductible may be too high to make it worth making a claim. Identity theft would likely not be covered by such a policy.


Do your research
Finally, a quality employer agency providing home care workers will screen for suitability for the job, may do drug testing, and will train and supervise its workers. It will also replace them if one leaves suddenly. Many workers in this field have roots in other countries, and leaving the job for family emergencies or other reasons, to return to one’s home country, is not uncommon.

The vulnerable elder who hires on one’s own does not have the capacity to replace the worker as quickly as an agency can. Not all agencies are alike, and not all are employer agencies. Do your research on the agencies you are considering. Longevity in the field is a good sign. With the increase in need, new agencies are springing up rapidly to meet it, making it harder for the consumer to check on past performance of the agency.

Doing your own background checking is essential if the agency checks only your state. Ask about the training and supervision of caregivers. Not all agencies provide this. Some use certified nursing assistants, and some do not. We believe that the extra cost of using established employer-model agencies is well worth the security they can provide to keep elders safe.

Those agencies which place independent contractors only are out of the picture to monitor quality or to supervise the workers, once they are placed and the placement fee is collected. It is certainly much simpler for the agency to keep only independent contractors as workers, but is more risky for the recipient of services. In many instances, reliance on an elder’s ability to monitor care, especially when the elder has cognitive impairment, does not make sense.


What’s the takeaway message here?

Follow these tips, and enhance your chances of safely using a home care worker to help an aging loved one stay at home.

1. Meet an aging loved one’s resistance to help at home with the “humor me” approach (it’s for your sake), and keep respectfully urging when you see the elder resisting.

2. Use an established, employer-model home care agency to find a qualified home care worker for an aging loved one.

3. Do your research on the agencies you are considering. Not all are employer agencies, and not all provide training and supervision. A supervised worker is safer for an elder.



--Carolyn L. Rosenblatt is an R. N. and Attorney at Law who specializes in elder care issues. For more useful tips on how to make the best choice of a worker, and consumer information about the pros and cons of hiring on your own are available in The Boomer’s Guide to Aging Parents, Vol. 2, How to Choose a Home Care Worker, at http://www.agingparents.com/