What future for residential care? Years ago I stood on a conference platform and suggested ” no future at all ” but this outdated form of provision has hung on, bolstered by the growth in the frail elderly population and the lack of suitable alternatives. It is also the warehouse of choice for social service funded residents with dementia. Not a good option, but an out of sight, out of mind one.
Sadly, dementia affects many of the people who are forced to move into residential homes. Only in extreme circumstances can it be right to consign someone with dementia to a life lived with lots of other residents who also have dementia. The confused leading the confused!
For the time being, and probably for a long time to come, the sheer size of the residential care sector and the continued growth of the frail elderly population makes this type of provision essential. To make the best of it, requires a much more highly skilled and better paid workforce.
Set against the backdrop of the precarious Southern Cross example (click on the Archive and see my blogs dated 29 June 2011 and 5 July 2011), this is not a good place to start. Nor is the Southern Cross situation an isolated case. Many other residential care operators are heavily indebted and have been forced to put profit before quality. When quality fails, occupancy falls and profit margins evaporate.
A rescue for this sector can only be engineered with a greater injection of funds. In the short-term this can only come from the public sector. Since there is no new Government money allocated to Social Services, new resources must come from a reallocation of NHS funds. This will be difficult to manage and will be a hard-fought transformation, but in the end it is probably the only way of keeping the residential care sector alive.
So what is the vision?
It seems sensible to start with dementia, since these patients are least able to be coped with satisfactorily within the NHS.
The first issue must be to improve diagnosis, since many elderly people who are confused, do not necessarily have a long-term condition of dementia. However, left without proper diagonosis they may well end up in a dementia home. The problem is that the fear of dementia is so great, that at the first sign of forgetfulness, elderly people are easily branded as senile. In turn this can lead to late diagnosis, as residents and relatives fail to confront the situation for fear of being ‘put into a home’. In fact their confusion and memory loss may be due to depression or something as easily treated as a urinary infection. Mis-diagnosis or no diagnosis at all, just assumption, can start you on the slippery slope of marginalisation, isolation, and incarceration.
Once an elderly person has a confirmed diagnosis of dementia, they need a personalised care environment and individualised, rather than institutional support. This suggests either smaller homes or sub-divided larger homes with a house group format. Maintaining people’s individuality is a key to a happier life, even with deteriorating mental health. It is possible for someone with dementia to lead a contented life, provided their support is tailored to their own personal needs, but to do this needs almost constant and skillfully observed attention and care. That is why spouses are able to cope for so long providing care in the home. They can read and interpret the early signs of distress and deliver an appropriate response. They also provide familiarity and continuity in an environment which is slowly fragmenting for the confused partner.
In my New Later Life Vision for dementia, much more support would be given to carers. They are a life line for their loved one – a last vestige of normality.
The dementing older person doesn’t just need wrap-around care, they need stimulation and interest in their lives just the same as anyone else. The boredom of a residential care lounge, with residents sitting in a circle around the edge of the room, or mindlessly watching television, only exacerbates confusion.
The New Vision of Later Life for people with dementia:-
Initially, there would be much more support for carers and a greater emphasis on enabling the sufferer to remain at home. This would also encourage people at the first signs of forgetfulness to come forward and seek help. The first stage of better support would be a more extended observation and assessment of the condition to eliminate the possibility of mis-diagnosis. Thereafter care at home would include frequent pop-in visits and escorted trips out to a social club, village hall or pub at least once a week. This is designed to give respite to carers as well as to the dementia sufferer. Several respite away breaks would also be planned each year to give relief from the slow decline into a lost world. All this will only be afforded by greater funding of preventative care, starting with using Attendance Allowance specifically this purpose.
For people living on their own and for couples, eventually, a move to residential care may be an inevitable outcome. To make it much more desirable, the new later life residential home will offer care and support based exclusively on the former life of the resident, not for them to live in the past, but to be surrounded by familiar things – beyond family photos – their own furniture and lifetime accumulated possessions. Equally important, someone who understands the significance of all these memories and can plan a unique support plan around them. The staff themselves would be specially trained in dealing with dementia, over and above the basic care skills. In the ExtraCare Charitable Trust, after a three year study by Bradford University, we developed a new post of “Locksmith” whose job it was to design an individual Enriched Opportunity Programme for residents with dementia. The “Locksmith” title symbolised the need to unlock the memories of a forgotten life and recreate familiar clues in a new life.
A number of specially skilled and trained volunteers would be needed to support this model of care. They would be drawn from family members and people who had previous experience as carers for those with dementia.
An active challenging life planned together in this way can provide a much more positive outcome to living with dementia.