Dolphins, Dementia and Swimming

“Incredibly interesting”  are the words Professor Simon Lovestone an old age psychiatrist at Oxford University uses to describe a study of dolphins with dementia.

It is a collaboration between researchers in Florida and Scotland based on examining the brains of dolphins washed up on a beach in Spain.     Laura Phipps of Alzheimer’s Research UK commented “It is fascinating and could provide valuable insight into the disease”.

Of course, as always, much more research is needed before any useful conclusions can be drawn.   All the researchers will no doubt be prepared to do the vital work, if someone coughs up the money.   Possible further subject areas include:-

  • Why dolphins like Spain ? This is a three year study which will need the researchers to spend a lot of time on the Costa Del Sol, waiting for the dolphins to wash up.
  • The Scottish team wish to examine the links between dolphins, whiskey and forgetfulness.
  • In Florida they want to research if dolphins are safer staying in theme parks remembering tricks, rather than swimming in the open sea forgetting things.

All the Universities agreed to do collaborative research on luxury hotels.

Meanwhile the Government Dolphin Scientific Study Commission has recommended, as a preliminary precaution against dementia:-

ALL PEOPLE OVER THE AGE OF 65 SHOULD SWIM IN THE SEA EVERY DAY AND EAT A LOT MORE RAW FISH.

Posted in Dementia, N.H.S., SMILES | 2 Comments

My Garden Age 70

My garden is growing faster than me,

 steadily,  constantly, relentlessly.

Some of the trees, shrubs and flowers,

were there before me and will be there after me.

 

I was born into my garden age,

to nurture the things around me.

 

I hope I have left my mark,

that vistas are different after my visit.

That my life’s work,

has made a better vision.

Posted in SMILES | Tagged , | 3 Comments

Bed and Breakfast Hospitals

My last post wrote about NHS England’s whacky ideas about fixing obesity.

Now, here comes another one, this time to solve the bed blocking problem.   At any one time there are estimated to be 5,800 patients in hospital beds who don’t need to be there.     The problem is they can’t go home because there is nobody to look after them. Especially in winter.

In sunny Southend they have a novel idea —- fill up all the empty B&B’s.   It helps the local economy and emptys lots of hospital beds.  What could possibly be wrong with that?    Throw in a few microwave meals and the occasional phone call from a ‘qualified’ carer and you have a service that is at least as good as the care in Southend hospitals.

I am not making this up, it is a proposal being considered at Southend University Hospitals Foundation.   The Care Rooms idea will offer £50 per day/night to people who will provide beds to patients who can’t be discharged home.   It would save the NHS money and release a hospital bed for other patients.

Of course it will probably never happen.    It is too simple an idea to ever work in the paralysed, burocratic, risk-obsessed world of the NHS.    The clinicians will be concerned about infection, because hospitals are so, so clean compared to homes.    The trade unions will probably oppose it, because it is privatising the NHS again.    The British Medical Association will certainly object, because it is a change and they don’t like any change, unless it means more money for doctors.    The army of hospital managers will need several more managers to manage the B&B’s and will also worry about who will be blamed if someone gets ill again and sues the NHS.     No-win no-fee lawyers will already be standing at the hospital gates.

Finally, the politicians will kick up a fuss just to get themselves noticed.   They will raise all sorts of arguments initially, but leave enough room to claim they were always fully behind these innovative and imaginative proposals if they turn out to be successful.

Posted in N.H.S. | 1 Comment

Fat Lot of Good!

The latest daft idea to come out of the NHS strategic think tank 😀

Not before time the NHS is stepping up its campaign against obesity.    NHS England’s great idea in their fight against the nations gluttony epidemic is to ban bumper chocolate bars from all the shops and vending machines in hospitals.   It obviously has not occurred to them that people might by two small bars instead !

However, they have  thought deeply about this new policy  and just in case visitors might be tempted to circumvent this excellent initiative they will have to be strip searched as they enter the hospital.    They will be allowed to bring in a banana, an apple, an orange, grapes and a carrot.    This fits with their earlier great healthy eating program of FIVE pieces of fruit a day.

If this doesn’t work they are already planning the next even bolder step.   Banning food altogether !   This is estimated to save the NHS over £ 2.4 billion a year even after the redundancy costs of letting go of all the catering staff.   Fortunately, they anticipated this possibility and contracted out the catering service several years ago.

This imaginative approach by NHS England has also begun another train of management thought.   The  cleaver new gimmick of “STEP” ( Strategic Thinking Exercise Program).    Under the fight against gluttony, all patients will be expected to get out of bed each day and complete a rehabilitation exercise program.   They will be given a mop and bucket and be required to clean the wards and hospital corridors (being careful to mop around the patients waiting on trolleys).    The FAGSTEP program has been calculated to provide at least another £1.3 billion in savings.

Many of us will not realise just how far-thinking our NHS England leaders are.  They anticipate that once it is fully rolled out, not only will they have saved £ billions,but many patients will wish to discharge themselves early to avoid starvation, thus solving the bed blocking problem !

All from banning a bumper chocolate bar 😀

Posted in N.H.S. | 1 Comment

Dementia Friendly Hospitals?

The Government has announced a new iniative on this, which is to spend £50million making hospitals and Care Homes “dementia friendly” .

I am intrigued, because hospitals by their very nature are strange environments for people with dementia.   What possible miracle can they come up with?     Or are they just trying to grab another headline at this year’s Alzheimer’s Association International Conference to counter the bigger headline, which is ” 1 million is the true figure for U.K. Dementia cases “.

So I looked at the Government website which indicated that they had been working on this issue since 2012.  Now their second phase of the programme was focused on implementing the “Dementia Friendly Hospital Charter” which has been produced by the Dementia Action Alliance.

The charter is a brief pamphlet – just six pages long – which spells out in straight forward language what they think hospitals and care homes should do to make themselves more age friendly.  It has 8 sections which cover staffing / partnership / assessments / care / environment / Governments / feedback.

In total the brochure contains 40 separate recommendations, some of which are blindingly obvious, such as:- (my observations are in blue)

  • Staff should be trained in dementia awareness;                                                               Whilst this is obvious, it doesn’t often happen in hospitals or care homes because of the frequent use of agency staff.
  • Encourage patients to eat and drink;                                                                                         All too often there have been reports demonstrating that this doesn’t happen.  Usually because residents need one-to-one assistance / encouragement.
  • Appropriate staffing levels and skills mix;                                                                              The biggest ommision in these recommendations is that there is no quantification of staffing levels or skills mix and without appropriate staffing, very little else can be achieved.
  • Flexible visiting hours;                                                                                                                This is an essential measure to facilitate patients seeing a familiar face as frequently as possible.  Unfortunately many hospitals are not visitor friendly.
  • Assessments should be carried out to rule out other treatable conditions;                     This is an indication that patients are frequently mis-diagnosed and therefore inappropriately treated.
  • Stimulating activities should be available.                                                                             This is a very good suggestion but in 30 years working with hospitals I have only very rarely seen this happen.

This is a well intended report with a lot of useful recommendations.  But they are only going to work if there are sufficient qualified staff to ensure the recommendations are followed.  That’s much easier said than done and it will take a lot more than £50 million to implement this approach.

THE BOTTOM LINE IS HOSPITALS ARE NOT FRIENDLY ENVIRONMENTS FOR PEOPLE WITH DEMENTIA.

In my view it would be better to concentrate resources on developing specialist dementia homes where people could be treated in a more domestic style environment.

Posted in Dementia | 1 Comment

APPLES

It’s a windy apples off the trees,

blow away the cobwebs, day.

The sun shines bright,

leaves alight from final flight.

 

Gravity may bring me

back to earth.

I wonder what inspiration

awaits me today ?

 

Posted in SMILES | Tagged | 1 Comment

Community Retirement Villages – next steps

This is a drawing together of my series of blogs about a new form of  Community Retirement Village.

It has not been easy to distill the essence of thirty years work building and then managing a new type of retirement housing in the U.K.   It didn’t start with a well thought out 30 year plan, nor did we even have a road map of where we were heading when we set off in 1987.

I had a great team around me and we were all agreed that we could do better than the then current provision of care and support for older people in later life.   The vision of what we were ultimately going to do only emerged over time with the benefit of experience and naivety in equal measure.

We had little money to play with, but we grabbed every opportunity as it arose.   We also had some benevolent partners, without whom we could not have flourished.    We owed a lot to Coventry Churches Housing Association, the housing organisation we grew out of and we adopted much of their thinking, particularly on the employment and management of staff.   (See the storey of Princethope Court, which you can find in the Archive, to understand how our early ideas were born there).   

In operational terms there were few footprints to follow in the early years, but treading in fresh snow is great fun.       We made it up as we went along but we were united in our intention to find a better model of housing and care for older people than the ones that had been developed in the past.      Our vision was to provide “Better Lives for Older People”.

The lessons we learned over all those exciting and challenging years were :-  ” TO BUILD MORE “COMMUNITY VILLAGES” and here are some of the next key steps :-

THE FINANCIAL MODEL

It’s no good expecting or relying on Government funding to make this possible.    Elderly people themselves have sufficient funds tied up in their existing housing, providing these resources can be unlocked and that can’t be just about downsizing.    A new financial model is the key to giving access to retirement housing and care to more people.    Whilst downsizing is an option for the lucky few, shared ownership has far greater potential to reach more people.    Neither should we forget that some people only have sufficient resources to rent.    In all cases people also need to be left with sufficient assets to access care in the future should they need it.   This suggests that people should be able to trade the equity in their house for exchange for care.    Either at the outset, when they first purchase the accommodation, or later if their care requirements change.  The Continuing Care Model used in the USA uses an up front, non-refundable premium to cover the cost of housing and all future care needs.    Some adaptation of this approach would significantly reduce the move in entry price, but would need careful and transparent explanation at the outset.

MARKETING

Retirement villages in the UK are still a relatively new phenomenon.    They are often seen as “ghettos of older people” or “large nursing homes” or “very expensive luxury housing with high services charges”.    They sometimes are any or all of those things.    In the promotion of a new village, it is important to address each of these issues directly ——- “they will become ghettos if the village residents shut themselves away”—— “most of the residents will be fit and able but they will see some high levels of frailty within their community”——” it is an expensive option compared to staying in your own home with no service charges and limited support”.

The unique selling point of retirement villages is more about the lifestyle than it is about the accommodation.   There are many more opportunities in a retirement community to participate in a range of activities and to access care and support than they would be in an individual home alone.

THE ACCOMMODATION

This is not a rural idle it is an urban village.  The village needs to be located close to “chimney pots”, because generally people don’t want to move far from their existing neighbourhood.   Whilst the site needs to be level, it is also important that the village is outward looking and all the accommodation benefits from good views beyond the site itself.

The individual dwellings need to have generous space standards because people will usually have come from larger accommodation in their previous house.     At the same time there needs to be a variety of dwelling sizes to offer as wide a purchase price range as possible.

OPERATION

Once the village is up and running, it is essential ever after to live up to the promises of the initial marketing campaign.    Staying true to the values of quality, lifestyle, innovation and fun.    Residents’ involvement in the running of the village is vital and listening and acting on residents’ views should be part of the village’s daily life.

The village offer should be extended to people in the surrounding community and partnerships should be built with local organisations.

WE DIDN’T START WITH A SIMPLE FORMULA FOR BUILDING VILLAGES AND I STILL DON’T HAVE ONE NOW.  I THINK THE INGREDIENTS ARE THE ONES I’VE OUTLINED ABOVE BUT IT WILL TAKE ANOTHER GREAT TEAM WITH THE SAME DEGREE OF NAIVETY AND EXPERIENCE.

Posted in RETIREMENT HOUSING | Tagged | 2 Comments