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.
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.
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 😀
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)
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.
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 ?
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.
The medical world is ringing its hands, because your not ringing out yours enough.
The Royal Pharmaceutical Society says poor hand washing is driving a superbug crisis. They estimate a third of cases of diarrhoea and a sixth of respiratory infections could be prevented through good hand washing. They suggest you take 20 seconds each time and measure it by singing “Happy Birthday To You” twice. Of course you may be taken off to the funny farm if you are heard celebrating your birthday several times a day, every day of the year. But on the positive side you mays get a lot more presents that way 😀
Dr. Gina Radford, England’s deputy chief medical officer, thinks longer is better, and recommends 30 seconds of hand washing, while singing the first verse of “God Save The Queen”. Perhaps you should also send her a get well soon card —- the Queen that is not the singing
Doctor.
I have a slightly modified children’s song which might keep you out of the mental hospital or from being overly patriotic. How about:-
If you’r happy and you know it WASH YOUR HANDS,
If you’r happy and you know it WASH AGAIN,
If you’r happy and you know it and you don’t want diarrhoea,
WASH YOUR HANDS !
Every few years there are pleas for more bungalows to be built. But, they never are. You would think people would learn. Every new Housing Minister thinks they are the answer to older people’s prayers. Think tanks and estate agents regularly produce reports claiming that something must be done. But nothing ever is! (You can find my earlier posts by clicking on Retirement Housing in the Topics List they date back to 2013)
Having fallen on deaf ears for years, House Simple, an on-line estate agent has come up with a novel reason to build more bungalows. Apparently they think that the bungalow shortfall may be forcing older people into care homes prematurely and may also be responsible for longer hospital stays, putting greater strain on the NHS.
That’s it then, just build a few more bungalows and all our retirement housing problems, underfunding of Social Care and bed blocking in the NHS will be solved at a stroke. Why didn’t anyone think of that before.
Just shout “HOUSE” and one will miraculously be found for you. All you have to do is use an on-line estate agent that doesn’t live in the real world.
SIMPLE.
Retirement villages should be a genuine partnership between residents and staff. For residents to take advantage of all the lifestyle opportunities, they need support from a management team that has a “can do culture”. The management team’s focus needs to be on the life of the residents and not on the administration of a housing project or the regulation of care, important as both those issues are. Residents need to like the staff and the staff need to like the residents, which is an obvious thing to say but it doesn’t always happen. Not all residents are reasonable and not all staff are perfect. Mistakes happen. The important thing to remember is that the entire village needs to be “One Big Team”.
Many of the pressures on management are driven by day-to-day administrative and financial issues. The safety and security agendas of regulators focus entirely on tick box procedures and often fail to see the bigger picture. The management team needs to ensure that this doesn’t impact negatively on the service they provide. These are not either / or options, the management challenge is to ensure there is an appropriate balance between the issues.
Because the residents effectively provide all the funds for the village and as a result of their prominent role as volunteers in running the village, they are entitled to a transparent view of all aspects of the village operation. The residents should be provided with all the facts and figures of the operation and there should be an open book approach to the financial accounts. Open and regular two-way communication is an essential part of this process. Where communication breaks down, gossip and the grapevine will fill the void with mis-information. There needs to be a whole variety of ways of achieving a healthy flow of information :-
Most of all what the village needs is courageous and ambitious leadership. This is not at all easy to do with a community of several hundred residents. Many will have different views on issues and in every community there’s at least one “Barrack Room Lawyer”. The manager’s job is to build bridges between the various interests, but occasionally stand their ground when non-negotiable aspects of the culture are challenged. As far as possible, it is important to maintain a flexible and open approach to everything with as few rules as possible.
At a fringe meeting at the Conservative Party conference Dr Phillip Lee made the suggestion that we have become a selfish society and are no longer prepared to look after our older relatives. This was echoed by Care Minister, Jackie Doyle-Price, who extolled the virtues of ethnic minority families who look after their elderly relatives. Is this an early signal of an orchestrated shift in policy, I wonder? If it is it is a very over simplified view of the situation.
It understates the reality of what has changed in our society in the last 30 years:-
Even so, I believe most families would wish to look after their older relatives if they reasonably could. However all these changed demographic factors mean that direct hands-on family care for older parents is not be possible for everyone. Any new policy direction needs to face up to this and be completely honest with older people.
We simply haven’t saved enough as a society to pay for the cost of retirement. Increased longevity and improved health care have changed everything and whilst this is good news, somebody has to pay for it. It could be through increased taxes, but that would fall on the younger generations who are still working.
Alternatively, older people could cash in the wealth they have accumulated in their houses and pay for their later life themselves, which is a solution I have advocated for a long time. In practice it is the only realistic option, but it could be made easier if there were much better ways of releasing equity from your house. This would enable more older people to pay increased for support in their own homes. This route is difficult currently not just because equity release offers poor value but also the quality of most domicillary care is hardly encouraging.
The other option for some people is to downsize, but again there are limited opportunities. That is where the ” Community Retirement Village ” comes into its own which I have talked about in recent posts.
Politicians won’t sort this out, maybe a Royal Comission on Social Care might ? Continue reading
GrumbleSmiles 