The series is described thus:

“Businessman Sir Gerry Robinson tries to improve three struggling care homes. Can Gerry change a culture of stagnant lounges, poor quality of life and a lack of specialist staff?”

That description alone sums up the deficiencies of the entire present regime.

The major flaw in the system is that most dementia sufferers end up in care homes in the first place (although actually nursing homes too in many cases), where in most instances, the logistics of providing a decent standard of care are fatally compromised by the sheer cost of doing so.

In other words, the overheads in such institutions are already so onerous that it can become a critical extra expense to significantly improve on the care delivered, the increasing cost of complying with ill-conceived and ever burgeoning Health and Safety regulations in particular (to which Sir Gerry refers) being a major element of those overheads.

Let us dwell for a moment on what the present standard of care actually is.

I quote from Sir Gerry’s commentary on the first program in the series:

“The average time a dementia resident is actually engaged in any form of contact with anyone is two minutes in every six hours”.

So for a total direct engagement time with their carers and other staff of just 56 minutes in every week, the average dementia sufferer in the average care home is being charged up to £750. As only a few pounds out of that figure is spent on the carers’ wages per se, then the rest is overhead, which as that is already now becoming unmanageable for many care homes (and is the reason why many are already now failing of course), means that any extra cost in improving the standard of care (such as the dementia mapping that Sir Gerry talks about) will simply send yet more of them over the edge into bankruptcy.

And that in a nutshell is why the average standard of care in UK care homes is so poor – the overheads are simply too prohibitive to enable all but a relative handful of them to provide decent care.

There is ultimately only one practicable solution to this problem and that is to abandon the whole concept of trying to care for dementia sufferers in care homes at all, and simply look after them in their own homes instead.

There they can receive more like sixty HOURS of direct contact with their carers per week as opposed to 60 minutes, and in that setting there is obviously no limit on the time their carers have available to give them all the help and support they need.

I would be interested to see other contributors’ views on the same issue.

It came the day before an announcement on the future of Crosfield House in Rhayader – the only RBL home in Wales – is due on Friday.

The home is under threat because the council has refused to pay a 30% increase in fees requested by the RBL.

A Powys council delegation has also met RBL trustees to discuss its future.

Crosfield House has 50 residents, some of whom are ex-servicemen, and 80 staff. It was opened 20 years ago.

The legion has blamed the rise in costs on a deficit in the home’s income.

But the council, which funds half the residents, said it could not afford the rise and would try to find a compromise.

At the meeting on Thursday, the RBL said it would consider a report commissioned in October 2007 on the future of the home.

It brings together discussions with the council, MPs, the home’s staff, residents and their families, said RBL.

The report also contains recommendations from the specialist consultancy, Pinders, which was asked to undertake an independent assessment of the home.

The RBL said it had consistently stated it would maintain a home in Wales and had always been clear it had made provision in its financial plans to invest around £5m for this purpose.

News reported by BBC

Now she is keen to get outside for a walk most days.

And she puts the transformation down to the most simple of medicines – water.

She is one of a group of residents at a care home in Suffolk who have been encouraged to increase their intake of water.

And they have all reported dramatic results.

Jean says she feels 20 years younger.

“I feel more alert – more cheerful too. I’m not a miserable person, but it’s added a sort of zest.”

Staff at The Martins care home in Bury St Edmunds started a “water club” for their residents last summer.

Residents were encouraged to drink eight to 10 glasses of water a day, water coolers were installed, and they were each given a jug for their room.

They report significant improvements in health as a result – many fewer falls, fewer GP call-outs, a cut in the use of laxatives and in urinary infections, better quality of sleep, and lower rates of agitation among residents with dementia.

Dehydration

Doctors have long highlighted the risks of dehydration for elderly people. It can cause dizziness and potentially serious falls, constipation, and confusion.

“The whole home buzzes now; there isn’t that period after lunch when everyone goes off to sleep” Wendy Tomlinson

While most people’s systems can adjust to insufficient water, frail old people are far less equipped to cope.

So when Wendy Tomlinson, a former nurse, took over the management of the charity-run home, she suspected that drinking more water might help the residents feel better.

Even she has been surprised by how much difference it’s made, though.

“It’s been fantastic,” she said. “The whole home buzzes now; there isn’t that period after lunch when everyone goes off to sleep.”

For Baroness Greengross, a cross-bench peer, it reinforces a conviction she has had for some time now – that many old people simply are not drinking enough, and it is harming their health.

She wants to see tougher regulations in care homes across the UK, so that staff have to make sure residents drink enough.

“We hear a great deal about malnutrition among old people,” she says.

“But we forget about the need for them to have enough water. It shouldn’t be very difficult to change the habits of care staff.”

News reported by BBC

Click this link to listen to a report by the BBC

The man, who had been a resident at Plas Rhosnesni in Wrexham, suffered head injuries in the fall on Sunday.

He was treated at Wrexham’s Maelor Hospital but died on Thursday. A post mortem examination will be carried out.

North Wales Police, the Health and Safety Executive and the Care & Social Services Inspectorate for Wales have launched a joint investigation.

Jane Worsely, director of operations for Hallmark Healthcare which runs the home, said: “I can confirm that an incident happened at the home at the beginning of June.

“We are working closely with all the relevant authorities to find out exactly what happened.

“Our thoughts and condolences are with the friends and family at this time.”

News reported by BBC

A questionnaire of staff from the Commission for Social Care Inspection (CSCI) also raised worries that residents are at greater risk.

The questionnaire was organised by BBC Radio 4’s Today programme.

A CSCI spokesman said that the organisation was taking more action against poor providers than before.

The spokesman added that the watchdog, which oversees 18,500 care homes in England, believed that services were improving.

“To be honest, I would not leave my dog in 90% of our care homes” Anonymous respondent

An anonymous questionnaire was distributed to more than half of CSCI’s employees via unions Unison, the Royal College of Nursing and Prospect.

In all, 30% were returned and more than 200 inspectors took part.

Some replies did not pull any punches.

“To be honest, I would not leave my dog in 90% of our care homes,” one inspector wrote.

Another respondent said: “I do feel CSCI is trying to get it right in terms of making the best use of available resources but given the reduced budgets and political agenda, it seems inevitable the system of inspections will become more arbitrary and less responsive to the needs of those who live in care homes.”

‘Less protected’

The BBC sent out the questionnaire after receiving concerns from a small number of inspectors. One contact told reporter Jon Manel:

“Homes aren’t inspected as frequently as they were before. We rely a lot on information given to us by the providers of a service to say how good that service is. When we actually go out to visit the homes they are completely different to what the proprietors have actually told us in their feedback to us.”

The contact added that at one time, all homes would be inspected a minimum of twice a year.

“That’s now changed and we’ll be inspecting homes anything from what could be a weekly or monthly process for very poor homes right up to a maximum of one inspection in three years.

“Services can change – even excellent services have been seen to go down to poor in the last year.”

Care homes now also carry out self-assessments.

Complaints raised by families about homes are no longer looked into by the watchdog. Instead, the complaint is passed to the care home owner or the local authority which funds the individual.

The CSCI says the new system helps the organisation focus on improving the performance of below-standard homes.

The questionnaire suggested inspectors were not doing enough inspecting

‘Huge pressure’

The BBC was also told that an inspector had been forced by a CSCI manager to change the outcome of an inspection.

The contact said: “For me the issue was the care is poor and if it is poor, we need to say it is.

“However the pressure I was under was huge and so against my own judgement, I made the rating adequate.”

The contact said that a poor-performing home required a lot of extra work. The contact said:

“As soon as a poor home comes on the radar, then an inspector’s time and a manager’s time is focused on that home.

“Managers don’t want that but inspectors do because that’s what we’re there for.”

Another questionnaire respondent said care homes were now effectively policing themselves.

“All people using care services regulated by CSCI are in effect less protected than previously because we are inspecting them less on the basis care services will police themselves.”

“The home was poor throughout and needed enforcement action to be taken but the regulation manager did not want this to happen – too many poor homes this year” Anonymous inspector

‘Improving services’

A CSCI spokesperson said that the organisation had consulted widely and received widespread support for the way it was carrying out inspections.

“Our new way of inspecting allows us to be much tougher with poorer providers than before.

“The evidence is clear. Services are improving. And we are taking more action against the poorest providers than ever before.

“Our new quality ratings for all providers will also give them a further incentive to improve. With better information people are likely to choose the best services, which will thrive.

“The poorest services will face closure by us unless they improve.”

News reported by BBC

“It is a watchdog without any teeth or even a will to act.”

John Matthews’ condemnation of the Commission for Social Care Inspection (CSCI), which oversees 18,500 care homes in England, is strong.

While complaints about standards of elderly care are not unusual, what makes Mr Matthews’ view important is that he is the coroner for the Isle of Wight.

Last year, he recorded a verdict of accidental death contributed by neglect after a 93-year-old man died following a fall.

He was found in a road, half-a-mile away from the care home where he lived. He had a tendency to wander off and on this occasion, he had wandered off unnoticed.

Compliance check

What came to light during the inquest was that eight months prior to his death, a CSCI inspector had discovered there were no risk assessments in residents’ files.

This was supposed to be rectified by July 2006 but according to the coroner “nothing was done at all”.

Mr Matthews condemned the CSCI as “toothless” and “worse than useless”.

“I used those words quite deliberately because it was being dressed up as though there was some institution which had this role when in reality it wasn’t doing anything,” he said.

“If we were to check that every requirement for every inspection has been delivered it would not be feasible given the scale of the task and the resources we’ve got” Mike Rourke, CSCI

“The public was misled into thinking there was protection which existed which in fact didn’t.”

In April 2004, the CSCI replaced the National Care Standards Commission, which itself had been formed to take over inspections from local authorities.

“In my view what would have happened in the past is the council or National Care Standards Commission would have inspected the home again shortly after the deadline to make sure it was now in compliance,” said Mr Matthews.

Resources available

Mike Rourke from CSCI said: “Our view is that we made it very clear to the provider what they needed to do and we would look to them to deliver their responsibilities.

“And if we were to check that every requirement for every inspection has been delivered it would not be feasible given the scale of the task and the resources we’ve got.”

“Unless they (CSCI) follow up what they have told owners to do, then they don’t seem to serve an effective purpose in protecting the most vulnerable members of society” Harry Montague’s daughter

The watchdog says it is now taking action to enforce the law more often. But next year, CSCI will cease to exist.

Following two re-organisations in six years, care home regulation is to be re-organised again. CSCI is to merge with the Healthcare Commission, which inspects hospitals, and the Mental Health Act Commission.

The CSCI’s duties include inspecting homes against national minimum standards, set by the government, and publishing a report after each inspection.

It sets out what the home did well and what it needs to improve, and according to the watchdog’s website its inspectors will work with the service to make sure improvements happen quickly.

But for the family of Henry Montague, the changes came too late.

Proper enforcement

In March 2006, Mr Montague was admitted to Eastbourne District General Hospital, south-east England, with severe facial burns.

His face was “grossly swollen” and “beyond recognition” according to a doctor who treated him.

Henry Montague spent 10 months in hospital

Mr Montague, then 80, had fallen out of his bed at the Farmstead Nursing Home, in Hellingly, and onto the hot water pipe which lay exposed on the wall.

It was a risk which the home had been made aware of some three months earlier.

A CSCI inspector had visited in December 2005.

“The hot and cold water pipes in some bathrooms and residents’ rooms were not covered. The expectation is that they are boxed in to protect residents,” she wrote.

But by March, in Mr Montague’s room at least, that had not happened.

His daughter said: “We were shocked that the matter had been brought to the owner’s attention and nothing had been done and that nobody had thought it was a sufficiently serious matter to remedy straight away.”

‘Action plan’

The CSCI did not impose a legal requirement for the pipes to be covered and a CSCI spokesman said there would have been “a clear expectation that the provider would have taken action to rectify issues identified in the inspection”.

But care home owner Ernie Graham says the CSCI had agreed an “action plan” for the work to be carried out by the end of March. He stressed that the inspector had not seen the specific pipe in Mr Montague’s room.

Mr Montague, who suffered from dementia, spent 10 months in hospital and died four months later.

Mr Montague’s daughter believes if the CSCI’s recommendations had been properly enforced, then their father’s accident would not have happened.

She said: “I would have expected CSCI to have told the owners that unless they make sure these matters were remedied immediately, within the next 24 to 48 hours, that the home would not be able to continue operating.

“What you have is a toothless organisation because unless they follow up what they have told owners to do, then they don’t seem to serve an effective purpose in protecting the most vulnerable members of society.”

News reported by BBC

There is no doubt that once you get in to your later years things become more difficult and help is needed for some of the tasks that might ordinarily have been a lot easier a when you were a bit younger. There is help at hand with care in your own home with the privacy that this brings with it. It might be that you only need help at certain times of the day, for example, you might need help with getting your breakfast, lunch or dinner, but to have someone there will make all the difference.

If you only require part-time care then you need to employ the services of a “Visiting Care Agency” who will be geared up for this type of service. However, if you need more regular care throughout the day, for whatever reason, or you would like companionship, then a live-in carer is what is recommended.

A live-in carer from say Care at Home UK Limited will have the experience to deal with all eventualities with an elderly person living at home and will have the necessary training to mach the skills.

Both visiting care and live-in care are very expensive, especially full time live in care, becuase it is labour intensive. However, your local council should be able to offer help where this is concerned and the goverment are pushing for more private home care by offering “Direct Payments” to the person requiring the care.