What it is like to be an older person? I sometimes ask people in my conversation groups to describe how it feels to be an older person and what that means in the context of their lives. They can usually share a few positive benefits – like being free of work responsibilities, not having to rush around and having more time. Some talk about the rewards of financial security after many years of work and saving.
However, they also speak of the frustrations of poor physical health and the need to rely on others for some, or even all of their care – unwelcome, constant reminders of their advancing age and probably the biggest drawback.
Yet none of my lovely older friends – even those in their nineties, define themselves in terms of being older. For most, the person they feel themselves to be ‘inside’ is much younger. They usually say they feel as though they are in their thirties or forties. If for no other reason, this shows us the damage that ‘stereotyping’ – an ever-present characteristic of services designed for the age group, can cause.
People talk of respecting and treating people as individuals and not defining them in terms of their age, or patronising them because of it. And yet the stereotypical attitude often still persists. Why do we continue to make assumptions about what older people do or don’t enjoy doing?
For example, one of the things nearly everyone likes to do is to go outdoors. A walk in the park, the countryside or on a beach is a much-loved pastime for many families. Even going to the shops or the cinema means some outdoors time. And yet most of the people I spend time with who live in care settings, are hardly ever able to do this – except on ‘special’ occasions. These might include when it’s warm (but not too warm), sunny, (but not too sunny), when it’s a ‘special day’ at the care setting, usually an annual garden party or some such, when it’s not too cold (which generally excludes some or all of November to April and let’s face it, sometimes May, June and October as well) and certainly not when it’s raining, windy or even breezy and so on.
Then there are the inevitable risk assessments and staff availability. Care workers are always in the minority. To ensure that the person is dressed appropriately for the weather, to give them the freedom to go where they would like to, usually means having access to local facilities of some sort. To take a person somewhere they’d like to go, to have enough time to help them get ready, enjoy the experience while they’re doing it and bring them back safely, might take a couple of hours. And that's time that the care worker is unavailable to other residents.
For those living with a dementia, the situation can be even worse. Honestly, there are people with advancing dementia I know who have been living in care homes, who haven’t been outdoors for years.
The CQC regulation about staffing from Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 18, states that to meet the regulation, providers must provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times and the other regulatory requirements set out in this part of the above regulations. Staff must receive the support, training, professional development, supervision and appraisals that are necessary for them to carry out their role and responsibilities. They should be supported to obtain further qualifications and provide evidence, where required, to the appropriate regulator to show that they meet the professional standards needed to continue to practise.
It’s worth noting that CQC cannot prosecute for a breach of this regulation or any of its parts, although they can take regulatory action and will refuse registration if providers cannot satisfy them that they can and will continue to comply with the regulation.
When a senior executive from the National Care Association (NCA) was asked, “How do I find the correct staffing level for 23 clients, five with full hoisting needs nursing care, ten needing full personal care?” the reply was as follows:
“There is no set method of calculating staffing levels for nursing homes but you need to have a method and stick to it. You also need to record in detail your calculations.
Assuming that you are a Registered Care Home the following is a relatively straightforward way of calculating staffing levels:
- Decide what your care staff numbers should be for the following when the home is full:
- Afternoon and evening
- You decide what the core staff is by deciding how many staff need to be on duty to comfortably provide care to 23 residents at the different times of the day.
- The core staff should exclude supernumerary staff such as the Manager.
- Regularly, at least weekly the Manager should consider whether individuals have higher care needs and how these needs can be dealt with. You say that five residents have high care needs, so their special needs need to be considered and a decision made as to whether or not the core staff are able to meet those needs particularly in the morning or if you need to take on someone else to help.
- As the staff are also expected to deal with laundry and kitchen duties that will of course be part of the calculation when the core staff is decided.
- I cannot stress enough the importance of recording all your decisions about staffing levels.
All well and good, but where are staff numbers in the context of wellbeing, relationships or quality of life of the individual? What of the need for communication, activity and the time that these require (and take). What if, as one example, going out is part of a person’s sense of self? How will that need and preference be addressed? How can the need of people living with dementia – who may regular one-on-one care (meaning that the carer can do nothing else at the time of need), be addressed?
Sad to say, even after the NCVO’s inspired project on volunteering in care homes whose Strategic Advisory Board I was privileged to be part of, in my experience, only a very few care homes recruit and encourage volunteer visitors who can offer additional help.
If we project forward to our own old age, wouldn’t we all like there to be enough people who care available to allow us to live well and pursue our chosen activities and relationships? Won’t we want to spend time doing the things we have always done if we can? How many of us are preparing ourselves for our old age and the privations this will bring? After all, as Bette Davis’s observed with deep insight, “Old age ain't no place for sissies”.
Wonderful photographs by Mike Stone https://www.mikestone.co.uk