This week I've spent hours in meetings, mostly management meetings, striving to keep our service ticking along nicely through basically asking simply for us to be left alone. Investing time in meetings to do nothing and change nothing is necessary, to stop well meaning folk make unhelpful changes, but there's little joy to this. The endless hours can be a bit of a dark cloud on your working week.
I've a gentleman who's just had his 6 week review by his social worker, having been placed in a care home from intermediate care. He's staying in the care home since he's immobile, episodically confused and falling.
He's got severe osteoarthritis, with the wear and tear on his joints causing severe pain, limiting mobility striking. From being independent a year ago, he's no sedentary and almost immobile. When he does try and walk he's in pain and falls, often.
He's an older gentleman and has prostatism, drippling urine and having continence problems.
He was made known to me by the care home, rather than from medics in Primary or Secondary care, with concern that he'd developed pressure areas and was this causing infection making him more confused, causing him to shout out at night now? A fair question for a regular residential home to ask. I pulled medical notes from the acute Trust, spoke with the GP, pulled off his blood results and scans and found a different picture.
His poor gait and falls wasn't put down to arthritis and pain. His incontinence wasn't put down to prostatism. His episodic confusion and decline in function over a year wasn't put down to dementia. He'd been investigated and found to have normal pressure hydrocephalus and placed in permanent residential care to support his consequent deficits.
The care home simply sought sensible advice on whether there was a treatable cause for his new behaviour (of feeling anxious and shouting out at night) or whether as they phrased it, it was part of the progression of his swollen brain.
Excellent.
Good initial GP assessment, then good medical work up by a physician, then good neurosurgical assessment and then good care in a care home.
My dark cloud this week has a silver lining.
Showing posts with label Care Homes. Show all posts
Showing posts with label Care Homes. Show all posts
Thursday, 16 September 2010
Tuesday, 2 March 2010
Complaints
Becca asked about how to complain about a poor care home, or effect a change for the better.
A number of possibilities exist.
1) Talk to the Care Home manager
In my corner, it works out at less than 2% of care home managers want to be left alone. I've no authority or statutory powers to enter care homes or direct how things should be in care homes. Even so, all but one care home manager I've worked with has welcomed me in to work with the NHS to improve care. Most reasonable managers will listen to opinions, especially valid opinions of people who've been through their home. They may listen and take your views on board. They may listen politely but ignore everything. But the first port of call should be the manager since they're in a position to improve things markedly and turn a poor care home into a great care home.
2) Talk to Secondary Care
Some hospitals have specialist services that visit care homes. Care Home teams, Outreach Teams, Liaison Teams, names vary. But it's becoming more common for NHS prividers to have a specialist team that visit private and Council care homes to provide support. Our team knows which care homes are great and which are dreadful. We're involved in all the Safeguarding referrals and all investigations, simply because we can contribute information to the processes but equally can contribute solutions in both staff development/training and direct patient care. Care home teams can therefore take on board comments you have. One of our carer forums gave great feedback to us, resulting in us training a large number of care home staff. The carers were pleased since standards have improved. The care homes are pleased since they've had free specialist training (and forged close working relations for ongoing support).
3) Talk to the company
Care Homes mostly are run by massive companies. There's a tension in them. They want to maximise profits. But they also want good publicity and to be seen to have decent standards of care, holding a decent reputation. Care home managers may compromise too much, eroding care (through poor food, poor staffing, poor environment, poor recreational opportunities) to maximise profits and be seen to succeed for the company. The company likes a good balance sheet. But extra profit at the cost of 21 Safeguarding cases and the home closed for investigation is less attractive to them. Which is what heppened in one of my local care homes. The company had no idea it was so bad. It can be very worthwhile telling the parent organisation what you feel, since you sharing your views affects their reputation, which matters to them.
4) Talk to the Council
What if it's not an independent care home? If it's run by the Local Authority, then get on to the Council. Heck, even if it's a private care home, the Council have major influence.
The Council will have a contracts department for care homes. They will have details of what care homes are registered to provide (although this is changing) but critically they details what the Council, through social care funding, will pay care homes. If a care home is embargoed, no Council funding is given. Nobody's funded to go there. Councils therefore have enormous clout. If you've concerns about a care home, you can talk to the Contracts department and share this concern. They'll not be able to act on their own, usually, but it's healthy for them to have an awareness that all's not well in Home Blah since then they're obliged to do some digging.
5) Talk to the PCT
The PCT fund a lot of care home placements now, through Continuing Care funding. This NHS cash going into care homes is managed by the PCT. If a care home's doing a rubbish job, the PCT can intervene through different systems. They can investigate directly themselves, informally or formally. They can use resources (like PCT pharmacists, Community Matrons, Health Visitors) to provide surveillance or support. They can refuse Continuing Care funding and with with the Local Authority to embargo a care home, effectively closing it down until it sorts itself out.
6) Talk to the Care Quality Commission
The Care Quality Commission (CQC) will take your complaint. They've taken over CSCI and now oversee care homes. They helpfully detail what they'll do. They can direct homes to progress certain actions and have teeth, effectively being able to close them down until they pull their socks up to the CQC's satisfaction.
A number of possibilities exist.
1) Talk to the Care Home manager
In my corner, it works out at less than 2% of care home managers want to be left alone. I've no authority or statutory powers to enter care homes or direct how things should be in care homes. Even so, all but one care home manager I've worked with has welcomed me in to work with the NHS to improve care. Most reasonable managers will listen to opinions, especially valid opinions of people who've been through their home. They may listen and take your views on board. They may listen politely but ignore everything. But the first port of call should be the manager since they're in a position to improve things markedly and turn a poor care home into a great care home.
2) Talk to Secondary Care
Some hospitals have specialist services that visit care homes. Care Home teams, Outreach Teams, Liaison Teams, names vary. But it's becoming more common for NHS prividers to have a specialist team that visit private and Council care homes to provide support. Our team knows which care homes are great and which are dreadful. We're involved in all the Safeguarding referrals and all investigations, simply because we can contribute information to the processes but equally can contribute solutions in both staff development/training and direct patient care. Care home teams can therefore take on board comments you have. One of our carer forums gave great feedback to us, resulting in us training a large number of care home staff. The carers were pleased since standards have improved. The care homes are pleased since they've had free specialist training (and forged close working relations for ongoing support).
3) Talk to the company
Care Homes mostly are run by massive companies. There's a tension in them. They want to maximise profits. But they also want good publicity and to be seen to have decent standards of care, holding a decent reputation. Care home managers may compromise too much, eroding care (through poor food, poor staffing, poor environment, poor recreational opportunities) to maximise profits and be seen to succeed for the company. The company likes a good balance sheet. But extra profit at the cost of 21 Safeguarding cases and the home closed for investigation is less attractive to them. Which is what heppened in one of my local care homes. The company had no idea it was so bad. It can be very worthwhile telling the parent organisation what you feel, since you sharing your views affects their reputation, which matters to them.
4) Talk to the Council
What if it's not an independent care home? If it's run by the Local Authority, then get on to the Council. Heck, even if it's a private care home, the Council have major influence.
The Council will have a contracts department for care homes. They will have details of what care homes are registered to provide (although this is changing) but critically they details what the Council, through social care funding, will pay care homes. If a care home is embargoed, no Council funding is given. Nobody's funded to go there. Councils therefore have enormous clout. If you've concerns about a care home, you can talk to the Contracts department and share this concern. They'll not be able to act on their own, usually, but it's healthy for them to have an awareness that all's not well in Home Blah since then they're obliged to do some digging.
5) Talk to the PCT
The PCT fund a lot of care home placements now, through Continuing Care funding. This NHS cash going into care homes is managed by the PCT. If a care home's doing a rubbish job, the PCT can intervene through different systems. They can investigate directly themselves, informally or formally. They can use resources (like PCT pharmacists, Community Matrons, Health Visitors) to provide surveillance or support. They can refuse Continuing Care funding and with with the Local Authority to embargo a care home, effectively closing it down until it sorts itself out.
6) Talk to the Care Quality Commission
The Care Quality Commission (CQC) will take your complaint. They've taken over CSCI and now oversee care homes. They helpfully detail what they'll do. They can direct homes to progress certain actions and have teeth, effectively being able to close them down until they pull their socks up to the CQC's satisfaction.
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