Opinion
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possible price. Unfortunately, that price does not necessarily result in well-trained and well-motivated staff. Care home fees may appear huge to many, yet they result in low wages and under investment in staff at the point of care delivery.
True cost of care Compassionate practice requires good managers who invest in the right staff and support them, say Nicky Hayes and Julie Whitney IN THE wake of the shocking abuse of frail and vulnerable care home residents featured in a recent BBC Panorama documentary, the call for solutions is understandable. But, sadly, there are no quick or cheap answers. More inspections, installation of surveillance cameras in residents’ rooms and prosecution of abusers might assuage public anger for now, but they are as likely to end abuse as to find a cure for dementia. In situations of poor care, the sanctity of human life is lost. Residents are seen as sets of ‘tasks’ to be completed, rather than humans. Carers are scarcely human either, with poor status and pay, yet often faced with the ‘physical impossibility’ of getting all the work done. The undercover reporter in Panorama bemoaned the fact that no one told her what to do. There was no time for a full handover of crucial information about individual residents’ needs. The film showed shockingly ignorant care such as staff trying to force a resident to walk 12 June 2014 | Volume 26 | Number 5
to the toilet, when a hoist should have been used. There is no excuse for abuse, but care home staff across the country are often left facing decisions about care delivery that they are not equipped to make, for reasons that extend beyond poor communication into inadequate recruitment practices, lack of training, lack of time and inadequate supervision. Cheap labour Families, and the general public, rightly want assurance that caring, compassionate staff will deliver safe and comfortable care to frail residents. But in this age-denying, death-denying and especially dementia-denying era, many members of society also want this care to be out of sight, out of the media spotlight and delivered as cheaply as possible. Dignity and respect for vulnerable people conflict with desires for ‘someone else’ to deal with the ‘messy’ business of care delivery and with economic drivers for getting that care at the lowest
Resilience As health professionals who regularly visit care homes, we hope that staff in general are not vilified for the actions of those few who were caught by Panorama’s secret cameras. Most staff want to give good care, despite their low wages and long hours. Five or more 12-hour shifts a week with few rest breaks are common and where staff turnover is high, shifts often go uncovered resulting in heavy workloads. We can all understand that carers’ pay does little to compensate for this. What is less well understood is the lack of control many carers have over their lives and how this may relate to their ability to ‘care’. Carers are predominantly women and many have other caring responsibilities outside their paid work. They often travel long distances to work. Many have limited employment choices or have work visas dependent on their job. Lack of control and anxiety do little to foster resilience, yet resilience is fundamental to having capacity to care in a compassionate way. The success of a care home in providing compassionate care hinges on good managers. While not tolerating poor practice, they provide compassionate employment. They know all the residents and ensure staff understand how to look after their individual needs. They seek to recruit staff with the right attitudes and skills and support those staff to get the best from them. It is time that the true costs of safe and compassionate care are recognised. CCTV in residents’ rooms might be a quick win for public opinion, but it deflects attention from the true costs of making care safe. If investment was made in compassionate staffing instead, perhaps whistleblowing would become a thing of the past. Nicky Hayes, nurse consultant for older people, King’s College Hospital NHS Foundation Trust, and consultant editor, Nursing Older People Julie Whitney, interface practitioner (care homes), King’s College Hospital NHS Foundation Trust NURSING OLDER PEOPLE
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iStock
possible price. Unfortunately, that price does not necessarily result in well-trained and well-motivated staff. Care home fees may appear huge to many, yet they result in low wages and under investment in staff at the point of care delivery.
True cost of care Compassionate practice requires good managers who invest in the right staff and support them, say Nicky Hayes and Julie Whitney IN THE wake of the shocking abuse of frail and vulnerable care home residents featured in a recent BBC Panorama documentary, the call for solutions is understandable. But, sadly, there are no quick or cheap answers. More inspections, installation of surveillance cameras in residents’ rooms and prosecution of abusers might assuage public anger for now, but they are as likely to end abuse as to find a cure for dementia. In situations of poor care, the sanctity of human life is lost. Residents are seen as sets of ‘tasks’ to be completed, rather than humans. Carers are scarcely human either, with poor status and pay, yet often faced with the ‘physical impossibility’ of getting all the work done. The undercover reporter in Panorama bemoaned the fact that no one told her what to do. There was no time for a full handover of crucial information about individual residents’ needs. The film showed shockingly ignorant care such as staff trying to force a resident to walk 12 June 2014 | Volume 26 | Number 5
to the toilet, when a hoist should have been used. There is no excuse for abuse, but care home staff across the country are often left facing decisions about care delivery that they are not equipped to make, for reasons that extend beyond poor communication into inadequate recruitment practices, lack of training, lack of time and inadequate supervision. Cheap labour Families, and the general public, rightly want assurance that caring, compassionate staff will deliver safe and comfortable care to frail residents. But in this age-denying, death-denying and especially dementia-denying era, many members of society also want this care to be out of sight, out of the media spotlight and delivered as cheaply as possible. Dignity and respect for vulnerable people conflict with desires for ‘someone else’ to deal with the ‘messy’ business of care delivery and with economic drivers for getting that care at the lowest
Resilience As health professionals who regularly visit care homes, we hope that staff in general are not vilified for the actions of those few who were caught by Panorama’s secret cameras. Most staff want to give good care, despite their low wages and long hours. Five or more 12-hour shifts a week with few rest breaks are common and where staff turnover is high, shifts often go uncovered resulting in heavy workloads. We can all understand that carers’ pay does little to compensate for this. What is less well understood is the lack of control many carers have over their lives and how this may relate to their ability to ‘care’. Carers are predominantly women and many have other caring responsibilities outside their paid work. They often travel long distances to work. Many have limited employment choices or have work visas dependent on their job. Lack of control and anxiety do little to foster resilience, yet resilience is fundamental to having capacity to care in a compassionate way. The success of a care home in providing compassionate care hinges on good managers. While not tolerating poor practice, they provide compassionate employment. They know all the residents and ensure staff understand how to look after their individual needs. They seek to recruit staff with the right attitudes and skills and support those staff to get the best from them. It is time that the true costs of safe and compassionate care are recognised. CCTV in residents’ rooms might be a quick win for public opinion, but it deflects attention from the true costs of making care safe. If investment was made in compassionate staffing instead, perhaps whistleblowing would become a thing of the past. Nicky Hayes, nurse consultant for older people, King’s College Hospital NHS Foundation Trust, and consultant editor, Nursing Older People Julie Whitney, interface practitioner (care homes), King’s College Hospital NHS Foundation Trust NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
