Care Homes: A Changing Culture

Most Britons shudder at the thought of moving into a care home. But they shouldn’t. Andrew Chilvers, from www.bettercaring.com, a unique consumer website that combines a comprehensive care home search engine with stories, tips and an online discussion forum, reports.

It’s chilling how far some pensioners will go to avoid living in a care home.

Last week a Brisbane pensioner committed suicide by pumping four bullets into his head from a semi-automatic handgun. In his suicide note he railed against his family for moving him out of his own home and into a care home. The pensioner’s method of suicide was all the more ingenious as he had built a robot specifically designed to fire the shots that killed him – downloading the robot’s construction plans from the Internet.

The world’s media quickly picked up on the ‘killer robot’ story claiming it was yet another – if extreme – illustration of the worries the majority of people have towards care homes.

Back in the UK only three months previously, the Commission for Social Care Inspection (CSCI) had published a report describing how frail and vulnerable elderly people were being mistreated, threatened and intimidated in care homes. The report, Rights, Risks and Restraints, was based on a survey of 253 older people and their carers, while also analysing CSCI’s recent complaints and official reports.

The report gave harrowing examples of abuse, including residents tied to chairs, dragged by their hair and drugged into a catatonic state. Again, the national media picked up on the report and it’s no coincidence that an ICM poll conducted around the same time found that two thirds of 50-something Britons were ‘frightened’ by the prospects of moving into a care home in their old age.

Indeed, in Britain care homes have become the bogey man of the middle aged and elderly, and even mentioning a move to a care home to an elderly mum or dad can cause an irrevocable rift in the family. Such is the irrational fear engendered by a move to a care home that many people view the government campaign ‘Putting People First’ – a move to encourage independent living through personal budgets – as a panacea that will solve the care home conundrum.

Their optimism, however, is largely misplaced, at least in the short term, as the campaign will take years to roll out across the UK amid countless debates about the ease and effectiveness of the process given the limited resources of the local authorities. Moreover, with the elderly frail or people suffering with dementia, no amount of home care will stave off the inevitable move to a care home that provides full-time care.

Horror stories
Despite the horror stories, most social care commentators agree that the majority of care homes are decent places that give residents a good standard of living. Moreover, many care home managers go some way to assuage fears by inviting family members to stay the night to see what the home is like or to have meals beforehand to test the food.

And most people who take the time to check out potential care homes for their parents can see they are not the nightmare places described in the national press. But despite the safe, secure environment of the home, they remain critical. Jackie Highe, the former editor of Bella magazine, had to look for a care home for her in-laws and found the experience so overwhelming that even talking about it reduces her to tears.

“It was a nice home, but I found it very difficult to see them in there,” she says. “They had been so independent and active and suddenly they had nothing to do. Imagine what it must be like for the rest of your life to live in a place where you can’t make a sandwich, you can’t put a kettle on, you can’t cut the grass, you can’t peel a potato, you haven’t got a kitchen, you haven’t got a knife, you don’t even possess a breadboard.

“We used to talk to other people in the home and an old lady said ‘thanks so much for talking to me, you’ve made me feel like a real person’.”
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Putting the ‘real person’ back into the care home is what many reform-minded care home managers are now striving to achieve. The buzzword is ‘person-centred’ care, which allows active residents to live a life similar to the one they recently left behind. Sheena Wylie, a programme development manager at Barchester care home group, believes that while care homes have improved significantly in recent years, much has still to be done to win the hearts and minds of the British public.

For Ms Wylie, the majority of care homes are big on rhetoric, but small on practice. It’s something she is determined to change. “Person-centred care needs to be embedded in our homes as a culture,” she says. “All care homes claim they are doing person-centred care, but if you go into them you can see it’s just words on paper.

“For me it’s not just kippers and curtains. I hope we’re moving away from the hotel concept of care homes where curtains and trimmings are beautiful. But if you sit for half an hour in the home, you realise nothing is happening. People are safe, but they’re bored.”

Ms Wylie believes that people should be allowed to go into the garden and get their hands dirty, they should be able to do the dusting, the washing up; in fact, what they always did in their own homes.

“What constitutes an activity?” she continues. “It’s not always about a musician coming in and having a sing song. It’s everyday stuff that’s important: washing, dressing, posting a letter. I have some homes that have a fish and chip evenings where the residents phone through an order to the fish and chip shop opposite and then go and collect them. Outside for residents is so important.”

Leadership
To achieve this person-centred approach, Barchester runs leadership courses to encourage its care home managers to think creatively about how to improve the lives of the residents. The company also runs a chefs academy and a masterclass to help improve the residents’ diets, even inviting relatives in for special dining occasions.

One organisation that is successfully coming up with new ideas about care home living is the Eden Alternative, an evangelical movement that aims to banish loneliness, helplessness and boredom in care homes. Eden’s regional co-ordinator, June Burgess, first learned of the movement in Australia and has been journeying around the UK in the past two years, talking to care home managers and groups about the benefits of introducing Eden concepts – and it’s working. Several care home groups have introduced the Eden philosophy into their care homes, including Cornwall Care and the Royal Borough of Kingston. Ms Burgess recently presented her case to Anchor Homes and is soon to give a presentation to Southern Cross group.

“You often hear people say, ‘it’s OK mum, when you get in there everything will be done for you’,” Ms Burgess says. “That’s fine for the first few months, then it gets boring. With the Eden Alternative, people are encouraged to do as much as they can for themselves. Most care home staff believe that it’s best to do things for you – but that takes away your independence.

“An antidote to all this is variety and spontaneity. It’s looking at activities as part of your daily life. What you’re going to do when you wake up in the morning. What you’re going to wear, if you’re going to the shops, when you’re going to have your meals. It’s introducing variety, changing the ambience of the home and creating a vibrant atmosphere.”

Persuasion
While middle aged and elderly Britons will continue to take some persuading that care homes are not just places to fade away and die, organisations such as Barchester and the Eden Alternative are making some headway in changing the culture and attitudes. But even here most agree that it will take time; nevertheless, giant strides have been made in the past few decades. Sheena Wylie was practicing back in the 1970s and has seen huge changes – and she believes these changes will continue.

“When I first started working, hospitals were places where you wanted to curl up and die,” she says. “Traditionally we’ve needed to hide older people and those with mental health issues away and care homes have to some extent colluded with that; out of sight and out of mind.”

For Ms Wylie, today’s outstanding end of life care homes are a testament to changing cultures and attitudes. Thirty years ago most people would shudder at putting a relative in an end of life home, but these days they are held up as shining examples of how care homes can achieve excellence. For social care veterans such as Ms Wylie and Ms Burgess, a similar attitude to care homes for the elderly will mean that their years of campaigning will have been worth it.

About Bettercaring
Bettercaring, part of the OLM Group, is an online service for anyone looking for care, needing answers to questions about care or the funding of care or simply looking for someone to talk to.  Re-launched in October 2007, Bettercaring provides an online database of more than 20,000 registered care and nursing homes across the UK.  Bettercaring boasts over 500,000 unique users per annum and over 2,000 individual care home searches every day.