Care homes experiences can be difficult. Katara Chan spoke to one lady whose mother suffered at the end.
Brenda Jones’ mother was half deaf and blind, recovering from dehydration at her care home. She was sitting at her breakfast table with no glasses, no hearing aid or bottom teeth in.
It was February 16, around 10.20am. Brenda – not her real name – arrived at the care home a day after her mother’s return from the hospital.
When Brenda asked where her mother’s hearing aid and teeth were, she was told “they had not come back from the hospital”. She went upstairs and saw that two bags packed from the hospital in her mother’s room remained untouched. Her 88-year-old mother was one of the hundreds of care home residents who are ‘avoidably admitted’ to various hospitals in Lancashire every year.
The number of avoidable admissions from all care homes based in Lancashire has soared from 2,209 patients in 2012, to 2,739 last year, according to figures from watchdog, the Care Quality Commission (CQC).
And Brenda’s mum was being cared for in a home that was given a top five-star rating by the CQC. Brenda claimed that her mother got dehydrated in her care home about four times a year after a young manager took over two years ago.
She said: “The last time she was in the Royal Preston, the doctor said to myself and my husband, ‘It’s up to the nursing home to provide the care and to rehydrate her.’
“Really, what the care home should be doing is having a jug of water or juice there all the time to make sure she drinks plenty, but they don’t.
“They are all like this. Think about it. It is a five-star care home, what are the other ones like if they are two-star or three-star?”
The CQC’s chief executive David Behan emphasised in an interview last year that more should be done to tackle these avoidable admissions, to ease strain on the NHS.
He said: “Where care can be provided for people outside of hospitals, it is better for them and eases pressures on hospital services.
“GPs, care homes, home care agencies, community health services and hospitals, with local commissioners, must plan effectively to make sure our older and more vulnerable people are cared for in the way they deserve.”
David Pulsford, senior lecturer at the School of Health from the University of Central Lancashire, says hospital staff “would often say that they had people admitted from care homes who don’t really need to be there, whose physical health needs could be met within the care homes if staff had the confidence or the skills or the will to do so”.
He said: “Sometimes care homes are a bit too ready to refer residents to hospital when they have these kind of physical issues.”
The other time when Brenda’s mother was dehydrated in her care home was on Christmas Day last year. It was found she had a urinary tract infection (UTC) – a common problem in care residents.
Among the 2,739 cases of avoidable admissions from care homes in Lancashire last year, urinary tract infections accounts for almost 19 per cent of the cases. According to Mr Pulsford, such infections could be caused by dehydration. While not a primary cause, if an older person is dehydrated they are more susceptible to other problems that generate avoidable admissions to hospital.
He pointed out that skills needed by care workers to reduce avoidable admissions aren’t “desperately complex: for example, like pressure care, like ensuring proper nutrition when someone is actually ill, or ensuring proper fluid balance so the person is drinking properly.”
But Mr Pulsford says that care homes don’t provide much related training to their staff, adding: “People are coming to care work with a range of motivations. Not all the people who come to care work really come in with the best interest of residents at heart.”
A survey by the Royal College of Nursing in 2012 emphasised a lack of training for care home staff in England, and showed that 26 per cent of the responses from nurses working in care homes said “they did not have adequate equipment and medical supplies needed for residents – up 6 per cent from 2010.”
It also found that most carers are paid minimum wage, which at that time was £6.08 an hour.
However, Mr Pulsford says that care homes are increasingly bringing in better training. He said: “A lot of unqualified staff have gone to do things like NVQs. We shouldn’t tar everyone with the same brush.”
Every time Brenda visited her mother, she had a bet with herself. She said: “I wondered whether she’s got a hearing aid or not. She might have a hearing aid in, but there might not be a battery in, or the battery is running out, or I wonder whether she’s got teeth in today.
“Little things matter to me, as I am sure it matters to most people. Little things like cleaning glasses, cleaning teeth. And yet so many care homes, even where my mum is now, it doesn’t get done. And yet how long does it take to comb somebody’s hair? Clean their glasses, and clean their teeth?
“At the end of the day you get really genuine caring, compassionate people, and that’s fantastic, but when you get others, really.
“They just do it for the money. They are not bothered. I feel compassionate about all the people who haven’t got anybody and what they have to put up with because there’s nobody to have a voice for them.
A spokesman for Lancashire Teaching Hospitals, which includes Royal Preston, said avoidable emergency admissions to their hospitals from care homes was “not a significant problem for our trust,” with no significant rise noted recently.
Louise Giles, head of operations and delivery for the NHS clinical commissioning groups working across Chorley, South Ribble and Greater Preston, said: “One of our main aims is to make sure that patients are cared for in the right place, whether that is in hospital, in the community, or in their own home.We also want to make sure that we can prevent patients needing to go into hospital wherever possible, because if people can be cared for at home or in their place of residence it is much better for them and also their recovery.”
• Brenda’s mother sadly passed away a short time after this interview was carried out.
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