Elderly Care Watch UK

Blogging the quality of elderly care in the United Kingdom's residential care homes for the aged.

Sunday, August 31


Taken from The Sunday Times (London)
Written and researched by by Paul Nuki, Chris Hastings, Andrew Alderson

On the first floor of St Mark's nursing home, Margaret Cotgrave, the deputy matron, gave her new care assistant a lesson on how to handle one of her most demanding residents.

"Mya," she said, turning to the excitable 69-year-old woman who is suffering from dementia, "this is Chris. He is a clinical psychologist. He's here to assess you and if you don't behave, you can't stay. You will have to go to a mental hospital."

Walking out of Mya's sight into the corridor, Cotgrave turned to her new colleague and counted to three on her fingers. As if on cue, Mya let out a plaintive wail and began to cry.

Later, when queried whether she had adopted the best approach, Cotgrave said: "Nobody likes doing that with her. But I mean, Chris, nothing is going to make her better."

It was a revealing lesson. Her care assistant, Chris, was an undercover reporter for The Sunday Times investigating the treatment and living standards experienced by thousands of elderly people in many of Britain's 20,000 old people's homes, which house around 500,000 residents.

The investigation, in which reporters were placed in four homes, comes as ministers are reviewing the legislation controlling old people's homes with a view to launching a package of reforms, or announcing a royal commission, in the spring. This summer the Office of Fair Trading launched a separate inquiry into old people's homes, which charge up to Pounds 500 a week, to see if they provide value for money.

St Mark's, a crumbling Edwardian mansion block, was built as a hospital for tuberculosis sufferers. It is owned by the Wirral Christian Centre Trust, a charity which has Frank Field, the social security minister, among its guarantors. It is home to a mix of 17 pensioners and mentally disturbed people, situated at the head of the Wirral peninsula.

In its brochure, St Mark's says it is staffed by "people who really do care" and it provides "a high degree of comfort and security".

However, during the undercover reporter's six days at the home, where he worked without checks being made on his spurious reference, he observed a catalogue of rule breaches. On at least four occasions the emergency alarm in Mya's room was switched off by frustrated staff so she would have been unable to summon help.

Immobile residents were left in their rooms for long periods while others suffered from bed sores which staff admitted could have been prevented with proper care. Bedroom doors were frequently propped open and potentially dangerous chemicals, such as bleach, were left on trolleys in corridors, where wires and pipes were exposed. Some residents received only one hot meal a day in the home's sparsely furnished dining room. Others, unable to feed themselves, were given only soup and sandwiches for successive days.

Residents were given cruel nicknames by staff. Mya was known as Jabba the Hutt (an alien from the Star Wars films) because of her size, and jokes were made about the incontinence of residents.

This weekend, Cotgrave denied she or other staff had behaved improperly. She declined to answer detailed allegations but added: "We have nothing to hide here."

However, the Rev Paul Epton, chairman of the trust, conceded residents should not have been threatened. "Staff acted improperly and disciplinary proceedings will be taken against them," he said.

The crisis over the poor policing of Britain's old people's homes comes as the nation's population is ageing sharply. More than 1 in 10 of the population, 6.5m people, are now older than 70. By 2030, it is estimated there will be more than 10m. One in four people aged over 85 now lives in some form of institution.

This has resulted in a boom in the nursing home sector, which is valued at about Pounds 8 billion a year. The number of private homes has more than quadrupled, from 4,021 in 1970 to 17,065, as local authority homes and geriatric hospital wards have closed. Most homes are caring and responsible but some are not; others are well meaning but find the daily struggle to care for their residents an overwhelming strain.

As part of the investigation, The Sunday Times also placed Brian McConnell, 68, a retired journalist, in two homes to observe life from a resident's perspective. In one home in Bournemouth he witnessed a carer publicly ridicule Hilda, a pensioner, for wetting herself.

Hilda was recalled from a group coach outing and rebuked in front of her fellow residents. "Why did you mess yourself, Hilda?"

Clearly embarrassed, she replied: "I didn't."

"Why lie?" the carer barked as the rest of the coach party looked on. "You did. Now I'll have to clean you up."

In both the homes McConnell visited he was shocked by the "poverty" of his surroundings and the way his dignity was eroded by "a regimented regime". People entered his room without knocking; frail but articulate residents were mixed with the mentally ill and quarrelling and screaming among residents were commonplace.

The family of Margaret Irons, 83, know about the danger of mixing behavioural-problem residents with other elderly people. Irons, who suffered from Alzheimer's disease, was found by a cleaner lying in a pool of blood under a bed at Callands nursing home in Warrington, Cheshire, in March. She had been attacked by a fellow resident with a history of behavioural problems and died four weeks later from pneumonia. Last week North Cheshire health authority announced an inquiry into the incident.

Old people's homes are intended to be split into two categories: nursing homes for people in need of medical care and residential homes for the more able. In practice, however, many homes are dual registered and mix their residents. Both types are regulated and licensed under the Registered Homes Act of 1984 and are vis ited twice a year by local authority inspectors (health authorities monitor nursing homes; social services visit residential homes).

Inspectors claim they are burdened by bureaucracy and not equipped with the powers they need to do their jobs properly; they are unable, for example, to operate undercover and some inspectors are responsible for monitoring more than 50 homes. While complaints and the number of homes are rising, their budgets remain fixed.

The Angell Rest Home in Southampton, Hampshire, illustrates the difficulties that inspectors face. In October last year, Hampshire county council withdrew the registration from Cellestte Angell, the proprietor, after receiving complaints from staff that she was physically abusing residents.

The home was kept open after Angell launched an appeal; that was dropped in March and the following month Angell's daughter, Sharah Pierce, was registered to run the home on the condition that her mother did not visit without first giving seven days' notice to social services.

Last week a Sunday Times reporter who volunteered for work at the home found Angell on the premises on two occasions. Pierce said her mother was only there to inspect a problem in one of the rooms. She described the allegations made against her mother as "malicious" and said she was running a "respectable" home.

In some homes visited by reporters, many residents were heavily sedated. This trend has alarmed the Royal College of Physicians, which recently revealed that more than 90% of residents in old people's homes are prescribed drugs, the average amount of which has risen by 50% in 10 years.

Dr Michael Denham, a consultant geriatrician at Northwick Park hospital in northwest London and chairman of the working party which produced the report, said: "In some homes, drugs are being used like a chemical ball and chain to keep patients quiet. I am concerned that too many patients are being 'switched off' at the same time as the lights."

The Sunday Times is now launching a campaign aimed at lifting standards in the nation's homes for the elderly. Yesterday, Paul Boateng, the health minister responsible for old people's homes, ordered a departmental inquiry into the disclosures.

[This article appeared in the Sunday Times, August 31st, 1997.]