The UK - A country fit to grow old in?

What are your chances of your old age in the UK being a matter of loneliness, confusion, fear, incontinence, neglect, and suffering? That is unfortunately the fate of the majority of people today, who are unlucky enough to live past 85. With the number of elderly growing, the situation is likely to get worse.

So, why is care so bad?

The biggest single reason is that we do not make it a priority. Let's look at a typical English old peoples home. They are typically conversions of large old Victorian buildings, usually with cheap and ugly extensions. They are privately owned and run, and paid for by sale of residents family assets, until they are exhausted, after which the local council is responsible. Many homes have gone bankrupt, usually after a debt financed takeover. This then results in residents having to move to another home with new staff and new neighbours.

In a typical home the residents usually sit together against the wall of a lounge, with a TV in the background showing something they have neither chosen or are able to follow. There is a smell of urine. Quite often, one or two residents become agitated and cry or scream, which is logical enough as they are actually locked in. Doors can only be opened with a key code which the residents do not remember.

The staff (on minimum wage and doing unsocial hours), have no time to organise activities or respond individually to the patients. There are no staff with nursing qualifications, so that they cannot do basic nursing. Simple tasks like giving insulin injections are done by various visiting community nurses, who rush in and out and have no time to look after the whole patient.

The medical and nursing needs of the residents are severely neglected. Community nurses tend to resent the fact that the homes do not provide nursing care to their residents, and just do the basic injections and dressings. Care home residents are also neglected by GPs and hospital specialists. GPs are called in by the staff only when residents get an acute illness. There is little or no continuity of care, and there is a huge overuse of medication, much of which is likely to be harmful. The medication is reliably administered by the care staff as that is one of the things that gets checked in inspections, and long term drugs are rarely properly reviewed by a doctor. GPs have  poor access to patient records when visiting patients in Care homes, as their records have become computer based, without anyone sorting out or paying for an effective mobile solution. GPs are not paid extra to look after care home residents although they are well aware that the 70 pounds a year they are paid per head does not pay for many doctors visits. They cannot actually refuse to accept care home residents onto their lists but there is a real disincentive against providing good and accessible care and becoming popular with care home staff.

Out patient visits to hospitals tend to be a waste of time as care staff can rarely take the time to accompany patients. There is no effective attempt to do or record advance planning to help decide what to do in case of serious illnesses. We know that most elderly wish to avoid hospital admission if at all possible, but we do nothing to implement their wishes. Patients tend to be discharged from hospital on lots of medication such as for blood pressure or cholesterol which is designed to prolong life when the aim should be quality of life not quantity. But hospital doctors feel they have to follow guidelines, which are based on research that is simply not appropriate for frail elderly patients. Admissions are difficult to prevent because care staff cover their backs by calling ambulances, and patients get admitted to hospitals even when their life expectancy is very short. Hospital staff understandably concentrate on curable cases and  many many people suffer a lonely, neglected, and frightening death in hospital against their stated wishes.

What are we doing about this? For most areas not much.

But some areas such as Sheffield have arranged systems led by Community Physicians specialising in the care of the elderly and in which GP’s are supported and paid to do regular visits and work together with care home staff and other community staff. Time is taken to discuss and record advance plans with patients and relatives.  The overall costs are lower, as the big expense, which is hospital admission, is cut by 15%. See the RCGP study on Sheffield Care Homes initiative 

We can also look, surprise surprise, to Scandinavia or New Zealand, where elderly people first move to retirement villages. There they are helped to remain independent and activities are organised to keep mind and body preserved as much as possible. There are usually gardens, and greenhouses and residents are not locked in as in the UK. When frailty increases they move to the residential block next door and there is usually also a high dependency unit with qualified staff for the sickest residents.

We could emigrate, but that's tricky, so let's change the dysfunctional set up we have in most of the UK.