I lost my knickers in a care home…
…I feared would be my experience of moving in to a residential care home for the weekend, but my laundry came back neatly folded (no surprise there, I am the CEO after all).
Having just been appointed as Chief Executive of The Fremantle Trust, I decided to spend some time finding out what our care homes were really like. I know I’m not elderly or disabled, so I can’t experience what it’s like to be dependent on others for my needs, but I can at least spend time soaking up the atmosphere, meeting people, observing what’s going on, eating the food and trying out the equipment. Part of my motivation was to illustrate to others, including colleagues, that if our care was good enough for the residents then it was good enough for me. And I wanted to learn, so that I could try to improve our services going forward.
I have to admit I had mixed feelings before moving in as I anticipated observing practices that could concern me. The number of people who thought I might suffer harm from staying in a care home (not just losing my laundry, but my dignity), confirms the widely held negative image that care homes have, sometimes deserved and sometimes not, and too often promulgated by people who have never set foot in one. I’m pleased to report that I learnt a lot, I had a lovely time and I can’t wait to do it again.
I was staying in a 60 place care home divided into four households of 15 residents, each household having its own dining room and lounge. My experience of the physical environment was mixed. I was horrified to find that not only was my mattress covered in plastic but the pillows were as well. Once I mentioned it, the housekeeper found me regular pillows and I understand that normally bedding is a matter of personal choice, mediated by the practical requirements of preventing pressure sores and managing cleanliness. My room was a good size and everyone had their own ensuite wetroom, but the walls were thin and my neighbour’s TV kept me awake at night. In fact, the ubiquitous TV was very much in evidence throughout the home. During the first night the night staff were talking in normal voices which disturbed me, but the next two nights were quiet. The food was good and there was always a choice, with the main meal eaten in the evening. I tried out the bath and it was fine but there was much to be done to make the assisted bathroom more inviting. There is a perennial lack of storage in care homes which means hoists, wheelchairs and even mattresses get left in places where they shouldn’t be (like bathrooms). I realised after a few days how quickly I acclimatised to the environment, it soon felt like home, and I stopped noticing things that might look out of place to a visitor, or worse, needed to be fixed.
The most fascinating insight that I gained was into the strong sense of community that existed between the residents and between the residents and the care team. At first I was concerned about the apparent lack of privacy, the banter and sometimes the bickering. ‘Isn’t that confidential information?’ I thought, as resident’s needs and whereabouts where openly discussed. I soon witnessed affection and camaraderie between the people who lived in the home. If anyone was ill or absent there was real concern for their wellbeing, not least for Maureen, who was receiving end of life care. On one day residents insisted that the staff phone around all the hospitals in the area to find out what had happened to Enid’s regular visitor, Don, having heard that he was unwell. Enid was so distressed by his absence and there was joy all around when he was located safe and well. There was a real atmosphere of playfulness and fun, not leased founded on an acceptance of the quirks displayed by people living with dementia, which I missed when I left. And there was solidarity in the face of adversity, adversity that arose not from living in a care home, but from facing illness and yes, death together.
I had the opportunity to observe first hand the impact that the of loss of mobility has on people and how much time it takes to help residents with their everyday needs. For some people, living with dementia means a gradual loss of personal agency and eventually a loss of control over bodily functions, such as eating, walking and continence and they need a great deal of attention. For others is was simply their inability to get around safely and without falling, that presented their greatest challenge. As a result a sea of Zimmers and walking aids filled every available space in the lounge.
Care workers were constantly busy throughout the day, supporting residents with limited mobility, to safely get up and about, to dress, to get to the toilet, bathe and take their medication. Several residents needed two carers to help them move from A to B. On top of that care workers were endlessly serving meals, snacks and drinks, and clearing up, both to keep the place tidy and to manage infection control. The individual call bell that residents have in order to summon help was always answered quickly, but the request could just as easily be for a cup of tea as for help with going to the toilet, and the care workers had no effective way of prioritising which bell to answer first. I saw for myself how well care workers understood the needs of the residents they were supporting and wondered whether endlessly recording in care plans is really helping anyone (other than being a defensive reaction to CQC inspection). One resident observed “I see them writing down a lot of junk every day”. Despite this the care workers would try to find time for just ‘hanging out’ and cultivating social relationships when they could.
I am convinced that we can do more to support people to maintain their mobility and we need to use physiotherapy skills to improve personal strength and exercise daily. I am equally struck by how little the residents were encouraged to participate in the daily routines, especially at mealtimes, barely pouring their own tea. Care workers were just too busy to encourage residents to get involved and as a result they had come to expect that they would be waited upon, perhaps losing their confidence along the way.
As if to reinforce this task-based approach at the handover meeting care workers rigorously went through every resident to ensure that their wellbeing (illness, diet, appointments, visits, birthdays, complaints) was communicated between shifts. But one resident that I had got to know who was very recently bereaved, was not mentioned in the handover, and I wondered to what extent emotional needs are routinely acknowledged and addressed.
My overriding observation was the level of skill required of care workers in a modern care home environment. Gone are the days of knit and natter, when able-bodied older people moved into a care home because they had lost a spouse or could no longer manage their home. People these days have acute health care needs and are often close to the end of life. I observed that care workers need to have technical skills, to communicate well and to have emotional intelligence. They must manage everything from the most intimate personal care tasks, administer medication, keep accurate records, assess day to day mental capacity, deal positively with professionals, visitors, the bereaved and the dispossessed, while at the same time giving control to residents to ensure care is person centred. I was so struck by how hard they work and how demanding the work is, yet, compared with other sectors, they receive minimal training, too little emotional support and are generally paid the minimum wage.
Following my weekend I have given myself a long list of potential actions to consider – encouraging resident participation, providing physiotherapy, more emotional support, increasing storage space; investing in technology, training and, not least, wages. And turning the telly off!
My stay in a care home brought all this home to me in a way that looking in from the outside never could, and I am grateful to residents and colleagues at Cherry Garth care home for giving me this experience.
Names have been changed.