Council fined over deprivation of liberty of elderly lady

A county council in the south of England recently received a hefty fine for depriving an elderly 91-year-old lady of her liberty whilst she was living in a care home.

The 91 year-old had constantly remonstrated that she wanted to leave the home but was ignored. No application to restrict her liberty was ever put forward by the homes management or county council representatives.

After winning her appeal, the lady has swiftly moved out of the home to live with her son.

Deprivation of Liberty Safeguards (DoLS) were introduced as part of the Mental Capacity Act 2005 and aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. Issues surrounding deprivation of a person’s liberty are also addressed in Article 5 of the European Convention on Human Rights.

It would appear that both representatives from the local council and homes management have not observed the five key basic principles of assessment when considering a deprivation of liberty application. These are:

  • A person must be assumed to have capacity unless it is established that they lack capacity.
  • A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success.                                 
  • A person is not to be treated as unable to make a decision merely because they make an unwise decision.
  • An act done or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in their best interests.
  • Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

This is a very rare case. Very few appeals against deprivation of liberty are dismissed and fewer result in compensation.

It could be argued in this case that the lady in question should have been placed in a respite bed for a short period with the view to a swift discharge back into the community when preparation for discharge had been made.

Summary

This case emphasises the importance of adhering to the 5 basic principles of assessment when carrying out a deprivation of liberty assessment, and as such serves as a warning to all care providers. It is essential that care managers undergo the correct training to ensure that they understand the assessment and application process surrounding deprivation of liberty and how to apply this when required to individual Service Users in their homes. If these basic principles had been observed, then the injustice this 91-year-old lady experienced in depriving her of her liberty could have been avoided, and legal action resulting in a fine would not have been the result.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director Bettal Quality Consultancy

Allegations of abuse that are damaging to the reputation of home care/domiciliary care workers

Home care / domiciliary care providers must be in a state of shock following the revelation of allegations that 23,000 home carers have abused the elderly and vulnerable in their own homes over the past 3 years.

A total of 23,428 accusations have been made to local councils during that time. Including, 12,000 involving neglect, more than 3,400 of physical abuse and 400 of sexual abuse.

The figures were obtained Radio 4’s Film on 4 programme through freedom of information requests to authorities across the UK. But what is alarming are the claims that this is just the tip of the iceberg as only half of the councils responded to requests for information. Michel King the Local Government Ombudsman said “What we see is just the tip of the iceberg. What we see is a whole range of complaints; failure to look after people’s personal care needs, help with eating, helping them with their own hygiene and with medication.

The data revealed that very few of the carers found responsible were held to account. There have only been 15 prosecutions in the past 3 years and police only investigated 700 alerts during that period.

Gary Fitzgerald from the charity Action on Elder abuse said: “The majority of abuse is criminal and never gets prosecuted. It gets social worked but never gets prosecuted. If the police are involved, they do not want to upset the older person, so won’t prosecute. People involved might receive a caution if you’re lucky or there may not be any prosecution.

What has led to this serious state of affairs?

According to Bridget Warr Chief Executive of the UK Care Association, which represents home care providers said: I think the challenges of too little money in the system through local authorities to providers and indeed to workers, absolutely needs to be investigated and put right.

There is no doubt that the lack of a proper funding strategy is a major component in the delivery of home care but can it be seen as the only reason for bad care practice? I happen to believe that despite these revelations, the majority of home / domiciliary care workers are honest, trustworthy compassionate and committed people. We need to recognise however that there are some care workers who are dragging their reputation down and steps need to be taken to protect it.

How can we prevent allegations of abuse?

First of all, we need to accept that this level of alleged abuse cannot be laid solely at the door of insufficient funding for home care. I am aware that funding will have a marked effect on staff training and recruitment for example. But I think we also need to look hard at current practice and see what can be done to prevent and reduce allegations of abuse. As a start we could adopt a strategy that would include the following:

  • During interviews to appoint staff, more emphasis on measuring the candidate’s attitude to the importance of trust and compassion.
  • Ensure every home care worker has a code of conduct handbook.
  • A greater emphasis on staffs understanding of duty of care during induction and supervision.
  • Monitoring on site the performance of staff.
  • Regular spot checking and random home visits by senior staff to check on people’s satisfaction with the service.
  • Looking for trends in complaints by service users.
  • Ensuring where applicable staff who have committed offences are included on the DBS Disclosure and Barring Service List.

Summary

These latest revelations of alleged abuse of elderly and vulnerable people who use home care services cast a blight on those hardworking honest and trustworthy home care workers. Providers must take preventative measures to ensure that people who use home care services are protected and safeguarded. The author of this blog believes it would be a mistake to think that this situation has been caused purely through the lack of funding. At the end of the day this is down to bad practice and steps need to be taken and a strategy adopted to prevent it.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

More funding for social care but the long term problem still needs to be addressed

 

Last Wednesday’s budget which saw the Chancellor of the Exchequer Philip Hammond announce an increase in social care funding in the next 3 years is to be welcomed. The constant pressure by providers of social care services, the NHS and MPs from all sides of the House has at last produced some tangible results, and the Chancellor has been forced to play his get out of jail card.

One could argue that far from the money been allocated to improve the quality of social care services or to alleviate the growing demands for social care by an ever-increasing elderly population. The main purpose of the funding was to ease the strain on the NHS by preventing bed blocking.

However, continuing with the positives. The announcement of more than £2bn of new funding for adult social care in England is welcome, and badly needed following years of funding shortfalls. Combined with measures announced in the 2015 Spending Review including the social care precept, this means that (in theory) more than £9bn of additional money has been allocated to social care in this Parliament.
The government highlights that the package announced since the election means that councils will be able to increase adult social care-specific resources in real terms in each of the final three years of the current parliament. Indeed, if (a big if) the amount councils spent on social care in 2016-17 were maintained in real terms and these new funds added on top, spending would increase by 16 per cent in 2017-18, and by almost one quarter (24 per cent) in the three years to 2019-20.

But the “big if” and “in theory” above gives concern. Largely because councils’ adult care spending isn’t ring-fenced, there’s no guarantee that current funds will be protected. There is a risk that additional earmarked funds simply displace non-ringfenced spending, with ongoing pressure on wider council budgets continuing to bear down on the social care allocation.

The second reason for concern is that even if total real care spending increases, the money the government has set aside will not be sufficient to close the social care funding gap. The immediate cash injection will go some but not all the way towards addressing an estimated funding shortfall of at least £1.3bn in 2017-18. But looking to the end of the parliament, £400m of new funding in 2019-20 means that only around 15-20 per cent of the commonly-used estimate of a £2.3-2.6bn funding gap that existed prior to this Budget has been filled (and even this might be optimistic – some organisations contend that the real value of the gap is much higher still). 

This raises the prospect of further increases in unmet need in coming years. The number of adults who say they don’t get the care they need having already doubled since 2010.

Looking to the future
While a short-term cash injection is very welcome, these concerns suggest that they are no more than a sticking plaster and the job still needs to be done. The debate must now turn to the longer-term settlement for care, so it’s welcome that the government announced in the Budget that it will publish a green paper on how the system can be put on a more secure footing. Long-term reform of social care funding therefore remains vital. Theresa May has said to be determined to find a solution to a problem that has thwarted all governments of the past 20 years, despite a series of reviews and inquiries in that time.

Any solution to this problem must face the challenge of protecting people against the risk of having their lifetime savings wiped out by care costs. The Dilnot Commission (2011) proposal of extending means-testing and capping the lifetime cost appears the right way to go. Indeed, this approach was enacted in the Care Act 2014, but then shelved in 2015. It’s now time to take it back down from the shelf and dust it off.

The other fundamental challenge is sustainable funding for an integrated NHS and care system, as set out by the Barker Commission (2014). This accepts that spending on health and care as a proportion of GDP would need to rise. To fund this, you might have to question the logic of some universal pensioner benefits, National Insurance rates for older workers and higher earners, as well as the increasing focus on taxation of income rather than wealth derived from property, inheritance and capital gains. Other ideas floating around include the suggestion of a “care Isa” to encourage people to save to meet their own costs, a guarantee of a set amount of free care for all and even retrospective payment of costs through an inheritance levy.

Summary
At long last the Chancellor in his budget has recognised the plight of social care services and the needs of an increasing elderly population. The injection of £2bn funding is to be welcomed along with the additional local authority contribution. However, some commentators believe it will hardly cover the funding gap. It must be hoped that the Green Paper promised by Theresa May comes to fruition and a realistic solution is found.

The difficulty remains that any long-term solution to social care funding will require a cross party consensus and as history has informed us this will be difficult to achieve.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Gaining an understanding of Dementia Care Mapping

Dementia Care Mapping was developed by Psychologists Tom Kitwood and Kathleen Bredin at the University of Bradford in the early 1990’s. They designed an observation tool that looked at the care of people with dementia from the viewpoint of the person with dementia. They found from the results of using the tool that it could assist with the development of person centred care.

The method itself draws on a value base of respecting personhood. It is possible that people with dementia, despite their disabilities, can experience a sense of well-being. However, for well-being to occur, care and attention must be focused on the uniqueness of the person, their tastes, abilities and their choices.

Crucial to the method is the belief that the social world that surrounds the person can have a positive or negative effect on well-being. DCM can help staff to understand this world more clearly and assist in the development of care that is person centred.

Well-being in dementia is viewed as a complex interaction of a person’s neurological state, their physical health, their personality, social world and background. DCM will help staff to gain a greater understanding of the person and in the process help staff to plan care.

Dementia Care Mapping was primarily developed to be used as part of a continuous quality improvement process to develop the quality of person-centred care over time. Through a process of preparation and feedback, staff are encouraged to consider care from the point of view of the person living with dementia. Based on these observations, changes can be made to care plans and to care practice generally.

The use of Dementia Care Mapping

Dementia Care Mapping is an established approach to achieving and embedding person centred care for people with dementia. It is recognised in key national policy and guidance. The Social Care Institute for Excellence and National Institute for Health and Clinical Excellence (2006) Guideline on supporting people with dementia and their carers in health and social care discusses the role of DCM™ in changing practice. The National Audit Office (2010) report on Improving dementia services in England recognises DCM™ as a method for measuring quality of life.

For over 20 years it has been used by care practitioners to improve quality of life for people living with dementia in a range of care settings, including care homes and hospitals.

Dementia Care Mapping prepares staff to take the perspective of the person with dementia in assessing the quality of the care they provide. It empowers staff teams to engage in evidence-based critical reflection in order to improve the quality of care for people living with dementia.

Dementia Care Mapping can be used for different purposes including:

• quality monitoring and improvement
• individual assessment and care planning
• review of key times of the day
• staff development and training needs analysis.

The process of Dementia Care Mapping

DCM is an observational tool that is only used in ‘public’ areas of care environments. It usually involves one or two trained mappers sitting in areas such as a lounge or dining area and observing what happens to people with dementia over the course of a typical day. At the end of a period of observation the results are analysed and fed-back to the care team so that care can be developed.

It has been used as part of a developmental, supervisory framework for staff who support people living in their own homes, and with other vulnerable groups of people who have communication difficulties.

DCM can be used to assist with the assessment and planning of care for someone who is displaying unusual behaviours that are challenging for staff and other residents and where the home has requested extra funding to help support them meet the needs of a resident. A shorter observational map can be beneficial in identifying possible triggers or patterns in behaviour to contribute to the support plan. Mapping is only carried out in public areas. Mapping in areas where sensitive care practice is undertaken is strictly forbidden.

The contribution of DCM to the field of dementia care

The UK’s Audit Commission (2000) in their Forget me not report on mental health services for older people underscored its role in improving quality care. The benefits of DCM™ include the improvement of people’s well-being and helping staff see care from the point of view of the person living with dementia, leading to evidence-based feedback and action planning that motivates staff and helps them to feel more confident in implementing person-centred care.

To learn more about Dementia Care Mapping readers should contact the University of Bradford.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Duty of care and responsibilities of domiciliary care workers

Allegations of abuse that are damaging to the reputation of home care/domiciliary care workers
Home care/domiciliary care providers must be in a state of shock following the revelation of allegations that 23,000 home carers have abused the elderly and vulnerable in their own homes over the past 3 years.

A total of 23,428 accusations have been made to local councils during that time. Including, 12,000 involving neglect, more than 3,400 of physical abuse and 400 of sexual abuse.

The figures were obtained by Radio 4’s File on 4 programme through freedom of information requests to authorities across the UK. But what is alarming are the claims that this is just the tip of the iceberg as only half of the councils responded to requests for information. Michel King the Local Government Ombudsman said “What we see is just the tip of the iceberg. What we see is a whole range of complaints; failure to look after people’s personal care needs, help with eating, helping them with their own hygiene and with medication.

The data revealed that very few of the carers found responsible were held to account. There have only been 15 prosecutions in the past 3 years and police only investigated 700 alerts during that period.
Gary Fitzgerald from the charity Action on Elder abuse said: “The majority of abuse is criminal and never gets prosecuted. It gets social worked but never gets prosecuted. If the police are involved, they do not want to upset the older person, so won’t prosecute. People involved might receive a caution if you’re lucky or they may not be any prosecution.

What has led to this serious state of affairs?

According to Bridget Warr, Chief Executive of the UK Care Association, which represents home care providers said: I think the challenges of too little money in the system through local authorities to providers and indeed to workers, absolutely needs to be investigated and put right.

There is no doubt that the lack of a proper funding strategy is a major component in the delivery of home care but can it be seen as the only reason for bad care practice? I happen to believe that despite these revelations, the majority of home / domiciliary care workers are honest, trustworthy compassionate and committed people. We need to recognise however that there are some care workers who are dragging their reputation down, and steps need to be taken to protect it.

How can we prevent allegations of abuse?

First of all, we need to accept that this level of alleged abuse cannot be laid solely at the door of insufficient funding for home care. I am aware that funding will have a marked effect on staff training and recruitment for example. But I think we also need to look hard at current practice and see what can be done to prevent and reduce allegations of abuse. As a start, we could adopt a strategy that would include the following:

• During interviews to appoint staff more emphasis on measuring the candidate’s attitude to the importance of trust and compassion.
• Ensure every home care worker has a code of conduct handbook.
• A greater emphasis on staffs understanding of duty of care during induction and supervision.
• Monitoring on site the performance of staff.
• Regular spot checking and random home visits by senior staff to check on people’s satisfaction with the service.
• Looking for trends in complaints by service users.
• Ensuring where applicable, staff who have committed offences are included on the DBS Disclosure and Barring Service List.

Summary

These latest revelations of alleged abuse of elderly and vulnerable people who use home care services cast a blight on those hardworking honest and trustworthy home care workers. Providers must take preventative measures to ensure that people who use home care services are protected and safeguarded.

The author of this blog believes it would be a mistake to think that this situation has been caused purely through the lack of funding. At the end of the day this is down to bad practice and steps need to be taken and a strategy adopted to prevent it.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy