Special Measures for Care Homes - a Last Resort

Special Measures for Care Homes - a Last Resort

It was inevitable that the government would extend 'special measures' to failing care homes and home care agencies having used the regime with some success for hospitals.

While special measures may make some care providers improve, it does not address the fundamental and growing problems in the care sector. It also ignores the differences between hospitals and care providers.

The recent Panorama and Tonight exposés of appalling neglect and abuse in care homes and by home care providers has forced the government to take action. The regulator - the Care Quality Commission - will now have to implement 'special measures' in the care sector but it's not clear yet how it will do so (even though CQC already has powers to close failing care services).

What is clear that the TV exposés are just the tip of the iceberg. An analysis of the 4,000 most recent reviews posted by families on the Good Care Guide site shows huge concerns about the quality of care for some of the most frail and vulnerable older people in Britain today.

These reviews highlight some key concerns about care homes, for example, such as incorrect medication, poor communication and failure to respond to calls for assistance as well as examples of physical abuse and restraint.

Underlying most of these reviews are concerns about staffing - the lack of staff, their inadequate training, the high turnover of staff and the fact that they don't have enough time to do their job properly.

These concerns are compounded by the increasing needs of care home residents, with the majority having dementia and many being extremely frail and requiring high levels of support. Without sufficient staff (there are no minimum staffing levels for care homes), these problems will only get worse as more residents need one to one support for eating and two care workers for toileting, washing, dressing and getting out of bed.

There are big questions for government, centrally and locally, about the funding of care, the inspection of care, the training of staff and the way care companies are run.

Unlike hospitals, most of these care providers are in the private and voluntary sectors. When care providers are put into special measures, how will they be supported to improve? Will they be funded to invest not just in staff and management training and development but also in improving staffing ratios?

Will families and commissioners use a care provider identified as being in special measures? And if not, will this exacerbate a cycle of decline? Hard-pressed local authorities have squeezed the fees they pay care providers over several years to such an extent that delivering quality care is already an almost impossible challenge.

And what will happen to older people if their care provider fails to improve and is closed by the CQC? Are other care providers ready and waiting to step in? And what about the well-known dangers of moving a very frail elderly person from their (care) home?

No doubt special measures may make some care providers improve - just as hospitals and schools have responded to the threat. But it is a last resort.

Wouldn't it be better to invest in the training, supervision and leadership of care staff and their pay? And to support advocates and families to speak out when concerns arise and provide early warning signs, rather than wait until things have gone seriously wrong?

If we value older people, then we should value their care. This is one of the biggest challenges facing not just the next government but all of us.

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