Neglect common in English care homes

News Release
March 21, 2018 | London – Neglect common in English care homes

The largest-ever survey of care home staff in England, led by UCL researchers, has found that neglectful behaviours are widespread.

Elder care

For the study, published today in PLOS ONE, care home staff were asked anonymously about positive and negative behaviours they had done or had witnessed colleagues doing.

Dr Claudia Cooper (UCL Psychiatry), the study’s lead author, said: “We found low rates of verbal and physical abuse; the abusive behaviours reported were largely matters of neglect.

“These behaviours were most common in care homes that also had high rates of staff burnout, which suggests it’s a consequence of staff who are under pressure and unable to provide the level of care they would like to offer.”

From 92 care homes across England, 1,544 care home staff responded to the survey. The staff were asked whether they had, in the past three months, witnessed a range of positive and negative behaviours. Their responses were linked to data from each care home describing a measure of burnout in care home staff.

Some negative behaviours were categorised as ‘abusive’, using a standard definition,* and based on the behaviour reported, rather than the intention of the care home staff. The most common abusive behaviours were: making a resident wait for care (26% of staff reported that happening); avoiding a resident with challenging behaviour (25%); giving residents insufficient time for food (19%); and taking insufficient care when moving residents (11%). Verbal abuse was reported by 5% of respondents, and physical abuse by 1.1%.

At least some abuse was identified in 91 of the 92 care homes.

Positive behaviours were reported to be much more common than abusive behaviours, however some positive but time-consuming behaviours were notably infrequent.  For instance, more than one in three care home staff were rarely aware of a resident being taken outside of the home for their enjoyment, and 15% said activities were almost never planned around a resident’s interests.

“Most care homes, and their staff, strive to provide person-centred care, meaning that care is designed around a person’s needs, which requires getting to know the resident and their desires and values. But due to resources and organisational realities, care can often become more task-focused, despite intentions and aspirations to deliver person-centred care,” said co-author Dr Penny Rapaport (UCL Psychiatry).

“Carers can’t just be told that care should be person-centred – they need to be given the support and training that will enable them to deliver it,” she said.

The study is part of the UCL MARQUE cohort study, which is also looking into cost-effective interventions to improve the quality of care for people with dementia, and will be using this anonymous reporting as a measure of how well training interventions are working.

More than two thirds of care homes residents have dementia. Agitated behaviours such as pacing, shouting or lashing out are more common in dementia, and can make provision of person-centred care very challenging for care staff to deliver, often with minimal training and limited resources.

“With the right training, care home staff may be able to deliver more effective care that doesn’t need to be more expensive or time-consuming. If they understand and know how to respond to behaviour, they may be able to do more without greater resources,” said the study’s senior author, Professor Gill Livingston (UCL Psychiatry).

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, commented: “70% of people living in care homes have dementia, and it’s clear from these findings that they’re bearing the brunt of a chronically underfunded social care system.

“It’s upsetting but unsurprising that abusive behaviours were more common in homes with higher staff burnout. We’ve heard through our helpline of people with dementia not being fed, or not getting the drugs they need, because a carer isn’t properly trained, or a care home is too short-staffed.

“By 2021, a million people in the UK will have dementia. The government must act now, with meaningful investment and reform, or we risk the system collapsing completely and people with dementia continuing to suffer needlessly.”

The study was conducted by researchers at UCL and the Camden and Islington NHS Foundation Trust, and funded by the Economic and Social Research Council and the National Institute for Health Research.

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Chris Lane

Tel: +44 (0)20 7679 9222

Email: chris.lane [at] ucl.ac.uk

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Learning from zoos – how our environment can influence our health

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CoolR/Shutterstock

Emmanuel Tsekleves, Lancaster University

We are told that we are a nation of couch potatoes, lacking the will and the strength to turn around the obesity tanker. We all need a little help in our quest for a healthier life and design can play a crucial part. If we designed our towns, cities, homes and workplaces more like animal experts design zoos, we could be one step nearer to reaching our fitness goals – as long as we can have some fun along the way.

It is reported that British people will be the fattest in Europe by 2025 and that if we want to reverse this we should have a healthier lifestyle by exercising more and eating less. But we are often made to feel guilty for not sticking to theses healthy lifestyle plans. I would suggest that before we start blaming people for adopting sedentary lifestyles, we should be taking a step back to look at the design of the environments, towns and cities in which we live.

The link between the design of the built and natural environment and its role in our health and well-being has been well explored. Now new research, led by Lancaster University, on “design for health” suggests that the environment, including buildings, cities, urban spaces and transport infrastructure, is closely linked to the lifestyles we adopt.

What is abundantly clear is that, as we shape our environment, it is also shaping us. Our psychological, physiological and physical status as well as our interactions with other people and with the natural environment are all affected. A key challenge that governments and policy makers worldwide are facing is how our built environment and infrastructure should be shaped to support healthier behaviours to prevent disease.

First, we should stop focusing on methods that tell people what to (or not to) do and which attempt to change their behaviour simply through media campaigns and punitive measures, such as tax schemes. While seeking to minimise the barriers that prevent healthy behaviours, we should make sure that the design of new environments is taken into account.

Looking to zoos

A good model would be to look at how zoos are designed. Before a zoo is built, it is common practice for zoologists, biologists, animal psychologists, nutritionists, architects, designers and landscape architects to work closely together to create an environment that optimises the living conditions for the animals.

Important environmental elements, such as vegetation, habitat, lighting, materials and each animal’s requirements are taken into account. The ultimate aim is to design an environment that fully supports the animals’ physical, psychological and social well-being. Ironically, we do not seem to make the same demands when a town, neighbourhood or workplace environment for humans is planned and designed.

Another opportunity that has recently emerged is the healthy new town NHS initiative. The aim is to radically rethink how we live and take an ambitious look at improving health through the built environment. Ten demonstrator towns will be built across England with community health and well-being as their main focus. Clinicians, designers and technology experts will reimagine how healthcare can be delivered in these places. Although this is a step in the right direction, what it is currently missing is the more holistic approach we have seen in the design of the zoos.

A crucial element in designing these towns so they are places that people would want to live in, is to include community members in their creation. This strategy would help design-in health-promoting behaviours, such as access to healthy food outlets or green spaces in which people can walk and exercise.

Embracing playfulness

Playful design – the mapping of playful experiences from games and toys to other non-game contexts – can play an important role here in inviting and encouraging people towards healthier alternatives. For example, the piano stairs project in Stockholm, which converts the metro stairs into a giant functioning piano keyboard – much like the piano made famous in the Tom Hanks movie Big (1988) – demonstrates great promise. It encourages commuters to opt for the intriguing new stairway instead of the escalators to enjoy making musical movements as they go up and down.

A project in The Netherlands, meanwhile, illustrates how everyday street furniture, such as lampposts, benches and bollards, can be inexpensively converted into impromptu exercise devices, inviting people to engage in casual activity and socialise with their neighbours. We could therefore envisage several other contexts were playfulness can transform mundane everyday activities into fun ones that encourage people into a more active and social lifestyle.

We could convert building walls into activity walls to encourage stretching of arms and legs through touch; redesign public squares and walkways into interactive dance floors that invite movement and guide you through a city; and transform workplace spaces and public places into “playgrounds” that boost movement and productivity and decrease lethargy.

The Conversation

So there you have it. If we want to be a nation of lean, mean and healthy citizens we need to learn from zoos and the animals that live in them. And we need to embrace playfulness and enjoy the place where we live. That way, we can tackle life with a hop, skip and a jump.

Emmanuel Tsekleves, Senior Lecturer in Design Interactions, Lancaster University

This article was originally published on The Conversation. Read the original article.

Trishaws anyone?

A beautiful intergenerational activity to celebrate the love of cycling, a spot of reminiscence, and the great outdoors.

 

How lovely is this? As a child, my mother and I use to jump on a trishaw after our trip to the wet market. I use to watch the spokes go round and round and I still can hear the “Tak tak tak” sound the wheels make as we head home. It’s always a magical experience no matter how short the trip was. Took less than 5 minutes to reach our home from the market on a trishaw and I’ve sat in it for years and years with my mum, but it never grows old. With the wind in my face, the clicky round of the rickshaw, and just cuddled beside my mum with all our groceries at my feet, the world was our oyster.

When Cycling Without Age it just brought back all these lovely memories of my childhood. I wondered how wonderful would this be for it to be reintroduced into the community. There would be so many older adults in Asia whose main form of transport was the bicycle or the trishaw at a point of their time in their youth. As we aged and our physical abilities deteriorate, we lose our abilities to cycle and with it, our memories of freedom, that wind in your hair, the road just beneath your feet, to go wherever you wanted to go and be wherever you wanted to be.

Such an intervention can only bring generations together, a real intergenerational project of adventure and bonds. To bring people closer through the love of freedom and the outdoors.

I’m so glad to see this in Singapore and I hope that more Singaporeans will jump on board to support this movement!

If you have time, have a read of these 21 inspirational stories from Cycling without Age http://cyclingwithoutage.org/book/

A Better Way of Looking at Dementia Care in Asia: The 4 Big Zeros

This is pretty amazing, a models of care from an organisation providing care in Japan. This is just incredible, it’s just so simple and functional.

At first glance, it looks confusing, like what? 4 big zeros? Zero wheelchairs? What does that mean? That the organisation don’t provide wheelchairs?

image from http://www.sompocare-next.jp/

4 zero is a really outstanding care philosophy, to ensure that the organisation work towards the physiological and mental health of the resident to ensure that their independence, dignity and autonomy is maintained as long as possible. So much so that until the end of days they will never have to live with diapers, assisted baths, tube feeding or wheelchairs.

1. Zero Diapers/pads

2. Zero Special baths

3. Zero Tube feeds

4. Zero Wheelchairs

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That really sums up the care that we need to provide to ensure that the people with dementia have a great quality of life. Too often we take it for granted that it’s okay for people to wear diapers/pads, to have assisted baths, to be on feed tubes and to grow old is to literally lose your mobility. Be it a home care service, residential aged care, or in acute care, that’s what we all should be aiming to help everyone live better. To ensure that people living with dementia can live healthy, respected and meaningful lives without the added pain, humiliation and anguish that we so flippantly systematically introduce into their lives.

Residents have told me that they are uncomfortable, humiliating, and some have even felt the need to become reclusive, as they are conscious that their pads or diapers may smell. This is awful for a person’s well-being. Living with dementia, it’s stressful enough to ensure that each day is lived to it’s fullest, to remember to do the things that they need to do. On top of that having to wear, change and walk around with a diaper or pad, really is one of the last things anyone really needs. Zero Diapers/Pads!

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As a child, can you remember getting your body scrubbed and being twirled around to be mopped up in the shower. Like a military exercise, the shower never comes on when you want it and it’s always too hot or too cold. Think of the dances that you did and the anxiety it brings trying to avoid that first blast of water. The pelting of water smacking into your face when you least expected it. Lots of scrubbing and before you know it, it’s all done and you are bundled out faster a bag of groceries at the supermarket at lunch time.

Some people rally appreciated their showers, they sing in the shower, play with the foam in their hair in the shower, and just sometimes after a long day which feels like the end of the world, they may just stand in the shower with the water streaming down on me in silence. Just listening to the sound of the water, enjoying the calming warmth in serenity, it’s much needed especially after a rough day.

Having assisted baths are just not the same, and for anyone who has showered a resident. Residents have mentioned that they don’t care anymore and for some it is frustrating and they get annoyed especially if they get a different person helping them with their shower that they may not be familiar with, and rightly so. Imagine having a stranger seeing you naked or scrubbing you, or standing in the room watching you while you try and enjoy a warm shower. We should try and help people to maintain their independence and mobility as long as we possibly can, so that for everyone who enjoys a nice hot shower by themselves in private, they can keep rocking on. Zero Special/Assisted Baths!

Imagine never being able to eat. Food is the breath of life, from the moment of birth we taste the sweetest of milk, we lick the salt off the palm of our sweaty little hands and as we grow, continue to enjoy the luxurious experience of having a meal. We open our auditory perception to the vibrators around us, to the sound of chewing in our mouths, the crackle and pops, the slurping, chomping of meat and vegetables, the crunching of chips. We open our senses to a world of gustatory perception, from the sweetness of honey to the heat of the beloved bird’s eye chillis from Southeast Asia. Our 5000 taste buds activating their 100 taste receptor cells, kicking themselves into action, working hard to make each meal an adventure (Siverthorn 2007). When the odorant molecules creep towards us and bind themselves to our olfactory receptors, we can’t help but take in the information that these little molecules have given us and up the glomerulus, the information is sent, right into our olfactory bulb that helps us make sense of the delight close by. They say we eat with our eyes, and watching chefs like Jamie Oliver put together a feast before us, some say it’s almost as good as having the meal in itself. Let’s not even talk about the tactioception, the spring of a baked muffin out of the oven or themoception, the cold of a vanilla ice cream, or the warmth of Ramen on a winter’s afternoon.

Kuraoka & Nakayama (2014) stated that common causes of issues that might require percutaneous endoscopic gastrostomy (PEG) where a tube runs pass the mouth and through the adomon to deliver contents the stomache include;

  • inability to independently have their meals as a result of cognitive deterioration
  • loss of interest/appetite in having their meals as a result of depression or poor mental health
  • damage to nerves and muscles required for the eating and swallowing in the event of stroke

Research (Taylor et al 1992), found that up to 70% of people with PEG will encounter complications ranging from minor to severe with survival probibility of 1.5 years to 4 years after referrel. Increased risk of death was also stated in the study and it was stated that individuals with people with low risk of survival will not benefit from having a PEG. A multitude of ethical issues that arise from PEG includes the stress and frustration that caregivers feel to have to make decisions regarding their loved ones being on PEG and most of these decision-making procession may only range for a few minutes, forcing caregivers to make an on the spot decision regarding this critical issue (Kuraoka & Nakayama 2014).

We should do our best to keep older adults, happy, healthy and independent and not flippantly take the important issues for granted and have people live with PEG feeding tubes/Nasal Gastric (NG) tubes. Zero Tube Feeds!

Walk Cycle Vector

The last of all is a big issue and a lot of people grapple with nurses and caregivers alike. We are all afraid of our loved ones and residents falling, in Asia we are also attuned to over caring and being time poor it’s a lot easier for us to do things for others then to allow them to do it themselves with our assistance. We pride efficiency and timeliness at the cost of the independence for others. This however is not fully attributed to staff, Residents, families and clients have to be aware of these issues as well. They have to be aware of the issues that are tied to muscle atropher or disuse atrophy which occurs from loss of physical activity. It’s not uncommon to see a person after recovering from a fall, filled with intense anxiety and grappled with fear that they literally wake up, sit in a wheel chair and never find the strength to be mobile again. Some nursing staff may also have encountered residents who on top of not wanting to walk, insist on being pushed around in a wheelchair. Residents feel that they pay for their care and therefore they should be wheeled everywhere and should not lose out, as caregivers and families, do they realise that the emphasis on the dollar is impacting their cognitive and physical health resulting in their loss of movement?

Just the basic movement of walking, in the part to the bus shelter, getting up to grab a drink result in the activation of different muscle synergies and motor corticol regions in our brain. Each movement that we take for granted and carry out with ease sets off a blaze of neurons. Imagine walking in the garden or a park, feeling the sun on your face or the breeze, or the heat and humidity working up a sweat. We are surrounded by a constant ball of experiences, though little they make up a whole of how we conprehend and understand our bodies, mind and the environment around us. The simple things in life are lessons in itself. We know (Ahlskog 2011) that physical exercise is a critial cost-effective preventative element against dementia and brain aging, so why are organisations strapping their clients down and paying for programmes which may not have adequate evidence base in the preventative treatment of dementia and brain ageing?

We should be working towards enhancing, enabling and empowering people to be healthy and fit, to help them maintain their independence, autonomy and mobility in an inclusive environment. Zero Wheelchairs!

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We have the obligations to provide good care for the people around us, to maintain a sense of harmony and homeostatis to keep our inclusive and complex society moving. Putting the needs of fulfilling black and white key performance indicators that provide quantitative information without any qualitative outcome for the people we are meant to care for is no outcome at all. What does it mean to give a part of ourselves and our time to pursure the more important and meaningful things in life and not just keeping up the numbers. Unlike the West, we were brought up with values that put the needs of society before our own, and we need to remember that and not pursue our own needs at all cost for our own brighter future at the risk of poorer health outcome for others.


 

References:

Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC. Physical exercise as a
preventive or disease-modifying treatment of dementia and brain aging. Mayo Clin
Proc. 2011 Sep;86(9):876-84.

de March, Claire A.; Ryu, SangEun; Sicard, Gilles; Moon, Cheil; Golebiowski, Jérôme (September 2015). “Structure–odour relationships reviewed in the postgenomic era”. Flavour and Fragrance Journal 30 (5): 342–361

Kuraoka, Y. & Nakayama, K., 2014. A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A small-scale before-and-after study. BMC geriatrics, 14(1), p.16. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24495735.

Rana M, Yani MS, Asavasopon S, Fisher BE, Kutch JJ. Brain Connectivity
Associated with Muscle Synergies in Humans. J Neurosci. 2015 Nov
4;35(44):14708-16.

Silverthorn, D. U. (2007). Human physiology: An integrated approach. San Francisco: Pearson/Benjamin Cummings.

Taylor CA, Larson DE, Ballard DJ, Bergstrom LR, Silverstein MD, Zinsmeister
AR, DiMagno EP. Predictors of outcome after percutaneous endoscopic gastrostomy:
a community-based study. Mayo Clin Proc. 1992 Nov;67(11):1042-9.

Other sources: 私たちの特長 | SOMPOケアネクストの有料老人ホーム・介護施設


 

Disclaimer: Just to be clear the blogger does not work or receive any funding from the company or organization in this article.