Dementia care leader comments: Stop stigmatising care homes


Paul Smith, Dementia care leader speak earnestly in defence of dementia care in care homes.

Care homes have been getting their fair share of media attention recently as the General Election looms; the various political parties jostle for a hearing in regards to social care and health care funding.

It was back in April 2014 that care homes took the first of what became many shocking blows with secretly filmed incidents involving a small number of individuals, acting independently, in a small number of care homes, shown by the BBC in the Panorama programme Behind Closed Doors: Elderly Care Exposed. < Click here for clips.

The outpourings of indignation in the press have given way to something more realistic – but equally as disturbing and pernicious and, as the occasional terrible cases of abuse continue to be front page I am struck by the lack of reporting (sensationalised front page or other) of the tremendous attrition going on in the sector – this seems to be happening without a mention?

Where are the reports of the larger care groups now growing seemingly unrestrained to the size of the collapsed Southern Cross – a collapse that caused a national scandal, led to new legislation and government promise that care groups would never be allowed to become too big to fail ever again? Where are the reports of the small family owned care homes going to ground as fast as the local pub?

Perhaps it is the moral question of the sheer volume of older people with seemingly no other option than to live ‘in care’ or perhaps the unacceptable question as to why in the 6th largest world economy people have to pay for their care in old age or the fact that this is mostly a private sector albeit highly funded by local authority payments?

It’s worth noting that 80 per cent of care home residents are living with one of the dementias or a related condition. This number will increase. Are we prepared?

Perhaps it’s the fact that care homes are so commonplace that their very existence is now too mundane to be worthy of a report or perhaps the few bad eggs have made the day to day workings of our care industry a place of generalised mistrust.

As this important political week comes to a conclusion I want to take a closer look at the lasting effect of the rare but highly publicised abuse revelations. The power of portraying these isolated cases as the ‘norm’ and contrast the tremendous good work and progress in caring standards that is exhibited by thousands of dedicated staff day in, day out across 17,600+ care homes and nearly 7000 nursing homes with not a BBC camera in sight.

Are we blameless as an industry for the care failings of the individuals we employ?

The simple answer is, of course, no, just as we are not, as an industry, responsible for the incredible dedication of thousands of care workers. But we do carry responsibility for the care delivered in our name. We have a duty to provide the right numbers of staff and with the right skill mix and to provide training, supervision, support and good, effective leadership. We have a duty to follow discipline procedures if these are not achieved and we have a duty to invest to ensure safety, dignity and choice – for residents, families, friends and visitors and for our staff group. Overall we must provide good and transparent governance

But this is the care industry and the basic requirement for any business is to make a profit. But making a profit is not wrong and it’s certainly not a bad thing if the profits are mostly reinvested to keep improving and making conditions better, but I fear in many cases the shrinking (in real terms) of funding for older persons care, has led us to a scenario where costs are having to be minimised simply to keep many businesses afloat. When this happens everyone suffers. We know some operators run with a rampant capitalist ideology but this is not as commonplace as many believe and many providers are and have been struggling to maintain their ideals with decreasing returns and massive debt

We all know of single home or small number of care home portfolio providers who are themselves choosing to go without the good things of life, just to keep these facilities running costs from affecting the care their services deliver – and they are loved and admired by their staff, the families and residents they care for and are the real unsung heroes of this industry – where are the BBC exposés of these guys?

We all know of staff who will spend as much time unpaid at their place of work as they do paid time because ‘my residents need me’ where are the cameras then?

And yes, we know of the big groups too who are investing millions of pounds into training, who are keeping the costs down and who are employing senior teams worried sick about how they can keep the reputation of their company safe when employing thousands of people, sometimes across hundreds of sites, and be hoping upon hope that they are doing enough to keep every resident safe and every family happy. I don’t see all of the above paraded across prime time TV with a programme entitled behind closed doors: in praise of care homes!

We do not always get it right

There are four hundred care homes not meeting some of the fundamental standards in England, many of these are breaches in governance, managerial practices, paperwork and recording etc., some are staffing levels, a small tint few are abuse and some are to do with lack of training opportunities. These are all hugely important areas but they do not paint a picture of a deliberately abusing industry, or deliberately brutal, uncaring care staff?

The home that featured the appalling failings in the programme with which I began this article, by the way, had actually been given a clean bill of health by the inspectorate just a few months before these failing came to light, on prime time TV and that clean bill, despite there being a number of whistleblowing allegations made to the CQC and others in advance of both the inspection and the Panorama expose

This fact may once again prove what we already know ‘you cannot inspect quality into a service’ (W Edwards Deming); quality is a culture, it arises from within.

From where I sit, I see government, academics, policymakers and world leaders all providing guidance as to how to care for our older population.

I also see organisations with minimum staffing, time-strapped, time pressured employees and poor, worn out, unsupported leaders and managers – all doing more – for less.

Until we understand that the former depends on changing the conditions of the latter we will be heard crying in the wilderness again, and again, there will be more BBC exposes, and poor credit if any for the care industry workers and the millions of unpaid carers taking the strain and saving the economy millions annually year after year.

But when we do

But, and here is the kicker, despite all of the above, sometimes in spite of it, I have seen amazing care in care homes, in hospitals and the community, I continue to see amazing care in care homes daily and as long as we can continue to attract the right staff by rewarding them with better and better pay and conditions and by supplying first class training and support than I will go on witnessing amazing care in care homes.

Don’t be put off by programmes blazed across a hungry for scandal media, learn from them, take solace that this does not happen at your place of work and that you would never let it happen and then step back and do something amazing for someone today – there is no camera there – but that’s not why you do it is it – you’re not called to this profession for glory all you came to do is to make a difference and you do, unquestionably make a difference day in day out 365 and for this you have my undying gratitude

We have a long way to go to make living in a care home a perfect experience, we have a tarnished image and a less than perfect funding system and living in a care home is not right for everyone and it should not be right for everyone. oh, but when it is the right option, the right choice and when it is a good care home with good food, lots of activities, adapted environments and truly person-centred cultures, then it can be a much better, safer and more fulfilling way to spend your later years than being as good as forgotten in your own home, not coping and not mattering.

Care homes are for living in, not dying and great care homes are for thriving.

Honour is a word too often missing in our nursing and caring profession these days but having spent more years than I care to remember working across these sectors I can tell you this is an honourable profession and by honouring those you care for you honour both the profession and yourself – once again thank you and God Bless.

You can follow Paul Smith on Linked In by clicking through to his profile here

Paul has achieved professional and academic qualifications in nursing, community nursing, dementia studies, dementia care, nurse education, psychotherapy, group psychotherapy, clinical and indirect hypnosis, project management and he is a master practitioner of Neuro Linguistic Programming. He is an author, public speaker, and researcher. He is an advanced practice nurse with 35 years revalidated registered practice.
Prior to taking up his most recent role, Paul was involved in national research and standards-setting
He has high industry recognition and trust and is known for his passion and integrity, creating award winning teams and for his innovative work in dementia and older person’s mental health.
Paul was greatly honoured to be a visiting research fellow (2008 – 2010) at the Green Templeton College, University of Oxford.

He is looking for a new role.



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