Q&A: Ask the Chief Inspector for Adult Social Care

So the current position among social care provided by local authorities is to push care in the home as it is less costly than residential care (the official line is it is where people want to be). Many people in this thread have commented about 15 minute visits, care workers less effective if unmonitored, choices between eating or maintaining continence.

My question is: how are CQC able to monitor this situation and what is their viewpoint on these comments? Are 15 minute visits sufficient? How can the boundaries between care at home and residential care be drawn so that people's care needs (and not finances) are at the forefront?

Obviously when asked where they want to be most people will say they want to be at home (the shadow of the workhouse endures), but does anyone ever go back after six months to check that this is still the case? That the person is not incredibly lonely, sick of choosing between food and continence? Do they offer the chance to look at residential homes before making their decisions so that choices are real and meaningful?

Councils cap the amount paid per hour of dom care (and care/nursing home) fees.
Dom care agencies are told that they will only be funded for 15 minute visits so are forced to cram as many visits in as possible often without allowance made for or paid travel time.
Result? Quality and meaningful support is sacrificed.

Care in the home is not less costly than residential care if done well. It is cheaper when it is done badly as now.

I appreciate that there will always be "best times" for providing care in the home and that most elderly people will want to get up, eat and go to bed at similar times. So unless these providers increase the amount of carers available we are always going to have situations (like my grandmas) where she can either get up at 6am or 10am. There is no availability inbetween until, (in carers own words) "someone dies or goes into resedential care" Likewise her lunch has to be really early or very late as there is nothing available for the premium time of 12.30. On the days I am not able to make two visits myself (days when I have the grandchildren) she is being put to bed like a child at around 7-7.30 pm, which is far too early.

You are of course entirely correct gilly - there is no easy way round it.

The European Respiratory Journal found, through a recent study, that indoor air quality in nursing and care homes is very poor as a result of domestic pollutants; this has a serious impact on elderly residents' lungs. This is the first study of its kind in Europe highlighting the damaging effects of heaters, building materials, furniture, cleaning materials, disinfectants and cooling systems. Lack of ventilation and indoor pollutants can cause lung diseases which are preventable and the body's ability to cope with harmful pollutants decreases with age. Should the UK not take the lead set by other countries in Europe by undertaking further investigations and conduct intervention studies to assess which prevention methods are the most successful?

Make full use of CCTV.I have been a nurse for 46 years and I would rather have a robot look after me.My mother had to go into hospital,her care was appalling.she called the staff non-carers,secretly to me.One night she had a nightmare and was screaming.Someone ran to her,it was the security guard,the staff were on there 'break'. That is when the went off to sleep.
A friend told me that they got wind of a visit from the CQC,they threw 50 old people back into bed and covered them with their quilts, as they had started dressing them all at 04.00 hrs.
My father was a B of B Pilot and very proud of the moustache he had ,all his life.He woke up just as they shaved it off.He didn't lift his head again.
When you get the two words,'Confidentiality and Professionalism'
together,watch out.

I feel a bit sorry for Andrea. We are not asking many questions but I think some of us have been traumatised by our experiences whilst trying to care for loved ones.

When my mother needed to go into a home, I asked advice from a hairdresser who works in homes and her advice was very good.

Reaching that time was the worst. My mother was in hospital and I said I didn't think she was capable of returning home. Two SW came and I explained she had Alzheimers but could sound ok for a few minutes. They spent about a minute with her and came back and said she was fine. If they had hung round a bit longer they could have had the same conversation with her again and again and again.

They arranged an assessment at Mum's home. If she could make a cup of tea and a piece of toast she was ok to live on her own. She couldn't so the assessor helped her!

I was seeing to her evening meals and someone came at lunchtime but she still managed to burn a hole in her kettle by forgetting about it so she went and found an old electric kettle and put that on the gas!

I don't feel sorry for Andrea - she is a professional and carries a big responsibility for ensuring that care is just that, and the organisation she works for is patently failing - you only have to look on any of the threads on here about so many of us trying desperately to find good care for our aging parents to see that something is seriously amiss. She needs to have this feedback and use it wisely and not become defensive. The sort of information we are putting before her should trigger an examination of how the inspection of care might better be achieved. If she is professional, she will be listening and worrying and starting to think what can be done. That is her job.

So....another question....in view of the overwhelming concern that the system is failing, what will be your first steps to rectify the situation?

And how can we help? - clearly the funding is inadequate. Should we be quizzing our election candidates about what their parties' policies are for improving this dreadful situation?

There is no room for complacency here - Andrea needs to hear this stuff.

Good post Mishap.

Who cares for the carers? I have just phoned my cousin to ask how her 91 year old mother is. My aunt is in rehabilitation and they are talking about her going home. My cousin is trying to hold down a job, has visited her mother every day, taken her to three different hospital appointments this week, looked after her own and her mother's house and is trying to deal with all her mother's financial affairs. Every time I speak to her she is almost hysterical. Her mother wants to go home but my cousin doesn't know how they are going to cope.

Tell me about it Liz46 !

There is the Carers' Act (which was drafted and pushed through by a lawyer I know) which entitles carers to a full assessment by SS and for their needs to carry the same weight as those of the "patient." SS are obliged to do this for any client of theirs who requires a community care assessment - they have to also do a carer's assessment. Your cousin should press for this.

Thank you Mishap. I did say to her yesterday that I thought I had heard of something about this. Unfortunately I don't think she is in a state to take anything else on board. They don't live near me but I did offer to go and help. She is wondering whether she and her husband should go and live at her mum's house (a stair lift has just been installed) or if they should get another stair lift fitted in their house. They only have a small house and have a wheelchair, commode, zimmer etc. etc.

I am so sorry for her. When I got into a similar state and was just sitting on the sofa crying, my husband said it was either him or my mother and we set about finding a suitable home for my mum.

I am hoping to have a few days away in May or June and cannot begin to wonder how my grandma will manage without me. She does have carers going in three times a day but after the early morning call the other two only seem to stay for a few minutes. I worry about her everyday needs. Her shopping, hospital appointments, cleaning etc. She rings me at all times of the day and night and wouldn't understand if I wasn't available. I sometimes wonder if the few days away is worth the worry. The only thing I don't do for my grandma is look after her money. (Another story in it's own right).

What an awful choice to be forced to make Liz46. My grandma constantly begs my assurance that I will not "put her in a home" and I have to say "of course I won't". What else can I do? She will be 99 this year and the thought of her getting to this age and ending up in some grotty, local authority, wee smelling "home" just breaks my heart (and she knows it too).

gillybob - you need to talk to SSD and ask for a carer's assessment for yourself, and also inform them that you will be away for a few days in May/June so they can plan for her care to be stepped up temporarily.

You do not have to be the nearest relative to be entitled to this assessment, just anyone who provides care.

By the way gilly, the LA homes are often much better than the private ones - or that certainly used to be the case. There were proper systems of checking and training for staff that were lacking in the private sector. Mind you I think there are very few LAs who now run homes themselves.

I think your plight truly highlights the lack of confidence that anyone now has in the inspections system - no-one expects them to be able to ensure high standards.

I do recognise that the CQC is faced with a huge challenge, as they are underfunded and understaffed - and how on earth do you get to be a fly in the wall in these establishments? That is the only way to ensure high standards. Should every home compulsorily have CCTV? This may be the only way, but what a sad reflection on our care system.

Thankyou for that Mishap I will take your excellent advice and contact my grandmas SW asap. I am (as you say) not her next of kin, my mum is, but she is sadly in worse health than my gran so it falls to me to do what my mum would have done, although my mum and dad control all the finances.

The only experience I have of care homes have been horrible ones. An auntie and great auntie had the misfortune of ending their days in two different ones in our town and I vowed that my grandma would never go through that kind of indignity. Carers (they should be done under the trade descriptions act) that don't. The smell of wee /disinfectant/cabbage and the fact that they seem to dress the poor residents in each others clothes? No stimulation, just sitting there waiting to die infront of some crap on TV.

Awful. I do hope I can keep my grandma in her own home for the rest of her life.

Gosh. I wasn't going to read this thread because not having anything to do with the care system in England (my MIL with Alzheimer's is cared for by her daughter in South Africa in her (daughter's) home, with nursing help, paid for out of my MIL's own money. But I'm glad I have read it because who knows what may wait down the line for us.

I'd like to suggest that anyone who works with the elderly is made to read Atul Gawande's book "Being Mortal: Illness, Medicine and What Matters in the End" - he describes an ideal - in America - the type of care home as described upwards in this link that was closed down - people flourished when they were allowed to garden, keep birds, set their own routines. In short, he found, people want "more from life" at every age. He references the work of Keren Brown Wilson, one of the originators of the concept of "Assisted Living". And the key word should be "home".

I can actually add my tuppence worth, and I know there is already a "litany" on here - my elderly neighbour, now deceased, had carers come to her house 3 times a day. I could see her front door from my kitchen window and I was always amazed at how (most not all of them) they flew in and out of there and wondered how much they could possibly accomplish in that time. (I spent longer at my daughter's when I was cat sitting). And I was the one who went and gently coaxed "Doreen" back inside when she came to the door wearing nothing but her incontinence pad and knickers in between those visits. Often on freezing cold days. So I would add my voice to those who say "The care in the community system isn't working".

I'd like to ask you a question as yourself, as a daughter, what do you recommend that people look out for when choosing a care home for their elderly relatives (let's forget about CQC for the moment).

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Does that mean that she will simply receive selected questions, rather than having the opportunity to register the massive concern that Gnetters have about the care system and the absence of confidence they have in the inspection process?

This isn't really a question but a comment for all the other posters - not ALL care homes are universally awful! We found a place for my mother (after visiting several others) that was a positive joy to be in. It was run by a charitable trust. All money was spent for the benefit of the residents. It was beautiful, well staffed, lots to do for those that wanted to be involved but quiet rooms for those preferring peace and quiet. Lovely food. Excellent staff in good numbers. I was interested to see that a local Uni sent students there on placement -surely a good sign. The whole atmosphere and ethos was lovely. This must reflect good management. I wish I could put my name down for it right now. I suppose my question would therefore be why can't all care homes be like this? We hear a lot of bad practice examples why not highlight some good examples for other places to learn from? (I can supply the name if people want to PM me. )

Yes indeed Jane10 - there are some very good homes and I found one where my parents were very well cared for. As my brother said at the funeral, they did what they said on the tin and cared. When both my parents were dying they called in extra staff to make sure that they had sufficient people to sit with them (even when they were unconscious) while waiting for family to arrive.

I think the point that we are all trying to make is that there is no way of telling the good from the bad on the basis of the CQC inspections. ALL the dreadful homes I visited had good inspection reports, or we would not have gone there in the first place. The inspection system is no help at all to those seeking a good caring place for their family members; and it fails to safeguard the well-being of residents, some of whom receive extremely poor care indeed.

My experiences both as a social worker and a relative bear this out.