it is to get staff at all. It must be equally in doubt whether individuals who might have thought about becoming care staff will bother to go all out to be recognized as capable and reliable in these circumstances, given the numbers of hoops they will now have to go through.
Only the worst cases of abuse make the news, such as the attack in 2000 on Lillian Mackenzie, who was kicked and beaten by two teenage girls who were befriended by her. Jean Lyons and her sister Kelly had run errands for Mrs Mackenzie, who lived in the same block on an estate in Manor House, north London. Wearing balaclavas, they kicked her, beat her with an iron bar, and robbed her of about £800, as well as stealing her handbag and some documents. They then visited friends and bragged about what they had done. Yet Kelly was able to tell the jury that Mrs Mackenzie had been ‘like a nan’ to her and had taken her for meals at a local cafe. This was, as one reporter put it, ‘as mean and despicable offence as can be imagined’.*
Yet if one scans the local papers, there are hundreds upon hundreds of cases. In June 2003, the Yorkshire papers took serious issue with a nurse who took away an older person’s buzzer because he was using it too much. He had to be fed by tube, as his stroke had left him unable to speak and partially paralysed. Yet he was perceived as being too much of a nuisance. As a result, he was overfed by five times the correct amount, could not let staff know things had gone wrong, and died unnecessarily.* Another nurse in Yorkshire strapped up her patients in incontinence pads so she could sleep the night shift through, resulting in blisters, sores, and burns.† In Leicester a care worker was given a caution for slapping a frail older person. Again in Yorkshire, a nurse was accused of running a military style ‘boot camp’ in a care home for mentally ill older people: she had sworn at a 90-year-old wheelchair-bound man, as well as instructing care assistants not to lift up a 78-year-old man with dementia after he had fallen on the floor with his trousers round his ankles.‡ A woman of 69, a psychiatric patient, had her bed moved away from an alarm button because she was constantly pressing it. Mrs Wootton had a long history of mental health problems, and had set herself on fire whilst in hospital. But her death was the result falling from her bed whilst trying to reach the buzzer. She sustained a broken hip and, later, bronchial pneumonia.§ And these examples are quite apart from the murder investigations and the major cases of neglect.
The truth is that we know about this in our hearts. We see it ourselves with our own eyes. Look at the fear, the terror, in the eyes of some older people in hospital wards, in care homes, in nursing homes. Listen to what they say in code. Listen to how their carers speak about them. It is not universal, by any means, but it is common. And one of the terrifying things is that we have known about it, subliminally perhaps, for many years.
The redoubtable campaigner Erin Pizzey, famous for her action on domestic violence, has now taken up the cudgels. She argues that abuse of the elderly has a terrible habit of being kept quiet: ‘It is a bit like domestic violence amongst the middle classes–no one ever talked about it, although people knew it was going on…If baby-boomers don’t start kicking ass now about elder abuse, this will be their future–and they are a generation who are used to their freedoms. Tackling elder abuse requires a revolution–a grey revolution.’*
We know human beings are often very abusive to people who are in their care. We understand that there is a risk, but our way of dealing with it is to add layer upon layer of regulation and inspection rather than to encourage the opening up of institutions such as care homes and nursing homes so that ordinary people can come and go frequently, as part of daily life. Whether those in care are children, older people, people with enduring mental illness or learning disabilities, or even prisoners, cruelty can often well up from the depths of the human personality. We know it well enough from all the inquiries into abuse in large institutions. Abuse occurs wherever vulnerability exists. If we have strong legislation to protect the vulnerability of animals, why not for older people also? But legislation needs to go hand in hand with opening up institutions, for openness is far more likely to breed an atmosphere of trust than any system of regulation and inspection.
Fear of abuse has been further exacerbated by the chaos surrounding care and nursing homes, particularly, though not exclusively, in the south and west of England. With the rise in property prices nursing home and care home owners find it difficult to maintain standards and get staff. One by one, homes have been closing. The result is that older people who moved–often unwillingly–into nursing and residential care find themselves with nowhere to go when they are at their frailest and most desperate. Though this is not abuse as such, it is a form of mistreatment that beggars belief. Many professionals suspect that many old people attempt suicide because their future in such circumstances is so bleak.
Abuse exists in the NHS sector as well, as the CHI (Commission for Health Improvement) report into conditions in Rowan Ward of the Manchester Mental Health and Social Care Trust made clear. There was abuse, an inward-looking culture, low staffing levels, high use of agency staff, poor supervision and appalling management.* The report, which came after complaints of abuse of older patients by staff, found amongst other things: a ward left physically isolated when other services were moved to more modern premises elsewhere; poor reporting and clinical governance procedures that failed to pick up early warnings of abuse; regimented care; ‘Patients’ clothing was changed and their hygiene needs addressed according to a schedule rather than when the need arose.’ They also found sickness rates of 9.8 per cent during 2002 among nursing staff; widespread use of mixed sex wards in the Trust’s older-age mental health services; ‘rudimentary’ performance management of staff; an aimless service; and a lack of management attention to quality of care caused by transition to care trust status.
So can the NHS do better? Its record in this area is not all that reassuring. An inquiry by the Health Advisory Service in 2000† demonstrated that older people were less satisfied with the care they received than younger people-which is surprising given that older people complain less than younger people. They experienced unacceptably long delays in admission, problems with feeding and with the physical environment, staff shortages, privacy and dignity, communication with staff, and, most profoundly, with staff attitudes towards older people. The recommendations were lengthy, but the most significant was that everyone-patients, relatives, and staff-has to take on responsibility for challenging negative attitudes about old age, about prospects for recovery, and about worth. So if the NHS has problems of this sort, will voluntary organizations take on the provision of care homes? Many already do, particularly those that are religiously or ethnically based. The mess in care home provision has come about as a result of inadequate planning and a cross-party agreement to shift the burden of care to the private sector. But the position is untenable. The risks of abuse would not be not hugely improved, and feelings of insecurity would remain.
An inquiry into the care market in London currently being carried out by the King’s Fund shows that there are still concerns about a number of familiar issues. For example, there is a very limited choice of care and support for older people. While there is no evidence of insufficient care home places for older Londoners, these may not always be where people want them; and there certainly is a shortage of services for older people with mental health problems such as dementia. The King’s Fund has also found that throughout London there are difficulties in recruiting and retaining nurses, social workers, therapists, and care workers. Older people’s views of services have been shown to be varied; some are very appreciative of a wide range of services, but there are widespread concerns about the quality of home care and residential care services. All of this is compounded by financial pressures, for in spite of increased government spending councils
