Many older people in Welsh care homes 'quickly become institutionalised'

Too many older people living in care homes in Wales ‘quickly become institutionalised, their identity and individuality ‘rapidly diminishes’ and they have ‘a lack of choice and control’, according to the first major review of residential care in Wales.

The review carried out by the Older People’s Commissioner in Wales found too many older people in Welsh care homes have an ‘unacceptable quality of life’.

The report ‘A Place to Call Home’ revealed a host of failings in the sector, including the use of de-humanising language such as ‘toileting’, ‘feeding’, ‘bed number’ and ‘unit’ and incontinence pads used inappropriately, with residents being told to use them, in spite of being quite capable of using the toilet, thus stripping them of their dignity.

Sarah Rochira, Older People’s Commissioner for Wales, said: “My Care Home Review has been the biggest Review of its kind ever undertaken in Wales and has the voices of older people and their families at its heart.

“While my Review report found excellent examples of truly person-centred care, enabling and empowering care that delivers the very best outcomes for older people, there are significant variations across Wales that result in too many older people living in care homes having an unacceptable quality of life.”

She added that the findings of the report “make for hard reading” and said it is not just about being safe and having basic needs met, it is about having the “best quality of life”.

The Commissioner and her team went on unannounced visits to a hundred care homes across Wales. They also collected over 2,000 questionnaire responses from residents and families, plus public bodies and care providers.

Lack of access to GP and dental care

They found there was a lack of social stimulation in care homes and a lack of awareness by care staff of the specific communication needs of people with dementia. In addition meal times were seen as a ‘clinical operation’ with very little positive interaction between staff and residents. Care homes are often not dementia friendly and there is a lack of consideration for residents with hearing loss.

Another problem is residents’ lack of access to a GP with diagnosis too often being done on the telephone and many residents rarely or never seeing a dentist.

The report lists actions that the Commissioner wants care providers to take to “ensure that quality of life sits at the heart” of the Welsh care home system. These include giving residents real control and choice in their day-to-day lives, making them aware of their rights and entitlements and making mealtimes a social and dignified experience.

'Wake up call for the sector'

Davina Ludlow, director of carehome.co.uk, called the Review “a wake-up call for the sector” but added: “Whilst poor care is unacceptable, it is the exception rather than the rule.

“We receive hundreds of recommendations from those with loved ones living in Welsh care homes, who acknowledge that the vast majority provide fantastic support, in warm and friendly communities, every single day.

“Everyone involved in the care sector needs to pull together to restore confidence, attract the best people to the profession and promote the excellent work they do.”

Older people living with dementia are failed

Sue Phelps, director of Alzheimer's Society in Wales, also responded to the report, saying: “Up to 70 per cent of care home residents have dementia and there is no question that they deserve the best quality of care. With this in mind we fully support the actions identified in the report and look forward to seeing progress in implementing these essential changes.

“As a member of the Advisory Board for the Commissioner's Review I heard about some excellent care homes; full of warmth, activities, person-centred care and interaction. But, as the report has uncovered, between these best examples and the worst, there is a forgotten scandal of older people, especially those living with dementia, who are failed and left living a life that at best can only be described as 'OK'.”

She added: “Too often we hear that people with dementia in care homes don't have the opportunity for regular and meaningful social interaction and activities of their choice which help them continue to live well with dementia. We desperately need to raise expectations about the quality of life that is possible in a care home.”

Commmissioning process should be about quality not price

In the wake of the report, Mario Kreft, chair of Care Forum Wales, backed Ms Rochira's call for urgent reforms of the way services are commissioned and paid for.

Mr Kreft said the report had also highlighted the fact that it was less viable to run care homes in Wales than it was in England.

As a result, an increasing number of homes are closing because they are not viable at a time when the need for them is growing because of the increase in the number of older people in Wales.

Care Forum Wales, he said, supported Ms Rochira's demand for a new approach which would see services being commissioned for quality rather than reinforcing a “culture of compliance to the bare minimum”.

Mr Kreft said: “The report is an important piece of work but it does not fully recognise what is being achieved despite the system and does not give enough credit to the good quality care being provided by many good people across Wales.

“Yes, the standard of care can be inconsistent in places and where there is bad practice it should be rooted out, but the majority of providers are doing a remarkable job in the circumstances.

“Most care homes and nursing homes provide a very good standard of care while there are many examples of excellent, life-enhancing quality care taking place, often under difficult circumstances and with extremely limited resources because of the chronic underfunding of social care in Wales.”