Care home residents with dementia pay for 'free' NHS care but get 'second class' treatment

Residents with dementia are paying for free NHS care and are treated like second class citizens say care home managers.

Many care home residents with dementia are left bed-bound, incontinent and sedated because the health service is too slow to respond to their needs, according to an investigation by the Alzheimer’s Society and the care home association Care England.

The charity's Fix Dementia Care report reveals that almost half (44 per cent) of care home managers believe the NHS is providing a second-class service to many of the 280,000 people with dementia who live in England’s care homes because it doesn’t give them adequate, timely access to vital services such as physiotherapy, continence and mental health services.

The report also revealed that one fifth of the 285 care homes surveyed have been wrongly charged by GP practices for services that should be free on the NHS – up to as much as £36,000 a year.

GP charges estimated to be over £26m a year

The total cost of GP charges to care homes is estimated by the Alzheimer’s Soceity to exceed £26m a year.

The findings of the report is based on a survey of 285 care home managers and the testimonies of carers of care home residents living with dementia.

The charity says people with dementia, who like other tax payers have funded the NHS, are having to pay again to see a GP through their care home fees or being denied access to services for months. It argues that the average GP charge of £12,191 a year is enough to fund care for a person with dementia for nearly six months.

The charity says the money care homes are spending on GP services, that are free on the NHS to older people living in the community, would be better spent on one-to-one care for older residents with dementia.

The investigation has also revealed the experiences of care home managers who shared damning examples of the effect of long waiting times and inadequate local services.

Resident waited for over a year for physiotherapy

One care manager said one of their residents had to wait for more than a year before getting any physiotherapy after surgery.

The care manager said "We had one [person] who fell and had a hip fracture. Physio follow-up in the community took over a year."

Another care manager admitted “A resident who was saying she felt suicidal had to wait over eight weeks to be referred to mental health services.”

Three month wait for continence products

And a third care manager said “Residents have to go without continence aids, leaving them isolated, with no dignity and low self-esteem.”

Some residents have had to wait three months for continence products.

Other shocking examples faced by care home residents with dementia include:

-Being prescribed pain relief over the phone for a broken collar bone.

-Being prescribed the wrong drugs because of a GP’s insistence on conducting consultations over the phone.

-Being restrained under an emergency Deprivation of Liberty Safeguard, due to a lack of mental health care.

These practices contravene the NHS Constitution, which states everyone, regardless of who they are or where they live, should have access to the NHS services they need free at the point of use.

70 per cent of care home residents have dementia

Jeremy Hughes, chief executive of Alzheimer’s Society said: “A care home is, after all, a person’s home and health services must treat care homes as a vital part of the community, instead of holding them in disregard.

“It’s unacceptable that this NHS double standard is leaving people with dementia waiting months for physiotherapy, incontinence and mental health services. In that time we are concerned they’re being robbed of essential care and pain relief, as well as their dignity, self-esteem and independence.

“With 70 per cent of care home residents living with dementia, we’re urging everyone to get behind our campaign to transform the second-class service that many receive.”

Free and equal access for all

The Alzheimer’s Society’s Fix Dementia Care campaign is calling for:

• An end to GP practices charging for providing access to a standard primary care service that should be free on the NHS.

• The Government to enforce the NHS Constitution to give care home residents with dementia equal access to NHS services.

• The Government to support improvements in the availability of district and community nursing in care homes so people with dementia receive better care, closer to home and reduce pressure on primary and secondary care.

Martin Green, chief executive of Care England, said: “Our research and report with Alzheimer's Society identifies that many people living with dementia in care homes, and the care staff who are responsible for their care, are being all but abandoned by primary care.

“Sadly, this charging has been going on for far too long: we have called for years for this practice to be put to a stop, and for care homes and residents with dementia to be more visible and equal in the eyes of the health service.

“As the Health Select Committee has recently recommended, access to primary care must be improved. Older people living with dementia in care homes have the same rights to primary care, health and support as any other citizen, and the government and NHS must act to ensure that these services are available to everyone when they are needed.”

Janet Morrison, chief executive of older people’s charity Independent Age said: “The care home market is already under pressure and the tens of thousands of pounds that GPs are charging care homes will, ultimately, be passed onto older people and their families."

Vanguards part of the solution says NHS

A spokesman for the NHS said: "The NHS has dramatically increased the number of people with dementia who are able to be diagnosed in order to receive early support.

"Care homes have first line responsibility for looking after their residents, with appropriate back-up from the local NHS, of the sort now being developed in the new vanguard programme."

The NHS’s 2014 five year vision for health includes the use of vanguards as a care model to offer older people improved, joined up health, care and rehabilitation services.

One example is the East and North Hertfordshire Clinical Commissioning Group vanguard, made up of Hertfordshire County Council, East and North Hertfordshire Clinical Commissioning Group and Hertfordshire Care Providers Association.

All care providers in the East and North of Hertfordshire are committed to the vanguard’s aim of improving the skills and confidence of care home staff through education and training.

The vanguard aims to have multi-disciplinary teams for care homes which will include GPs, community psychiatric nurses, district nurses and geriatricians. They will work with homes to support residents proactively as well as if a resident’s condition worsens. This quick response service means care homes have access to services in two localities with a combination of community nurses, matrons, therapists and home carers who can be deployed within 90 minutes if required.

For details about the vanguard programme visit: www.england.nhs.uk/ourwork/futurenhs/new-care-models/care-homes-sites/