Of misplaced trust. Of bureaucracy & cover-up. Of a social care system paying lip service to the needs of Scotland’s most vulnerable.
Extract IV: ‘Control, not Care’ in commercially-unviable care homes for older people in Scotland
Dr Well-Beloved
I call her Dr Well-beloved for all sorts of reasons.
For being completely unfazed when I rocked up at her surgery a week before Christmas 2018 and bawled the place down when she tried to stick a needle in my arm.
For showing patience and understanding when she failed to persuade me that it wouldn’t hurt. And, for being non-judgemental when I refused to cooperate.
For three weeks, I was shielded from people who intrude, those who regard it their right to pry, since being rescued by my son from the care home, but a visit to the GP was needed and it fell to Dr Well-beloved to examine me. Tall and willowy, she would have looked equally at home in jodhpurs and riding hat. I understood perfectly well that I should have felt in safe hands.
Poor Dr Well-beloved! How was she to know that the most effective way of getting rid of my abuser from my room in the care home was to holler at the top of my voice. Or that, since the abuse began, I trusted no-one which seemed reasonable since, at my great age, pretty much anyone, who so wished, could do me harm. By hollering, I was in control. And not as defenceless as I felt … or as any potential abuser might think!
The trouble was, immediately it began, I saw everyone as a potential abuser, out to hurt me. So, I retreated into myself and was crotchety with anyone who just wouldn’t leave me alone.
Looking back, this seems a perfectly rational and reasonable response – to me – but someone really ought to explain it to so-called dementia experts in Scotland, in my opinion. And, by ‘dementia experts’, I don’t mean teenage care home staff who know no better or misguided social workers who would have every new care home resident declared insane on admission, giving care home staff the green light to needlessly exercise discretion in the use of chemical coshes and restraints on people like me.
A cautionary tale
My abuse was covered up by the local authority but my GP’s diligent record-keeping and my son’s detective work have let us piece together the whole sorry matter.
It began shortly after the care home staff learned that I was self-funding my care.
They should never have got to know this nor been free to discuss it openly but it became a talking point with staff who could not comprehend why someone with the means to shop around for good quality care would choose such a grotty care home. They did not to know that my social worker had directed me to this specific care home, advising against almost every other, for reasons the local authority see no reason to explain.
For a few days, until they got used to the idea, I was teased in what seemed a good-natured manner by staff unable to decide what to make of it. Then, one night someone came into my room, turned off the light, grabbed me by the wrist and told me that I was “no better than anyone else” just because I was paying to be there and warned me that there would be no preferential treatment. That night, I barely slept, fearing what would happen next.
The following day, I asked to be left alone in my room and had nothing to eat or drink until accepting a cup of tea at 4pm. My so-called ‘dedicated carer” recorded only that I was “a little under the weather”!
That night, my abuser threatened to “pee” in the cup of tea I desperately needed. This was the last time I would ask for a cup of tea for comfort when I couldn’t sleep.
At 5am the following day, the duty nurse called for an ambulance.
What the duty nurse told the medic who attended is on my medical record. What she told the care home manager I can but guess as no time was wasted in persuading the local health authority to start the process of having me declared insane. And, in double-quick time a psychiatrist diagnosed vascular dementia with a prognosis of three years – all without my or my family’s knowledge and having failed to involve my GP who recorded that he found “no evidence of incapax”.
Six years later – three years after I should have succumbed to the diagnosis – I am here to tell this cautionary tale.
According to my medical records, on a date two months after my abuse began, the afore-mentioned psychiatrist came and chatted to me in the care home. I assumed he was a doctor on a routine visit. As we spoke, he noted that I was bright and alert and that I engaged fully with him, that I knew my name, how old I was, the day of the week, the month we were in, and so on. He noted, also, that I answered, “In prison!” to the question, “Do you know where you are?”
It’s in my nature to engage in verbal sparring when people pry and I thought he would appreciate the joke. As you will understand, I’m sure, some awkward truths underpinned my reply but, what I said was not meant to be taken seriously. However, the psychiatrist detected no humour or irony and concluded on the basis of this response alone, which he didn’t even question or ask me to explain, that he found unambiguous evidence of dementia.
How ironic that a more correct and appropriate diagnosis would have been a sense of humour which, one day, would be the end of me.
And, with a flick of his pen, this dementia ‘expert’ set me on a slippery slope without so much as a cheery wave. The care home’s persistence had paid off.
BetterCareScotland’s data, from the lived experience of our subscribers – care home residents, their family members and friends together with care home staff, former and in-post social workers, and Care Inspectorate staff who dare not blow the whistle for fear of the consequences – show that the routine-sedation of residents in care homes for older people and the use of restraints follow directly on from Adult With Incapacity (AWI) certificates that are issued in the complete absence of safeguards against abuse.
Our data indicate AWIs being sought for the convenience of the hard-pressed staff and, therefore, the direct benefit of the owners of commercially-unviable care homes kept in business by local authorities – looking to pay as little as possible for care – with a steady stream of state-funded residents and, whenever possible, the reward of unsuspecting and more desirable, from a commercial perspective, self-funding residents.
In care homes for older people, where staff have come to expect GPs to produce AWIs on demand, we find residents being CONTROLLED rather than CARED-FOR and that this can happen in plain sight. But it gets covered-up by local authorities and ignored by the Care Inspectorate whenever it fails to act independently of the local authority!
The risks to which residents are exposed need to be recognised and addressed with urgency since social workers who ‘indulge’ hard-pressed care home staff who cut corners and bend the rules in order to ‘cope’ and Care Inspectorate staff who “somehow” cannot “sense” on inspection visits that something is wrong have degraded the social care system of one the world’s richest nations.
SCOTLAND’S HIPPY DIPPY CARE INSPECTORATE
The recently-retired chief executive of Scotland’s Care Inspectorate claimed routinely that the Care Inspectorate’s staff can, in some hippy dippy way it seems, “sense somehow” when things don’t feel right on inspection visits to care homes for older people in Scotland.
BetterCareScotland’s data show that the Care Inspectorate’s crystal ball doesn’t work!
Email BetterCareScotland for a copy of our February 2021 research paper for Scotland’s Parliament,
HOLDING SCOTLAND’S CARE INSPECTORATE TO ACCOUNT?
A critical evaluation of Parliament’s scrutiny of Scotland’s social care regulator!
GARBAGE IN, GARBAGE OUT
BetterCareScotland views as a critical issue the concept of ‘undiagnosed dementia cases’ feeding into the decisions and assumptions of social workers and care home staff in Scotland. And that flawed, so-called ‘diagnoses’ create issues which local authorities may have perverse incentives to exploit.
Biased data lead to poor forecasting and should not be relied upon for funding decisions.
In the extreme, it takes little imagination to see a time when some misguided individual with power or influence proposes issuing everyone in Scotland with a dementia diagnosis together with their bus pass when they reach the age of 65 and be done with it once and for all!
LET BETTERCARESCOTLAND KNOW
If you or a family member or friend have concerns about a dementia diagnosis, let BetterCareScotland know!
Flawed and misdiagnoses of dementia undermine care outcomes and lead to genuine dementia sufferers being denied the care they need. And, could have perverse implications for research into the condition if data are flawed.
“There is no greater agony than bearing an untold story inside you.” … Maya Angelou
Help to ensure that the vested interests and perverse incentive structures in Scotland’s social care system can be be designed out of the National Care Service so that the Scottish Government can deliver on its promise of good care outcomes, as standard, for all people in need of care in Scotland.
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Love and Peace!