Caroline Mozley - Towards Quality Care

TOWARDS QUALITY CARE

Related Titles in Association with PSSRU

Series Editors:

Professor Martin Knapp, LSE, Professor David Challis, University of Manchester, Dr Ann Netten, University of Kent

Care Management in Social and Primary Health Care
The Gateshead Community Care Scheme
David Challis, John Chesterman, Rosemary Luckett, Karen Stewart and Rosemary Chessum
ISBN 1 85742 206 6

Equity and Efficiency Policy in Community Care
Needs, Service Productivities, Efficiencies and Their Implications
Bleddyn Davies and Jos Fernndez
ISBN 0 7546 1281 3

Caring for Older People
An Assessment of Community Care in the 1990s
Linda Bauld, John Chester man, Bleddyn Davies,
Ken Judge and Roshni Mangalore
ISBN 0 7546 1280 5

Community Care, Secondary Health Care and Care Management
David Challis, Robin Darton and Karen Stewart
ISBN 1 84014 581 1

This work was undertaken by the PSSRU, which receives support from the Department of Health; the views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

Outcomes for Older People in Care Homes

Caroline Mozley
York Hospitals, NHS Trust, UK
formerly PSSRU, University of Manchester, UK
Caroline Sutcliffe
PSSRU, University of Manchester, UK
Heather Bagley
PSSRU, University of Manchester, UK
Lis Cordingley
University of Manchester, UK
formerly PSSRU, University of Manchester, UK
David Challis
PSSRU, University of Manchester, UK
Peter Huxley
Institute of Psychiatry, UK
formerly PSSRU, University of Manchester, UK
Alistair Burns
PSSRU, University of Manchester, UK

First published 2004 by Ashgate Publishing

Reissued 2018 by Routledge
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Personal Social Services Research Unit, 2004

Caroline Mozley, Caroline Sutcliffe, Heather Bagley, Lis Cordingley, David Challis, Peter Huxley and Alistair Burns have asserted their right under the Copyright, Designs and Patents Act, 1988, to be identified as the authors of this work.

Typeset by Nick Brawn at the PSSRU, University of Kent

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

A Library of Congress record exists under LC control number: 2004043703

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The publisher has gone to great lengths to ensure the quality of this reprint but points out that some imperfections in the original copies may be apparent.

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ISBN 13: 978-0-815-39853-0 (hbk)
ISBN 13: 978-1-351-14436-0 (ebk)

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by Elaine Murphy, Chairman, East London and the City Health Authority and Visiting Professor, St Bartholomew's and the Royal London Hospitals Medical and Dental School, Queen Mary.

What makes a good home? Every year in the UK, some thousands of older people, the vast majority with a degree of mental impairment as a result of dementia, leave their own homes for good to go into a residential care home or nursing home. The decision is rarely made solely by the individual and in many cases it is essentially the choice of close relatives or health and social services professional staff. The authors report here an important government funded study designed to throw light on the vexed and complex question of what characteristics determine whether a home provides good quality of care and explore the characteristics of that even more elusive nirvana, homes in which the residents experience an enriching and enjoyable life in their final months and years in spite of profound disabilities.

The research team's findings are satisfyingly clear and direct, and reassuringly make intuitive good sense. At the risk of over-simplification, the research team found that the key quality of a home where residents are happy to contemplate staying for a long time and where staff felt part of a highly cohesive team and enjoyed working is characterised by having a lot of things for residents to do. Daily occupation and opportunities for social interaction are crucial elements which make the difference, a difference which is important enough to influence mortality and whether they become depressed or not. This holds good even when levels of dependency have been taken into account. In other words, having something to do is a life or death matter.

In this study, it was not the physical environment, not the number or qualifications of the staff, not the ethos or specific care practices but opportunities for pleasurable activities. And doesn't this make good common sense? These are homes where there is a satisfying bustle, where staff are engaged in conversation and daily mutual banter with residents, where even the most disabled person is brought into an exercise or music group and included in outings, where the televisions are kept out of sight in residents' private rooms. These are homes where relatives are in and out and welcome and time flies by for both residents and staff, who are busily stretched, tired at the shift's end, but know they are doing a rewarding and worthwhile if tough job. Most professionals in the field have visited homes like this, rare though they are, but are all too familiar with the converse, homes 'like a morgue', a slang expression which takes on new meaning once the implications of this study have been understood.

The recommendations of this study are few and the main one, that homes should be required to provide staff whose sole responsibility is to provide activities and entertainment for residents, will be unpopular in some quarters because it requires resources. The data here are too convincing to allow a criticism of 'unaffordable' to lie unchallenged. Many homes are run too cheaply to provide more than the bare minimum of supervision. Local authorities must take seriously the cost of such services in their contracts and in their criteria for registering a home. Quality care may not require huge investment but it cannot be provided on the cheap.

The report's other recommendations are familiar but important and necessary pleas, first for the universal recognition that all residential and nursing homes provide a service predominantly for people with mental disorder, whether specially designated for elderly people with mental illness or not. Ninety per cent of residents in this study sample had cognitive impairment and nearly a quarter were both demented and depressed. That has been true now for a quarter of a century and it seems astonishing that nursing staff can 'qualify' without formal study of the common psychiatric disorders of late life and only a small fraction of nursing and care assistants receive training in the management of these disorders.