Blueprint for Advocacy? Changing the Culture of Care
Recently I had the opportunity to read a report of Northern Ireland’s independent Commissioner of Older People advocating for “a change of culture” to better protect older people in care settings. The thirteen primary proposals strike me as concise, reasonable, and extraordinarily important, for any (make that every) country, including the U.S.. See what you think:
1. The rights, quality of life, dignity and care needs of vulnerable older people should be at the heart of planning, delivering, regulating and inspecting care services; it is their needs that must matter the most.
2. Standards for the care of vulnerable older people should be clearly displayed and available to all service users and their families and relatives of all nursing, residential and domiciliary care services as well as for any prospective users.
3. Inspection processes should be rigorous, with decisive and timely enforcement action taken when failings are detected.
4. The regulation and inspection service should include a rating system for care homes and domiciliary services. In addition to an overall rating, it should clearly identify if there are any breaches of regulations or failures to comply with improvements required.
5. There should be clear and rigorously applied sanctions taken against care providers for non-compliance with the minimum standards.
6.Persistent or serious breaches of regulation and/or compliance should result in decisive sanctions being applied without delay and within a defined timeframe. The sanctions that should be applied should include de-registration of owners and managers, home closure, financial penalties as well as suspension of new admissions to care homes, and domiciliary care services.
7. Health and Social Care Trusts should not continue to place vulnerable older people in nursing and residential care homes, or with domiciliary care services, where there are serious unresolved compliance failures and unacceptable standards of care.
8. New legislation to better protect older people from abuse should be enacted in Northern Ireland without delay. This should include a criminal charge of ‘corporate neglect’ to allow prosecution of care home and care service owners who abuse and neglect older people in homes they own or services they run.
9. Health and Social Care Trusts and older people who self fund their care should be entitled to a refund of part of their fees paid for any time that a care service fails to meet the required standards.
10. Whistleblowers and older people or relatives who raise concerns about poor care or abuse should be better supported and better protected from unfair treatment.
11. A well-trained and registered social care workforce, which is respected, valued and properly remunerated with opportunities for career progression, is essential.
12. Complaints processes, safeguarding procedures and details of the organisations which can assist complainants should be made clear to all prospective and current service users, their relatives and staff of care services.
13. The contract through which older people occupy care homes should be reviewed so that as long as the care home can meet their assessed needs, they cannot have their tenancy terminated without due process, reasonable due cause, and without appropriate alternative care being in place.
My thanks to Commissioner Claire Keatinge for sharing the detailed November 2014 report with these 13 primary points (and much more) on “Changing the Culture of Care Provision in Northern Ireland.” I’ve had the privilege of working with two research teams and the staff of COPNI for the last two years on other studies. I have come to deeply appreciate the candor and strength of Commissioner Keatinge’s advocacy on a larger range of issues.