Sunday, August 19, 2007

Elderly people suffering abuse and neglect in British residential care homes

Elderly people are suffering from abuse, neglect and malnutrition in hospitals and care homes, according to a report by peers and MPs. The report, published today by the Joint Committee on Human Rights, calls for changes in the law to safeguard the care of older people, and for a "complete change of culture" in health and care services.

More than a fifth of care homes have been found to be failing basic standards for privacy and dignity, with the most vulnerable residents struggling to eat without proper help, being subjected to verbal and physical abuse or being left to lie in their urine or excrement.

Two thirds of NHS hospital beds are occupied by the over65s, while the number of older people in the population is growing such that, by 2050, there will be twice as many Britons aged over 80 as there are today. Although the committee was told that some patients received excellent care, it said "there are serious concerns about poor treatment, neglect, abuse, discrimination and ill-considered discharge".

It also found evidence of "historic and embedded ageism" within healthcare services, causing a failure to "respect and protect the human rights of older people". The report includes the example of an 80-year-old woman who was sexually assaulted by a fellow resident in a care home in 2004: "It was recorded in a log book but no action taken . . . It was only reported to the resident's daughter in July 2005. She reported the matter to the police."

Another woman, who had difficulty feeding herself, "appeared to be slowly starving to death" because visitors who could have helped her were discouraged from staying during meal times. In other cases, bed sores were not treated because staff said "it was not their job". The charity Age Concern estimates that 500,000 older people are subject to abuse at any one time, mostly in healthcare settings.

The committee's report adds: "In our view, elder abuse is a serious and severe human rights abuse which is perpetrated on vulnerable older people who often depend on their abusers to provide them with care. Not only is it a betrayal of trust, it would also, in certain circumstances, amount to a criminal offence."

It also cites problems with malnutrition, dehydration and the abuse of medication as a means of controlling older patients. The Alzheimer's Society said that up to 40 per cent of patients with dementia were being prescribed powerful sedative drugs, despite the risks to their health. Other examples of neglect included a lack of hygiene in some hospitals that encouraged potentially deadly infections such as Clostridium difficile.

Some 21 per cent of care homes failed to reach minimum standards for privacy and dignity last year, the Commission for Social Care Inspection told the committee. Problems included the use of mixed-sex wards and, a lack of confidentiality in discussing medical problems. Despite this, the committee was "alarmed" that the Government's planned new healthcare inspectorate would not be given powers to investigate individual complaints from patients or their families.

It criticised the Department of Health and Ministry of Justice for failing to "provide proper leadership" and guidance on the Act to providers of health and residential care. Local authorities are increasingly referring elderly patients to homes run by the private and voluntary sector, which are exempt from the Human Rights Act. The committee calls for care standards regulations to be amended so that all care homes are brought under the terms of the Act.

Ivan Lewis, the Minister for Care Services, said: "We recognise this anomaly and will continue to work closely with the Ministry of Justice and all other interested parties to ensure that people cared for by the NHS and councils have the protection of the Act." Kate Jopling, head of public affairs at Help the Aged, said: "The shocking examples highlighted by this report provide all the evidence this Government needs to justify urgent action."


Paramedics being used instead of doctors in New South Wales (Australia)

Another government health system downgrading its services because it cannot provide enough doctors and hospital beds

AMBULANCE officers will be trained to treat non-critical patients and take them to GPs or non-hospital services under a controversial plan. The shake-up of health care roles, kept secret by the NSW Health Department, is aimed at easing the workload of hospital emergency departments. It is part of a growing trend to generalise health care, as seen in the creation of practitioner nurses, community health and hospital-in-home teams.

A draft Ambulance Service of NSW document, obtained by the Herald, said ambulance officers could "safely assess and manage certain conditions in the home without the need to convey patients to hospital for care". Like regular ambulance officers, extended-care paramedics would respond to emergency calls and treat critical patients. However, they would also be required to administer simple drugs such as antibiotics and arrange x-rays and other diagnostic tests as well as make direct patient referrals to GPs and community nurses. "It is becoming increasingly recognised that the emergency department may not necessarily be the most appropriate . destination for the patient to have their health care needs met. However, [it] is often the only current option provided," the draft said.

But emergency experts say the plan is a stop-gap measure in a failing health system, while GPs are concerned the plan may add more pressure to practices.

Extended-care paramedics will be chosen from the ranks of the NSW Ambulance Service and undergo eight weeks of training. Program trials are due to start next month and will involve 12 ambulance officers from western Sydney, where attendance at emergency departments rose more than 9 per cent last year. About 20 per cent of NSW emergency calls attended by ambulances do not result in the patient being taken to hospital, according to the draft proof of the concept document.

Modern ambulance services were facing challenges which included an ageing population, the rise of chronic disease, unpredictable delays at hospital emergency departments and increased demand due to the reduced availability of after-hours GPs, the draft document said. Dr Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, said the new system could put pressure on paramedics to keep patients at home or refer them to non-acute care instead taking them to hospital. "If you delay someone going to hospital who needs to go, when they do eventually get admitted . they are often sicker, they stay longer in hospital and there will be increased cost to the community," Dr Joseph said. "If we are going to do it right, do it the first time."

Dr Joseph said the program appeared to be another "stop-gap measure for a failing health system". The chief executive of the Nepean Division of General Practice, Michael Edwards, said the plan would "extend an already over-extended workload" for GPs.


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