• Death in a care home 04 January 2016 | View comments

  • 4th January 2016 | By David Jolley

    Media attention over this holiday period has been dominated by concerns about the weather, rain and floods, especially in the north of England. Whilst this has been part of a global phenomenon of unusual weather, worries have surfaced that failure to provide the best flood defences in vulnerable places has contributed to the devastation.

    Attention has also been drawn to the murder of Rita King, an 81 year old resident of a care home in Essex by her 86 year old husband Ronald. There seems little doubt that Ronald was responsible for his wife’s death and had planned the act well ahead of the killing. She is said to have a diagnosis of dementia, her move into care was occasioned because he found he could no longer cope with her needs at home. He is himself disabled and had booked to stay at the care home over the holiday period, taking with him the gun which would be used. He is quoted as saying: ‘She had had enough’.

    No doubt more details will emerge about the background and current factors but this is a personal tragedy for Rita and Ronald and their family and friends. It is an alarming happening for other residents and staff of the care home and everyone in the care industries.

    www.theguardian.com/uk-news/2015/dec/30/essex-care-home-shooting-pensioner-ronald-king-charged

    www.mirror.co.uk/news/uk-news/pensioner-shot-dead-husband-pictured-7091586

    Death in a care home is usually a matter of routine. Sixty percent of people with dementia die in a care home. But death at the hands of another whilst in care is unusual.

    In 2014 Ryan Guest - a 33 year old man killed his grandmother – smothering her on the instruction of voices which he believed to be God. He has paranoid schizophrenia and is now detained in Broadmoor. He had left another prisoner in a vegetative state after a previous attack

    www.bbc.co.uk/news/uk-england-bristol-27936735

    www.bbc.co.uk/news/uk-england-bristol-30374727

    Similarities include kinship to the victim and altered health of the perpetrator, but there are likely to be many differences between these cases. It is a constant worry that when people are under stress and have responsibilities for vulnerable relatives, they may take action which they believe to be well motivated but are damaging or destructive.

    Reducing circumstances which produce or compound stress, identifying trigger times and taking preventative action are things we will want to do and ought to do.

    In contrast we are more used to reading of problems in care produced by neglect or orchestrated institutional abuse:

    www.telegraph.co.uk/news/health/news/11442024/Police-investigate-neglect-claims-following-death-of-care-home-pensioner.html

    Orchid View 2013

    http://www.dailymail.co.uk/news/article-2465955/Five-elderly-residents-died-neglect-care-home-institutionalised-abuse.html

    Such happenings are also identified as consequences of stress within a system where care to the most vulnerable is underfunded and low in priority and kudos. Crises receive dramatic, scandalised headlines for a few days but these are rarely followed up by shifts of funding, training and ongoing support which might reduce the likelihood of similar tragedies in the future.

    Dr Claire Hilton is currently researching the work of Barbara Robb whose investigations and publication of ‘Sans Everything – a case to answer’ in 1967 gave impetus to the movement which generated Psychogeriatric Services (AKA Old Age Psychiatry) and other more positive approaches. Much has changed in the interim, but much remains unchanged and is challenged only at times of scandal. Blame is too often and too easily directed at immediate relatives or hands-on staff.

    The current climate is reflected in some of the statistics gathered by Age UK:

    Median time to death after admission to a care home: 462 days 

    Growth in population 65+ since 2001 – 11% - Growth of places in care homes – 0.3%

    Estimate of older people abused per annum: 500,000 (150,000 being in care)

    Day care places halved 2014 – 15

    Spending on Social Care in England – reduced by £770m 2010 – 2015

    Threshold for the provision of any care: ‘Substantial need’ in 85% of Authorities

    900,000 people with care related needs receive no help from formal agencies

    www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true

    This is a man-made microclimate which leads to man-made tragedies. It can be more directly modified than the phenomena which are causing recurrent problems to the Lake District and other parts of the world. It is a question of will.

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  • Comments

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    Claire Hilton Created on 06/01/2016 08:56

    Thank you for mentioning Barbara Robb (1912-1976) and ‘Sans Everything’, her book about the care of older people mainly in the back-wards of psychiatric hospitals (1967).  Relating to the issues you raise, Barbara was desperate not to blame the ward nurses for bad care.  She worked closely with the Royal College of Nursing (RCN), Nursing Mirror, Nursing Times etc. One of her allies was Phyllis Rowe, a vice-president of the RCN in the 1960s.  
    You also say that much is challenged only at times of scandal.  That was another amazing thing about Barbara – she stuck tenaciously to her campaign.  Over several years, she kept up pressure on the government and helped keep the scandals in the national press at a level at which the public, policy makers and professionals could not forget them and could keep mulling them over constructively without being overwhelmed and retreating from them.
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    Dave Jolley Created on 06/01/2016 13:51

    Thanks for this comment Claire and for the work you do as historian-clinician - There is so much to learn from others and it is so easily lost below the layers of what has come later. The basic needs are there, as are the errors of perception and action. The challenge is to somewhere near as effective as she was
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    Ian Greaves Created on 06/01/2016 15:56

    Happy new year to all. I will be glad to see the back of 2015 that was littered with family bereavements and illness. It also saw my friend and colleague David Jolley take his well earned retirement (AGAIN). Although he deserves his peace away from the hum drum of clinical practice I will miss him. So I suspect will a lot of others.
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    Dave Jolley Created on 06/01/2016 22:23

    Not much which is hum drum when Ian Greaves is around. We have enjoyed fabulous times and brought honest to goodness clinical work to bear where it matters most - to people and families with minimal fuss and palaver. Giving priority to honest respect of people and families is what Barbara Robb was about and we will continue to be about - with a little help from our friends
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    Caroline Glendinning Created on 10/01/2016 11:29

    And the National Living Wage will further increase the financial vulnerability of both home care and care home providers. Meanwhile the Govt has scrapped a scheme, due to have started this month, that would have skilled up basic grade care staff in nursing homes to take on lower level nursing tasks.  Recruitment of nursing staff for nursing homes is also in crisis; these nurses tend to be older (near/at retirement) and can earn much more in the NHS.
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    David Jolley Created on 22/01/2016 06:51

    Bit behind with responding to this - Thanks Caroline. This feels like a challenge we should be meeting. if there has been a letter to the Guardian I have missed it. We may not have Barbara Robb amongst us now, but she showed the way. Maybe we can join forces and get a grip on this. Are there any takers?
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    Susan Benbow Created on 24/01/2016 13:11

    I'm a bit behind too! As Dave knows I have been involved in domestic homicide reviews (DHR) as author/ independent chair. With colleagues at the University of Chester I'm also involved in some research - we're looking at some reports from DHRs where either the victim or the perpetrator/ alleged perpetrator is aged over 60. Too early really to make any comments on findings but we hope there will be some learning to come out of looking at a series of DHRs, and we are certainly coming across some tragic cases.
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