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A Quiet Night In

February 1, 2015

The excellent Mark Harvey has published some fascinating results of a project carried out by Hertfordshire CC. Members of his team did an 8.30pm “swoop” of 21 residential services in the borough to see what is happening. The 21 sites were “home” to 136 residents. This is what they found:

  • 17% of people were in bed asleep.
  • 21% of people were in bed awake
  • Of the remaining 62%, 43% were in their bedclothes and only 19% were still in their daywear.

This doesn’t surprise me but it is deeply shocking. In an age when so much of the social care narrative (spin?) is about “choice” and “independence” and “person centred plans”, these results show that the reality is very different.

I showed the results to two of Steven’s support workers, who have both spent time working in residential placements. They both said that a “night shift” for staff usually starts about 7pm. It used to be later but managers are more and more, offering staff just two shifts – 7am to 7pm & 7pm to 7am. And the latter, “night shift” has far less staff employed than a day shift. It is not uncommon to have just two staff on duty to care for up to 10 residents on a night shift.

The consequence is inevitable. For any resident, whose care plan states they need 2:1 support when they are out and about, they won’t be able to do anything in the evening because it would leave the “home” with no staff to support the remaining residents. One of the guys told me about a man in his 40s that he was supporting who had been a season ticket holder for his local non league team ever since he was 8. It was the most important thing in his life. But for the two years, he had to live in the Unit, he wasn’t allowed to attend a single evening fixture and missed most of the Saturday matches as well. This happened with Steven when he was in the Unit as well. Since Steven was 11, he has gone to the Mencap Pool every Friday evening. There weren’t sufficient staff on duty at that time of evening (5.30pm to 7.30pm), so I was classified as the “second support” and went with him. Of course, I didn’t mind doing this – it was one of the few times during the week we were allowed to see each other, but if I’d been unavailable, that important activity for Steven couldn’t have happened.

I don’t think this is just happening in residential homes. People keep telling me stories about our local “independent supported living scheme”. In theory, each person has their own flat and the opportunity to live their own life. But the truth is from about 7pm, there are only two staff on duty for nine flats, so most, if not all, the residents are packed off to their flats from 7pm until the day shift staff arrive the following morning. It’s a crying shame. These flats are in the perfect area for someone to have a decent social life. There are a couple of pubs within short walking distance. The Arts Centre is about five minutes down the road and they do some fabulous stuff every evening. Stockley Park leisure centre and Uxbridge Football Club are very very close. Sadly, for an independent supported living person, all of these places are off the radar, completely inaccessible. And all because the needs of the service and managers & staff are put before the people for whom the service is meant to be geared. All in all, it’s not a service. It’s a non life.

Steven was totally institutionalised during his year at the Unit and it has been near impossible to reverse that. Although, he can tell the time, Steven tends to map his day by the TV. So, even though he has been home for four years, as soon as Come Dine With Me starts at 5pm, Steven wants to have his tea. Then as the 6 o’clock news starts, he asks the support worker to start running his bath. Then as News At Ten starts, Steven takes himself off to bed. I know that routine is crucially important to Steven to help his anxiety, so I’ve respected this routine. But I’m left feeling sad, that some of the things Steven used to do in the evenings prior to his time in the Unit, don’t ever cross his mind anymore. He used to go to a disco once a month but when he was at the Unit, it was driven by staff availability. Sometimes he couldn’t go at all. On the other occasions, he could go but had to leave early so the staff could get back to provide cover. Now he never mentions the disco.

Time and again, during the discussions about #LBBill, people have said that the place in which someone lives is important but no as important as the kind of life they live wherever they are. Someone may have their own home but if they can’t live a life within their home, what’s the point. Mr Harvey’s report this week demonstrates that all too clearly.

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From → Social Care

11 Comments
  1. Shocking future for we older people hearing this – but good to know Herts at least was trying to hold people to account. (I’m not sure if some of the LAs who’ve been cut have any capacity to do this as the differentials between cuts is difficult to justify – locally our LA is reducing the number of preferred providers as they say they have no capacity to monitor the current number… as if their ways to monitor are actually effective. Something like this on occasion would be far more effective) I can’t see any justification for shift patterns like this, or for shifts not being staggered to cover what people want. We’ve all heard of services where they run for the convenience of staff shifts and I remember interviewing someone for a job where they had been working in a service where the “day” staff and “night” staff had divided the wards/rooms between them – so they were telling some they couldn’t go to bed until the night staff came on and making others go to bed!! The cultures that this develops are the most concerning These are the important areas to help people with – for most of us our friends and social lives are key to our “wellbeing” (new buzz word – but should be useful once we move into the new Care Act). There are providers whose staff are flexible and for example negotiate with the people they support if late to come in/get up later; there’s some good local schemes who have developed some volunteer support and some providers are trying to see how instead of separately supporting people to social events, they can share and support other people supported. However I’d be naive to think this is the majority – we’ve all been to events where most people have gone by 8/9pm due to shifts! It’d be good though to share people’s solutions – it’s hard times and LAs are struggling to fund all that people really need. However people can be more flexible and should be. I’ll be interested to see if we can all get rather cleverer about assessment & reviews – and the new Care Act guidance appears to present more chance for outcomes that are about such as these issues.

  2. Reblogged this on rosemarytrustam and commented:
    let’s hear from people who are managing to find ways to help people have a social life and find ways not to be dominated by “shifts” which aren’t fitting with people’s needs

  3. ParentCarer permalink

    The core staff would not do the community activity unless it is to do with shopping or a doctors appointment. If the user needs2:1 support the local authority needs to put in additional support. The only way they go out to the clubs in the evening is if all the users go there is no choice and there is very limited days out.
    When I go to visit supported living units users are generally watching Jeremy Kyle or resting on the sofa.

  4. The same silly schedule is copied in hospitals. During the last few years of his life, my dad (in his late 50s) spent a lot of time as an in-patient.

    At home, he’d have lunch at anyone else’s teatime – 3 or 4 pm – and would have dinner late, perhaps 10pm – midnight. He enjoyed late night TV and radio programmes, going to bed at maybe 2am.

    In hospital, he was woken early to have breakfast, given lunch at midday, and dinner around 5pm. Then nothing until morning. So he was fed when he wasn’t hungry, was expected to go for over 12 hours without food (longer if he didn’t force himself to have dinner at tea time) and then was told he couldn’t go home if he didn’t eat properly! (we got round that, but it’s a long story)

    Then after the lights went out at what, 9pm? he had to keep his reading light on, so he could watch TV, read the paper, or listen to the radio with headphones. Nurses didn’t seem to think this was normal. But the point is, it was normal *for him*.

    I can understand care homes, hospitals and other institutional environments have limited resources and need set times, especially when arranging medical treatment, taking pills with food, and accommodating visiting hours. But there should be some flexibility. The patient / customer / service user / term of choice should at least be asked what they prefer – and accommodated as best possible.

  5. ex worker permalink

    Much of this is the result of the cuts that local authorities have imposed on care providers (because of the cuts on their budgets by government / council tax freezes). Having a life is seen as a luxury, so people are given just enough to survive. Care providers have been bludgeoned by the contract / competitive culture into submitting to this or folding. No one is in a position to speak out and if they do no one is listening. You would struggle to design a worse system for delivering compassionate and meaningful care! Meantime the regulators focus on counting the deck chairs , while the ship sinks.

  6. meg permalink

    Not all residences are like this. I work mainly in outreach in the community with LD adults who.live in their own homes within the community. My office though, is within a building that houses 5 guys with a variety of LD needs who need a little more support than those I see in the community. There, the staff day shift ostensibly ends around 9 pm with two remaining onsite for the 5 until 11. Extra staff are drafted in if someone wants to attend a local event such as Blue Camel Club. The sleep-in is only staffed by 1 support worker but there is extra support available on standby if required. I read your blogs regularly and often I empathise, working with adults your blogs give me insights into their earlier lives and helps explain some of their behaviours. Thankfully, this time, I have not witnessed this particular scandal first hand.

  7. Helen permalink

    We always think we are talking about quality of life and improving lives. The real narrative is always about money. Adult Social care is a means tested benefit. What is the dominant narrative around means tested benefits? They are paid for by ‘hard working tax payers’ it is for the bare survival for the hapless, lazy, drunk, addicted and those stupid enough not to be able to support their own needs and those of their family. ( not my narrative ). If you are really unlucky it is a safety net for the short term – but smart, bright people will see the light and pull themselves out.
    We are fools to continue to be drawn into dialogue that dresses up cuts so well. No doubt many of us are sitting round tables ‘co producing’ integration. Be careful – we are probably sanctioning cuts. I see only fragmentation in health – a free service – but I bet we can find a way to integrate health and social care and shunt more free health to means tested social care.

    We make it soooo easy.

    My message – lets get the basics – in every conversation we need to place how it is going to be paid for and who is paying alongside all the other words. Yes, yes it’s about values and working smartly – but there is a bottom line. Otherwise we will continue to be duped. Helena Kennedy called for a 21st C Magna Carta – lets be as ambitious as this

    Helen

    • To use an X factor term, you’ve nailed it! Who pays and what pot of money is going to be made available is always going to be key to any change or improvement. (And a measure of the seriousness of any government in following things through & making them happen)

  8. We had exactly this problem with the “supported living house” that Nico was moved to (and we know how well that ended up!) We had loads of meetings with them asking why he wasn’t able to access the great arts centre down the road or do any evening activities he enjoyed like going to the pub – particularly on summer nights. But we soon discovered, in spite of the staff’s evasive answers, that they liked to get all four of them into bed by the time the night staff (the single, solitary night staff) came on, so in truth he was in pjs and in bed by 7.00pm and the home’s only nod to the fact he was a young adult was allowing him to be watching a DVD in bed. But lights were out as soon as they could. It didn’t seem to matter what we did or said, if WE didn’t cross the county, go there and physically take him out ourselves, he didn’t go. This made us very angry at the time and frankly I’m still angry about this.

  9. Eve permalink

    A terrible state of affairs, but local authorities are telling providers to ‘keep people safe’ and strongly inferring there is little money for much else. I manage an adult LD service and we’ve been told not to book extra staff when people are sick/on holiday unless the service falls below safe satffing levels. This has an obvious impact on people.

    You should complain, complain, complain – to the provider, the local authority and to CQC.

    Then complain some more.

    • meg permalink

      Could not agree more. I work in adult learning disabilities in the community. If you think of learning disability support as a Cinderella of social services, then adult learning disability support is the Cinderella of learning disability support and adult community learning disability support is the biggest Cinderella of them all. The cuts to what local authorities pay service providers per hour are bringing that payment perilously close to my hourly pay. I once heard, couple of years ago now, some pillock on a news item declaring that elderly care in the community ‘costs as much as £13 an hour!’ Like this was a huge sum. Some poor bugger has to get a wage out of that after employers take their overheads and profit.

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