Paul Edwards: Creating care where older people regain the value they richly deserve

There has rightly been a raising of public concern and hard words by those charged with overseeing our services for older people, but few are asking the questions why such appalling neglect and abuse can and does occur within NHS settings. While there are some notable examples of humane care practice within older people’s services, ageism is clearly still rife within the NHS.

Ageism persists despite the Department of Health’s aspiration to eradicate ageism in its 2001 National Services Framework for Older people. If you are older, it seems, you are at increased risk of receiving a poor standard of care.

The language we use to describe older people who use NHS services is a cause for concern in its own right. ‘Bed blockers’, the ‘away with the fairies’, the ‘old biddy’ are all phrases I have heard professionals use to describe people in their care.

Why do we use such pejorative terms for older people who need care? I am quite sure that no health care professional was trained to offer a lower standard of care to older people and no health care organisation markets themselves as one that promotes the active neglect of older human beings.

In my role as Head of Training and Practice Development in Dementia Care at the University of Bradford, I receive emails from family carers of people with dementia that describe the lack of care and attention their love ones received in the NHS.

A recent example would be an older person with dementia taken to their local A & E department who needed their head suturing after a fall. The person received no local anaesthetic prior to having the procedure done as the professional wrongly held the assumption that people with dementia cannot feel pain.

Clearly, there is a lack of knowledge about what it means to live with dementia and this has been noted by the All Party Parliamentary Committee on Dementia (Prepared to Care Report, 2009) and improving hospital care for people with dementia is set out as a national priority and is a key aspect of the National Dementia Strategy (Dept of Health 2009). But there is also a more deep-rooted ageism and dementism that requires tackling. Somehow in our care cultures, we have lost sight of the person as a feeling, human being. We seem to have lost our empathy for older people and fail to see what life is like from their perspective.

We can always blame the system, nurses having to do too much paper work, lack of resources, target-driven health care, a lack of training and indeed all of these add to the de humanising process of health care but for me it isn’t so simple. In the 1990s, the introduction of ‘modern matrons’ temporarily calmed society’s clamour for better standards. In the 2000s, we established ‘dignity champions’ in order to promote dignity in care settings. I would argue that the very nature of us needing ‘dignity champions’ only goes to show that there is something fundamentally wrong in our personal and institutionalised attitudes towards older people. What has happened to us as a society that we need a ‘dignity champion’ for our frailest and most vulnerable members?

It is within all of our gift to treat the person as unique. Sometimes in health care it can be a real challenge to treat all illnesses that older people face, but, at the very least, we can afford people respect. We can support the human needs for comfort, belonging and identity even if we can’t find a cure for every ill.

More enlightened healthcare providers know this and there are many moving examples of how care can be so different up and down the UK. Crucially, for me, what all of those good examples have in common is the insistence on putting the person first.

They train staff in an ongoing way of what good human care should be and continually monitor the experience of older people and use this information to actively improve choice and treatment options.

Individuals are treated as less of a task to be done to and empowerment and individual rights of the person come to the fore. Above all else, relationships between human beings become paramount and are based on trust and respect. No surprise that these care settings use less medication to control behaviour, have more satisfied staff and have management structures that support human care.

We have to learn from these pockets of excellence and develop and embed a new kind of humanistic care that promotes excellence not mediocrity. We need those charged with leadership in health care to understand that good human care is not an add on.

In short, we need to move beyond unloving care and create care where older people regain the value they richly deserve. Perhaps in health care our first step should be replacing the word ‘patient’ with the word ‘person’.

Paul Edwards is dementia expert at Bradford University.