THE appalling cruelty inflicted on Mrs Gladys Wright (and presumably on others) at the Granary Care Home in Wraxall, Somerset, when a trio of careworkers were filmed pushing, shoving and verbally abusing the 79-year-old dementia patient, sends shivers down our spine.
This is because, terrible as it is for anyone to be treated that way, we know that it could easily be us next.
Our population is ageing: it is not youth that is the future but the elderly. For the first time in history most people will survive into old age, indeed into advanced old age. Large numbers will have to be looked after in care homes, not because their children or other relatives have become callous or indifferent but because they will suffer from conditions that will make it impossible for them to be looked after at home.
Contrary to what many people might think, our society has not become so bad that the young simply abandon the old to a miserable fate
Contrary to what many people might think, our society has not become so bad that the young simply abandon the old to a miserable fate. My wife, who was a doctor who looked after thousands of old people during her career, was generally very impressed, and much moved, by the immense efforts and sacrifices most people made to keep their ageing parents at home. There were exceptions, of course; there were wicked children who cared more for their inheritance than their parents. But far more often things simply became too much for them and removal of their parent or parents to a home was inevitable.
As the population ages so will the need for care homes increase: unless, of course, cures are found for all the conditions that make removal to care homes necessary in the first place.
This is not likely in the foreseeable future as most people in care homes suffer from multiple problems, not just one. We had better assume that more care homes will be needed.
Old people are particularly vulnerable for obvious reasons. They may no longer be mentally capable of complaining of their treatment in a coherent manner and abusers know this perfectly well and therefore feel beyond the reach of management, let alone the law.
But even where the elderly are capable of complaining (and most still come from an uncomplaining generation in any case), they usually feel afraid to do so.
After all, they are dependent on the very people they are complaining about who might wreak revenge in any one of a thousand ways. The elderly dare not complain of even minor annoyances, such as being called disrespectfully by their first names, let alone gross cruelty that would lead to dismissal or even criminal charges. Work in care homes is both difficult and ill-paid, an unfortunate combination. It is all too easy, especially for untrained people, to ascribe the difficult behaviour of some of the residents to sheer awkwardness or bloody-mindedness when in fact it is the consequence of the disease or diseases from which they suffer. It is not only that many old people cannot complain: they cannot explain. When they are in pain or discomfort they cannot put it into words and so may shout or scream. It is easy to be exasperated by this, all the more so if you regard the person as fully responsible. But even trained staff find it difficult.
Once – nearly 40 years ago – I worked on a ward in which a woman (not elderly) screamed incessantly and could not be calmed. This went on for months until one day she was found dead in bed. I believed she may have been poisoned by the staff at the end of their tether but it was impossible to prove it.
Then again, it is a regrettable fact that some people are not by nature kindly. Closed institutions such as care homes, indeed, may attract those of a sadistic disposition who think they can act with impunity on their impulses. Occasionally such sadists “find” each other, as Fred West found Rosemary, and then they amplify their cruelties. There have been numbers of such examples, usually with a nurse taking the lead.
Care homes, like other institutions, will never be perfect but a strong and fearless inspectorate would greatly help to reduce the worst abuses. The problem with our inspectorate at the moment is that most of their visits are announced in advance and the things inspected are easily measured, such as regulation size of rooms, but not necessarily the quality of the care given to the residents. As Einstein said, what can be measured is not necessarily important and what is important is not necessarily measurable.
Inspections should be as frequent as possible and impromptu rather than prearranged. And they should not be bureaucratic exercises to tick the boxes of easily measured things. It should never be forgotten that the purpose of a care home is to provide as good (including kindly) care to the residents as possible, and to give them as rich a life as possible. My wife knew of very good homes forced to close because they failed to meet an entirely irrelevant but easily measured standard.
Instinct is at least as important as measurement. My wife could “smell out” (sometimes quite literally) a bad home and likewise a good one. Visiting doctors and nurses are often best placed to sound an alarm on the basis of unexplained injuries, neglect and so forth.
We will never eliminate all abuse but impunity is the worst of all enemies. The sentences given to the culprits in Wraxall, amounting to a few months in prison or community service, seem derisory.
‘We need a strong and fearless inspectorate’