Elderly care homes: Wales quality review by commissioner

Older people in care homes are to be asked about the quality of care they receive in a new review. Sarah Rochira, the older people's commissioner for Wales, says she will use her legal powers to carry out the study.

It will involve speaking to older people, their families and carers to ensure more consistency of services. The Care and Social Services Inspectorate Wales has welcomed the move.

"Since I took up post, I have spoken extensively about the need to ensure that older people living in care homes in Wales are safe, well cared for and have a good quality of life," Ms Rochira said. "I have visited many care homes and have seen for myself much good practice across Wales, but I have spoken many times about my concerns that this is not consistent and that we are not getting it right for everyone. We must remember that a person's home is so much more than bricks and mortar, it is where you should feel and be safe, well cared for and happy."

Ms Rochira and her team will gather evidence from older people in care homes, their families and carers, as well as from local authorities, local health boards, care home providers, regulators and inspectors. The evidence will be used both to highlight the best care in Wales and to make recommendations to ensure that the rights of older people are upheld and they have the best possible quality of life.

"It's not enough just to be safe and well cared for," Ms Rochira told BBC Radio Wales. "This is the place that people call home and they have a right to a really good quality of life. I don't think we yet understand what that means - that's why I'm going to give voice back to older people through my review. When I talk to older people - they talk to me about words such as friendship, hope, love, staying in touch with people, feeling valued, feeling respected - words of real description and warmth, and of course they would in the places they call home. But actually the response of our system tends to be national minimum standards and the two just don't fit together. I want to give older people back their voice and put their voices back at the heart of the place that they call home."

Last year Ms Rochira warned that public bodies could face legal action if they fail older people when she published the commission's work programme to improve services to older people in 50 areas. The new review, which will begin in September, has been welcomed by Care and Social Services Inspectorate Wales.

Its chief inspector Imelda Richardson said: "Making sure that homes are safe and that people's experiences are good is at the core of our inspection work, and I look forward to working with the older people's commissioner. In the last two years we have transformed the way we inspect services. As well as checking that they are run in accordance with the law, we also focus and report on the quality of experiences for people using services. Our inspectors spend more time listening and speaking to people about their experiences of the service and support they are receiving. This allows us to get a more accurate picture of a service."



New research from MGM Advantage, the retirement income specialist, shows the UK’s retirement nation collectively manages mortgage and personal debt to the tune of £105.5bn. 13% of retirees are managing mortgage debts totalling £76bn, while 34% of retired people are managing loans, overdrafts and credit card debts worth a cumulative £29.5bn.

- Over four million retirees (or 34% of retirees) each have an average of £6,952 personal debt

- One in eight retirees (13%) continue to pay off a mortgage in retirement, collectively worth £76bn (average of £47,458 per person)

- 10% of people in retirement each manage a personal debt worth over £5,000

- 6% of retirees aged 55 and over work part-time to supplement their income

Andrew Tully, pensions technical director, MGM Advantage said: “These figures are alarming and show the pressure people face on a daily basis trying to balance the household budget. Although many people consider themselves retired they are continuing to pay off their mortgage, some with quite substantial balances. Dig a little deeper and many people are working part time, sometimes through choice but often simply to make ends meet.” 

Tully concluded: “Talking about debt in retirement will be a taboo for many people who find themselves in this position. But there are ways retirees can access practical help and advice.”

MGM Advantage has published a checklist of things for people to consider when making important decisions at retirement:

1. Claim all state benefits to which you are entitled, to check, go to www.gov.uk/benefits-adviser suggests that pensioners are missing out on up to £5 billion a year in unclaimed pension credit, housing and council tax benefits, as well as attendance and disability living allowances

2. Keep a track on any old personal or occupational pension arrangements. If you think you might have lost track of an old pension arrangement, you can check via the Department for Work and Pensions tracing service here www.gov.uk/find-lost-pension

3. You can check if you have any old savings accounts which you might have lost touch with over the years by going to www.unclaimedassets.co.uk

4. Don’t just accept the annuity rate offered by your pension provider. You should shop around for the best rate and you might qualify for an enhanced rate because of lifestyle and/or pre-existing medical conditions

5. Seek professional financial advice as this will help you get the best product and rate for your individual circumstances. To find an independent adviser go to www.unbiased.co.uk

6. You may have old National Savings accounts or Premium Bonds. To check for unclaimed prizes please go to www.mylostaccount.org.uk or contact NS&I here www.nsandi.com for further information.

Seven in ten retirees (70%) own their own homes outright with no mortgage, while 16% live in rented accommodation.

 2% of retirees live with family or in other types of accommodation, while 13% own their property with a mortgage.

Nearly two in three retirees over the age of 55 have no personal debts (66%). 34% of retirees have some personal debt, with 70% of those people managing debts of £5,000 or less.

Asset Rich - Cash Poor?



Bournemouth University research finds ‘Asset rich, cash poor’ pensioners sacrificing social activities because of fear of debt and may be more vulnerable to exploitation. The economic downturn is having a marked impact on the wellbeing of ‘asset rich, cash poor’ older people, Bournemouth University (BU) researchers have found.

The study looked at the financial challenges facing retired older people, who are often considered to be asset rich but cash poor – owning property but not receiving a large monthly income. As well as the economic downturn affecting their social, mental and physical wellbeing, researchers found that the income many older people expected when planning for retirement had not come to fruition, and they felt poor in relation to their previous lifestyle and expectations. 

Lead researcher Dr Sarah Hean, Associate Professor in Health, Wellbeing and Ageing at BU, said: “It’s really frightening. They have done everything right – saved, got pensions, taken out policies and ISAs and put money into property. But the return on investments at the moment is nothing – there is no interest on savings, and they can’t sell their houses. They are just in a terrible place.”

Academics from BU’s School of Health and Social Care and Business School studied the experiences of retired home-owners from across Dorset, who were over the age of 65 and were not in receipt of a means-tested state pension. They also conducted focus groups with service providers for older people – including health and social care professionals, financial advisors and professionals from the not-for-profit sector. The research found that older people tended to manage their money carefully, and had an aversion to debt.

But this meant they were sacrificing non-essential activities like holidays, hobbies, and socialising, and worried about unexpected and potentially costly events, like large heating bills and repairs to their homes. Many interviewees spoke of worry and stress about their financial situation, and the fear of debt and future ability to cope financially. The study also found that, in order to make ends meet, older people may take greater financial risks or be more vulnerable to abuse.

“There was concern about how vulnerable older people are to exploitation, and they talked a lot about how the economic downturn was stopping people going out, exacerbating their isolation,” said Dr Hean. “The austerity cuts could have a real impact on services relied on by older people for their social and physical wellbeing - there was one woman who kept going to the library because it was warm and it saved her on heating bills.”

The researchers conducted interviews with 28 older people from both rural areas and urban conurbations within Dorset, and held focus groups with 20 service providers. They found that older people preferred to go to friends, charities and the media for financial advice, rather than professionals – suggesting a need for more appropriate financial information and support for older people. “Trust is huge for older people, and a lot of them don’t really trust financial advisers,” Dr Hean said. “We would like to see greater communication and collaboration between charities, health and social care services and providers from the financial advice sector. Perhaps charities and trusted sources could direct queries to financial services that they had vetted.”

She added: “We have also got to target young people and people mid-career who can still do something about it, as well as those who are about to retire. They need information about how to budget, how to invest and how to make money work for them.” 

The research was published by the Research Committee of The Institute for Chartered Accountants, and was funded by the Scottish Accountancy Trust for Education and Research (SATER) and the BU Foundation.

Stroke 'emotional impact often overlooked'

The emotional impact of a stroke is too often overlooked and should be given the same priority as physical rehabilitation, campaigners say.

A survey of more than 2,700 survivors and their carers in the UK found many had experienced emotional suffering.

More than half of the stroke survivors surveyed said they had felt depressed and two-thirds reported anxiety.

But 42% told the Stroke Association they felt they had been abandoned after their physical needs had been seen to.

Of the carers who took part in the poll, eight in 10 had experienced anxiety and frustration.
Strokes affect about 152,000 people in the UK every year. The brain damage caused by the condition means it is the largest cause of adult disability in the UK.

There are now more than a million stroke survivors in the UK - a figure set to rise because of the ageing population.

Stroke Association chief executive Jon Barrick said: "Stroke leaves survivors and families shocked, shaken and anxious as their lives are often irreversibly changed in an instant.
"Better recognition by health and social care professionals of the impact of stroke will help people to be properly assessed and get the right support."

New screening programme urges men to know their size! Men aged 65 and over will soon be invited to take part in a new screening programme The Wales Abdominal Aortic Aneurysm (AAA) screening programme will offer men a quick, painless one-off check for a condition that can be life threatening if left undetected. The aorta is the main blood vessel that supplies blood to the body. Sometimes the wall of the aorta in the abdomen can become weak and stretch to form an aneurysm. When this happens there is a risk that the aorta may split or tear (rupture). An AAA can happen to anyone but is most common in men aged 65 and over who smoke, have high blood pressure, high cholesterol or a history of AAA in the family AAA rarely has symptoms and if an aneurysm ruptures, it can cause serious internal bleeding. It is estimated that 80 per cent of people who suffer a ruptured AAA will die, usually before reaching hospital. Sixty five year-old men living in Wales and registered with a GP practice will be sent a letter inviting them to attend an appointment for a simple ultrasound scan of the abdominal aorta to check whether an AAA is present. Men who do not have an AAA will not need to be screened again. If an AAA is present, it could be small, medium or large. Men with small or medium aneurysms will be invited for further scans to check on the growth of their AAA. Men found to have a large AAA will be referred to their local hospital to discuss treatment to repair it. Llywela Wilson, Head of the Wales Abdominal Aortic Aneurysm Screening Programme, said: “We would encourage all men who receive an appointment for AAA screening to take up the offer for this quick, free and very important check of their health. “Most men with a large AAA will know nothing about it until it ruptures, and their chances of surviving will sadly be very poor.” More information on AAA screening is available from the programme website at www.aaascreening.wales. nhs.uk

So, we are all being encouraged to excercise but BBC presenter Andrew Marr blames his recent stroke on overworking and an overly vigorous exercise session on a rowing machine.  The 53-year-old said he had, to his detriment, believed the newspapers... that we must take very, very intensive exercise in short bursts for good health.

So should we now leave high-intensity training to only the youngest and fittest people? People of all ages can have a stroke, although they occur most commonly in people who are older. More than 150,000 people in the UK have a stroke each year and a quarter of them are under 65. Most of the time there will be underlying health problems like having high blood pressure. And there are simple lifestyle changes that you can make to reduce your risk of stroke. These include keeping fit by doing regular exercise, maintaining a healthy weight, refraining from smoking and making sure you don't drink too much alcohol.

Doctors say that regular exercise can halve your risk of stroke. About 30 minutes of activity five days a week is enough. And you do not have to do it all in one go - it is just as effective to exercise a few times a day in 10, 15 or 20-minute sessions. But in terms of intensity, erring on the side of caution might be best.

Advocates of high-intensity interval training say doing a few short bursts of exercise each week - four 30-second sprints on an exercise bike, for example - is a good way to keep fit. The idea is that pushing your body to its limit gives you a better workout. And, like any new exercise regime, if you have a pre-existing medical condition you should consult your doctor before trying it.

The Stroke Association also advise caution. They say it is important to find a balance between how hard the exercise is, how long you exercise for and how often you exercise. You will benefit more from doing regular gentle exercise for a good length of time, than exercising very vigorously for a short length of time or infrequently, they say.

Nikki Hill, director of communications, said: "Regular exercise is an important factor in stroke prevention and recovery. "We have heard anecdotally that some activities like vigorous exercise can sometimes cause blood vessels to burst. "We need more research on the underlying factors that might make that happen. We do know that high blood pressure itself is the single biggest cause of stroke, until more research is done on specific triggers we'd suggest getting your blood pressure checked and taking steps to keep it under control, exercise can help with that."

There can be warning signs that a stroke is likely. Andrew Marr says he had two minor strokes in the year before his major one, but had not noticed.

Many strokes are preceded by mini ones called transient ischaemic attacks or TIAs. These may be silent or cause only a few of the symptoms that come with a full-blown stroke - such as face or arm weakness and speech problems - and last just a few minutes, making them easy to miss. A TIA is a sign that part of your brain is not getting enough blood and you are at risk of having a stroke in the future.

Each year about 46,000 people in the UK have their first TIA. There is no way of telling whether you are having a TIA or a stroke when the symptoms first start. If you think you or someone you know is having a TIA, it is a medical emergency so call 999

The standard of care provided for people with dementia is "patchy", the National Institute for Health and Care Excellence (NICE) has said. Some people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services. Care services were playing "catch-up" on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles. But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes. NICE's dementia guidance includes 10 standards it wants the care sector to follow. One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities. Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: "The general picture is that care is patchy.  "We know that it is really good in places but it's not consistent. My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically."

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer's Society, said people with the condition were being denied the quality of life they deserved. "These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect," he said.  "But, as they are not mandatory, it's a case of 'wait and see' as to whether this guidance will drive real change or just sit on the shelf."