‘Open cultures’ in care homes
Des Kelly, R&RA Trustee, reflects on the virtues of a virtual AGM and ‘open cultures’ in care homes
The Relatives & Residents Association (R&RA) held its first virtual Annual General Meeting last month. Like so many charities, over the last 16 months or so, the R&RA has had to embrace online communication methods as a way to keep trustees and members updated, facilitate staff discussion and maintain good governance. And so, our first AGM by Zoom! Anyone who has ever been to an AGM will know they are necessary but I doubt that anyone really relishes the prospect of attending with all the standard procedural formalities.
Curiously in this instance the constraints of the virtual format meant that it was possible to deal with the important procedural matters in an efficient and effective way, to receive reports, elect trustees and then to move on to discussion.
The formalities were followed by a lively discussion around the theme of “closed cultures” in care homes. An issue covered in the recently published report from the Care Quality Commission (CQC) which detailed the 39,017 death notifications involving Covid-19 over the last 12 months by all care homes across England. An unbelievably tragic situation that the CQC report reminds us: “every number represents a life lost”. The CQC report observes: “In many cases, the loss of a loved one has been made even harder for the relatives and friends of people in care homes who were unable to be as near to them as they would have wished in their final days and weeks due to COVID-19 restrictions. Losses will also have been felt by the staff who have cared for and supported them, and who may have built up a relationship over years.”
The Covid-19 pandemic has undoubtedly had a devastating effect on residents, their relatives and staff as well as the wider care home sector. So much so that when we have the public inquiry into the handling, and mishandling, of the Covid-19 crisis it will need to dedicate space to reviewing solely the experience of care homes and the impact on those living and working in them.
All those that contributed to the discussion at the R&RA AGM spoke from first-hand experience. Relatives seldom feel that they are treated as ‘partners in care’ and yet there was a great deal of empathy for what care homes have had to deal with during the various stages of the pandemic. R&RA members spoke of the way in which freedoms for residents in care homes and their relatives and friends have been curtailed, the problems associated with visiting, the implications of inconsistent guidance and the importance of community engagement in the best care homes.
The latest ‘Covid Insight’ from CQC considers the theme ‘Identifying and Responding to Closed Cultures’. The report reflects on human rights breaches and abuse resulting from closed cultures and, although specifically addressing services for people with learning disability, the patterns and difficulties are relevant for all people living in care settings.
The report observes: “While there is no single factor that can lead to a closed culture developing, we know that there are certain risk factors. These include:
people being placed in services far from their family, friends and communities
people staying in inappropriate environments for months or years at a time
weak leadership within a service
staff not having the right skills, training or experience to support people
poor culture, with a lack of positive and open engagement and communication between staff, and with people who use services and their families.
The development of closed cultures can be deliberate or unintentional – but either way it can cause unacceptable harm to a person and their loved ones.”
The brief discussion at the R&RA AGM drew attention to many of these points and, in particular, the vital part that relatives play in ensuring that people receive the right care and support at the right time. Access to family and friends is a principal way in which such safeguards are secured. The lockdown restrictions have resulted in severely constrained visiting arrangements for many care homes and lonely and isolating experiences.
The R&RA continues to make the CQC aware of its concerns about reduced inspections and the consequences of closed cultures in care.
The R&RA also welcomed five new trustees to the charity board. I’d like to add my good wishes and look forward to working with them.