Rose Park Care Home Fire tests Scots Law

The Crown Office has announced that it is to launch a third attempt at a prosecution of the owners of Rosepark Nursing Home (Care Home) were 14 residents died in a fire in 2004.

Two previous attempts at a prosecution have floundered because of technicalities with Scots law which have so far resulted in the failure to hold anyone properly to account for the Rosepark care Home fire tragedy.

A first attempt at a prosecution foundered when the trial judge Lord Hardie ruled that it was only possible for the alleged offences to be carried out by employers, and he ruled that the three owners of the home who had been named in the indictment were not in fact employers in law.

Later in July 2008 a second attempted prosecution failed, this time because the indictment named the partnership as the legal entity in the indictment. The partnership had however at that time been dissolved and the prosecution could not proceed because having been dissolved the partnership no longer had any legal identity.

A third prosecution is now being attempted against Thomas Balmer, Anne Balmer and Alan Balmer in their capacity as the surviving partners of the dissolved firm of Rosepark Care Home.

The Crown Office said that "The whole surviving partners are indicted in their representative capacity only and not as individuals."

Also named on the indictment are Croftbank House Limited, formerly Balmer Care Homes Limited.

The Crown Office stated that "In Scots Law, a firm is a separate legal person distinct from the partners of whom it is composed. The Appeal Court held that on dissolution of the firm there was a complete cessation of the persona of the partnership (that is the separate legal person) and that a dissolved firm did not retain a limited persona for the purposes of criminal prosecution which could be prosecuted in its own name."

A Preliminary Hearing on the new indictment is to be held at the High Court of Justiciary in Glasgow on the 30th October 2008.

The relatives of those who died will be impatient to see a proper court examination of the occurrences around this fire. It is vital that the court proceeds with examining whether those charged with the duty of looking after their relatives safely fulfilled their responsibilities. It would be a sad day for justice in Scotland if this third prosecution also fell on a technicality and prevented the bereaved seeing those involved in the ownership and provision of this care home called to account.

This case must also proceed because otherwise it will become clear that other owners of care homes can by means of dissolving their partnerships or companies avoid being held to account for their actions.

Bristol Care Home Abuse Closure

Care regulator,The Commission for Social Care Inspection (CSCI) has applied for an emergency court order and closed Overnhill House, Downend, near Bristol. The care home for elderly people was shut because of concerns about the safety of residents following a period of monitoring.

Questions remain however about why there has so far been no police involvement given the nature of the concerns raised about what went on at the Overnhill home.

CSCI reported there had been complaints that one resident had been dragged across a room, that another had heavy bruising, concerns about issues about medication being administered and concerns about staffing levels .

All 10 people living at the Care Home were moved. The Owners, Danny Purgaus and Patricia Purgaus have not made any comment.

The home which has 14 beds was registered in 1992 and offered residential care for elderly people with dementia or Alzheimer's disease.

A CSCI spokesperson said, "The decision to close a care home is never taken lightly and is usually the last resort after every effort has been made to get the owners to improve standards and comply with legal requirements. We know all too well the impact that closure can have on the people who live there, their families and their carers, as well as members of the staff."

Bristol City Council said the authority had responded to concerns about the welfare of the residents and had found new residential placements for them.

An Avon and Somerset Police spokesperson confirmed that there has so far been no police involvement in the case.

The lack of police involvementy raises serious issues given the reports from CSCI that the complaints inluded the suggestion of at least one resident being dragged across the floor and the suggestion of heavy bruising on another.

Care Home residents are entitled not only to the protection afforded to them by a regulator such as CSCI - which appears to have acted firmly in this case. Care Home residents are also entitled to the protection afforded by the criminal law and it is clear that the police must investigate the possible abuse that may have taken place in this home.

Abuse of residents in care homes must be seen not only as a regulatory matter but also as a matter for possible criminal prosecution. Only when the State acts both to close such homes and to prosecute abusers will people in Care Homes feel truly protected.

MRSA in Care Homes and Nursing Homes

Methicillin-resistant Staphylococcus aureus (MRSA) is not only a dangerous, sometimes fatal and difficult to treat disease for hospital patients but also a significant concern in care home settings where residents often have nursing needs. Despite this surprisingly few studies have examined how to prevent MRSA spread among elderly residents in Care Homes according to Carmel Hughes, lead author of a recent review of the subject.

( Check here for other MRSA related publications)

MRSA Risk Factors
The usual antibiotics, like penicillin do not work with the organism MRSA and the problems it causes are compounded by the fact that it spreads very easily, often on the hands of health care workers. Elderly Care Home (Nursing Home) residents can be particularly vulnerable not only because the risk of infection increases with advancing age but also because a proportion of residents will have periods in an out of hospital where they may either pick up or pass on the bug.

In addition to these factors residents in nursing homes also live in close proximity to each other, are often on multiple medications, are susceptible to pressure sores and often have catheters. All of these are factors which facilitate MRSA infection.

The reviewers searched for randomized and controlled clinical trials that focused on infection control interventions in nursing homes. "We found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people," they report.

Hospitals have isolation facilities and greater access to infection control expertise compared to Care Homes and infection control training is not routinely available in nursing homes.

MRSA control measures in Care Homes
Care Homes (nursing homes) can and must still learn lessons from the existing research; which has been mostly hospital focussed.

MRSA intervention in Care Homes / Nursing Homes should include screening of recently admitted residents to the nursing homes possibly with the assistance of attending GP's. A thorough approach might also need to take account of residents who have periods of hospital admission and the possibility that they may aquire MRSA during these periods.

Staff training in the importance of hand washing and high standards of cleaning and decontamination is very important as are mechanisms to ensure the staff follow such routines. Identifying specific members of staff to take responsibility for promoting and monitoring infection control measures may also help.

Carmel Hughes is a professor of primary care pharmacy at Queen's University Belfast in Northern Ireland. The Cochrane Library is an international organization that evaluates medical research.
Reference: Hughes CM, Smith MBH, Tunney MM. Infection control strategies for preventing the transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people (Review). The Cochrane Database of Systematic Reviews 2008, Issue 1.

Care Home Standards:When big is not better

The Care Home market in the UK has seen a significant move over recent years towards the consolidation of ownership into the hands of fewer and larger ownership organisations. While in financial terms this may make sense there has been concern among commissioners and regulators whether these larger corporate organisations are always delivering a better quality of care in their homes in comparison to the smaller or single single home providers that are becoming a less significant part of the market.

Much of the concern about the standards in the Care Homes provided by the "big players" has admittedly been anecdotal and we are not aware that there has been any systematic study of this in the UK. Nevertheless the anecdotal evidence seems quite strong and it has been interesting to speculate why these larger organisations sometimes do not match the quality of care in smaller scale provider organisations.

Now a study by the University of Michigan School of Public Health suggests that the very strengths of the larger nursing home chain- its ability to standardize and perfect administrative practices throughout the chain-may also be the very thing that hurts patient care. While the study was confined to the more Nursing Home oriented facility in the US, it may have important lessons for the delivery of care across the Care Home sector.

"Consumers need ways to identify what is a good or bad nursing home when making choices about where to place a loved one," said Jane Banaszak-Holl, corresponding author on the study. "Right now, we have an easier time distinguishing the quality in McDonalds versus Boston Market than we have distinguishing how, for example, a Sun-owned nursing home differs from a Beverly Enterprises nursing home."

As in the UK these larger chain-owned nursing homes are the predominant type of institutional care in the United States. Studies in the US have shown that care in chain-owned nursing homes is generally not as good as care in nonprofit and singly-owned nursing homes.

"If they (chain-owned nursing homes) are really not as good, we need to think about how to improve them," said Akiko Kamimura, a U-M doctoral student in Health Management and Policy at the School of Public Health, and first author of the study.

The study suggests that corporate standardization of clinical and facility processes improved resident care, but that corporate standardization of administrative processes hurt patient care. The study concluded that chains need to balance administrative efficiency with the local needs of the individual chain-owned facilities to optimize the quality of their patient care.

The researchers surveyed 203 nursing homes in Michigan and North Carolina and looked at the effects of corporate standards and training in three areas: administrative processes, clinical processes, and facility design. The study examined the impact on the total number of health deficiencies given to facilities on state inspections, and the percentage of residents with bedsores. An example of a health deficiency would be inserting a catheter unnecessarily because it makes care easier.

An example of standardizing administrative processes would be to share common marketing materials. An example of facility standardization would be to use the same facility layout, and an example of standardizing clinical processes might be to implement guidelines for the treatment of resident bedsores throughout the chain.

"Standardization is a way to think about changing service delivery across many areas, including administrative and clinical processes and even within facility layout," said Banaszak-Holl. Chains that over-emphasize administrative processes don't take advantage of how much their staff can learn---and ultimately improve patient care---from the shared knowledge of developing protocols for handling resident needs.

"What we have stressed in the larger project is that chain ownership is not necessarily bad for the quality of health care, Banaszak-Holl said. "What is problematic is a shift away from community values and local needs, and an overly strong emphasis on administrative rather than clinical outcomes. A good corporate chain can implement a set of practices that still attends to local needs and resident outcomes while introducing greater economies of scale and better business practices."

The study, "Do corporate chains affect quality of care in nursing homes" The role of corporate standardization" appears in Health Care Management Review.

Research: Dementia patients die from prescribed drugs

Research by a leading UK dementia charity, the Alzheimer's Research Trust, has revealed that many Alzheimer’s patients die early because of prescribed sedatives. The research is the largest neuroleptic withdrawal study of Alzheimer's patients and the only long-term one of its type.

The research results were presented at the Alzheimer's Research Trust conference in Edinburgh. Results from the five-year project, which was funded by the Alzheimer’s Charity revealed that the prescribed drugs were linked to a significant increase in long-term mortality - patients dying on average six months earlier than normal.

The investigation was conducted by King’s College London researchers and found that the sedatives, known as neuroleptics, were associated with significant deterioration in verbal fluency and cognitive function. They also found that neuroleptic treatment had no benefit to patients with the mildest symptoms.

In nursing homes they found up to 45% of people with Alzheimer’s disease are prescribed neuroleptics as a treatment for behavioural symptoms such as aggression.

Professor Clive Ballard, Professor of Age Related Disorders at King’s College London, and lead researcher on the project, said:

“It is very clear that even over a six month period of treatment, there is no benefit of neuroleptics in treating the behaviour in people with Alzheimer’s disease when the symptoms are mild – specifically when a measure of behavioural disturbance known as the Neuropsychiatric Inventory Score is equal to or less than 14. For people with more severe behavioural symptoms, balancing the potential benefits against increased mortality and other adverse events is more difficult, but this study provides an important evidence base to inform this decision-making process.”

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:

“These results are deeply troubling and highlight the urgent need to develop better treatments. 700,000 people are affected by dementia in the UK, a figure that will double in the next 30 years. The Government needs to make Alzheimer’s research funding a priority.

“Only £11 is spent on UK research into Alzheimer's for every person affected by the disease, compared to £289 for cancer patients.”

It will be interesting to see if this research results in changes to prescribing patterns for Dementia patients, particularly in care setting where there has been concern at the use of medication as a form of chemical restraint.

An outsiders view of Elderly Care Home Standards

Random Acts of Reality is written by a London Ambulance worker. He has written about his experience of visiting a care home to pick up an elderly lady. It makes sobering reading and illustrates just how far some care settings have to go to achieve reasonable standards.

Elderly Care at Home gets EU boost

Care at Home for the elderly gets a significant boost with the announcement of
a consortium of 20 partners from European universities, public bodies and private companies to develop improved technology that should allow vulnerable older people to continue to live independently at home.

The Service Orientated Programmable Smart Environments for Older Europeans (SOPRANO) project is part-EU funded and aims to develop IT based assisted living services that promote the independence of older people, improve their quality of life and address the issue of ageing.

Mike Hodges, the Research and Development Director at Tunstall, the private company leading the research project, said: 'Against a background of accelerating demographic ageing across Europe, the latest telecare and telehealth solutions will play a pivotal role in helping to relieve some of the growing pressure on healthcare providers. Tunstall is proud to be leading this cutting-edge project which is addressing these key issues.'

The project will demonstrate how to use telecare technology, Information Technology (IT) and mobile communications to develop new community-based models of care and support. The research hopes to advance global knowledge in remote diagnostics, semantic IT, Radio Frequency Identification (RFID) location, and radar and integration architectures. 600 users will test the viability of these technologies in real homes.

The project will have two goals: to develop new ways of integrating assistive technology, telecare and telehealth solutions into users' homes to provide assistance; and to investigate the motor, sensory and cognitive difficulties experienced by older people and the best vision, voice or sensory-based means of communicating with users.

SOPRANO hopes to investigate the development of a fully networked home environment where integrated appliances support users in carrying out their everyday activities, and advanced telecare and telehealth solutions can monitor well-being to ensure that assistance is provided when required.

It is hoped that such low-level, round-the-clock telecare technology will offer a cost-effective alternative to traditional care, while also ensuring users get the support they need in the familiarity of their home environment.'

What such technology systems will never be able to offer though is real face to face meaningful human interaction and for many eldery people this can be the differenec between just living and enjoying a quality life. The development of these technology solutions to the problems of caring for the elderly must be supported and encouraged but we must never forget that the elderly, like the rest of us, need the warmth of human companionship and this is something that more traditional forms of care , at their best, have provided. The challenge is to develop systems of care which can meet these full range of needs.
http://www.tunstall.co.uk/

Elderly care: doctors discriminate says study

Half of doctors discriminate against elderly patients because of their age according to a study of elderly patients with angina. They were less likely to be prescribed a statin to lower their cholesterol, given appropriate tests, be referred to a cardiologistor or be offered surgical treatments. They were more likely to have current prescriptions changed and be told to come back later.

The survey questioned 28 GPs, 28 elderly care specialists and 29 cardiologists from southern England and the Midlands. The study of doctors treatment of the elderly (published in the journal Quality and Safety in Health Care)found patients over 65 were managed differently from younger patients.

In the study the doctors were interviewed about 72 fictional patients with varying degrees of heart problemsangina were presented using a specially-created computer programme.

Care Home Complaints:Scotland

According to the Edinburgh Evening news over 170 complaints have been upheld against care homes in the Lothians, Scotland, by inspectors from the Care Commission who discovered multiple failings in scores of residential facilities.
Problems included poor hygiene, rooms smelling of urine for weeks on end and residents sleeping on dirty and stained mattresses . Some residents were routinely receiving "hot" meals that had been allowed to go cold and were left to live in dirty and ripped clothes.

There were examples of staff shortages, badly-trained care workers and an absence of meaningful activities for residents.
The complaints involved around five per cent of the Lothians' 2256 care homes.
The information was discovered by the Evening News using Freedom of Information laws.
In less than three years 174 complaints have been upheld, wholly or in part, against nursing homes in the Lothians.
One complaint was where elderly residents were being forced to get up at 6am to get dressed and ready for breakfast at 8am in order to suit staff shifts. In another there were concerns about the "inappropriate" terms used by staff to describe residents, such as "padders" and "hoisters" used to describe those who were incontinent or needed extra help to move around.
The inspectors also criticised inadequate communication with residents and their families in some homes.

An investigation into the death of 92-year-old resident Isabella McGregor from Ashley Court Nursing Home in Morningsiden February last year found unacceptable practices in 17 areas of basic care provided to often extremely frail residents. Inspectors found residents dishevelled and in a poor state of dress and restraint methods being used inappropriately on elderly residents.
The Care Commission ordered the home to take "urgent" action to improve or face losing registration and the home reportedly complied with all aspects of the improvement notice issued by the commission.
At Braid Hills Nursing Centre in Liberton - now under new ownership - inspectors found staff speaking of residents using inappropriate language. This included calling residents who were bed-ridden as "24seveners".
The statistics from the Lothians mirror a national trend where the number of complaints against Scotland's care homes and nurseries has increased by more than a quarter in the past year.

A number of questions arise from this but a key question is why it requires a Freedom of Information action to reveal this sort of information. Surely the results of complaints investigations should be released routinely perhaps as part of the Care Commissions reporting process?