APPENDIX 18
Memorandum from The British Geriatrics
Society (EA26)
The British Geriatrics Society is a professional
association of physicians, general practitioners and scientists
with an interest in Geriatric Medicine. It is the only society
offering specialist medical expertise in the whole range of health
care needs of older people, from acute hospital care to high quality
long-term care in the community. It now has over 2,000 members
worldwide.
Geriatric Medicine is that branch of general
medicine concerned with the clinical, preventive, remedial and
social aspects of illness of older people. Their high morbidity
rates, different patterns of disease presentation, slower response
to treatment and requirements for social support, call for special
medical skills. The purpose is to restore an ill and disabled
person to a level of maximum ability and, wherever possible, return
the person to an independent life at home.
BGS Policy and Guidance on Elder Abuse.
Our professional advice to doctors about this
subject is available on the BGS website www.bgs.org.uk and is
enclosed here for your reference.
Particular points for emphasis.
We would like to draw to the attention of the
Health Committee the following points which because of particular
and current issues in the NHS are especially relevant. We have
arranged them under the headings for which you have asked:
Abuse of Older People in care homes is often a result
of poor training and poor support for staff. The present payment
mechanisms for care homes in England, whereby many local authorities'
maximum payments for care homes is well below the local "going
rate" means that those homes which do accept social services
rates often employ poorly paid and casual staff. This contributes
to the likelihood of poor care and thus abuse.
The recent decision by the National Care Standards
Commission (NCSC) in England to both allow discretion over the
Criminal Records Bureau checks for care homes staff and not to
make them a requirement at all for home care staff has been an
endorsement of drift to drive down standards of care. There is
evidence that staff who have a criminal history or a personality
disorder may be more likely to abuse. By definition the older
people in care homes and needing home care are the most vulnerable
and thus need the greatest protection. This is not the message
being given by the NCSC.
Preventing Abuse and What can be done about it:
Any form of ageism, or lack of person centred care
is a form of abuse. In this respect the implementation of the
NSF for older people is a vital part of the fight against elder
abuse in England and thus it must continue to be a major strand
of health service policy.
Abuse of older people by their own relatives and
informal carers can often be a response to a lack of support in
caring for a sick older person. The "inverse care" law
still applies for many older people. The GMS contact negotiations
are an ideal opportunity to ensure that community health and
social services including GP's are engaged in regular review and
surveillance of frail older people so that those people who are
struggling are offered help before a crisis in order to avoid
the stress and isolation in carers which can lead to abuse.
In the same way hospitals must still be expected
to address the needs of frail people even if they don't appear
to present an acute medical problem. A worrying side effect of
the reimbursment legislation could be the legitimising of the
attitudes that older people are a burden. This desensitises otherwise
caring staff when considering discharge planning and offering
choices to patients and their carers. There can be few situations
more distressing to a stressed carer than an ill timed and ill
planned discharge, or more distressing to a frail older person
than being forced to make a move to a poor care home so as to
avoid a reimbursement "fine"—in itself a form
of abuse.
Dr G F Turner
Chair, Policy Committee
British Geriatrics Society
November 2003
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