‘Get up, stand up for your rights’: a call for an Older Peoples’ Commissioner. A blog for United Nations Day.

Heroes come in all shapes and sizes. At different stages of our life we probably most of us need heroes. For some they will be the celluloid stars of imagination, sporting greats or fashion and style icons. For many they are the famous and extraordinary, the remarkable and amazing. Our heroes will doubtless change over time but at the risk of exaggeration most of us need a few heroes in our hearts. They are the people who inspire and motivate us, who are exemplars of something we admire and whose lives push us to be someone we want to be. Regular readers of this blog will probably have guessed that most of my heroes are individuals who are not well known, many of them folks I have met along the way, but all of them people whose compassion and care, humanity and sensitivity have made them for me heroes of our humanity. That’s why during the first wave of the pandemic I spoke about ordinary frontline carers as being the real heroes of this year.

But in a more traditional way there are some people who have always inspired me and who have taught me something important about the essence of what matters. For most of my life I have found the story and example of Rosa Parks to be truly inspiring. Many of you will know her claim to fame and the heroism of her actions.

On December 1, 1955, in Montgomery, Alabama, Rosa Parks when travelling home from work on a bus refused to give up her seat in the “coloured section” to a white passenger after the whites-only section was filled. Bus segregation was part and parcel of the law at the time and was a physical embodiment of the race laws that existed in the United States. She was arrested for civil disobedience in violating Alabama’s segregation laws. Her quiet dignity led to many in the black community to boycott the Montgomery buses for over a year which became the first major direct-action campaign of the post-war civil rights movement. Eventually in November 1956 the courts decided that bus segregation was unconstitutional. She became in many senses the ‘mother of the civil rights movement’, spent her life thereafter fighting for equality and now even has a day named after her to commemorate her actions.

After years of struggling to achieve justice , after her retirement, Parks wrote her autobiography and continued to insist that the struggle was not over and there was more work to be done. In her final years, she lived with dementia and spoke and wrote with passion about the rights of older people and those with dementia.

Today is the 15th anniversary of the death of Rosa Parks in 2005. It is with a real synchronicity of time that today is also the 75th anniversary of the founding of the United Nations.

On October 24, 1945, 51 countries came together to create the United Nations. Its purpose was to promote peace and cooperation around the world.

The 75th anniversary is happening at a time of massive upheaval and uncertainty for the world living as we are through the  global health crisis which is the COVID-19 pandemic. The pandemic is resulting in severe economic and social turmoil. But as the UN has said this week it is also a reminder that times of struggle can become an opportunity for positive change and transformation. It is at such times that we learn what is intrinsic to life, why collective action and inter-national co-operation are so important, and perhaps why most of all peace is what remains the aspiration at the heart of the founding Charter of the UN.

There may be occasions when we can be tempted to forget the way in which the actions of others impact on our own story, but the global pandemic has shone a light on the way in which we are all inter-connected, one with the other, co-existing in our humanity and on our planet.

The COVID-19 pandemic for many of us has become a watershed. Even as we now respond to a second wave and no doubt prepare for future waves of the virus; even as we accept the reality that pandemics will become part of the pattern of our future, we are now being presented with opportunities to do better and be different.  These are the times when the lessons of our heroes can come off the page of our imagination and be written into action and response.

So, it is on this United Nations Day and in recognition of those who have stood up to injustice that I want to argue that Scotland needs to urgently decide to commit to creating the role of an Older Peoples Commissioner.

There has been much debate over the years about whether or not the time is right for Scotland to join Wales and Northern Ireland in the UK, and many other countries across the world in appointing an Older People’s Commissioner. I would argue that the time for such debate is over and that the pandemic response requires such a role to be created.

Ageism has been at the heart of so much of what has been the experience of older people during this pandemic. Whether it has been the suggestion that Covid19 was a ‘baby boomer harvest’ and only affected the old, all the way through to comments in the media this past week about the requirement to ‘segregate the old and vulnerable’ in order to protect and safeguard them. Throughout the pandemic there has been an obscene , conscious and at times unconscious, ageism at the centre of much social and media commentary. In practical actions, from a questionable ethical Guidance document which used age as a proxy for decision making, through to the inappropriate use of DNACPRs, to unequal treatment of older people in terms of access to social care packages, to the lack of agency and voice to those who receive care at the table of decisions – this pandemic has been a shameful enactment of profound age discrimination right across Scotland.  It is time for that to change. It is time for Government and political leadership across the parties in Scotland to take older age seriously and create a post for a Commissioner.

Scotland does indeed have a Minister for Older People but that is not enough – that is part of the structures of government, an Older People’s Commissioner is someone who is appointed by a parliament, responsible both to it but primarily to the older people of a nation, and who is enabled to speak and act with independence, able to hold those who rule and decide to account for responsible human rights based actions. She/he becomes an advocate for older age.

In the last few months I have had the privilege to work alongside Helena Herklots and Eddie Lynch, the Older People’s Commissioners in Wales and Northern Ireland respectively. Their ability to champion the voice of older people, to challenge and remind, to articulate and to speak out has been inspiring. Scotland needs such a voice to hold all of us to account, to remind all of us of our responsibilities. The election in 2021 should offer us that as a legacy to all who with older age have struggled in these last few months. I recognise  the creation of such a post is in itself no panacea but it is the first step in a journey to equality regardless of age. As a people, as communities and as a nation we must challenge the pernicious acceptance and allowance of age discrimination.

Growing up I was very aware that others had heroes who sat alongside those I held important. It felt to me that every night in my teenage years that I feel asleep to the sounds of the music of Bob Marley, the undoubted super-hero of my older brothers’ world. Over time – perhaps with sleep appreciation – I have grown to appreciate the awesome power of Marley’s words. One verse in particular resonates today as I remember those who have stood up for equality, justice and peace throughout the 75 years of the United Nations, including Rosa Parks who literally refused to move, and as I continue to work with others to create for Scotland an Older Peoples’ Commissioner.

Get up, stand up, stand up for your rights
Get up, stand up, stand up for your rights
Get up, stand up, stand up for your rights
Get up, stand up, don’t give up the fight

 

Donald Macaskill

 

 

Care home visiting:  the keeping of promises in winter: a personal reflection.

In the week that has passed one thing has dominated my conversation and consideration – care home visiting. On Monday the Cabinet Secretary published Guidance which amongst other things extended the potential of outdoor visiting to include up to 6 people, indoor visiting was enhanced to enable the possibility of physical touch (with PPE), longer visits (up to four hours) and involvement in activity with residents. In addition, there was permission given to allow children, pets, and hairdressers into care homes.

In the hours and days after the announcement I have held and heard many conversations with individual family members, providers, managers and staff. The conversations have sharply illustrated the degree of disagreement both about the visiting guidance but indeed about the risks and opportunities around visiting altogether.

I am writing on this subject this week to partly reflect the variety of views but also to attempt to identify steps that might be taken in the weeks ahead to give greater reassurance, and most critically to argue that unless we all of us work collectively over the next few weeks then the winter we are about to face will be a very dark one indeed.

There can be no doubt about a point of overwhelming agreement and consensus – namely that everyone involved in care homes both recognises the importance of restoring a more normal and natural family and resident relationship, and that there is growing evidence of the physical, emotional and psychological harm that is resulting from the enforced and extensive separation that has occurred over the last seven months. There can also be little grounds to dispute the knowledge that the risks of Coronavirus upon those who are our very old, frail and elderly are immense and considerable. No one wants to see a return to the devastation which brought such heartache and sadness to all our lives in the spring and early summer. But there are also points of real tension beyond agreement.

I have heard this week from providers, care home managers and staff who are deeply concerned and very fearful indeed about the measures which were announced on Monday. The grounds for their concern are numerous but chiefly they feel that the timing of the announcement and the start of increased visiting is miscalculated. They argue that at a time when cases of the virus are increasing in the community, when hospitals are beginning to fill up and when large parts of society are facing increased restrictions in order to protect, then this is not the time to extend visiting and increase the risk of transmission from the community into care homes. They further argue that the safeguards which we have been operating over the summer months are now at a state of real fragility, this is especially the case with care home testing where the experience of many is that delays in the UK Portal mean that some staff are having to wait for test results for a period of up to and beyond a week. They express further concern that without the testing of visitors that there will be real harm to residents from the risk of asymptomatic individuals coming into the care homes. They state that they have a duty of care not just to individual residents but to all residents and staff. They have also highlighted the huge pressure extending visiting places upon already stretched and exhausted care staff and managers at a time when they should be focussing on keeping people alive.

In addition, I have heard from family members who have written and spoken to me who are alarmed at the extension of visiting and see this as posing a risk to their family members. They have stated that they are the silent majority who are either happy with the level of visiting as it exists or simply fear for the extensions on similar grounds to those I have already mentioned. I know of families where some visit and others refuse to do so.

Then there are other voices, and I have spoken directly to many including representatives of the Care Home Relatives Scotland Group who I met alongside some providers and managers on Thursday evening. They have long campaigned for a normalisation of visiting and have broadly welcomed the new enhanced Guidance. Their case is simple, that it is a human right for an individual to be able to be with their family; that care homes are not prisons and that we have to respect and listen to the desires and will of those who are residents. They point to the research evidence from SAGE and others that the risk of transmission of the virus into care homes is very low, almost absent, with the appropriate use of PPE and certainly lower than other associated risks. They point to research which shows the level of deterioration and decline being experienced by care home residents devoid of contact and encouragement, presence and family love – they point out that no matter how good the quality of paid care is in a care home it can never replicate the love and touch of husband and wife, son and daughter and family in general.

I think it is important to state that everyone involved in this discussion and debate is starting from a point of real sincerity and desire to protect, keep safe and enhance the quality of life of residents in our care homes. The way that is to be achieved are the points of disagreement.

Even though the First Minister has made clear that guidance will not be mandated it is critical we work collectively together to move issues forward. I do not think this is the best place to go into the various individual elements of some of the debate, but I do think there are several actions which can be taken to improve things on the ground.

Firstly, we need to get to a working Covid testing system as a matter of urgency, one that can give as much assurance as possible to staff working in care homes. The current UK system is not working and the sooner there can be transfer to a robust NHS Scotland system the better.

Secondly, we need to develop a mechanism which will enable family members to either become part of the standard staffing testing system or much more desirable to introduce either in every care home or on a local community basis a rapid testing system that would enable them to be tested and get their results quickly, recognising their critical role in the care and support of their relatives.

Thirdly, the Scottish Government and COSLA need to make very clear that additional costs which result from enabling visiting to happen will be speedily met so that providers of all sizes are able to be sustained.

Fourth, we should collectively work to develop a system whereby the sheer managing of visiting (in these current circumstances) becomes the focus of one individual in each care home, whether volunteer or not, because we cannot over-burden existing staff who are already tired, exhausted and focussed on keeping life going and maximising health and wellbeing.

Fifthly, it is time to develop a National Care Home Visiting Action Plan and Statement where we bring together all the diverse voices and commit to how we will move forward into the spring. This is as important an area as any of the other realms of winter planning and will itself be no doubt impacted by other threats such as the growth of seasonal respiratory conditions, the flu and Brexit fall-out.

Sixthly, we need a degree of consistency around decisions taken by Public Health officials over when visiting is restricted due to community transmission. Explicitly we need all of us to know not only when this happens but also why. So why is it in some parts of the country that even window visits are being restricted but in other parts they are allowed? Why do we exclude visiting for 28 days in instances that a staff member tests positive and is not at work? This seems disproportionate and risks closure to visits becoming a rolling reality for some homes.

Seven, it is increasingly clear that we need more localism in the implementation of decisions. We need to find a better balance that avoids blanket positions being adopted and which enables individual care homes in specific parts of the country to work together with their stakeholders and family members to take decisions locally which reflect the risks in the local area. We are losing the ability to trust our care professionals.

Eight, as was shown in an open letter from some of our leading Infection Practice and Control experts in yesterday’s Nursing Times, we have to urgently develop a way of understanding infection practice in our care homes which is not simply the adoption of what works in acute health settings. Care homes and their residents are not equivalent or the same as hospital wards and their patients. One is an institutional setting, a care home is not; it is a home of friends and companions, who interact, mingle and mix. As we move into winter the ‘IPC fundamentalism’ which has been adopted around infection control practices needs to be replaced by an understanding of the imperatives of infection prevention which work for a different context.

Lastly, we must all of us get better at communicating and consulting. There will be many times when decisions have to be taken which are hard and challenging. It is especially important at such times that all involved both understand reasons and feel involved in the taking of these decisions, where it is possible to be so involved. It is equally important that when any new future Guidance is developed and issued that those most impacted are the first and not the last to know.

At the heart of all the debate and discussion I have held in the last week, one thing has continually struck me, and that is the need for us all to work together. At a time at which wider society is obscenely chattering about the possibility of segregating the old and most at risk, in some pretence of humanity, it is incumbent on all who are committed and concerned about care in care homes and in the wider community, to be united rather than divided.

It is not always easy to see the perspective of the other, especially when the urgency of action, the desire to protect, the passionate need to be present with loved ones, the fear of failure and blame, the terror of the virus, dominates our thoughts, But we can achieve very little without working alongside others.

The next few weeks and months will be ones of challenge for all who care. The nights are already growing longer and the evening sets earlier with each day. I have always been more at ease in the draughts of winter than the rays of a summer sun, but one thing I have discovered is that you cannot rest for long in winter, you have to keep moving on to the hope which spring beckons, bringing a new start and new beginnings. We cannot simply settle content with the ways things are at the moment – we need to work together to make sure contact with family is enhanced and safety of residents is deepened.

One of the poems I read this week is an old favourite. It is ‘Stopping By The Woods on a Snowy Evening’ and is one of Robert Frost’s earlier poems. It describes the woods as a place of beautiful silence and peace, but it is also a place that exists alongside danger, stress and activity, amidst obligation and responsibility. For me it is a reminder that we all have promises to keep, not just to keep going, but to be better, to restore, and to re-build. That is the essence of care wherever it is delivered. We cannot stand still in the winter peace – we have to move forward. “I have promises to keep, And miles to go before I sleep.”

As we move into winter it is critical beyond the obvious to state that we must find ways of being open in our dialogue, working together and making sure that we maximise the protection of folks from the virus but at the same time increase the alongsideness of family presence. I believe we can do this but not in our own defensive and reactive siloes. We owe it to those we love to work together with a responsiveness and mutual regard which is at the centre of all good care.

“Whose woods these are I think I know.

His house is in the village though;

He will not see me stopping here

To watch his woods fill up with snow.

 

My little horse must think it queer

To stop without a farmhouse near

Between the woods and frozen lake

The darkest evening of the year.

 

He gives his harness bells a shake

To ask if there is some mistake.

The only other sound’s the sweep

Of easy wind and downy flake.

 

The woods are lovely, dark and deep,

But I have promises to keep,

And miles to go before I sleep,

And miles to go before I sleep.”

Robert Frost

 

Donald Macaskill

Announcement on updated adult care homes visiting guidance – 12 Oct 2020

Today (12 Oct) at the daily briefing, the Cabinet Secretary for Health & Sport announced the publication of updated guidance on visiting in adult care homes.

In her announcement, Ms Freeman MSP highlighted that care home residents and loved ones wanted to see changes to visiting restrictions, and that Scottish Government had been working closely with Scottish Care and others on a staged approach to reintroduce visiting in care homes as safely as possible while COVID-19 remains in Scotland.  In doing so, they were trying very hard to balance health of residents with quality of life.

The updated guidance provides additional advice to care homes to better balance safety with need for greater contact.  It provides greater flexibility for indoor visiting in particular.

Easing measures within the guidance include:

  • Extending indoor visits from 30 mins to up to 4 hours
  • Outdoor visits extended to up to 6 visitors from no more than 2 households for up to 1 hour at a time
  • Increased personal interaction including holding hands

The guidance also provides more clarity & visibility for essential visits. Essential visits should be supported generously, and care homes can draw on local support to implement these where necessary.

The guidance also sets out that visits can be enabled from spiritual care professionals, hairdressers, pets and therapets, and also allows for some gifts and resident belongings to be brought in.

As before, to implement these measures care homes must be COVID free for 28 days and must be taking part in the weekly staff testing programme

The Scottish Government will continue to keep the guidance under review, but this guidance hopefully provides some opportunity for greater & more meaningful contact.

The guidance and accompanying documents, including a letter from the Cabinet Secretary to care homes, can be accessed here: https://www.gov.scot/publications/coronavirus-covid-19-adult-care-homes-visiting-guidance/ 

 

Scottish Care statement on updated visiting guidance:

Everybody is working hard to ensure that care home visiting can be sustained, particularly indoor visits.  The measures announced in the guidance today have been considered by the Clinical Group to be safe but it should be recognised that unfortunately, easing of existing restrictions won’t be able to happen everywhere – for instance in areas with additional restrictions – and also won’t be able to be implemented overnight.  We very much welcome the increased visiting flexibility that this guidance provides but it will require real partnership activity between Public Health, care homes and relatives.  The sector must also be supported, most crucially in sorting out testing to ensure it is reliable and that results are received promptly.  Care homes continue to work hard to keep people safe and connected to loved ones, and this announcement must be supported by the wider population continuing to follow FACTS advice as well as other national and local guidance.

2020 Care Home Awards now open for entries

We’re delighted to announce that the 2020 Care Home Awards are now open for entries! Scottish Care would like to invite you to enter your company, staff and residents for the Care Home Awards 2020.

Last year’s event was a great success and recognised the work of fantastic staff and providers whilst also giving positive visibility to this often neglected sector.

There are 13 award categories:

  • Ancillary & Support Staff Award
  • Nutrition & Eating Well Award
  • Meaningful Activity Award
  • Training, Learning & Staff Development Award
  • Emerging Talent Award
  • Outstanding Achievement Award
  • Management & Leadership Award
  • Palliative & End of Life Care Practise Award
  • Nurse of the Year Award
  • Carer of the Year Award
  • Specialist Service/ Unit of the Year Award
  • Care Home Service of the Year Award
  • Positive Impact Award

Find out more about the awards and submit your nomination here.