Old age psychiatry: Moving up the food chain

At the Faculty of Old Age Psychiatry conference in Bristol the Chief Executive of Care England gave an inspiring talk. He talked about the relationship between care homes and old age psychiatrists. He said some quotable stuff, but I need to stress that this is what I heard, so apologies if I heard it incorrectly, and bear in mind that I’ve put my own slant on it.

“To the end user good integration is invisible.” Who would argue with that? And oh my, doesn’t it put our services in their place?

He also talked about using the Me Test (would I use this service?) and quoted a care home resident who had said to him something like “I want a life, not services.” The personal is powerful!

I was taken with his description of how learning disability services set their standards higher than we do in old age psychiatry. Their clients have comprehensive care plans, addressing, for example, engagement with the community and contact with family; whereas an older adult’s care plan might be at the level of getting up, dressed, taken to the toilet and kept clean. I think we could learn a lot from learning disabilities services. Here are two examples:

1. ageing in place (footnote 1) – I’ve worked with learning disability services that commit to doing everything possible to keep the person at home for as long as possible despite increasing age, disability, and dementia,

2. nothing about me without me (footnote 2) – the expectation is that people with a learning disability will be involved in their care plan and we must do everything we can to help them express their wishes, and respect their wishes, despite their disability.

He also used the terms casual ageism and paucity of aspiration – think about it, what a challenge to services! He talked about the way that, in older adult care, it is acceptable to reframe health care needs as social care needs. Is it?

I heard him say “choose your battle” and, for me, that connected with some of the points made by the National Clinical Director for Dementia and Older Peoples’ Mental Health (footnote 3) in his talk: focus on something, be realistic, and predatory thinking – I wasn’t sure I understood the latter, but maybe we need to be shameless in taking advantage of opportunities and be predatory towards those who are predatory towards us. Think strong! If healthcare is a food chain, we owe it to our patients and their families not to be at the bottom.

1 This Resource Guide (see link) describes ageing in place as a lifestyle choice but it’s also potentially an approach that some services embrace.

2 This was a document that formed part of the Valuing People work and has now been archived by the Department of Health. Unfortunately the link to the archived website doesn’t appear to work.

3 See his blog here. There are interesting posts on end of life care for people with dementia and psychological therapies.

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