(A guest post by Tracey Logan)
I recently had responsibility for organising the care of an elderly aunt with dementia. It shocked me how much time was spent by visiting local authority carers – none of whom knew my aunt – writing notes about her mood and demeanour, and leaving them in a folder on the sideboard that nobody ever looked at. When my aunt eventually went into extra-care sheltered housing, the form-filling continued, even though there was an on-site team of carers who met daily and shared updates on residents. Each breakfast, lunch, evening meal and intervening visit would be recorded in a loose-leaf folder with 1-3 lines on what happened. These sheets were filled in by staff standing next to my aunt, but with their backs to her, in her small bedsit living room. She clearly found this rude and upsetting, and who wouldn’t?
Three things occur to me about this: 1) To my knowledge, while my aunt was still living at home, these notes were only flicked through occasionally (approximately quarterly) by a social worker. Anything recorded in them could not be acted upon in a timely manner, though they recorded details of her daily life such as whether she was sad, happy, chatty or whether she ate her meal. They seemed pretty pointless, to me, at least where my aunt’s care was concerned.
2) The day my aunt moved into a local authority extra-care sheltered housing facility, we found copious notes on the previous, deceased, occupant in the kitchen cabinets of her new bedsit. And the form-filling about my aunt then continued. This seemed superfluous, since the mainly permanent team of carers had daily meetings where they shared information about the people they looked after. I noted that the folders of all 35 or so residents were gathered up weekly by the manager and scrutinised. Again, there seemed to be little resident benefit in this, but rather additional costs to the local authority who paid for the time spent writing out these forms as part of allocated hours of individual care packages.
3) I found evidence of falsification of my aunt’s records and a culture of re-writing notes if they demonstrated a breach of procedure or cast the action of carers in a poor light (such as when the fire alarm the went off and my aunt and her guest were not evacuated).
I mention my aunt’s case, not to focus on her, but just to paint a picture of the waste of time involved in writing these notes. Perhaps there would be a terrible backlash if anyone suggested scrapping them because they appear to represent accountability and transparency in public service. However, I believe they give a false sense of security since, in practice, they reduce the actual care for patients in the allocated time. They must surely be a significant cost: if even three minutes of a 15-minute care visit is taken up form-filling, that is a huge waste of money and, nationwide, it is a huge loss in care to vulnerable elderly people.
Not only that, but for my aunt whose dementia caused paranoia, having someone she didn’t know in her living room, standing with their back to her and writing personal notes about her was an offensive intrusion into her private life. I believe that cutting back on this form filling could save the state a lot of money in care provision, which could be ploughed back into actual personal care. If, at the very least, home helps and personal carers used that extra 3 minutes or so in a 15 minute visit to speak to their clients or do something for them instead, that would represent a 20% quality improvement. And the costs of such time as is spent processing these notes could also be saved.
For those who might fear their loss I would simply say that those forms never once protected my aunt from harm or suffering. Neither she nor her family would have missed them, but over six years’ worth of them were written before she died.