Care home probe: 'What went on there was wrong'

In the second part of our series we speak to a family left heartbroken by their grandfather's ill-treatment.

'HE was sitting in his room at about ten to two in the afternoon with just a pair of pants on. The window had blown open as it was broken and there was no duvet on his bed. He had just had an operation to remove some skin cancer from his left hand. The bandage he was supposed to wear was off and his skin graft was showing.

"The bed itself was a mess and there was blood on the sheets from his wound."

Christina Weatherstone has to fight to retain her composure as she recalls the state she found her 84-year-old grandfather Paddy Raeburn in during one visit to Bonnington Nursing Home.

"It was such a shock," explains Christina, 40, a classroom assistant from Leith. "I just thought what's going on? He was rocking on the bed, saying he was freezing. I saw the tears in my mum's eyes. She was just so angry to see her dad like that."

It was all so different from what the family had hoped for when Christina's mother, Christina Ulke, made the difficult decision to place her father in a nursing home after two years of looking after him at her own home. But they grew so concerned about his care, they felt they had to take a stand. Their complaints to the Care Commission have now resulted in the home being ordered to make a series of improvements.

The family found the whole experience harrowing, but they are far from alone. Every year at least 60 complaints are upheld, or partially upheld, by the Care Commission against care homes in the Lothians.

The most common areas of concern include short staffing, poor hygiene practice, and the conduct of a small minority of their staff.

Christina is the first to admit that her grandfather, whose wife Chrissie had died, was at times very difficult to care for. Before he sadly passed away last month, he suffered from dementia and a blood disorder, as well as being partially deaf and partially blind.

"Bonnington were fine when he was able to do things but when he had his hand operation and couldn't do anything, they couldn't handle it," she says.

"He could be very stubborn and if he wasn't well or had an infection, he could become very difficult. It wasn't an easy job looking after him but we thought we were putting him in a place where the people knew how to deal with this. I couldn't do their job but we did expect the staff to be trained in dealing with people like that.

"At the end of the day nothing is going to bring my grandad back – our fight is over. My grandad is gone. But it's wrong what happened in there.

"My mum promised her mum she would look after her dad and feels she's let them both down. If we can make a small change to people still in there, then we will."

Patrick Raeburn, or Paddy as he was known, had been living with his daughter at her home in West Pilton since May 2005. However, as his dementia grew worse, Mrs Ulke, who is 61 and suffers from a bad back, found it increasingly difficult to cope, and her father's doctor suggested that he move into a home. So, in May 2007, Mrs Ulke and her daughter moved Paddy into Bonnington.

"My mum was heartbroken about putting him into a home," says Christina. "She went in nearly every day and the days she couldn't go in, myself and my sister went in.

"When he first got there, he could manage to feed and go to the toilet by himself. He could also partly dress himself. At first he was great and the staff all said how cheery he was. He was known by staff as the 'Miracle Man'."

The nickname was a result of a near fatal accident, when the former coal merchant was knocked down by a 40-tonne truck on Ferry Road nearly 30 years ago, and subsequently had the last rites read to him six times.

"He broke nearly every bone in his body and spent six months in Western General, but he got through it, and remained active afterwards. Whatever life threw at him, he got on with it."

But shortly after he moved into the home, Christina and her mum noticed his fighting spirit was fading. She explains: "After around four months his health started to deteriorate. He wasn't eating and staff weren't doing anything to encourage him. He was an old-fashioned man who liked stew and potatoes and they were giving him pasta, risotto and lasagne that he wouldn't eat at home.

"We did take in mince pie, sausage rolls and scrambled egg on toast but after a while staff said he was suffering from stomach upsets and we weren't to take in any more food.

"We used to take him out for afternoon and day-trips but he began to lose interest in everything. He was always in bed and staff didn't force him to get up. He became unsteady on his feet and lost more and more weight.

"He had always been such a strong man and to see him in this state we knew it must be bad."

One of the most distressing problems was repeatedly finding Paddy's bandages had come off or were in a poor condition following an operation at Hogmanay 2007 to remove a cancerous patch of skin on his hand.

The family ended up taking Paddy to St John's Hospital in Livingston twice a week to get his bandage seen to.

They reported other problems too. Once Christina stood on a pressure mat, which is designed to alert staff to a patient who has fallen, and says it took staff 20 minutes to answer the call.

On another occasion she says they found another resident's incontinence pad in Paddy's bin and staff didn't know where it had come from.

On February 6, Mrs Ulke responded to phone calls from the home to say her father had fallen. When she got there she hardly recognised him and he wouldn't respond. He was complaining of rib pain, had a cut on his arm and a red mark on his head.

"Because he wouldn't go into hospital and no-one in the home would change the bandage, his bandage had not been changed for nine days. He started crying when mum said he had to go to hospital to get his dressing changed.

"I told the manager I was fed up of the treatment he was receiving and was going to the Care Commission. It was at this point that the manager got the doctor to phone for an ambulance.

"When he got to hospital, they could not believe his condition. He had bandages on parts of his arm we didn't know about which were crusty and hard. The nurse had to get him some pain-killers and soak his hand overnight to get his bandage off. He was also dehydrated. He was diagnosed with kidney and heart failure."

Paddy was admitted to the Western General Hospital and then the Royal Victoria Hospital. Christina and her mum did not think Bonnington could cope with Paddy after that and so moved him to Ferryfield House, where he died on March 14.

The Care Commission has now ordered the home to make improvements to its incontinence management and wound management, and recommended staff are given training on the completion of observation charts for its residents.

Southern Cross, which owns the home, said: "We acknowledge that in the last couple of days the Care Commission have partially upheld the family's complaints."

Long hours and very tiring . . but it could be worse

"THE hours are long and it's hard work, I mean hard physically – a lot more than you'd think.

"You are having to move people around all the time, and if they can't support themselves then they are basically a dead weight. Put it this way, I used to get up at six in the morning to muck out horses, but this is the hardest job I've done.

"The worst thing is when the residents die. It happens a lot, obviously, sometimes more than once in a night. You never really get used to it though – not properly."

Susan, 32, who did not want her full name published, has worked in care of the elderly for seven years, after previously working in a nursery. Most of her jobs have paid a little over the £5.52 an hour minimum wage.

The 32-year-old works 12-hour shifts at a care home, although she has also worked as a carer in the community.

"The money isn't great, but it could be worse. I like working with people. I preferred working in the community, visiting old people at home, to what I do now.

"You get the chance to chat while you're doing the home visits – which you usually don't in the nursing home – and the people you visit are pleased to see you.

"It's not like that in the home. It's not the residents' fault, of course, a lot of them have dementia and it's hard to talk to them. And we just don't have the time to sit and chat.

"A lot of staff don't stay. They leave after a few months, or even a few days. It never feels like there is enough of us for the work that needs done, although, where I work, there's usually enough to meet the regulations."

Low pay and hard work make for staffing crisis

CARE home owners say they are on the verge of a recruitment crisis and admit homes face significant challenges in improving standards of care.

They identify the low level of public funding for care home places as the root of the most serious problems.

Two thirds of care home residents placed by the city council rely either entirely or almost entirely on local authority funding. The council, in turn, receives cash from the Scottish Government.

In Edinburgh there is a top limit of £523 a week for funding care home places.

That leaves care homes typically offering wages of just over £200 a week for care assistants who can expect to work long and gruelling shifts.

Ranald Mair, chief executive of nursing home umbrella body Scottish Care, said: "We know staffing is a big issue. About one-in-five people leave the sector each year and we know we have a sizeable task on our hands in terms of retaining staff.

"If we do not work incredibly hard at addressing these staffing issues we will have a crisis on our hands, especially given that we need to expand the sector to match the changing demographics.

"But it is important to note that care homes are often restricted by the level of funding they get from councils. Often owners' hands are tied in this respect.

"There is an ongoing drive to improve standards, particularly on a training level, but it remains a significant challenge. Some of the smaller homes in particular are struggling to cope with the demands on them."