Does the meaning of care differ that much across the world? And what does it tell us about how we see care in the UK?
This last month I have been leading a training programme for the Hong Kong Health Authority and also working in Riyadh, Saudi Arabia on quality care of older people with dementia in hospitals. So what are the headline differences?
In fact although there are many differences in culture, and in the practicalities of how care is paid for and how staff are trained, there is a lot that all three countries have in common.
A lot of care is free at the point of delivery. Many of the clinicians I met, particularly doctors, had worked in the UK, the USA and Canada. There are shared cultural reference points and experiences.
And the same is true of families. We may talk in the UK about the breakdown of families and the burdens placed on carers, as though this is unique or culturally sensitive. But in all three countries in many cases where the person with dementia is cared for at home, families make the same difficult commitments – moving a long way to live with them or giving up paid jobs to do their job of caring.
One area where there is a striking difference is in the provision of high quality, dementia friendly, care homes in the UK. How surprised are you at that? The media coverage for care homes here is unrelentingly negative, though DSDC’s review of the media in 2014 sees a slight shift in this. See Mark Butler’s blog for more.
But the point remains that we do not really appreciate how most care homes in the UK have benefitted from statutory attention. UK care homes are regulated. This is not the case in the countries where DSDC has been working. We might believe that regulation has limited value in driving up standards in the four countries of the UK, but at least it highlights when basic minimum care is not provided. And it does this publicly.
Care Homes – what care homes?
The UK actually has care homes. In Saudi Arabia people are much more instinctively and culturally committed to care for their elderly parents. In general a move to a care home would be seen as a shameful failure of family duty. So there is simply no care home industry. As a result, when the family cannot physically provide care because of the design of their house or the frailty of their parents, old people spend far too much time in hospital, blocking beds, costing money and, most importantly, not actually receiving optimum care. Designing purpose-built, well-run care homes is a new aspiration.
DSDC would love to help our friends in Saudi Arabia leap over the mistakes we have undoubtedly made in the UK, and not trip over them. Dementia-friendly design is essential for human dignity worldwide.
When driving through the streets of Hong Kong we had care homes pointed out to us, where the “home” has been opened on the upper floors of commercial property that used to be offices or shops. The absence of plumbing is not a problem if there is little attempt to maintain continence.
In a bright, modern acute hospital for the first time in my 35 years of nursing I saw an agitated old lady, in a straitjacket, restrained on her bed. Even so we met many inspirational nurses and doctors, including chief nurse Maria Chui who, with remarkable determination, has achieved the first and only restraint-free hospital in Hong Kong. Her dedication, supported by her medical colleagues including Dr Timothy Kwok, is world class.
One shared hope has to be that the things we have in common, the international connections and comparisons, can be made to benefit more people in the world.
This is not an argument for a single standard. Cultural differences will always matter. But finding better ways of working internationally to raise standards for people with dementia is something I am now, more than ever, committed to pursuing.
In the meantime in the UK we must recognise that, compared to other countries, our care homes mostly do a really good job, though of course we cannot afford to be complacent about this either.