Care homes rapped for giving hidden drugs to patients

A REPORT described as "deeply shocking" on the treatment of people with dementia in Scotland's care homes yesterday revealed an "excessive" use of drugs and cases of medication being hidden in food.

The report – Remember, I'm Still Me – also found that staff often knew little about the past lives of the people they cared for and many of the residents rarely left the building.

Based on visits to 30 care homes, the report found that 75 per cent of residents were taking psychoactive drugs, given for behaviour problems, depression or insomnia. Many had also been on their medication for long periods without it being reviewed. And 20 per cent were given "covert medication" – drugs that were hidden in food or drink without their knowledge.

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Public health minister Shona Robison said the report was a "wake-up call" and that the findings were "deeply shocking".

The investigation, carried out by the Care Commission and Mental Welfare Commission, concluded that homes needed to significantly improve the care they provided to people living with dementia.

One key area was the use of medication to manage behaviour. The report said that drugs should be "a last, not a first resort". Campaigners have previously raised concerns that drugs are used for the convenience of staff in dealing with residents, rather than for their benefit.

Looking at the records of 1,335 people, the researchers found that 75 per cent were taking one or more psychoactive medicines such as antipsychotics, antidepressants and hypnotics.

The drugs are used to treat behavioural problems such as agitation, verbal and physical aggression and wandering. The medicines can have side-effects that can make the patient sleepy, confused, lack co-ordination or develop tremors.

The report described as excessive the level of use of these drugs. Some 439 people (33 per cent) were taking antipsychotics. These can be helpful for symptoms such as agitation and hallucinations, but they have been linked to an increase in the risk of stroke. Eighty-five people were taking olanzapine and risperidone, despite warnings about the risk of stroke.

The report also found residents taking drugs to relieve anxiety and irritability for long periods, despite guidance that they should be used for the shortest possible time.

Many patients were also taking antipsychotics, hypnotics and tranquillisers for over a year without their treatment being reviewed.

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The report also found evidence of "remote prescribing" where GPs prescribed medicines without having seen the patient.

The report also investigated covert medication – drugs given in a hidden way because residents refuse to take it. Across nine care homes, the investigators found evidence of covert medication of 20 residents.

If someone is to be given medicine in this way, guidance says that an Adults with Incapacity Section 47 certificate should be in place. The report said even when such certificates were found, they were often not completed properly.

Another key part of the report looked at how residents were treated as individuals, with carers knowing their history. When investigators looked at 182 residents' personal plans, they found only 24 per cent had an adequate record of their history.

In one case a patient's total life history was recorded simply as "likes cats; likes milk".

The report also found that residents were often not leaving the home – around half of all the people they looked at never left and 25 per cent rarely went out.

Susan Brimelow, from the Care Commission, said while there were some "heartening" examples of good practice in the report, the overall quality of care needed to improve: "There is some uncomfortable reading in this report, but we must highlight what needs to change if we are to get improvements."

The report made 78 requirements and 235 recommendations for improvements, which must be made in the homes where concerns were raised.

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Dr Donald Lyons, director of the Mental Welfare Commission, said: "There is a certain irony that it is often the services that deliver care that seem to 'forget' the person inside the dementia.

"One of the key findings of this report is that care homes provide a 'one size fits all' service for people with dementia – with care plans that pay little attention to the life the person has lived."

Ms Robison said failings in the report on the standard of care were a "big wake-up call".

"This is a deeply shocking report. That's why we will accept all the recommendations and I will meet Scottish Care, the Mental Welfare Commission and the Care Commission to discuss the all issues raised as a matter of urgency," she said.

She said the new dementia strategy would build on the work already being done to improve dementia care.

Henry Simmons, chief executive of Alzheimer Scotland, said people with dementia "must be afforded dignity, respect and liberty" in care homes. "We are particularly disturbed that the inappropriate prescribing of antipsychotics continues to take place in Scotland's care homes. These drugs are often wrongly used to control the behaviour of people with dementia and have extremely harmful side-effects."

Ranald Mair, chief executive of Scottish Care, which represents care homes, said:

"The collective task of getting it right for those who require care outwith their own homes, including those with dementia is a very real challenge for all those involved."

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Room for improvement as 'good' environments offset by care shortfalls

The main findings of the Remember, I'm Still Me report:

• Only 24 per cent of people in care homes had an adequate record of their life history. The majority of people had too little information about their personal preferences recorded in the personal plan.

• Care was being regularly reviewed, at least once a year for most people, but the quality of care reviews varied.

• About half of all people never went out of the care home and there was very little planned activity outside the care home.

• Care home environments were generally good and getting better, but there were too few quiet areas for people to relax and more needed to be done to make homes dementia-friendly.

• There was a lack of understanding about financial responsibilities throughout care homes. There was little creative use of funds to support the person.

• Most people had a good assessment on or before admission. However, few had a planned health check every year by their GP and there was little evidence that medication was regularly reviewed.

• 75 per cent of people in the care homes were taking one or more psychoactive medicines.

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The report found evidence of inappropriate and multiple prescribing. The report also found evidence of GPs prescribing medication without having seen the person.

• Evidence was found in nine care homes of medication being given in a disguised form, usually by being put in food or drink. Very few care homes had the right information or legal safeguards in place to give covert medication lawfully and safely.

• The report found care homes where staff did not understand the legal safeguards in place for people with dementia. They did not know who had legal powers and there was often no indication that formal discussion had taken place with a person's welfare guardian about their powers.

• Only a third of care home managers had undergone a recognised training course about caring for people with dementia. The majority of care staff were generally unaware of best practice guidance and some felt their knowledge was insufficient or they didn't have enough time to be able to give the care they wanted to.

• The law on medical treatment for people who lack capacity is not being obeyed. Only a minority of people had appropriate assessments of capacity, certificates of incapacity and treatment plans. Where certificates existed, they were usually not completed well.

Dealing with dementia difficult yet rewarding

WHEN caring for residents who have been diagnosed with dementia, staff can face a number of difficulties daily, writes Melanie Abram.

In some cases, people can be resistant to care staff who are trying to help them. Because of difficulties communicating, they may not understand what is happening and that it is being done in their best interests.

People with dementia may lose their appetite and not realise when they need to eat or drink. This can make mealtimes a challenge. There can also be difficulties with personal hygiene, such as washing and dressing, or with those who need help going to the toilet.

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When dealing with residents with dementia, we also try to make sure that their personal choices are respected and they are treated as individuals.

We record their likes and dislikes and talk to their families about how they would like to live their lives. This could include activities they enjoy such as gardening or housework.

Staff are given training to help them deal with the challenging behaviour of residents with dementia. Communication can be difficult so it is vital that staff know how to deal with this.

Despite the difficulties, working with residents with dementia can also be very rewarding.

Our links to the community enable residents to contribute to society and remain part of their family and community at large.

• Melanie Abram is home manager of Bupa's Fullarton Care Home in North Ayrshire

Case study

HUNTER Watson has spent the past few years campaigning to raise awareness of drugs being hidden in the food of care home residents.

His mother Helen Watson may have been suffering dementia when she went into a care home, but she knew when medication was being concealed in her pudding without her consent.

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The active pensioner first went into a care home a few days before her 90th birthday and although she needed help she insisted staff stuck to a lifelong vow against chemical medication.

Mr Watson respected his mother's wishes, but was shocked to find out her care home in north-east Scotland had been putting drugs in her food.

On two occasions, Mr Watson found his mother drowsy and claiming she had been given sedatives in her food and drink. Staff admitted drugs had been administered.

Mr Watson, from Aberdeen, said his mother knew what was going on and was not pleased.

He eventually managed to ensure no more unwanted drugs were given.

Mrs Watson later passed away, but her son has continued to fight to ensure others are not given drugs against their will.

Along with other campaigners, he believes it is against the human rights of vulnerable adults to give medicine without consent.

Their concerns helped prompt the investigation by the Care Commission and Mental Welfare Commission.

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Some care homes have claimed that giving medication covertly is necessary to look after the needs of patients.

About 67,000 people in Scotland have dementia and this figure is set to rise dramatically with the ageing population. About 40 per cent of people with dementia currently live in care homes or hospitals.

The Scottish Government has launched a consultation which will gather the views of people with dementia and all those involved in their care about what should be included in a new strategy to be published this year.