Should I mind my own business when I see something questionable at the nursing home?


Suppose I see someone with a health concern that doesn't appear to be getting adequate attention, in fact it has become alarming worse. I don't know his mental status but I think there is some level of cognitive impairment. I don't know if he has someone to advocate for him or if his advocate is fully aware of circumstances. I fully acknowledge I don't have all the facts, I only know what I see right in front of me. I know (at least I'm fairly certain) that if I speak I will be patronized and told it isn't my concern. It is hard for me to sit on my hands when I would be raising hε!! if it were my mother. What would you do?



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We are led to believe that terrible abuses are the exception to the rule, that some poor soul just slipped through the cracks and of course that is true - the vast majority of people get adequate care. But.

And often - almost always - someone knew, someone might have actually reported, but for whatever reason nothing gets done. In our infamous nurse Wettlaufer case people she worked with felt something was wrong years before she was exposed, I think I read that she actually confessed to a pastor - if she hadn't confessed to her therapist she might be murdering people still.

I am going to stop looking up Serious Case Reviews after this because I am about to crawl under my desk and just lie there curled up in bleak depression.

But I was interested to come across this document published online by,* "A Decade Of Serious Case Reviews." It is a rare thing: intelligible, thoughtful and practical. It is a determined (if forlorn) attempt to get people to learn from mistakes and *apply* what they have learned.

What it doesn't tell you (or I don't think it does, I have read the whole thing yet) is how many serious case reviews there were each year in the whole of Adult Safeguarding; and what category of vulnerability (old age, learning difficulty, physical disability, e.g.) the subjects of them fell into. Instead, they have selected SCRs from a range of categories: you can see why, but it means they don't identify the scale of the abuses going on.

But look at that figure. 1170 recommendations.
How many of those recommendations had to be made time after time?
How many have been implemented?
Who's following up?

Anyway, here's the excerpt. You can get the whole thing online if you like; or even better spend twenty minutes on Google and find the exact equivalent for your area - I'll bet there is one.

Oh, and gloriously - in one case, a whistle-blower's desperate cry for help in writing was forwarded for action to the Manager of the care home he worked in. Brilliant.

Hull Safeguarding Adults Partnership Board
Serious Case Reviews Analysis

This document collates information gained from Serious Case Reviews [74 of them] undertaken since 2003 [to 2014], by 41 local authorities.

There are over 1170 recommendations focussing on:

Practices 28%
Reviews 19%
Accountability 13.5%
Strategy 10%
Training 9%
Joint working 8%
Systems 7%
Involvement 4%
Commendations 1.5%

The settings range from:
Own home 27%
Residential / nursing home 28%
Hospital 30%
Other 15%

SCRs are not about blame – they are about learning lessons, asking SO WHAT changed, for example what has improved outcomes; look for good and poor practice; and ensure that actions happen to prevent poor practice and improve services.


* ADASS, I now discover, rather late in the day considering for how many years I have been paying attention to the subject, is:

"the association of directors of adult social services in England. [note: these are all public sector organisations; none is commercial] We are a charity and the association aims to further the interests of people in need of social care by promoting high standards of social care services and influencing the development of social care legislation and policy. The membership is drawn from serving directors of adult social care employed by local authorities. Associate members are past directors and our wider membership includes deputy and assistant directors."

As I happen to know, for reasons I'd rather not relive, you treat scabies by stripping naked, smearing yourself (and your tearfully protesting children) from top to toe in toxic lotion and leaving it on for the specified time.

I'm imagining organising that procedure for a staff of dozens of people, some of whom will indignantly reject even the idea that they might be such disgustingly filthy people as to carry a parasite. And you have to do them all at once. It's a complicated project.

But no one among the regulators was either required or prepared to get in there and direct the operation. Why not? Do they not have the necessary legal power? Isn't this something they could legitimately pass on to the CDC?

See also Victoria Climbié, MsMadge, but only if you're feeling especially robust. The scabies in her case is often skipped over as a detail, an example of the neglect she endured; but in fact it was the key to the entire story. That beautiful little girl haunts me.

Article in news - Rebecca Zeni, died in a Georgia NH from scabies having been eaten alive for years

I wish hoca had a memorial notice - but then again, I've lost count of how how many have passed in the time mom has been there.

One of the things I find difficult at the nursing home is you are never sure why most of the people are living there or what their story is, staff aren't allowed to tell for privacy reasons and you can't very well sit down beside someone and ask "so, why are you here?". Dementia is pretty obvious, physical disabilities are obvious but you can only guess at the cause. And then there are the people who seem fine and you wonder what the heck they are doing there and one day you walk in the door and there is their memorial picture on the bulletin board, and only if you can find their obituary can you get a clue as to WTF happened to them.

Thank you for sharing that confession with us. I am not in the habit of receiving confessions, but I just want to say:

We are responsible for today.

"Am I my brother's keeper?"


Dear cwillie,

Thank you for sharing this example with us. I would like to think that I would take action and get it reported. I see so many people that need good advocates, but I know sometimes its just not possible

I try practicing using my voice. I know I have to stop worry about offending people and just do something or say something. I know saying something is not the end of it. Thinking back about my dad's care, I really believe I was too passive and too accepting. I shouldn't have been afraid to challenge the doctors and nurses.

I know we are all only human and we can't save everyone. But I hope in my heart, I am trying a little more every day to be braver about speaking up for those that can't. And continuing to fight the good fight.

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