Nursing Homes and the Care of the Elderly


As people live longer and longer and society changes the more care for the elderly becomes an issue for society as a whole.

Historically, the elderly did not live as long and were cared for by family members in the extended family. This is less and less the case.

When trusting an elderly relative to the care of a Nursing Home or a Residential Home then you need to know that they are going to be safe and well looked after.

Regrettably this is not always the case.

Care can fall down simply because of a lack of understanding or, a lack of training as to what is needed.

For example, an understanding of nutritional and hydration needs. Is the elderly person getting enough fluids? How do you know? Are fluid charts being maintained?

Is the elderly person getting enough nutrition? Are they being given food they are able to eat and are willing to eat? If food is left with an elderly person in a communal area, how do you know who ate the food.

Has the staff had manual handling training? If the staff are not properly trained then they may not know, for example, how to lift an elderly resident properly. A failure to lift properly can cause injury.

Are elderly residents developing bedsores? Bedsores are a common problem with elderly immobile residents and they need the right mattress and ‘turning regimes’ to minimise the risk. You would expect a tissue viability nurse to be called in when bed sores develop.

Are signs of infection being monitored? Does the Home have a procedure for vetting and managing residents with C. Difficile and/or MRSA? Elderly residents can be in and out of hospitals and if they return from a hospital with a hospital acquired infection then this will need to be properly managed.

Are incontinent aids being used properly, are the elderly residents being toileted properly and regularly.

Is your elderly relative safe? There have been cases where Homes have been found to restrain elderly residents to prevent them wandering. Similarly, there have been cases where elderly residents have been found to wander off the premises.

The care of the elderly is not easy, particular when dealing with for example dementia sufferers.

Overworked and exhausted staff are not always best placed to be looking after the vulnerable. Would you want your elderly relative to be in a care home where the carers are paid less per hour than a supermarket shelf stacker receives?

The elderly are vulnerable in the same way children are vulnerable, they may not be able to voice what is happening and so they need a voice for them.

The Protection of Vulnerable Adults legislation provides a framework of protection for vulnerable adults.

The Department of Health can investigate allegations of abuse/neglect in nursing Homes and Residential Homes.

If the Department of Health finds abuse has taken place then the individual under investigation can be barred from working with vulnerable adults (and children) for 10 years.

The Care Quality Commission regularly inspect Homes and they do have the power to shut down Homes and to refer individuals to the Department of Health for investigation (and other Regulatory bodies, such as the Nursing Midwifery Council).

The majority of CQC inspections are on notice, which means the Home is on notice, but CQC do have the power to implement walk in inspections without notice and will do this with Homes raising alarm bells.

CQC do publish reports on the Homes they visit and the public can of course ask for copies from the Home they are thinking of placing an elderly relative with.

Concerned family members can refer concerns to CQC or can contact the Department of Health or the other regulatory bodies.

Individual Nursing Homes may have their own complaints process and will investigate complaints.

P.S. The NHS: has a complaints system

Trusts handle their own complaints and so standards may vary from Trust to Trust.

There are those who consider the process too complex and time consuming and feel the effect of the process simply wears out the complainant.

In brief, the NHS complaints process require the complainant to first make a written complaint to the Trust, within 1 year of the treatment complained about.

The Trust will then investigate and give a preliminary view. The investigation should involve the complainant, usually through a meeting with all of those concerned. If the complainant remains unhappy they can ask for the complaint to be referred for Independent Review. The complaint will then be looked at again; the outcome may or may not be the same.

If the complainant remains unhappy there is a right of appeal to the Ombudsman.

And of course, you can always take legal advice; there may be a clinical negligence claim. (Call our medical negligence team now to see if you have a case on 0800 195 8464 or complete our online enquiry form.)

Regulation of Healthcare Professionals

Nurses are regulated by the Nursing Midwifery Council (NMC). In addition, nurses and carers on the Home sector are also regulated by the Department of Health.

Doctors are regulated by the General Medical Council (GMC).

The NMC and GMC and Department of Health are there to protect the public and to protect the reputation of the profession. They do this by imposing sanctions. Both regulators have the power to remove a nurse or doctor from the register, in other words to ‘strike them off’, which means that individual can no longer practice as a nurse or doctor. The Department of Health can ban working with children or vulnerable adults.

The NMC and GMC can also impose other sanctions for example a caution, or to impose conditions on the nurse or doctor’s practice, for example that a nurse or doctor cannot work in a particular area e.g. Intensive care, paediatrics, elderly.

The NMC and GMA are looking at fitness to practice and professional misconduct, they are not there to punish or to compensate.

Criminal Courts

The criminal courts are there to punish and investigations are carried out by the police.

Civil Courts

The civil courts are there to compensate victims of negligence for the effects of that negligence. If the elderly person has been caused injury, pain and suffering by failures in their care then they may have a claim for compensation. This can be the case even if the elderly person has gone onto die.

This article was written by Susan Hotchin, Solicitor – Medical Negligence team.

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