Care Home Patients at Risk Through Lack of Water

Staff  ‘don’t want them going to the toilet at night’

The Daily Mail reports today regarding elderly care home residents’ lives being put at risk because many staff do not give them enough to drink, experts warned yesterday.


They were found to be at least five times more likely to be dehydrated on admission to hospital than those living in their own homes.

Residents who had not been given enough fluids by care home staff were also up to ten times more likely to die in hospital than patients who arrived properly hydrated, they said.

Some carers are suspected of not giving their patients enough fluids because it makes them more likely go to the toilet or suffer incontinence during the night.

In a report, the researchers said the findings were ‘disturbing’ and ‘distressing’ and that conditions in some care homes may be as bad as those found by the Francis Inquiry into the Mid Staffs hospital scandal, which found patients had been drinking water from vases.

Their warning comes at a time of growing concern about standards in some homes and the ability of regulators and social workers to ensure they are well run.

These concerns were underlined last year when two unsatisfactory Surrey homes were closed by industry regulators the Care Quality Commission, one so quickly that residents waited to be moved for hours in their pyjamas on one of the coldest nights of the year.

The study calls for strict measures in hospitals to check how care homes treat residents.

If one elderly person at a care home is found to have high sodium levels that indicate dehydration, the home’s GP should be alerted, it said. If there is a second case, the Quality Care Commission should be alerted.

The study published in the Journal of the Royal Society of Medicine, was based on records of more than 20,000 patients aged over 65 who went into North London hospitals over three years.

It found that the official figure of just 200 elderly people admitted to hospital each year from care homes with dehydration was ‘implausibly low’. The main author, Dr Anthony Wolff, of the Royal Free London NHS Foundation Trust, said: ‘I have anecdotally heard  that care home workers have been advised not to give too much water to reduce incontinence and people getting up at night.

‘It may be these workers are thinking they are doing the right thing. Residents don’t want to get up at night, they are at greater of falling and there is a greater risk of being incontinent.’

Along with David Stuckler, of Oxford University, and Martin McKee, of the London School of Hygiene and Tropical Medicine, Dr Wolff found that one in 100 older patients admitted to hospital from their own homes showed high sodium levels. But among patients admitted from care homes, 12 per cent had high sodium levels.

Once the higher ages of care home residents and the possibility that they are suffering from dementia was taken into account, care home residents were still more than five times more likely to be dehydrated when admitted to hospital.

The study explained: ‘Our findings are consistent with concerns about the quality of care in care homes.

‘Care home staff do not offer water in sufficient amounts, either as an act of omission or, more perversely, as an active decision in an attempt to reduce incontinence and frequent requests for assistance.’

American research, it said, found there was a worse risk of dehydration when homes were inadequately staffed and workers did not speak English.

It said the link between dehydration and death in hospital was a matter of further concern.

Norman Lamb, the Minister for Care and Support, said: ‘Failings of care that lead to people being dehydrated are completely unacceptable and if it is being done deliberately then this is abhorrent.

‘The law is very clear – care homes must make sure residents get enough to eat and drink  and we are making it easier to prosecute homes that fail to do so.’

Caroline Abrahams, of AgeUK, said: ‘Deaths linked to dehydration are completely avoidable and unacceptable.

‘Older people may need assistance with drinking, and we need to ensure that care home staff are trained to help them drink enough and avoid health risks associated with dehydration, like confusion, low blood pressure and falls, which can lead to hospitalisation.’

Dr Ros Altmann, the Government’s business champion for older workers, said: ‘This is a problem that can be fatal – many elderly people die of dehydration, which simply should not happen in this day and age.

“This really is OUTRAGEOUS – but you can bet your bottom dollar this and other forms of neglect and cruelty have been going on for years”

PIP extends further into England and Scotland

Personal Independence Payment (PIP) is being further rolled out to working age Disability Living Allowance (DLA) claimants in more postcode areas.

From 26 January 2015, PIP will be extended to the following postcode areas:
• G – Glasgow
• NE – Newcastle
• WA – Warrington
• WN – Wigan
• DH – Durham
• SR – Sunderland
• IV – Inverness.

Claimants in these postcodes will be invited to make a claim for PIP where:
• Their existing DLA award is fixed term and is coming to an end;
• They are approaching their 16th birthday;
• DWP has received information about a change in their care or mobility needs;
• Someone chooses to claim PIP instead of DLA.

This follows on from the rollout in November 2014 when PIP was extended to a number of postcode areas including Manchester (M), Liverpool (L), Chester (CH) and Huddersfield (HD).

As part of the on-going drive to improve the PIP process, DWP carried out a small pilot to test the effectiveness of phone calls to claimants whose claims had been disallowed or whose benefit had been reduced.

The pilot showed that most claimants had already received and understood the written notification before being called by DWP and that some of them did not need or want further explanation of the decision.

Department of Work and PensionsAs a result DWP is now leaving it to claimants to get in touch if they need further information.

The first independent review of PIP, carried out by Paul Gray, was published on 17 December 2014. This explored how PIP is operating and the effectiveness of the assessment and made a series of recommendations based on the information that was gathered throughout the review.

These focus on three main areas:
• Improving the experience for claimants;
• Clarifying and improving the collection of further evidence;
• The overall effectiveness of the assessment.

The Government has welcomed the review and will publish a detailed response in due course.

The latest set of experimental official statistics on PIP, up to October 2014, was also published on 17 December 2014 which included detailed breakdowns of people’s medical conditions for the first time.