A growing scandal: The nursing home manager's story

Anita Astle is the manager of Wren Hall Nursing Home in Nottingham and the director of the Nottinghamshire Care Home Association. She sent her email to express her own point of view after watching Panorama's first film on the website.

"I decided to write to Panorama after watching the programme featuring Pamela Coughlan.

"The programme highlighted her fight for full time NHS care. The case was in 1999 and remains the test for who should get fully funded NHS care.

"Panorama said that the Coughlan test means the NHS is legally responsible for funding all care, including accommodation, if the person's primary need is for health, rather than social care.

"But Pamela was nothing like I presumed her to be.

"I've worked in nursing homes for 16 years and encountered only three people funded by continuing health care. All were either totally bedbound or terminally ill with an expected lifespan of less than four weeks.

"Although totally dependent on others for all her physical needs, Pamela could speak and make her needs known.

"On a day to day basis I care for extremely dependent individuals who are less abled than Pamela yet none receive total funding of their care under continuing health care.

"Many have to pay for their own care and in my opinion they are paying for the privilege to die. This sounds harsh I know but those I care for are not going to get better. They will deteriorate, have greater health needs and ultimately they will die.

"This frustrates me and spurred me on to write to Panorama.

"I did not think about the consequences of writing at the time. But a few hours after sending my email I started to think about what the impact would be if Panorama did contact me.

"How would it affect the care home which I manage, those I am responsible for, the community I serve as a non executive director and my post as executive director of the Nottinghamshire Care Home Association.

"I contacted some colleagues for their opinions but in the end I felt that this issue of means testing for health care needed to be addressed. I decided that if I were to be contacted I would relay my experiences but I would not compromise anyone else in the process.

"About two weeks later I received a telephone call from a researcher at Panorama. We chatted for about 20 minutes and our conversation ended with me confirming that I was amenable to Panorama contacting me again.

"Some time later the producer of Panorama contacted me which resulted in us meeting and having a lengthy discussion about my perceptions and experiences.

"This was followed by me meeting the producer and presenter. They fired various questions at me, I think to see how I handled it.

"After this I was asked if I was willing to be filmed and if my nursing home, residents and staff could be filmed.

"I confirmed that I was happy to be filmed and that I was happy for filming to take place at Wren Hall providing staff, residents and relatives were also happy.

"I also stressed that if residents agreed to be filmed I wanted reassurance from Panorama that all filming would be done in a dignified manner.

"I was then informed that a female researcher, Katy, from Panorama would come to spend about two weeks at Wren Hall to gather information for a possible programme.

"Initially staff, relatives and residents were apprehensive. I think this was due to a suspicion that we may be secretly filmed as most media coverage about care homes is very negative and filmed under cover.

"However as Katy was so friendly and spent time getting to know everyone at the home she soon became accepted. Residents, relatives and staff were asked and not pressured into whether or not they wanted to be filmed and Panorama respected this.

"The actual filming was fine. There were obvious feelings of self-consciousness and embarrassment especially as we all may look a stone heavier!

"I wait to see how accurately Panorama reflects what I actually said after all the editing has taken place.

"I also look forward to seeing if I have paid any part in making a positive difference to the lives of older people in need of nursing care."

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Christine Bates works for Anita as a care assistant and describes how her job has changed

"My name is Christine Bates. I have been a Care Assistant at Wren Hall Nursing Home for the past 16 years.

"I started work as a night care assistant with no previous care experience. I had previously worked in factories as a machinist.

"I changed to working day duties six years ago.

"I have always had excellent training. I have gained NVQ level 3 in Continuing Care and my Manager ensures that we all attend a relevant training course each month e.g. Dementia Care, Stroke Management, Principles of Care etc. Although I class myself as an experienced and competent Care Assistant there are always new things to learn and that enables me to keep up to date.

"Over the years I have seen a considerable change in the abilities and the dependency of our Residents.

"In the early years our Residents were able to communicate freely, the majority could walk with walking sticks or zimmer frames, we cared mainly for those who had suffered dense strokes and we were able to increase/improve individuals independence through the assistance, support and encouragement that we gave.

"My role as Care Assistant has totally changed. Now all our Residents are dependent on us for most if not all of their needs.

"I have little opportunity to promote an individual Resident's level of independence as most Residents are too debilitated through ongoing deterioration of their health.

"I spend my day delivering very personal care; washing, dressing, toileting & dressing Residents.

"As all our Residents need toileting I sometimes feel that I spend most of my day in the toilet! We also have so much paperwork to complete. Apparently if it is not documented it didn't happen! So I have to record everything I do - this takes time away form our Residents and that is who I am here for!

"I get very frustrated with the current situation. Despite our Nursing Home being extremely well staffed (for 41 Residents, 3 Registered Nurses, 8 Care Assistants & Breakfast Hostess each morning shift) I now find that I have no time to socialize, just sit and chat with Residents. I hear myself repeatedly saying "Just a minute, I'll be with you in just a minute." I hate that!

"I also get angry about the way Social services and the NHS come and assess our Residents. They spend an hour or so reading care plans, talk to our Nurses & any Relatives then pop to look at the Residents, leave and make their decision. How can this be sufficient to know the level and intensity of care that a Resident needs to receive?

Don't get me wrong I love my job. I love caring for and about our Residents. I get a sense" of pride from knowing that I have cared for our Residents properly. I never forget that they were once able bodied, independent and proud. I show them respect and never forget how difficult it must be for them to accept such personal care from someone else."

Christine Bates

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