The good old days. Do you remember them? I do, because I started in residential older adults care back in 2003.
Day 1 – 22 years ago.
My wife and I completed our first care home purchase in September 2003. Excited, keen and idealistic, we started our first day with the new staff team. The home was CQC registered, 19 beds and full. Beautiful seafront location. Perfect.
At lunchtime that day, a lady fell in the dining room and broke her hip. Ambulance, hospital, operation and then sadly she died the next day. We told CQC and her next of kin. That was that. Death certified due to heart attack post operation. No Coroner, no safeguarding and no stress. I recall we did an accident form and some daily notes.
2025
I have no doubt that if the same circumstance arose today, that we would notify Safeguarding, CQC, ASC, family and expect Coronial Investigation if not an entire Inquest. We could then expect our Quality Monitoring Elf from the Local Authority to pop along and start asking probing and accusatory questions. No doubt the Old Bill would have an interest and pop in for a look, seizing notes, records, MARS, Incident forms and so on. They would come in at least a pair and look stern, giving those knowing nods that tell us we may have some silver bracelets applied in the near future. Cop 1 “It might be criminal, but at the moment we are here on behalf of the Coroner”. Cop 2 would say “we cannot say any more at this stage”.
After all, a fall is not just a fall anymore. Accidents don’t happen in care homes. As Managers and Providers, we have to risk assess which means predict and prevent, without exception. Failure is not an option.
Actually, let’s just stop a second and apply some sadly rare common sense. People fall. People trip and people certainly have medical events such as strokes, low BP, heart attacks and so on. So why should we feel guilty and concerned when an injurious fall occurs? Because we do. I do and you do. Such is our reality, and it is because we care.
But the difference today is that it has to be someone’s fault. Well, actually it has to be the care home at fault which means the RM is rubbish, the place is failing and CQC should nip in and look at rating it as RI or Inadequate. After all, if anyone gets injured in a care home, that must mean it is a failing service, right ? Wrong.
We, despite grey hairs, wrinkles and years of coal face experience can no more predict a fall than we could pick the lottery numbers. And, importantly, nor can anyone else in the entire Health and Social Care Economy.
We can assess, determine a level of risk, mitigate and then cross our fingers and hope whilst preying to a deity of some type that Doris doesn’t actually fall and injure herself, let alone die as a result.
New Resident Assessment
Scenario – and this will be familiar if you are a manager or Provider.
You get asked to assess a new resident. That’s good because the boss will be happy and your quarterly bonus is occupancy based and due soon. That trip to Benalmadena with the girls might be on after all.
They are on a ward in the local hospital. They are on 1:1 in the hospital because they have dementia and they are wandering about a bit. They may have had a fall or two. They certainly have eyes on them at all times. Are all wards overstaffed?
But, when they are discharged, they will no longer need 1:1. “Well” says the Social Worker “they haven’t fallen for the last week, so there is no evidence that they will need it and we won’t fund that in a home”.
There are 2 types of response to this.
- Chicken out and say no – kiss your sunny holiday goodbye.
- Admit them and hope for the best – and go on leave worrying.
Cynic that I am, I would have said third option would be demand 1:1 for 4 weeks whilst they settle in. We all know that that’s not going to happen.
Don’t even get me started on Trusted Assessors – that will be another day.
Support? Where do you turn ?
How confident would you be as a Manager responding to a serious injurious fall?
Do you know when a Sec 42 would be appropriate and necessary?
Would you worry that this would snowball into a visit from Contracts and Commissioning and the local Quality Monitoring Team, oh yes, and probably CQC? And then HM Coroner?
Would you like to phone a friend ?
We are the Care Guys – experts in safeguarding, QMO, Coroner and CQC.