When I was a specialist social worker working with older people who had dementia I was very concerned about the willingness of relatives, housing officers, ward staff, GPs and fellow social workers to ignore the wishes of people with dementia based on the fact that they were confused and forgetful.

What this meant was they were admitted to a residential or nurseling home without being involved in the decision. As a result, anyone visiting one of these homes would be accosted by a distressed resident asking to be let out as they wanted to go home. In response, the staff would lock the doors, keep the individual under sedation or use the food tray attached to an arm chair to in effect pin the person into the chair.

The person’s home having been given up or sold, staff would inform them “you live here now”. If this distressed them or they became aggressive in their attempts to leave then staff simply upped the medication.

Times have changed – in theory

Being old and suffering from dementia all too often meant the risks they posed to themselves overruled their human rights. The difference in these cases to other people with a mental health problem was the total lack of protection for the person who was to be deprived of their liberty till the end of their days.

A whole range of other decisions would be made about their hom , their possessions, how their personal finances were spent, when they had a bath and even if they had sugar in their tea.

It is over 30 years since I was a social worker, attitudes have changed, care staff have specialist training and the law has changed with the introduction of deprivation of liberty guidelines, which independently balance against risks.

‘Without adequate resources and changes in attitude the reality remains much the same’

Well that’s the theory, but a recent report by the Care Quality Commission concludes it is not the reality. All too often dementia in old age leads to relatives and professionals disregarding a person’s rights in ways no one would get away with towards younger people.

The report says hospitals and care homes often act to deprive an individual of their rights, either through ignorance or convenience, and that too many local authorities are under-resourced to carry out their duties of assessment and safeguarding.

This is yet another example for those who think the job is done when the law is changed, not appreciating that without adequate resources and changes in attitude the reality remains much the same.

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