Why care homes are putting red tape before residents

Older people are being reduced to a ‘bundle of paperwork’ by a culture of form-filling and box-ticking that benefits nobody, warns John Kennedy.

For the past nine months I have been talking to people working in and with care homes, to try to understand what is wrong and what needs to change. Paperwork is an issue that comes up again and again, whether it’s care staff complaining about the amount they need to complete, or residents and relatives bemoaning that staff seem to spend so much time writing when they should be ‘caring’.

So is excessive paperwork in care homes undermining care for older people? A JRF report published today finds the answer to be ‘yes’.

Firstly, there is a lot of it. The research identifies more than 100 separate items of paperwork that must be completed regularly in care homes. Secondly, there are questions of efficiency. There’s a lot of duplication and in the care homes I visited, some staff felt that paperwork was inefficiently designed or implemented. About half of the paperwork produced was used infrequently.

A most startling finding for me is the perception that it is the quality of a care home’s paperwork which drives judgement and values, rather than the care it provides. Staff feel they’re valued – and often promoted – on their ability to produce paperwork rather than ability to deliver quality care. And some care home managers report spending 20% of their time (one day a week) on paperwork rather than on leadership activities that could improve the quality of care for residents. Care homes are driven to place greater emphasis on paperwork due to feelings of insecurity and a fear of blame.

Care home quality is perceived to be judged on paperwork rather than on values and vocation. This reduces residents to a ‘bundle of paper and risk’ and staff to defensive office dwellers.

Previous JRF research tells us that what older people with high support needs value most is the quality of their relationships – the day-to-day interactions, the conversations, the kindnesses.

Just because something is recorded or written up well doesn’t mean it was done well. Paperwork has limited our ability to assess the quality of interactions between staff and residents. Paper offers false assurances in this regard and yet it is these interactions that are of ultimate value to residents and their relatives.

The report makes several recommendations. For me, the key one is that all the parties, the paper-requesters and the paper-makers work together to minimise the amount and maximise the effectiveness of paper. This would mean the true mission of the care home – to provide personal, kind, relationship-centred care – has the best chance of success.

I am responsible for a number of care homes and can be just as guilty of requiring paperwork to reassure myself and the board. In my experience, care homes are very passive – they never say no to any request for another form, another assessment or another policy. Of course we need paperwork, but should it really take up so much time and energy? As part of this year-long Care Home Inquiry I have commissioned a number of pieces of work, which will be published over the coming weeks. I would be very grateful for comments and views.