HARM REDUCTION MODEL While some homes tried to care for people with alcohol dependence using a harm reduction model – without requiring them to stop drinking as a precondition of care – other issues alongside lack of training are that CQC doesn ’ t include management of alcohol as a mandatory part of its inspections , and residents , families and staff ‘ don ’ t always know what good care in relation to alcohol should look like in this setting ’, the document says . It also points out the significant gap in specialist residential care places for people with alcohol dependence .
Aspinden in South-East London ( see box ) is one of the UK ’ s few ‘ wet ’ care homes . ‘ They have a lot of these in other countries – particularly the Nordic countries – but in the UK there are very , very few ,’ says Wadd . ‘ One of the problems with not having enough specialist homes is that often people will get stuck in either hospital or a homeless hostel because they can ’ t find a home that will accept them .’ Families may also minimise their relatives ’ use , she points out . ‘ They won ’ t tell the care home that they ’ re drinking so much because they ’ re desperate to get them into a home , and then the person experiences withdrawal because the staff didn ’ t know they were physically dependent . We also saw cases of people being coerced into stopping drinking when they weren ’ t ready . No one else would take them and they couldn ’ t live at home anymore , so they had no choice , and that ’ s really a breach of their rights .’
When it comes to mainstream homes , if someone ‘ doesn ’ t want to discuss or change their alcohol use , you should not try to force the issue ,’ says guidance for care staff produced by the study ’ s authors . With the resident ’ s permission , however , staff can ask someone from the local alcohol service to visit , carry out an assessment , and provide talking therapy or arrange a detox if necessary , it says , adding that it ’ s also important that anyone who has stopped drinking is fully supported .
STRONGER LINKS What mainstream care homes should be doing is recording alcohol preferences in residents ’ care plans along with a risk assessment , the guidance states . So should they also be fostering stronger links with their local alcohol services ?
‘ Yes , and to a certain that really wasn ’ t happening ,’ says Wadd . ‘ First , many of the people weren ’ t ready to reduce or stop drinking , and alcohol services often don ’ t want to work with a group who aren ’ t ready to change . Also a lot of the people we ’ re talking about had alcohol-related brain damage or other cognitive impairment , as is very common in older people , and drug and alcohol services are really not very good at working with that group yet – some are , but most aren ’ t .’
While silo working has long been an issue in both treatment services and the care sector , it doesn ’ t need to be , she states . ‘ We know that people can work with those who have both cognitive impairment and alcohol dependence . It takes a little bit of skill , but sometimes it seems people are being rejected from services when there ’ s no reason why people shouldn ’ t be able to work with both . We can
ROBERT ’ S STORY
Robert is a resident at Aspinden Care Home , a CQC-registered facility in South East London . Operated by the Social Interest Group ( SIG ), its staff are fully trained to look after people with long-term alcohol issues .
Robert came to Aspinden in April 2021 after he was evicted from a supported living service . They were unable to manage his high alcohol intake , erratic and anti-social behaviour and deteriorating mental health . He presented with very challenging behaviours and non-engagement for the first few months . However through our harm minimisation model and our caring , supportive and stigma-free environment , Robert was able to develop trust in our service and staff . We were able to work closely in partnership with our local GP , on-site nurses , and community mental health teams to stabilise Robert . He has an agreed daily plan for his alcohol , which he adheres to , and he participates in many of the home ’ s activities , keeps his environment clean and is independent with his personal care . There have been no signs of him going into crisis or evidence of any anti-social behaviours and he is a joy to work with .
At Aspinden our client group tends to be older adults who ’ ve been known to social services for many years and ‘ bounced around ’ due to their complex health conditions and support needs . This is a barrier we have to overcome with most new residents as they tend to have lost faith and trust in professionals . Our aim is to be the long-term , stable environment that they ’ ve never had but ultimately all deserve .
never remove risks altogether , but what we would say is that they can be minimised . It takes a specific skill set to work with this population , and we did detect some stigma among staff who hadn ’ t necessarily chosen to work with this group . Some people with alcohol dependence can be cared for perfectly well within a mainstream care home , but for others with complex needs there need to be more of these specialist homes .’
The university has now applied for funding to look at the issues in more depth – as
well as talking to people with alcohol dependence about their experience of being cared for in mainstream homes , it will also include drug use as the cohort of people with substance problems grows ever-older . ‘ People in care homes have told us this is increasingly an issue ,’ she says . ‘ And it ’ s obviously going to become more and more of one .’ DDN
Alcohol management in care homes : A good practice guide for care staff at https :// www . beds . ac . uk / media / q1obc4nf / care-homeguide-for-staff-final . pdf
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