Cluster’s Last Stand

The information within The book “The Commodity of Care”;, is being blocked by major agencies and some individuals. Sadly many nurses, care assistants and students, want to discuss the issues within it as indicated at a recent conference where I was distributing information.

I do not expect everyone to agree with everything within this work- it all needs further research which I am not in  a position to do.

I do not seek a job

I do not seek promotion

And I do not seek an award.

(There must be  a song like this- or can anybody write it? The ” Quack Club” National Anthem)

I do seek justice and the freedom of information for profession and public.

This issue of “censorship” and personal agendas, so underlies the problems within CARE.

“And there’s more”-

Some major agencies and individuals must cease the politically driven bickering or blocking out of individual research/writing. We write about taboo subjects that have been untouched certainly within the UK. This means they have not been recognised as issues eg culture/fake certificates/ or have not been accepted on the research agenda. Myself I was unaware of such factors until I began this analysis, and until I spoke to others who have worked with many more overseas staff than myself. There are thankfully, many more issues that others are aware of that I am not. To hide behind a sign of “we knew anyway” is not the answer They declare this when it suits and when issues create  a “stink”. There are other writers in other fields who recognise this issue eg David Icke. They need to unite.

30 years ago the issue of poor care -certainly in nursing homes- sadly was not recognised as  a problem, despite ourselves and others, approaching many people and individuals.

I say this as best I can at the moment. If somebody can say it better I would be so grateful.

I have always been- and always will be- a one-off.


Qualified Care Assistants: The Tide that comes

Nurse technicians Florida: taken from article RCN affiliations

Graduates of the ‘Florida State Nursing Assistant Progam’ would argue that they were well prepared to identify signs and symptoms that may indicate further investigation. Such facilities as the Erwin Technical Centre ( offer 165 hours of instruction: ‘The Nursing Assistant Program combines classroom theory and over 20 hours of clinical experience that prepares students to take the Florida State Certification Exam and to pursue an entry level position in a nursing home. All nursing assistants working in long term care in Florida must be certified by the State of Florida’. They state: ‘Nursing Assistants are an important liaison between the residents and nurses. Nursing Assistants are trained to notice changes in residents and report pertinent information to the nurses in charge so adjustments in care can be made. In addition, nursing assistants help residents perform activities of daily living such as bathing, grooming, eating, and toileting. Nursing Assistants are the eyes, ears, and hands of medical professionals keeping residents comfortable, clean, and fed. The courses are held over either two days a week for two months, or two evenings a week for four months. Graduates are informed that: ‘The U.S. Department of Labor lists Nursing Assisting as one of the fastest growing occupations, and the need is expected to grow by 18% over the next six years’. This reflects the current emphasis on budgetary constraint, a ‘tide’ which it will be useless to swim against, and one which will inevitably encroach further on roles traditionally performed by the nurse.

The average pay in 2010 of Florida nursing assistant graduates was £7.15p per hour as of currency exchange rates applying 0ctober 22, 2013. The annual rate of pay for a patient care technician in the USA as of May 2013 was $15,866 – $42,644 for those with between one and four years experience ( median rate was $26,240 ( ). This equates to £16, 240 per annum. The highest rate ($42,644) equates to £26,380 per annum. Newly qualified nurses in the UK typically start at £21, 000 per anum (nursing.nhscareers.nhs.), which roughly equates with the starting salary for a qualified teacher (point M1): £21,588 (ibid.). Generally, a patient care technician would, on average, expect to earn 80% of the wages of a newly qualified nurse, with nursing assistants expecting 66%. Obviously, as the newly qualified nurse progresses through pay scales, the relative ‘affordability’ on nursing assistants and nursing technicians increases. According to figures from NHS Employers, average pay in the NHS in 2012 – including basic pay plus additions such as overtime – was £30,564 for a nurse, £109,651 for a consultant, £47,702 for a manager and £36,130 for a qualified paramedic.


Erwin Technical Centre (


International issues- Privatisation and Care homes


‘Certainly one of the most extreme examples of market-optimism and anti-statism comes from the Stockholm County Council. Between 1998 and 2002, when a centre-right alliance controlled the county, public property for SEK 30bn has been sold off in the region of Stockholm and 25% of the social services have been outsourced to private providers. Deregulation and privatisation have particularly touched the health system including care for the elderly. By 2008 all of Stockholm’s major hospitals had become public limited companies (plc) and 100% of Stockholm county’s wards were in private hands. The outcome of this situation provides an impressive and depressing summary of everything that critics of neoliberalism think is wrong with private provision of public services.

Rather than decreasing, the costs of health services rose by as much as 12% in one year, leaving the council with a deficit of SEK 2.4bn by 2004, while the now private wards made handsome profits. Even more disturbingly: the shareholders of the now incorporated wards – in many cases the formerly council-employed GPs – paid themselves dividends amounting to as much as a million SEK per year (Dagens Nyheter, March 3, 2007).

The Council was accused of selling off the wards basically at the inventory price – not including any goodwill as would be the case in a takeover of one business by another. The Council justified this sellout of state property as a subsidy to start-up companies, which was what the new private wards were considered to be.

The rising costs were explained not by the increasing profits that went into private pockets, but by a lack of competition. (The same lie spun about the UK energy market). There were simply not enough private providers on the ‘market’ and competition was not fierce enough. Stockholm County Council next elaborated  a new programme called “Ward Choice Stockholm” in an effort to bring down costs. Ward Choice Stockholm – which entered into force on January 1, 2008 – aimed at stimulating competition between health care providers, by cutting subsidies and making payment of services dependent on some simple metrics. The new metric that would determine how much the Council paid health care providers was the number of patients that they treated in a given period of time.

Yet, over the past months it has become increasingly apparent that the reason for Carema Care’s competitive pricing may derive not from economies of scale but from a wholly different source. Since early October 2011, Dagens Nyheter has run a series of articles about alleged shortcomings in the caring standards at two of Carema Care’s nursing homes in Stockholm. DN had been granted access to reports from nurses in different elderly care homes run by Carema Care, complaining about working conditions and the standard of the facilities. The complaints concerned mainly cost cutting in terms of not replacing staff, cutting the budget to buy such basic necessities as toilet paper, soap and incontinence pads. The company had also ‘made redundant’ cleaning staff at one home, asking caring staff to do the cleaning themselves – with the only exception being the day before announced inspections when a professional cleaning service provider would be brought in.

Why should the British public care about this tale from the North? Beyond, the obvious lessons to be drawn from the Swedish horror stories in the context of the current debates about the Health and Social Care Bill, the UK played a direct role in the changes in Swedish welfare services. Indeed, Ambea – the holding company that owns Carema Care – was owned between 2005 and 2010 by the London-based private equity and venture capital fund 3i. The fund bought the holding in 2005 for SEK 1.85bn and resold it in 2010 for approximately SEK 8bn to Triton – an investment fund owned by several Swedish citizens – and KKR – the famous US private equity firm.  When the company was taken over, KKR and Triton also extended large loans to the company and loaded it with external debt. Overall, Carema Care has debt to service amounting to SEK 8bn, approximately half of which stems from the two private equity firms that own Ambea. What is more, the loans from KKR and Triton were made at an interest rate of 12% – well above the current market rates for such a loan‘. (

‘An assistant nurse has been reported after forcing a roll of tape into the mouth of a patient with dementia at a Carema-run nursing home in southern Sweden. We’re taking this very seriously and have filed a Lex-Sarah report,” said the head of the home to the local Smålandsposten newspaper. The incident occurred at an elderly care home in Växjö,  southern Sweden, and was reported by one of the nurse’s colleagues last week. According to the paper, the nurse forced the tape roll into the mouth of the dementia-sufferer when attempts to subdue the patient’s aggressiveness failed’ (, Sept. 19, 2012).

‘Two nurses at a senior citizen’s home in Norrköping, Sweden are back on the job after they were suspended for a few weeks for verbally and physically abusing patients, according to the Folkbladet newspaper. When a patient protested against the nurse’s painfully hard grip, the nurse responded “don’t touch me with your disgusting fingers,” and “you’re lying where you are, and I’d like to see you try to catch up with me,” reports Folkbladet. On another occasion, the same nurse chose not to clean up a patient’s vomit, instead deciding to press the vomit back into the patient’s mouth, using a bib. The other nurse slapped a patient hard on the behind, pinched her stomach and shook her breasts, and pressed another patient’s fist into her mouth. This gruesome maltreatment, taking place over two days in March, was discovered by another employee, who then reported it. The behaviour of the two nurses was deemed so serious that it resulted in no fewer than five Lex Sarah reports, a law obliging staff in the care industry to report instances of mistreatment to social services. Despite this, the two nurses are now back at work after a suspension of two months for one nurse, and three weeks for the other. “The personnel department didn’t think there was sufficient cause to fire them,” said Teresa Påhlsson, district manager of another area in Norrköping municipality, to newspaper Svenska Dagbladet ( , 7/7/2011).

Carema Care was hit by a series of scandals last year, when a slew of incidents ranging from unchanged diapers to poor working environments saw patients suffering due to cost-cutting. The scandals led to raised concerns at the time for tightened quality control of elderly homes as well as an ongoing debate about the role and responsibilities of private companies operating in the care sector. The nurse has since been fired. “The person in question has engaged in conduct which should never occur and the other workers have been informed of the dismissal,” wrote Carema Care in a statement on Wednesday, according to the TT news agency. Kommune´s like Carema as they are the cheapest and what could be more important ? There are 92 old age pensioners residing at the Tallbohov nursing home, run by care company Carema, in the Stockholm suburb of Järfälla. Staff and ex-employees have told DN that there often wasn’t enough toilet paper, paper towels, alco gel, or soap to keep the place or the patients clean. Sometimes, staff told the paper, the toilets would be so filthy that staff wouldn’t sit down on them. According to the staff, the management want them to do all cleaning, as well as repairing medical equipment, by themselves. “But we haven’t the time nor the expertise to do that,” an ex-employee said to the paper. The day before health inspectors were due this year, an army of cleaners arrived at the home. All areas were thoroughly vacuumed and scoured, and all dispensers of soap, alco gel, toilet paper and rubber gloves in the pensioners’ rooms were filled up. “Carema ought to be ashamed of themselves. They should keep the place clean both for the elderly and for the staff. Not to scam the inspectors,” said one of the nurses to DN. The cleaning used to be done by two cleaners but in a bid to save money, the company chose to add it to the staff responsibilities (, Sept. 19, 2012).

The need to make economies have also had another, more dire, consequence according to the staff who claim that the management question every prescription that would cost them money. Another area where savings have been made are the residents’ beds. Earlier this spring one resident’s bed broke, which was solved by requisitioning that of another patient, making him sleep on the floor for several months. A third patient was too tall for his bed, but it took six months before he was given a new one, despite pleas from staff who were forced to tie his bed together, according tot he DN report’. “And when something ran out, it was out. Whether it was a question of diapers, food or toilet paper.” According to the employees, management solved staff shortages by making personnel from other departments fill in 20 minutes here and there over the course of the day. When staff tried to complain they were not met with understanding. Eventually they went straight to the municipality’s medical officer. This was not appreciated by Carema’s management, which told them that anything that happened at the home should stay within the walls of the facility.

‘Workers in old people’s homes should be allowed to report poor conditions and mistreatment of the residents anonymously, according to Social Welfare Minister Maria Larsson.She says too few reports of bad practices are being sent in, and worries that it is because nurses and other staff are afraid of reprisals from management if they raise the alarm. A law in Sweden, called ”Lex Sarah”, means that carers are obliged to tell the authorities if they suspect malpractice, and the minister says she wants to amend the law to guarantee anonymity, and hopes more would then dare to come forward (, April 19, 2009).

‘The reason why alarming reports never stop coming is that politicians are shirking their responsibilities and referring to employees, authorities, municipalities and care companies,’ wrote Håkan Juholt in daily newspaper Dagens Nyheter. Venture capital firms, existing first and foremost to maximize profits, have no place in tax-financed elderly care, he opines’.

Blog Responses:

‘Did the state hire the company with the best history, care, expertise, etc., or did the state seek to employee the company that was least expensive or a company based on good-old-boy connections’? ‘I don’t know, and nothing excuses the abuses of Carema, but these abuses seem to have been known for some time. Why did no one within the state, which hired the company, immediately seek legal action to address these abuses or seek social welfare representatives to immediately correct the inhumane conditions? Carema should have been fired long ago’. ‘If a parent hires a babysitter and the sitter abuses the children, it’s expected the parent would take immediate action, not look the other way and continue to subject the children to abuse’. ‘If a private industry can’t turn a profit from a given field and provide services effectively, maybe those services should be undertaken by the government which doesn’t have the requirement to turn a profit and is accountable to the public at large rather than a group of wealthy shareholders who have no vested interest in the quality of the service provided but rather the monetary bottom line’.

‘Attempts at privatizing elder care have historically been failures. These are human beings, not machines being turned off a production line. This debacle simply emphasizes the importance of recognizing the limitations of privatization. Perhaps the powers that be would be more attentive if older people and their families voted with this in mind’.

(, Nov. 12, 2011).





Lenin Nightingale 2014 c








































































Diary of a Home Carer UK

This important piece, truly outlines the work of a carer who was employed to care for people within their own home. Recognise any of the issues?


Well it was a struggle to get out of bed today, day 15 without a break. I have to work extra to be able to afford essential repairs to my car, without the car I am limited to the amount of work I can do and areas would need to be restricted meaning less money to live on. Yet there is no petrol allowance or consideration to the increase in my insurance.

My first call today is to assist a lady out of bed; it’s a 2 person call as she is very disabled. When I arrived there was an awful smell, I then noticed that her commode had not been emptied the night before and had been placed right next to her bed, how she managed to sleep is a wonder! We have 1 hour to assist but once she is safely seated I left the other carer to assist with her breakfast and tidying up as my next call often takes much more time than is allocated.

 Mrs M is fast asleep when I arrive, she likes a lie in but they regularly give her a 9am call so that we are able to fit more people in. I offer her a drink to entice her to get up this alone can take 20 mins today I’m lucky, 10 minutes and she is ready to go into bathroom. Mrs M has difficulty with her bowels so I leave her alone to use the toilet. 15 minutes later she is ready to get washed. As this is a ½ hour call I am left with 5 minutes to get her washed, dressed, meds prompted and make her breakfast. I have reported my concerns but social services say this is an adequate time scale – I disagree! I would never leave a client because their time has elapsed so I carry out all tasks as required – if a little rushed and leave 20 minutes late.

 Luckily my next client lives with a family member but as it is several miles away I arrive almost ½ an hour late. Today is her trip to the daycentre so her family have given her breakfast and started to get her dressed. As most of the work was carried out before I arrived I have condensed a 45 minute call into 20 minutes giving me time to get to my next call a simple medication prompt.

 Mrs C has dementia and often requires more assistance that is currently in place. I offer her breakfast and a cup of tea and check the house is safe. She has no family nearby and suffers from agoraphobia so the 3 calls a day she receives are her only social contact. I make an effort to sit and chat while she has her breakfast and reading through her file I notice that yesterday evening the carer was here for only 10 minutes.

 As we are very short staffed in a different area I have been given some new calls to cover 15 miles away this trip alone takes 25 minutes. So far today I have spent 1 hour travelling and its only lunch time, that’s 1 hour of my day at work that I don’t get paid for! I am running behind so after preparing a microwave meal and a cup of tea for the service user I run out without having time to have a conversation, it makes me feel so guilty but there is always someone else waiting.

By the time I arrive at my next call it is 1.45 and the lady is very unhappy at my time keeping, I apologise and explain how far I have come but she very angry with me. I can feel my head pounding knowing that I am going to be late for a sit I have to do next. I sit with the lady while her daughter goes shopping but as I am ½ an hour late she will come back ½ an hour later which means I have childcare issues! Again! I phone around and get my 76 year old neighbour to agree to sit with my children so that my husband can go to work. It’s nice to get home and see the kids they were in bed when I left, but I haven’t seen my husband at all.

Miles travelled: 42

Unpaid travel time: 1 hour 45 minutes.


Early start again today house was very quiet as I left at 7. The schools are shut for summer but I haven’t been able to do anything with the kids, and as I need the car they don’t get very far with my husband either. I arrive at the first job on my timesheet only to be shouted at as the lady wants a 9 am call and they keep giving her very early calls she refuses to let me in, I wish they would consider peoples choices more.

 I report the matter and carry on early to my next lady she is quite happy for me to be early as we can have a cup of tea and a chat after I have helped her dress. I love it when this happens I also get chocolate biscuits which is great as I haven’t had time for breakfast and it’s very unlikely I will get time for lunch either.

 I know when I arrive at Mrs. B that all is not good. She is sobbing uncontrollably as I enter and I struggle to understand what she is saying. I am due to be here for ½ an hour to assist with washing and dressing then encourage her to eat. I spend 20 minutes trying to calm her down before I can even suggest getting started. Mrs B is due to have a shower today but I have to assist with just a quick wash and dress before leaving her with some breakfast. I am supposed to monitor her food intake as she has been refusing to eat but I am already 20 minutes late so I really have to get on. I report this to the office.

 I am back at Mrs C’s for a medication prompt , I have 1 hours break after this call then I am due to come back for her lunch. I decide just to stay, Mrs C needs assistance with domestic tasks so I encourage and support her do some washing and while I cleaned the bathroom she hoovered through. Mrs C really enjoys these normal activities and it’s great to see her looking so proud of her achievements today.

 I get to the lady who shouted at me yesterday at a much more reasonable time, she even apologised – but really it’s something you get used to .I made her lunch and made sure I was with her the whole ½ hour as I didn’t want to upset her again. I had a break today then back at 5. My husband is off today so I can work later. We have a sandwich and a coffee and I see the kids for a bit before I head off again. My son begged me not to go. He was screaming as I left the house I don’t think we have spent more than 4/5 hours at a time together this holiday as I am desperate to make sure my car is road worthy.

 I have 3 tea calls and 2 people to undress a catheter bag to empty, 1 medication prompt and 2 men to put to bed so I can’t afford to get stuck in traffic this evening. It all seemed to run quite smoothly only having to cut the odd 10 minutes off calls to allow for travel. My last call always runs over I am due to finish at 10 but most staff don’t take the time to speak to Mr W , his wife is very ill and they have no children. Mr W needs assistance to get dressed for bed and I also give him medication. As he has little social contact he hangs onto everything I say and begs me not to leave, I tidy around while we are chatting, basically making the floor safe to walk over. Social funding has been reduced and his services have been cut Mr W is severely visually impaired and needs help with domestic tasks but as he has to pay privately for this he has cancelled these calls. Mr W is using this money to pay for assistance and transport to the hospital to visit his wife. I eventually manage to leave at 10.40 knowing my husband will be very unhappy at how late I am and all the kids in bed when I get back.

Miles travelled: 36

Unpaid time travel: 30 minutes

Unpaid work time: 1 hour 40 minutes


A whole day without the worry of how much petrol will cost or if my brakes will continue to work. The car is booked in for repairs and I have a 2 man run with another driver. I was a little confused that my timesheets stated I started at 5, but after phoning the other girl she said it was ok for her to pick me up at 7. It became quite obvious early on that this is call cramming at its worst!!

Each service user was rushed in a way I honestly haven’t seen before, on one occasion as we were leaving I said ‘I will just open the curtains ‘ to be told I had no time and her husband would have to do it! We managed to cover 6 hours work in less than 4, the driver seemed positively proud of her ability to reduce the timing of calls. I was even warned before entering a house not to get into conversation as this would just hold us up! At one point I asked why she had so many people to see when it was obvious they were not getting the care and support they so needed. She told me the office staff knew she was quick so just piled on more meaning she could get paid 60-70 hours a week for working much less.

 I felt extremely disheartened at what I have seen today, but given the lack of pay and poor terms and conditions this way of working has become the ‘norm’ for many.

Tonight I feel like crying – I’m not sure if its work or the £280 I’ve just had to spend on the car. After finishing early I would have loved to take the kids somewhere nice but that’s quite frankly impossible, we walk to the park –  I worry about using petrol for non work purposes.


Miles travelled: 0

Unpaid travel time: 0

Unpaid work hours: 0


Day 18, this is beginning to be a real struggle, after an early night I expected to jump out of bed feeling refreshed and revived instead it feels like I’ve had a bottle of whiskey. I’ve no time to feel ill I have 4 people to get up and dressed one of those needs a shower then a medication prompt followed by 4 lunch calls and a 2 hour sit. All seemed to be going well until I got to the man who needed a shower, he suffers from dementia and can become rather violent. After struggling to wake him and get him out of bed he became quite angry (I would be angry if someone came in and woke me up to get straight in the shower!) this meant I was held up quite considerably trying to calm him down. I have 45 minutes for this call which often is sufficient time but today I was there 1 hour 5 minutes. I usually feed him his breakfast but as I had over run so much his wife offered to help out once id got him ready so I left her to do this while I hurried on. Mrs C was next on my list luckily a medication prompt can be done in 5 -10 minutes so I was able to make up a bit of time , I know how much she loves a bit of social interaction and I feel so guilty having to leave her with just a hello – goodbye.

With little or no information on service users it can come down to guess work on a lot of calls. My next medication prompt told me she had taken her meds I was not convinced. After offering her a cup of tea I called office to ask where medication was kept so I could check. I found her medication along with 11 old dosette packs all of which contained medication which had been missed, others must have accepted her explanation and left without ensuring administration. This meant I had to return all packs to the pharmacy and get a receipt , this took a good 25 minutes of my time – time again I don’t get paid for.

 Some days I think about getting another job, I would get paid more and pay less in petrol if I worked in a supermarket. But I don’t think that a possibility, I love my job; I really do care and have wonderful relationships with my service users and their families. All I want are better terms and conditions and a living wage would be nice!

As per usual I ended up running late thanks to the medication error, so managed to see my husband for about 5 minutes before he flew off to work and I got the kids ready for bed. I feel like a single parent some days.


Miles travelled: 39

Unpaid travel time: 40 minutes

Unpaid work time: 45 minutes


Ahh – only another 15 hours of work ahead then 2 whole days off to spend time with my family. It feels like I’ve been at work for months now. My husband is off again tonight so I am just working straight through. I hope to make at least ½ an hour so I get a chance to come home and see him and the kids, maybe even get something to eat!

Well that was a stupid idea, where did I get the idea I may get a lunch break, I thought 15 hours for one day was more than enough then someone called in sick!  Originally I had a sit this after noon followed by 4 tea calls, 2 medication prompts 3 undresses and 3 put to beds. I was then expected to fit in an extra 2 tea calls and a medication prompt followed by an extra call to put someone to bed. It’s impossible to stick to my times I had to start getting people ready for bed at 5.30 and cut most call down to 15-20 minutes the medications were done in 10 minutes each. I hate cutting calls but if I didn’t I would still be putting people to bed after 12. Its not always comfortable being out late at night travelling alone but as none of my service users require 2 people I would never get anyone else to come out with me.

 Lunch was a dried out offering from the local garage and a multi pack of crisps all of which I managed to eat whilst driving! What with that and the speed limits I have managed to break its surprising I haven’t got myself a criminal record today!

But on the bright side there was no time to waste so I have managed a day without any unpaid time, the down side being I don’t think any of my service users have had a conversation or quality time. After a quick shower and hello to my husband who was waiting up I collapse into bed looking forward to doing something with my family (I haven’t seen my kids at all today), the phone is to be ignored all weekend!!


Miles travelled: 64

Unpaid travel time: 0

Unpaid work time: 0

Hasta La Vista Gran!

Carol Dimon c

Looking for somewhere for  a relative in a nursing home? Peruse the web This is just one example.

Glossy images, and lower fees attract many from countries such as Switzerland, UK, and Germany. Buchdahl  (2013) comments “Germany is in the throes of a ‘grandma export’ as one in five Germans say they are considering sending their elderly relatives to a care home abroad.” More than 7146 people from Germany are said to live in retirement homes in Hungary (ibid).There are many positive tales of patients there with dementia- recollected by relatives who are unable to visit often. Many have never been to the country before. Some may actually have distant relatives there, more so with migration to the home country. People in America also send old people to nursing homes abroad (Foxnews 2013). This article describes a positive situation involving swimming, massage and personal attention from some carers who have had “no formal training”. “His caregiver, Kanokkan Tasa, sits on the grass beside him, gently massaging his legs and tickling his chin. She has been with him for six years, eight hours a day and earlier cared for Woodtli’s mother.”

Some relatives were said to have been disappointed in the standards of care in their own country (ibid). Other reasons for dissatisfaction  include cost. Political reasons for overseas care include the rising number of old people compared to the young, with few people available to care for them. However, this is unsupported by statistics of newly qualified nurses without jobs in the UK and other countries (Dimon 2014).

Beware, some of the adverts are false, asking for money for nursing homes that do not exist  “One place called Pensjonat Ania in Tomislaw near the German border, which offered delights such as mushroom hunting excursions for its residents as well as an on-site nurse and ultra-cheap rooms at €400 (£340) a month, was exposed in April to be entirely non-functioning” (Buchdahl 2013). Innes (2014) discusses older people being sent to Thailand , with an example of  a lady sent there  from Zurich. It is stated that the quality of care in Thailand is of  a higher quality with evidence of more nurses and better facilities. There are also concerns of moving people who suffer from dementia from their home country to Thailand. Indeed, is it possible that older people who have no relatives may be more likely to be sent to nursing homes overseas? -especially if suffering from dementia.

A web search for reports of  quality of care overseas, yields few results- why is this? Is care suddenly perfect? There can be no perfect care because care depends on a relationship between people who have different beliefs and expectations. Italy provides one example  regarding freezing residents kept  in an attic ( 2013).

We hear of 3 or 4 nurses per resident, unlike the UK level  of about one or two  per 30, but, what is  a nurse? What training has the nurse had? Dimon (2013) reports of overseas nurse education being unequal in content and duration to the UK. Culture also differs which does affect attitudes and acceptability of standards. Not to mention fake certificates, which may easily be bought . Many countries discourage the questioning of doctors or more senior staff (Duell 2013), thus staff may be reluctant to raise issues. There are also differences regarding such aspects as pain control (RCN 2003 ).  Another difficulty may be bringing the person back from overseas or visiting quickly  if problems occur such as sudden illness (Kresge 2013).

Poland  may query whether there will be enough high quality homes to care for people who live in Poland as many cannot afford the home used by people from Germany (Kresge 2013). Will care home companies react by commencing to build nursing homes overseas instead of in the more expensive home countries? There may also be less regulations to meet in certain countries.

“Sorry- no room at the inn, or in the country”.  Is this considering people as COMMODITIES to the extreme?  This approach could well be fuelled by neoliberal approaches of politicians in many countries; individuals are responsible for themselves, and make their own choices of where they wish to be cared for, or, in the case of lack of mental capacity, this choice is  made by relatives.  Does “empowerment” mean you have the choice – but we are not responsible? Horton (2007) claims neoliberals view of the world is  as a “vast supermarket”. Yet, as Horton describes, the disadvantaged cannot “shop” at this supermarket. This reflects the preoccupation of neoliberalism with consumerism and the acquisition of goods, and neglects to address society’s caring role. Horton describes the resulting control held by the ruling class, who have “approval and consent of members of society”, as “hegemony”. As a consequence, those on welfare benefits may be regarded with less compassion, as they are viewed as not contributing towards the wealth of society.

This approach of discarding old people mirrors historical ones within some countries -Eskimos were said to have been killed when they reached  a certain age “Historical data exists that in the past some Eskimos did kill old people when circumstances were sufficiently desperate ( capefrasers 2010 ) . Yet, in Eastern countries, families have been very loyal to their older relatives- this is not without reports of abuse from the family  (Holder 2013). Of course families do need help and support. The present overriding culture fuelled by politics, particularly in Western countries, seems to be to value people who are regarded as directly contributing, such as workers, rather than  old people.

The approach to old people, and other vulnerable people, reflects the culture that exists within society ; “The True Measure of Any Society can be found in how it treats its most vulnerable members” – Ghandi” (seventhvoice 2012).

What is to be said of  sending old people abroad – even with skype and a couple of visits  a year ?

Ask yourself, would you send grandma or mother abroad? Mother, would you like to be sent to Thailand?

Is this ever more likely to occur in the UK, as arguments continue regarding quality of care and payment for care?



Buchdahl E (2013) Germans sending parents To Cheaper Nursing Homes With One in Five Planning to do it 17.9

Capafrasers (2010) Eskimo Woman Arrives At Cape Dauphin-1820

Dimon C (2013) The Commodity of Care Cloister House Press

Dimon C (2014) Culture and Care

Dimon C (2014) Roll Up! Roll Up! By Your Fake Certificates in Anything.

Duell M (2013) ‘Full of life’ great-grandmother, 100, ‘died from fractured skull after falling 5ft when foreign carers failed to properly strap her into hoist’ mailonline 8 January

Foxnews (2013) More Alzheimer’s Patients Finding Care Far Overseas 30.12

Holder H (2014) Japan’s solution to providing care for an ageing population? The Guardian 27.3

Horton E .S. (2007). Neoliberalism And The Australian Healthcare System. Conference of The Philosophy of Education Society of Australasia, Wellington, New Zealand. Web: February 2013.

Innes E (2014) The Families Sending Relatives to Nursing Homes in THAILAND: Care is ‘Cheaper and Often Better in Asia’  They Say  9.1 (2013) Italian Nursing Home Seized After Six Patients Found in Cold Attic 30.12

Kresge N 92013) Germans Export Grandma  To Poland As Costs, Care Converge 16.9

RCN(2003) “We Need Respect”: Experiences of Internationally Recruited Nurses  In The UK 1st March

This article also published in nursesfyi edition 16 August (2014)







Internet advertisements blatantly offer fake degrees. We are not talking about bog-standard pieces of paper, but of ones that are  ‘authentic and very realistic looking … from colleges and universities worldwide’, which will give you ‘that extra edge’, and come with ‘authentic seals from the college or university of your choice’. The ‘instant graduate’ can also get a ‘cover letter from the college or university you will have graduated from.’

There is a distinction between  ‘counterfeit fake’ and  ‘genuine fake’. In the former case, the counterfeiters use state of the art technology to produce degree, birth, marriage, and driving documents that are incredibly difficult to distinguish from genuine ones. These sophisticated documents are produced by forgers working for international crime syndicates, which have access to specific types of paper and inks used in the genuine document. The counterfeit document undergoes a quality assurance check, for the industry would soon implode if a high ‘pass’ rate was not achieved. The ‘genuine fake’  is a certificate produced by a recognised university, obtained by bribery, complete with university stamp, hologram, recommendation letters, and placement on the  university register for verification. The ‘instant graduate’ is guaranteed that they will pass all scrutiny.

The  fake degree industry is rife in many countries:

An article in The Hindu (thehindu 2014), reported on a global survey undertaken by the screening firm First Advantage, which showed that, in 2013, over 70% of Indian ‘job experience certificates’ were forgeries. The article confirms that ‘forgers have been able to decipher what kind of  paper to use, the right kind of ink to use as well as identical stamps, making it extremely difficult to spot a fake’, and that the ‘system allows some of the fake degrees to be issued with the help of university officials themselves for the price of a few hundred dollars’.

A report in The Economist  (2012) tells of  ‘the ease with which almost anyone in China can buy a fake degree …  (for) those who cannot afford a degree from a fake foreign university, more than 100 fake Chinese universities now offer diplomas for sale. Many of them have websites and use names similar to those of real colleges. Some even use doctored photographs to advertise their qualifications: one image online shows a group of students said to be from the non-existent Wuhan University of Industry and Commerce standing in Tiananmen Square’. Within China, a growing number of  authenticity checks are being carried out by officials.

Florian Bieber (2014), informs us that ‘dozens of private universities have emerged in the Balkans whose primary motivation is to make money. It’s no surprise that with weak state supervision and low standards, there is ample room for abuse. While good private universities have emerged in recent years, there are probably ten dubious institutions for every serious one’.  A report by Mark Tutton of CNN (2010), estimated that more than 100,000 fake degrees are purchased each year in America, with a third being postgraduate degrees. One degree ‘manufacturer’ reportedly made $7 million from selling fake degrees to more than 9,600 ‘instant graduates’ in 131 countries. A Nigerian report (nairaland 2011) disclosed that the number fake universities in the country has risen from 44 to 51, some of which had been taken to court.

A foreign student attending a British university does not have  to work to obtain a degree – course work can be bought, with many internet-based companies offering this service, and a  guaranteed pass. Exams can be taken by a paid ‘doppleganger’. A report in The Independent on Sunday ( Brady, Dutta  2012), commented on an enquiry led by lord Willis in 2009, which concluded that the technology used by essay writing companies makes their products almost impossible to detect. ‘The Independent’ used the Freedom of information Act to establish  ‘that at least 45,000 students at more than 80 UK institutions have been hauled before the authorities and found guilty of misconduct in their exams or coursework over the past three years … including individuals caught taking exams for someone else’. The high number of international students was implicated in the high rate of cheating.

And so on, and so on … Yes, there are companies that will perform checks on documents supplied by foreign students, these services are not cheap, can not guarantee to eradicate all cases of cheating, and are not used by most UK universities, who often use a ‘does-it-look-genuine’ approach.* Cynics will not be surprised by this. Whilst debt-ridden UK degree students typically pay £9,000 per year for their education (among the highest rates in the world), overseas ‘cash cows’  are ‘milked’ of upwards of £35,000 per year for the same degree. In 2013, the House of Commons Education and Skills Committee accused universities of being “driven by short-term gains in fee income”.

*UK universities have to demonstrate that they are using a set process to evaluate students from outside the EU, which forms the basis of ‘good practice’. The Home Office confers HTS status on universities – the right to recruit international students – as long as ‘good practice’ is being met. This involves having an admissions policy, detailing how the university evaluates applicants, and what sources of information staff use to make decisions. These are usually the applicant’s previous qualifications, their performance in an admissions test, or interview. How a university confirms previous qualifications is up to them.

They may engage a company to check whether an education provider is listed on an accredited database.

They may do this themselves.

They may check for the use of an official stamp.

They may check the paper quality of the certificate. Is it compatible with that known to be used by the issuing university?

They may check for security features used by the issuing university, such has a hologram.

They may check for font styles used by the issuing university?

They may check for alterations on the document.

They may check for Scanned (pixelated) signatures taken from website.

They may check for the formality of language and correctness of grammar.

They may check for confirmation letters, passports, birth certificates.

They may check for entry on a university register.

The student under ‘scrutiny’ has, however, in many cases, already been recruited by university sales people, who attend plush-hotel ‘degree fairs’ in such countries as India. The level of scrutiny applied to those already recruited, at no small cost, is open to question. Also, as this article makes clear, the above checks, although constituting a ‘process’, are thoroughly useless against the technological advances in forgery and the use of bribery – a bit like trying to detect underground water with a willow stick. At best, they will flush out the most obvious  fraudsters, those who can not afford a bespoke forgery service.

The more useful parts of any  authentication process  are the admission test and interview. The former should require the candidate to be retina scanned or finger-printed, before undertaking a rigorous exam in the subject they wish to study, with proficiency in English being a key element in the marking process. If passing the exam, their retina or finger-print records should be checked on attending their initial lecture.

The same checks should be used on those interviewed, and the interview should thoroughly expose any lack of claimed expertise, and deficiency in spoken English. In the case of applicants of university teaching posts, a rigorous exam and interview should be the norm.  This should be a  retrospective requirement, with all current overseas lecturers, who have not done so, having to undertake an exam at the level of their claimed qualification, to be followed by an interview. These ‘authentification’ measures should also apply to EU applicants.

(British  degree-qualified nurses can not simply apply for jobs in America, Australia, and Canada. Before they can register to practice in these countries they have to undertake exams specified by various State boards.  Why should other academic disciplines be exempt from such testing?).

The opposition to anything resembling rigorous checks is of the same camp that opposed  the recent rules to tighten the students visa system, in which academic staff are required to report to immigration authorities if non-EU students are absent from classes. This apparantly puts “pressure on staff to spy on their students” (notwithstanding that school teachers have always reported truancy), and would create “an environment of mistrust”, which would endanger “the crucial relationship between staff and students”. This is the argument from ‘lovey-dovey Tower’. Why should university lecturers be exempt from what is the norm in the real world? – the school teacher reporting truants, the manager reporting staff absence, etc. What type of trust is at risk of being broken by someone reporting  absences, or, indeed, suspiciously poor course work? Lecturers are not being asked to undertake GCHQ levels of surveillance, GCHQ spies do that. Who would be “affronted” by a more rigorous ‘authentification’ process? – the fraud, for the genuine applicant would welcome the opportunity to prove the validity of their qualification. The belief that any measure should be opposed that makes the UK a less attractive place to study is simply putting economics before ethics. The real debate should be centred around why the British government is not adequately funding university education, and forcing universities to attract funds.

Many British universities are run as fund-seeking businesses, all too eager to exploit an applicant’s bank account, thus devaluing the degrees they issue. It is only a matter of time before some UK universities are placed on a banned list in other countries.

A question is: when is a university so predominantly a commercial enterprise that it is only masquerading as a university?

lenin nightingale 2014



Bieber F (2014) Revisiting New Universities in the Balkans: European Visions, UFOs, and Megatrends 14.6

Brady B, Dutta K  (2012 ) 45,000 Caught Cheating At  Britain’s Universities The Independent 11.3 (2011) 22.9 (2014) Beware of Fake Degrees 3.3

The Economist (2012) A quick Study Bogus Degrees From Non-Existent Colleges Cause Headaches For Employers 7.7

Tutton  M (2010) Uncovering The Multi-Million Dollar Fake Degree Industry 12.1

































A recent report (Caya 2014) quoted Attorney General Eric T. Schneiderman: “Nursing home residents are among our state’s most vulnerable citizens, and the perpetual neglect in this case is shameful”, whose comment pertained to 8 nurses and 9 certified nursing assistants who were sacked following a New York state investigation that showed neglect of duty and making false records.

The investigation used hidden cameras to show that a highly dependent 56-year-old male resident, who suffered from Huntington’s chorea, was not routinely given pain medication, liquids, and incontinence care at Highpointe on Michigan Health Care Facility, with charts and nursing notes routinely claiming he had.

The 17 accused appeared at Buffalo City Court, facing various charges of willful violation of health law, endangering the welfare of an incompetent or physically disabled person, and falsifying business records. Endangering this patient is a charge which is a felony and carries a maximum prison term of four years.

Schneiderman commented: “The charges filed send the message that my office will not tolerate anyone being neglected by those responsible for his or her care. We will use every tool in our arsenal, including hidden cameras, to ensure that nursing home residents receive the care they need and the respect they deserve.” (ibid.). This follows the New York authorities arresting 22 people in 2010 after hidden cameras revealed maltreatment of patients in two facilities (NursingHomeNews 2010).

The use of hidden cameras to record instances of poor nursing care has been a constant theme in the American press. Jan Hoffman (2013) reported a hidden camera catching a nursing assistant stuffing latex gloves into the mouth of a ninety six year old patient, as another taunted her and tapped her on the head. Once thrown on a bed, one of the nursing assistants assaulted her with heavy-handed chest compressions. Their treatment was accompanied by laughter.

Jeremy Pelzer (2013) reported that in Ohio new legislation would enable nursing home patients the right to install hidden cameras in their rooms. Cameras can be installed by relatives, the only requirement being consent. States such as Ohio and New York are single consent jurisdictions, so if a patient or their legal representative consents to the use of a camera, no other consent is needed. A prosecutor can install a hidden camera without a court order or subpoena. The nursing home or hospital need not be told about the surveillance camera. Other States are expected to follow this trend.

The laws in other States may vary. Many nursing homes have installed cameras in common areas and hallways, but they cannot install them in the patients’rooms. In the case of patients with enough mental faculty to make an informed decision, courts may act to prosecute a relative for invasion of privacy if they install a camera unbeknown to the patient. Nursing facilities in some States may instigate legal proceeding against those installing cameras clandestinely.  They may use ant-surveillance detectors. They may ask patient to leave a nursing facility if cameras are discovered. Patients or their representatives on admission to a nursing facility may be asked to sign an agreement not to use a surveillance camera.

The power of business interest to block the use of cameras in nursing homes is evidenced  by the vote in the Senate Medical Affairs Committee concerning  the right of families to  install cameras in South Carolina’s nursing homes. The committee was evenly divided , with a 7-7 vote, meaning that it will not progress. Adcox (2014)  quoted the sponsor of the bill, Sen. Paul Thurmond, “This is really about empowering an individual who’s in a nursing home. The older generation is fraught with neglect and abuse.” They also quoted committee member Sen. Brad Hutto, who commented on the opposition of the nursing home industry to the bill: “They are concerned this is a ploy to catch them doing bad things to patients. That’s not what this is about. This is empowering families to take care of loved ones.” He added, “Generally, people with cameras on them behave better.”

Abuse recorded by hidden cameras is not confined to the elderly: A Canadian report (, November 20, 2012) commented on the case of a teenage girl who was bound and hooded, and was forcibly injected by nursing staff with an antipsychotic drug, despite the fact that she appeared calm. This girl had entered the world of prison nursing for the at the age of 14 for throwing crab apples at a postman. She subsequently killed herself. The footage of the injection was the subject of court action by the Canadian government, which sought to block it. The same report states: ‘In Canada, mandatory video surveillance in prisons is designed to protect both inmates and staff.  However, elderly citizens in Canadian hospitals and nursing homes have no such protection. Instead, unlike the U.S., Canadian governments and courts vigorously prohibit video surveillance inside the hospital and nursing home rooms of elderly people’. The report claims that criminal charges and convictions have ‘increased substantially’ in States like New York since they licensed the use of hidden cameras.

The situation in Canada was also commented on in a CTV report (Leung 2013) which highlighted the case of  a hidden camera in a Toronto nursing facility recording  an elderly resident being roughly manhandled as her incontinence pad was changed, having a soiled wipe shoved into her face; an employee wiping his nose on her bed sheets; employees having sex in her room as she lay in bed. Four employees were sacked, but did not face any legal charge.

Abuse of patients has been caught on hidden cameras in the UK. David Brindle ( 2011) reported, ‘Inspectors have been called in to private hospitals that care for people with learning disabilities after exposure of a regime of shocking abuse by staff at a unit run by one of Britain’s leading care companies’. Another report (, April 23, 2012) gave details of footage of an Alzheimer’s patient being repeatedly beaten in a care home, which was later screened on TV. Helen Nugent  ( 2012) reported an  89-year-old woman who was suffering from dementia being dragged across her bedroom floor, as she scream in pain, and was then threatened with violence.

Such abuse is the UK is  not as  isolated as some reassuringly make out. As in America, there has been a constant flow of reports of abuse, which begs the question, how much more abuse would be discovered by using hidden cameras? Exactly what  lies under the ‘tip of the iceberg’?

The continuous reporting of abuse in American care facilities led to the passing of the Elder Justice Act (EJA) in 2010, which established  mandatory reporting requirements for those suspecting abuse in long-term care facilities (EJA, Funding for training and certification, 42 USC, sec. 1397, 2010). All employees are required to report  reasonable suspicion of abuse to the Secretary of Health and Human Services and law enforcement agencies  Failure to report can result in harsh financial penalties of up to $300,000.

The need for a debate on the use of hidden cameras in nursing homes was made by  the Care Quality Commission (CQC) in its document A Fresh Start for the Regulation and Inspection of Adult Social Care (2013), which states: “We would … like to have an open conversation with people about the use of mystery shoppers and hidden cameras, and whether they would contribute to promoting a culture of safety and quality.” This produced a similar reaction from the care home industry as it had in America, with claims of patients’ privacy and staff moral being under threat. These claims are seen as a ‘red herring’ by some in America, with the care home industry more  “concerned this is a ploy to catch them doing bad things to patients” ( Adcox 2014  ), i.e. employing too few and inadequately trained staff.

The issue of patients’ privacy is addressed in certain American State legislation (Ohio etc.) by linking it to consent to use hidden cameras, by the patient or their representative. If the patient has requested the use of an hidden camera, or one that is marked by a notice on their door, then all that can be objected to is their choice to do so. If a relative makes this choice, what can be questioned is their right to make a choice based on a knowledge of the patient and their likely wishes. What can not be objected to is a  person’s right  to make an informed choice, even though that choice may be anathema to others. That is, people should have the same right in most instances to not have a camera in their room as others do to have one. The qualification in most instances  seems an important one where abuse is suspected,  but can only be proved by a hidden camera. In this instance, should authorities have the duty to override the wishes of a patient’s relative?

To the charge that cameras, whether hidden or otherwise, lower staff moral, should it not be asked, which staff? If nursing staff do their job, and do it with a caring manner, what have they to fear? Your every step along the High Street or shopping mall is recorded, which will trigger a response if  you mug someone. Your right to privacy is being infringed, yes, but the general right of people to be protected from mugging is enhanced. Would some staff, too intimidated to report abuse, welcome the use of cameras that would instantly stop that abuse? Would some staff welcome cameras that showed the good care they gave?

Ethical issues surrounding the use of cameras in nursing facilities have previously been debated, the BBC reporting: ‘The use of hidden cameras in hospitals to spot child abuse by parents is legal and ethical, says a report. The technique was used most controversially at North Staffordshire Hospital where researchers suggested some cot deaths were the result of child abuse. A specialist advisory committee in paediatrics was set up as a result and raised reservations and objections concerning the procedure, which is only used when abuse is suspected. But another study, published in the Archives of Disease in Childhood, the journal of the Royal College of Paediatrics and Child Health (RCPaed), says hidden cameras, monitored by nurses or other health staff, should continue “in the absence of any viable alternative”. The research, conducted by Dr Neela Shabde, one of the doctors on the advisory committee, and Professor Alan Craft, a vice president of the RCPaed, says medical staff have a legal duty under the Children Act 1989 to intervene to protect the best interests of the child (,  September 29, 1999).

If it was deemed that hidden cameras had a role in protecting a child from an abusive parent under the Children Act of 1989, then why do they not have a similar role today in protecting such as the elderly from an abusive or neglectful nurse or nursing assistant?

The whole issue is a contentious one. Who would review camera and audio footage? What  guidelines would be issued that defined abusive or neglectful care? What rights would there be to appeal?

I suggest that the debate about the use of cameras should be extended to include NHS and private hospitals, local authority and private homes for the elderly, and those with learning disabilities. It should also be extended to all those who work in these facilities, nurses, nurse students, and assistants. The debate should not be between committee members, or be dominated by those with the loudest ‘voice’. It should be a debate in which opinions are sought, discussed, and form the basis of action. The following questionnaire is suggested as a means of initiating this process.

Answer yes or no:


Hidden cameras should be used in care facilities.

Patients in care facilities are abused and there should be camera to catch the offenders.

No one should get paid to abuse our older citizens who deserve respect for their contributions to society.

Serious physical abusers should be fired and reported to the police.

Hidden cameras should not be allowed in care facilities.

Elderly patients are humans that have rights to privacy.

It is morally wrong to constantly watch the elderly in care facilities without their prior consent or their knowledge.

Neglectful or disrespectful abusers should be suspended and reported to the NMC.

Do people with cameras on them behave better?

Would cameras show low levels of staffing hindering care?

Should  patients the right to install hidden cameras in their rooms?

Should relatives have the right to install hidden cameras in rooms?

Should relatives have the right to install cameras if a notice of this is displayed on the door?

Should care facility managers have the right to install hidden cameras in rooms?

Should all people have to declare in the National Census if they would like cameras in their care facility rooms?

Should cameras be installed in common areas in care facilities, such as hallways and nursing stations?

Should it be compulsory for nursing staff to report abuse or suspected abuse?

Should there be severe penalties for those who do not?

Have you witnessed nursing staff not giving care, but writing in notes that they had?

Do you think this is a common practice?

If a camera is installed, should it have an audio capability?

Should cameras be mandatory in all areas of care facilities?

Should cameras be mandatory in all areas of care facilities, allowing patients or their relatives to opt out?

Would nursing staff who did their job, and in a caring manner, have anything to fear from cameras?

Would cameras show nursing staff to be hard working and caring?

Would cameras protect ‘good’ staff from more dominant ‘bad’ ones?

Would cameras increase the public’s confidence in nursing?

Lenin nightingale 2014 c



Adcox S (2014) Effort To Allow Cameras in SC Nursing Homes Stalls The Washington Times  20.3

BBC (1999) Experts Back Hidden Abuse Cameras

Brindle D (2011) Abuse At Leading Care Home Leads To Police Inspections At Private Hospitals The Guardian 1.6

Caya C (2014) Hidden Cameras Used To Catch Alleged Nursing Home Neglect 25.4

Hoffman J (2014) Watchful Eye in Nursing Homes New York Times  18.11

Nugent H (2012) Care Home Worker Jailed For Abuse of 89 –Year- Old Caught on Hidden Camera The Guardian 29.8

NursingHomeNews (2010)

Twenty-Two Arrested in Hidden Camera Nursing Home Probe

Staff at two New York nursing homes charged with abuse and neglect

04/01/2010 | ConsumerAffairs

Leung M (2013)  Nursing Home Workers Suspended After Son Turns Over Hidden Camera Video CTVNews

Pelzer (2013) New Legislation Would Guarantee the Right of Nursing home Patients To Set Up Hidden Cameras  29.10

Seniorsatrisk. (2012) Videos Show Nursing Staff Abusing Defenceless Patients

The Guardian (2012) Hidden Footage of Elderly Abuse To Be Shown in BBC Documentary 23.4