Since the first edition of this book was published there have been considerable changes in continuing care. NHS nursing homes have been created, enthusiasts have developed new initiatives, and attempts have been made to improve attitudes. The recent White Paper on Community Care is likely to accelerate the transfer of large numbers of elderly patients from long-stay hospital beds to private-sector accommodation: a move often accompanied by much anxiety about standards of care. Although Health Authorities visit private nursing homes and apply the National Association of Health Authorities' standards to them, anxieties continue. Unfortunately for the patients who remain in hospital, many Health Authorities seem reluctant to apply these same standards to their own long-stay departments, since many would fail abysmally. The 1987 annual report of the Health Advisory Service (see Chapter 3) presents a damning indictment of the care given to old people: A recent review of twelve consecutive HAS Reports on services for older people in hospitals shows that long-stay wards consistently offered environments which were unable to offer privacy, homely surroundings, personal space and possessions or adequate furniture. In the twelve districts there was not one comprehensive personalised clothing service. Half of the reports commented on the lack of effec tive management of continence. Catering was often provided according to the needs of the institution rather than those of the resident patients.
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