Half of care homes failing in parts of England

 Which? investigation of care home inspections data reveals postcode lottery of care home quality across England

 More than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’, according to analysis carried out by Which? of data released by the Care Quality Commission (CQC).

In six local authority areas, good quality care home places are so limited that 50% or more of local beds are in homes rated by CQC inspectors as requiring improvement or inadequate, making it less likely that people looking to move into a care home will able to find a good place close to home. 

The lack of good quality care is particularly acute in the London borough of Westminster, where seven in ten (69%) beds were found in care homes rated poor or inadequate. In Manchester and Wakefield, three in five beds (58%) are in care homes rated as poor or inadequate, closely followed by Kirklees (57%), Portsmouth (56%) and Tameside (55%). With demand for beds set to rise, the time for action is now.

Poor quality care homes

In 45 local authority areas a third or more care places are in poor quality care homes. Nine of these councils are in the capital and include Westminster (69% of beds are in failing homes), Tower Hamlets (48%), Islington (47%), Kensington and Chelsea (46%), Newham (41%), Haringey (41%), Barnet (40%), Ealing (35%) and Harrow (33%). While the research, which compared the quality of local provision in 151 council areas that provide adult social care, provides some worrying figures, there are a small number of areas where at least nine in 10 care home beds are in homes rated as good or outstanding. 

These include the Isles of Scilly (100%), Richmond upon Thames (94%), Rutland (91%) and Blackburn with Darwen (90%). Overall, the analysis highlights the huge regional variation in the provision of quality local care across the country that exists in the current care market.

Care provision ‘could get worse’

Which? has already heard from hundreds of relatives of care home residents, who have highlighted existing problems in the current care system. Some have had to wait years to find a suitable care home or have had to place their relative far away, as there was no suitable place available locally. Which? is warning that this picture could get worse, as the demand for places starts to outstrip supply in an increasing number of local areas.

 

Previous Which? research shows that almost nine in 10 council areas across England could see a shortfall in care home places by 2022. The research also raises questions around whether some councils will be able to continue to meet their statutory duty to offer local authority-funded individuals at least one suitable care home place that will meet the prospective resident’s needs.

SOURCE: Which, Joanna Pearl

Toddlers brighten up the lives of care home residents

In the sunlit front room of Hengrove Lodge residential care home, residents smile with delight as they see how many children are visiting today from the nearby Hengrove branch of Southern Links Children’s Center. 

Two-year-old Lexie-Jay makes a beeline for the home-made play-dough on the coffee table, and everyone becomes absorbed in every move the children make, many waiting in anticipation for a cuddle from their favourites.

Hannah Stopford is a community development worker at Bristol Aging Better, who are running this scheme in partnership with the children’s centre. “We wanted to do more integrational activities in the area,” she explains. “The main aim is to reduce social isolation but it’s also to set up projects that are going to last. We are working with the community to help them run these schemes and we’re also tapping into activities already going on within Bristol.

 “The visits to Hengrove Lodge run on a stay-and-play basis, so the parents bring the children along as they would in the children’s center, and we’ve set up the activities so the residents and children can enjoy them together.”

With many children’s toys brought along to the sessions, as well as art and craft activities, these stay-and-plays sessions last an hour and take place every other Wednesday.

 “Raising awareness of social isolation is key, but these visits are also having a big impact on the elderly who are suffering from dementia,” explains Lil Bowers, centre manager for Southern Links Children’s Centre. Around 850,000 people in the UK live with Alzheimer’s disease – the most common cause of dementia.

Lil says that, following a few visits, the children have started to mean a lot to the residents, who remember more and more about them each time and even ask for them by name. “It’s a real show of community spirit, and having these families visit Hengrove Lodge is vital to the work we do.”

Alex Evans carefully places her eight-month old son Charlie-Jay into the arms 95-year-old resident Dot Whittingham, who coos over him, a picture of happiness. “From the moment Dot’s cuddling Charlie-Jay, she alters,” comments Sue Hodge, deputy manager of Hengrove Lodge. “It’s an indescribable feeling watching one of our oldest residents light up with joy from cradling a child. She just loves to see him and for us that’s a wonderful thing to be a part of.”

As the session draws to a close, Josh Stanford helps his two-year-old son take off his brightly-coloured crocodile suit. “This kind of thing should definitely happen more often,” he says. “It’s a brilliant idea and it makes a lot of sense. I don’t see why this kind of amalgamation couldn’t be developed further across the city. All the residents love it and it’s good all round for everyone involved.”

SOURCE: Bristol247.com, Lily Newton Browne

Are Antipsychotics Used Appropriately for Managing Dementia?

A study reviews data on the indications for use of antipsychotics in elderly patients with dementia across four clinical settings in Canada.

Dementia is a medical condition that affects the brain and causes memory loss. It is more common for older adults. Antipsychotics are a class of medications that are mainly used to manage psychotic disorders, including schizophrenia and bipolar disorder. Symptoms expressed by psychotic disorders include mania, hallucinations, and delusions. The use of antipsychotics is not recommended in managing elderly patients with dementia, in the absence of behavioral or psychotic symptoms. The objective of the study was to evaluate the prevalence of antipsychotic medication use in this patient population.

The retrospective study was published in the journal BMC Geriatrics and included data from eight provinces and one territory in Canada. The researchers obtained their data from four different clinical settings. These include complex continuing care hospitals (CCC), patients in acute care hospitals who no longer required an acute care bed (otherwise known as Alternate Level of Care or ALC), long-term care nursing homes (LTC), and long-stay home care (HC). The researchers included data from adults with dementia, aged 65 years or older, but were unable to determine the name, dose, and duration of use of the antipsychotics administered.

The researchers reviewed behavioral and psychotic symptoms exhibited three days prior to the assessment. They also looked at antipsychotic medication administered seven days before the assessment. Behavioral symptoms reviewed include verbal abuse, physical abuse, social inappropriateness, and resisting care from the caregiver. Psychotic symptoms reviewed include hallucinations and delusions.The results of the analysis show that the use of antipsychotics was most common in elderly patients exhibiting both behavioral and psychotic symptoms. In the absence of behavioral and psychotic symptoms, antipsychotic use was most common in the alternate level of care setting at 32%. The long-term care setting was the second most common at 29%, followed by complex continuing care hospitals (20%) and home care(12%).

It is unclear whether the patients with no behavioral and/or psychotic symptoms had a psychotic disorder diagnosis. A prior diagnosis would explain the need for the medication. While the results of the study indicate the possible over-use of this drug class in elderly patients with dementia, more information is required. The higher prevalence of antipsychotic use in institutions indicates that staff education in managing uncomfortable behavior in elderly patients might be beneficial.

Antipsychotics, as with all other drug classes, should be used only as indicated except when appropriately used for off-label purposes. Elderly patients are more sensitive to medications and it is important to avoid exposing them to the risk of medication side effects when possible.

SOURCE: Medical News Bulletin, Anuolu, Bank-Oni

Dementia ravaged David Cassidy – and its going to devastate the world

David Cassidy, a teen idol from the 1970s and one of the stars of the hit television show the “Partridge Family,” died Tuesday, after suffering from a disease expected to afflict over 100 million people in the next three decades: dementia.

The 67-year-old performer, who died from organ failure in a hospital surrounded by family and friends, first revealed he had dementia earlier this year after falling on stage and forgetting the lyrics mid-performance. Some critics incorrectly assumed he was intoxicated. Soon after, he retired. His mother and his grandfather had dementia, and he said during an interview with Dr. Phil earlier this year, “A part of me always knew this was coming.”

Dementia is a neurological illness that affects the mind and memory, and it can affect a person’s ability to perform everyday tasks. There are numerous types of dementia, including Alzheimer’s disease, Parkinson’s disease and Huntington’s disease, according to the Alzheimer’s Association.

More than 47 million people worldwide have dementia, with about 10 million new cases every year. The number of people with dementia is expected to rise to 75 million in 2030 and 132 million by 2050, according to the World Health Organization.

It’s also expensive — it costs $215 billion a year to care for dementia patients, according to the National Institute on Aging, more than double what it costs overall to care for patients with heart disease and almost three times as much for patients with cancer.

People normally don’t detect dementia until years after the disease has developed, but researchers are working on diagnosing it earlier, said Luigi Ferrucci, scientific director of the National Institute of Aging. Although it appears more prevalent in older people, there is a rise of early-onset dementia among those younger than 65, according to research by Bournemouth University.

Some theories behind the rise in dementia cases, aside from the more obvious knock-on effects of an ageing population, include air pollution and the growth of insecticides. Additionally, people who have dementia end up living longer now, Ferrucci said, and some form of dementia is more likely to show the longer people live.

Telltale early signs of dementia include forgetfulness, losing track of time and becoming lost in familiar places, according to the World Health Organization. As the disease progresses, the patient will also become forgetful of recent events and people’s names, and eventually need help with personal care. The late stage of dementia means the patient is completely unaware of the time and place, does not recognize relatives and friends and has trouble walking.

There’s good news: More than a third of dementia cases may be preventable, by controlling nine lifestyle factors, which include not smoking, lowering high blood pressure, maintaining a healthy weight and managing midlife hearing loss, according to a report presented at the Alzheimer’s Association International Conference last summer.

Brain exercises haven’t been proven as successful, but learning new skills has, as well as following a Mediterranean diet which could prevent or even slow down dementia, particularly Alzheimer’s disease, said Kim Gerecke, director of the neuroscience program at Rhodes College in Memphis. Practicing two and a half hours of moderate exercise per week also helps, according to the Centers for Disease Control and Prevention.

SOURCE: New York Post, Alessandra Malito

The truth about who really picks up the tab for care home provision

Your article (Soaring care home costs mean you now pay £34,000 a year, 18 November) fails to give an accurate account of the financial obligations of self-funders. This happens all too often across the media. 

Local authorities do not “pick up the tab” when a person’s assets fall to £23,250. In fact, LAs continue to take £1 per £250 on a sliding scale until a person’s assets reach £14,250. At this point a care home resident is allowed to hold on to the remaining sum. However, their contributions do not end there as a council will claw back any pensions, state or private, while also expecting families to pay top-up fees. 

My mother has severe dementia and has been in a nursing home for over four years and has paid over £250,000, having been compelled to sell her two-bedroom flat and use her savings.

One of the major problems is the privatisation of care homes as there is no limit to what they can charge a self-funder when demand is so high. This inevitably means that a person’s resources diminish quickly and then the LA has to step in.

 A few years ago I became aware of newspaper advertisements around the world encouraginge people to invest in UK care homes as they’d be assured of a 8% return on their stake. 

Yes, there is a compelling need for a concrete plan on the future of social care, but it must re-examine the whole structure on which provision is founded. Our elderly must not be treated as mere commodities but with the dignity and fairness they deserve.

SOURCE:The Guardian, Diane Wall

Care homes to take in lonely, older people for free over Christmas

While the Christmas build-up is a time of excitement for many, for the thousands of older people living alone, it signals a countdown to the time of year when feelings of isolation and anxiety can be at their greatest.

As part of its annual Companionship at Christmas campaign, care homes belonging to Abbeyfield Society will open their doors for six weeks to provide overnight stays, meals and entertainment for people affected by loneliness, completely free of charge.

With an estimated 500,000 older people expected to spend Christmas alone, Abbeyfield chief executive, David McCullough, said: “The Christmas build up resonates with excitement and celebration for many of us, yet it’s a time when older people can feel at their most isolated and alone. Their usual clubs or activities close down for Christmas, relatives are dotted across the UK far away from them and feelings of bereavement for lost loved ones is amplified at a time when families traditionally come together.

“Abbeyfield was founded over 60 years ago in response to the crippling loneliness endured by a forgotten generation of older people. That ethos continues today with campaigns such as Companionship at Christmas as Abbeyfield continues to enrich the lives of older people and make their later years happy, easy and more fulfilled.”

Now in its eighth year, Companionship at Christmas has offered a lifeline of warmth and friendship to thousands of older people at Christmas, such as 83-year-old Ron Hoverd, who lives on the Isle of Wight.

The former RAF corporal and his wife, Mary, were inseparable during their 45-years of marriage but her death left him devastated and struggling to cope.

Ron said: “I couldn’t have had a better woman which made losing her so difficult. I watched her die, which was heart-breaking. After the funeral I reached rock bottom and was struggling to get by. I was so lonely. Everything was so quiet.”

For Ron, who has no immediate family, Christmas was one of the most difficult times. “There’s nothing worse than being on your own at Christmas,” he said. “You know you’re supposed to be enjoying yourself, but you’re sat there by yourself, wishing the day would end.”

Age UK put Ron in touch with his local Abbeyfield House in Cowes, where staff invited him to join them for Christmas Day lunch, and since then, he has become a regular at Abbeyfield Clifton House.

“It’s a lifesaver from my point of view,” he said. “It means so much having Abbeyfield there.”

Abbeyfield patron Aled Jones will be bringing Christmas cheer to the charity’s Victoria House in South West London on 27 November, where he will be supporting the campaign with a Christmas singalong for residents. The popular singer and presenter will also be helping to carve the turkey at a Christmas lunch on 28 November at The Kingslodge Inn, County Durham.

He said: “I’m very much looking forward to sharing an early Christmas with Abbeyfield residents and getting into the Christmas spirit! Christmas is a time of love and sharing and no one should be alone at Christmas.”

SOURCE: carehome.co.uk, Melissa McAlees

Specialist care home deemed inadequate in damning report after inspectors visit five times in three months

A specialist dementia care home has been deemed inadequate in a damning report after a series of inspections.

Inspectors from the care watchdog the Care Quality Commission visited the home five times in the past three months.

A report from the CQC deemed Allison House, part of Cleveland Alzheimer’s Residential Care Limited, to be inadequate or to require improvement in all areas of assessment.

The single story, purpose-built home on Fudan Way, Thornaby , has the capacity to care for up to 38 people living with dementia.

Concerns were raised about:

• Infection control procedures in the home

• “Areas of malodour” being present, furniture was worn and carpets frayed

• repairs “not always undertaken in a timely manner”, with some remedial work taking up to five months

• a bathroom window with no restrictor being able to be “opened wide enough to climb through”

• residents at risk of malnutrition as their weight was not being accurately monitored

• “inadequate signage” and “poor use of colour”, meaning people with dementia were unable to navigate their way around the home independently.

• the dining experience being in need of improvement, as people were seated at dining tables for up to half an hour before receiving their meal.

Despite staff assuring inspectors mealtimes were to become staggered to combat the problem, this had not been put into place effectively.

Allison House was given an overall rating of ‘inadequate’ and has been placed into ‘special measures’ by the CQC.

Services in special measures will be kept under review and inspected again within six months, where “significant improvements” should be made.

A statement released by the home highlighted good work at the home including how staff are “caring and kind”.

It read: “The safety, well-being and happiness of those entrusted to our care is always our top priority.

“As a charitable provider of specialist dementia care for more than 25 years, Cleveland Alzheimer’s is absolutely committed to providing the best possible service we can. “We would like to reassure residents and their families that the matters raised in the CQC report are being urgently addressed through a robust, far-reaching and thorough action plan and wherever possible, have been rectified immediately. “An on-going programme of replacement for furniture, flooring and equipment is underway.

“The report acknowledges that people and their relatives are happy with the care provided at Allison House and that staff are caring and kind.

“We thank the CQC for highlighting this and other positives around the quality of care provided at the home.

SOURCE: Gazettelive, Bethany Lodge

Aging for Amateurs: Hearing loss tied to dementia

Earlier this year, a group of international experts on dementia commissioned by The Lancet, a British medical journal, to study “dementia prevention, intervention and care,” reported their findings.

Part of the report took a fresh look at risk factors for dementia and found that more than a third of our risk is likely modifiable. That is, we can do something about it, as opposed to risk controlled by genetics. Most of the modifiable risk factors have been discussed in previous columns (increasing formal education, controlling high blood pressure and diabetes, exercising regularly, avoiding obesity and smoking, treating depression adequately and being socially engaged). But the single strongest potentially modifiable risk factor in their research was a surprise to me and many others — hearing loss.

According to their calculations, 35 percent of dementia can be blamed on the nine risk factors listed above. Among those factors, more than one-fourth is linked to hearing loss. 

Why does hearing loss make dementia more likely? The mechanism for creating problems with thinking due to decreased hearing is “not yet clear," according to the authors of the report, but is probably related to adding to the “cognitive load” of a vulnerable brain. If you don’t hear well, it makes the brain work harder to try to interpret what is going on around it, increasing levels of background stress in many minute-by-minute interactions. In addition, not hearing well may lead to increased risk of social disengagement and even depression.

Certain subgroups seem more likely to develop poor hearing. Men are twice as likely as women to have hearing impairment. Years in school also seem to matter, less education is associated with hearing loss. However, noise on the job (previously associated with lower education levels in workers) didn’t seem to matter, even though very loud noise can damage hearing.

People are exposed to less noise at work than they were 30-50 years ago due to changes in regulations regarding noise on the job and an increase in white collar positions. Obesity also increases the risk for hearing loss, as does smoking and poorly controlled diabetes (but the high level of risk for dementia due to hearing loss is present even without these “co-factors”).

What can we do to protect our hearing? First, avoid very loud noises. Prolonged exposure to any noise over 85 decibels (dB), such as heavy city traffic, a busy school cafeteria or a lawn mower, can cause gradual hearing loss.

No more than 15 minutes of unprotected exposure to noise above 100dB (wood shop, snowmobile, maximum volume level of a personal listening device) is recommended.

Remember that few types of headphones shut out all or even most ambient noise, so listening to music on your iPhone or other device while mowing the lawn creates additive noise levels. Regular exposure to more than a minute of 110dB noise risks permanent hearing loss (rock concerts, ambulance sirens, jet take-offs, fireworks at close range , shotgun blasts, etc.)

If your ears ring after a noise exposure, this suggests that a least a tiny bit of permanent damage has been done to your hearing. 

What about dietary supplements? We have said before that a wide variety of fruits and vegetables (filling half our plates when we eat) is better than a load of supplements. Research suggests that folate, beta-carotene and other carotenoids, and omega-3 fats are some of the likely protective components, but there are likely many more in that half plate of fruits and vegetables. The healthy fats in a couple of servings of fish per week are also likely to help us hear better.

What about hearing aides? We don’t have research to support their use to decrease risk of dementia yet.

But we do know that effective aides can improve social interactions and make interpersonal relationships less stressful. If you are over 50 and haven’t had your hearing tested, it is probably a good idea (at your primary doctor’s office; ear, nose and throat specialist, or independent audiologist). If you prefer, another low cost screening called the National Hearing Test requires only a land line telephone and a quiet room in your home.

SOURCE: The Post and Courier, Lauren Sausser

Action needed over 'inconsistent dementia training' for students

Student nurses and other trainee healthcare professionals are failing to be taught about dementia care to the same standard due to inconsistent approaches by regulators, academics working in the field have claimed.

The Higher Education Dementia Network, which represents lecturers at 65 UK universities, said nationally agreed dementia training frameworks already existed but were not being used by regulators.

“Professional bodies have a clear role to play in ensuring the health…workforce are meeting the needs of those affected by dementia”

The group said this meant there was likely to be a wide variation in the amount of dementia training healthcare students received at university.

This risked parts of the health and care workforce having different levels of knowledge, skills, competencies and attitudes towards caring for people with dementia, the academics warned.

The Nursing and Midwifery Council’s current training standards do not explicitly require universities to teach students about dementia, although they do refer to working with people with cognitive impairment, said the group.

While new education standards being developed by the NMC do refer to dementia care, there is still no mention of meeting standards set out in nationally agreed skills frameworks, the group said in a position paper published on Tuesday.

The lecturers called for the Nursing and Midwifery Council and other regulators to require universities to adopt the existing training frameworks.

“The existing dementia knowledge and skills frameworks from across the four home nations of the UK have been developed by expert panels”

They said universities in England should be required to use the Dementia Skills and Knowledge Education and Training Framework drawn up in 2015 by Health Education England, Skills for Health and Skills for Care.

In other parts of the UK, the Promoting Excellence Framework in Scotland, Good Work Framework in Wales, and the Dementia Learning and Development Framework in Northern Ireland should be included within the NMC and other regulator’s requirements for university education, they added.

“The existing dementia knowledge and skills frameworks from across the four home nations of the UK have been developed by expert panels including people affected by dementia, health and social care providers or their representatives, governmental bodies and education providers,” said the position paper, released to coincide with the UK Dementia Congress in Doncaster this week.

“In developing our new standards, we engaged with a wide range of stakeholders including dementia charities and we’ve had an excellent response”

Claire Surr, a member of the Higher Education Dementia Network and professor at Leeds Beckett University, said: “Professional bodies have a clear role to play in ensuring the health, social care and housing workforce are meeting the needs of those affected by dementia.

“We would like to see national knowledge and skills frameworks established as a required and monitored sector minimum standard. We recommend that application of the frameworks become a requirement for (re)validation of health, social care and housing pre-qualifying education.”

A spokesman for the NMC said it was vital that nurses were equipped with skills to care for people with a range of complex healthcare needs, including dementia, especially in light of the ageing population.

”That’s why we’ve recently consulted on draft education standards which will enable nurses to deliver the highest standards of care to people with cognitive healthcare needs,” he said.

“In developing our new standards, we engaged with a wide range of stakeholders including dementia charities and we’ve had an excellent response to our consultation. We’ll take this feedback into account as we finalise our standards,” he added.

SOURCE: nursingtimes.net, Nicola Merrifield

Derry health workers receive ‘virtual’ dementia training

Health staff in Derry have taken part in an innovative new training programme aimed at allowing them to understand what people dementia experience every day.

180 Western Health and Social Care Trust (Western Trust) staff began the Virtual Dementia Training on Monday, which is being hosted at both the Waterside Hospital and Seymour Gardens Residential Home.

The aim of the training is to act as ‘a window into their world’ of people with dementia, and gain first-hand experience of the physical challenges and sensory loss that can deteriorate when living with the disease.

To achieve this, the staff were provided with headphones, glasses, shoe insoles and gloves to limit the sensory input people with dementia experience.

Those taking part were then placed into a darkened room whilst talking and movement continued around them, in order to provide participants with an insight into how to approach and interact with those living with dementia.

It was also aimed at giving staff a greater understanding of why people with dementia sometimes exhibit particular and potentially upsetting behaviours.

Commenting, Dr Bob Brown, Director of Primary Care and Older People at the Western Trust said that the training would help ‘enhance’ the care they provide for patients with dementia.

“We were delighted to be able to offer this Virtual Dementia Training to our staff,” he said.

“It is a way of helping staff to experience at first hand the physical and mental challenges facing those with dementia.

Dr Brown continued: “It helps staff understand what people with dementia experience every day and will ultimately further enhance the quality of care we provide for people living with dementia and their carers.”

The Mayor of Derry City and Strabane District Council, Maolíosa McHugh added: “The Council is very supportive of the work the Trust is doing in relation to providing training to its staff that will assist them in gaining a better understanding of the issues facing those with dementia.

“This type of training is a really positive step towards creating better awareness of dementia and giving people the tools to deal with it in their day to day work.”

SOURCE: derrynow.com, Alan Healy

'Dishy' Harry Styles visits care home to play bingo

Harry Styles, the former One Direction singer, chaired a game of bingo at a Warrington care home yesterday, and while there seemed to be initial confusion as to who he was, he won the residents over along the way.

As part of a BBC special with pal Nick Grimshaw, the 23-year-old spent half-a-day at St Oswald's House, and made quite an impression on the residents, with one lady saying “I thought he was rather dishy” and another commenting, “that lad made a big difference to me today.”

Ria Percival, home manager, said: "It was a bit chaotic, but it was a great experience for all the residents and staff that took part. They thoroughly enjoyed the day and Harry and Nick's company.”

As Harry walked into the room to an introduction from the home’s activities co-ordinator, he was met with a loud ‘Who are you?’ He then showcased the bingo prizes, which ranged from handkerchiefs to boxes of chocolates, and a copy of his debut album.

A spokeswoman from the home added: “The residents and team from brighterkind’s St Oswalds House Care Home in Warrington had a wonderful afternoon playing bingo and doing armchair exercise with Harry and Nick. The residents described them both as ‘very nice boys’ and hadn’t a clue who they were. It just goes to show that it’s nice to be important but more important to be nice!

 “Our residents were keen to be involved and thoroughly enjoyed watching the programme when it aired on 2 November. The residents and team organised an ‘Oscar’ evening to watch and celebrate their part in the programme. They went to bed smiling and giggling after seeing the piece about St Oswalds.”

‘Harry Styles At The BBC’ is a one-off special that shows the star performing a number of tracks from his debut self-titled solo album.

In addition to performing, Harry also sits down with host Nick Grimshaw and talks about his career and life to date, being a solo artist and the start of his acting career. The hour-long show aired on BBC One on 2 November.

SOURCE: carehome.co.uk, Melissa McAlees