Social care for older people: Home truths

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Part of The sustainability of social care services

This report, published jointly with the Nuffield Trust, looks at the current state of social care services for older people in England, through a combination of national data and interviews with local authorities, NHS and private providers, Healthwatch and other groups. It considers the impact of cuts in local authority spending on social care providers and on older people, their families and carers. Alongside this work, we were commissioned by the Richmond Group of Charities to interview older people about their experiences of social care.

The picture that emerges is of social care providers under pressure, struggling to retain staff, maintain quality and stay in business; local authorities making unenviable choices about where to make reductions; a complex set of causes of delays in discharging older people from hospital; and the voluntary sector keeping services going even when funding was curtailed.

Key findings

  • Social care for older people is under massive pressure; increasing numbers of people are not receiving the help they need, which in turn puts a strain on carers.
  • Access to care depends increasingly on what people can afford – and where they live – rather than on what they need.
  • Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care The Care Act 2014 has created new demands and expectations but funding has not kept pace. Local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties.

Policy implications

Based on the evidence in the report, the authors recommend that policy-makers need to address three major challenges in shaping the development of social care over the next five years, focusing on how to:

  • achieve more with fewer resources – for example, through better commissioning and integrated care – recognising that these initiatives will not be enough to close the funding gap
  • establish a more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and families
  • reform the long-term funding of social care because reliance on additional private funding is unlikely to be sufficient or equitable.

Comments

BRIAN GUMBLEY

Position
Director,
Organisation
MATM cic MH RECOVERY ORG
Comment date
20 September 2016
Can I stress to all -a home truth ------ fact that a lot of older folk have paid a lot of there hard earned income over the years into the health service believing that in older age they would be secure in the knowledge that there health care would be provided for by the state it seems they have been led up the garden path -----------today's earners and those on exceptional good retirement pensions should have no choice and more empathy with those who have done the lower paid jobs and pay extra into the tax system from now ---for the better off to say it doe's not effect them because they have the private sectre to care for them are kidding themselves and selfish ---even that group of people should be more understanding and caring for those less fortunate after all even the rich very often need the emergency services to help them at some time in there lives

BRIAN GUMBLEY

Position
Director,
Organisation
MATM cic MH RECOVERY ORG
Comment date
20 September 2016
in answer to Moira's letter which is correct and the needs of the disabled should be dealt with now ---because if we don't as a nation look after this group regarding there care ---we will all only bring more problems down the years with carers breaking down through anxiety and stress

Sue Hester

Position
Retired RGN,
Comment date
02 November 2016
I am a retired RGN aged 65with a husband aged68 unfortunate enough to have Parkinsons Disease. We have no children so are making informed choices now regarding our care for the future.
Whilst I agree totally that social care is in crisis I find it alarming that most of our friends and acquaintances think they will breeze through old age with the state or their family to look after them .
. Having all 4 of our parents spend their last years in a home (where my mother was the the subject of a care safety order ) we are determined this will not be our fate.
To end up with £23000 from the sale of their properties after paying to be the subject of a care safety order is scandalous.
Spending your final days apart because your loved one is too far away to visit is scandalous.
Living in one room the size of a shoebox with no en suite at £900 a week is scandalous
There is an alternative but unfortunately only available to the well off.
Retirement villages.
Home ownership with facilities available for help as needed ;nursing home facilities onsite so that loved ones can be visited every day especially at mealtimes so meals can be taken together.
Consistency in care with regular staff on site not 10-15 min visits by a different person every visit.
If there is going to be 6 million elderly by 2030 we need to be encouraging people to make their own informed choices to provide for their care in their old age.
Whilst there continues to be a limited choice in retirement properties ,most people will want to remain in their family homes.
Decent affordable retirement villages need to be incorporated in town planning,to encourage people to downsize.
Financially it makes sense.
Economically it makes sense.
It works in the USA,New Zealand ,so why not here.

Julie ellis

Position
Community carer,
Organisation
Caring forever
Comment date
21 November 2016
Being a home carer I can see this happening. As we are not allowed to do half the things we use to do when visiting a client. We are supposed to stick to our times. We'll sorry it doesn't happen with me being old school. So I can garentee by the end of my shift I will be over about an hour or so which I do not get paid for . The other point is yes I have now reached 60 and all through my working life (since age 15 ) I was told my ni contribution would look after me in my old age. We'll here I am told I got to work till I 67. Not being horrible but I could be dead by then. If I am still going I dread to think what the caring system will be like in another 10 years.

Tom McEwen

Position
Palliative care doctor,
Organisation
Local hospice
Comment date
10 January 2017
Because of a shortage of carers we cannot get patients looked after in their homes although funding is allocated to them. This is due to poor pay and a shortage of personnel, now worsened by the effects of Brexit. Care homes are also closing as funding is inadequate to pay staff wages and red tape has raised overheads. Patients in hospital are in the same "bed-blocking" quandary. This causes crises at the admission stage.

Shuaiba Ahammed

Position
CEO,
Organisation
http://www.yourcareandsupport.co.uk/
Comment date
26 August 2017
I agree with your opinion. The article is very helpful.

Irene N Hardie

Position
Volunteer, adult mental health auditor,,
Organisation
CRCC Rethink/Mind
Comment date
05 September 2017
I have been doing independent hospital visiting for CRCC, but funds finished last October. Rethink is now only funded on a yearly basis : we had to form an independent group because we thought that the paid workers had to leave in February. Their contract was renewed for 1 year but the room had to be changed to a smaller one for economic reasons & may close next February. It is disgusting as all people, old or young have an uncertain service & virtually no support at all.

Linda Jane McLean

Position
Coordinator,
Organisation
Arac (Charity)
Comment date
06 February 2018

It is interesting that the "shortage of carers" is cited so frequently. All it takes is slightly different thinking. My local Social Work Department was surprised when I told them I was not looking for carers to support my mother to live at home. I was looking for Personal Assistants. Carers are task orientated, and will only do certain things. Quality of life can only be gained through personal assistance, where empathy is hooked, and you become a part of the individual's life.

Linda Lawrence…

Position
HE Lecturer,
Comment date
19 March 2018

I agree with the last comment on the need to value those working in social care and to place a higher priority on caring for the vulnerable people in our society. I notice the policy implications include intention to place primary responsibility for funding with individuals and families. This is simply not fair or equitable that care will depend on how much money someone has to buy a service. Are we living in the USA with mainly privatised health and social care services? How long will it be before this is suggested for the NHS?

Pearl Baker

Position
Carer/Independent Mental Health Advocate and Adviser,
Organisation
Independent
Comment date
26 September 2018

I really find it difficult to start my response: firstly we all pay National Insurance, based on our earning, those not in employment have their State Pension protected, however their are many 'working poor' who cannot survive' without visiting 'food banks' and 'handouts' from friends and family: to actually have a further 'compulsory' deduction from your already low wage, will have serious consequences. The United Nations are to Investigate the Increase in Poverty in the UK in November 2018, we should be ashamed.

I have recently attended a FOCUS group regarding CHC, commissioned by the NHS England, where this 'fits into this latest idea' is NOT clear.

Dementia is a HEALTH issue so where is the CHC.

It is clear' Care' needs to be provided closer to the COMMUNITY, smaller units, where family and friends could be part of their caring process (if they choose).

'ICS' should receive Government funding to allow the COMMISSIONING of these NEW smaller Residential/Nursing/Care UNITS, closer to the COMMUNITY. This should be included in ICS discussions re: 'integration'.

The LA should take over the STAFF recruitment and management of these HOMES.

There are many individuals who can't wait to help others for FREE.

The idea that these Nursing Homes are actually providing 'value' for money is a 'myth' £1495 a WEEK for sitting in a CHAIR with twenty other residents with the TV on is a disgrace, 'hard earned' SAVINGS gone in a 'wink'.

The current system is open to 'abuse' Financially and 'Physically' extra COMPULSORY payments by those left with hardly anything left to live on will have 'dire' consequences. Depression, Suicides will increase, and their younger family members will be the next generation to access the Mental Health System.

My idea is the only 'viable' one, it creates a better 'environment' closer access for family and friends (who can be included in the caring programme) lets be realistic, many CARERS and Friends visit as often as possible, why are they paying a Nursing Home £1495 a week, when they are there for hours, but 'charged' for the 'privilege'!

Residential Care is a BUSINESS and nothing more, STOP the 'GRAVY TRAIN' and bring it back 'in house'.

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