Posts Tagged ‘elderly care’

Government announces additional GP funding, with elderly services at ‘the heart of the plan.’

Thursday, April 17th, 2014

The government announcement that 1,000 GP surgeries will start offering appointments in the evenings and weekends is welcome news with the ‘heart of the plan’ offering a personalised service for the elderly.

Over 75,000 elderly patients are set to receive this benefit in a bid to reduce the pressure on already over-stretched A&E departments which saw the number of elderly people taken to hospital double in just five years – a problem Prestige Nursing + Care has recently emphasised. This new system seeks to reduce the number of beds being taken up with over-75s one of the fastest growing age groups of the population. Although critics have argued this should have been put in place years ago its swift implementation will ensure as many people as possible receive the support they need from now on.

Until now, the lack of accessible care at GP level has meant elderly people are forced to either attend A&E early on or wait until the problem intensifies at which point they have no choice but to go into hospital. The new changes could prove invaluable in ensuring people receive early treatment preventing minor ailments from getting worse by shifting care from hospital to home. The benefits of providing support early on, much like home care, can prevent people from going to hospital unnecessarily.

This comes at a time when there will be more than 6 million people aged over 75 by the end of the next decade, and the number of dementia cases is set to increase significantly. It marks a positive step forward but ultimately, more critical to the solution is the reduction of budget cuts that have left councils unable to provide social care where it is most needed. With better allocation home care can work alongside doctors and GPs to eliminate unnecessary hospital trips; reducing costs to the NHS, suffering to those requiring assistance, and allowing people to stay in their homes, comfortably, for longer.

Budget 2014 – implications for funding care

Friday, March 21st, 2014

George Osborne’s Budget announcement on reforms to pensions has huge implications for those approaching retirement yet the impact this will have for funding long term care is also significant.

His changes will increase the flexibility of pensions by easing access, lifting tax restrictions and, in essence, offering improved competition. This could play a significant role in helping people pay for care in future. Individuals will now be able to access their savings should they need to pay for care services, which may otherwise have been tied to a fixed income allowing no access for emergencies or unexpected costs. Up until now in cases such as this, those requiring residential care have been forced to sell their homes to cover the cost but now many will be prevented from having to do this.

However, there are also concerns in some quarters that these reforms could result in people having to pay more towards social care. Currently amounts tied up in pensions or annuities are not included in the means testing to assess how much one has to pay towards care while cash assets and property are. At this stage it is unclear what this could mean for people who elect to withdraw their entire pensions pot as a cash lump sum but the government has denied it will mean having to spend more. It is crucial the government makes clear the potential implications for funding care in order to avoid any confusion later on and to help people plan well in advance.

The Chancellor also announced a government guarantee to provide people with financial guidance upon reaching retirement. Prestige Nursing + Care has stressed the importance of financial advice for funding care in previous blogs so it is great to see the government is encouraging this. It should be used not just to address immediate retirement planning but also longer term suggestions for funding care, an issue that continues to worry people and will only grow in magnitude as the population gets older.

Funding long term care.

Thursday, March 6th, 2014

The issue of receiving financial advice to cover the cost of care is a topic briefly commented on in an earlier blog: it has long been the case that people use financial advisers to help with investments, savings and planning for retirement, yet seem hesitant to use it for funding long term care despite the complexities within this area and the high potential cost. The Government’s Care Bill has called for local authorities to make advice on care more accessible to the public, a positive sign that this issue is being taken note of, however, a recent article in The Daily Telegraph highlights that this is not going far enough at present.

As the issue garners publicity and people grow ever more concerned about how best to prepare for the future, elderly people are being increasingly lured into high-risk strategies in a bid to protect family homes and other assets from care home costs. Costs which, on average, cost twice the average pensioner income resulting in a shortfall of £14,568. These strategies are being displayed in roadshows and seminars that recommend options such as putting assets into trust. However, advisers have stressed that these schemes are costly and may fail to do what they claim with local authorities being able – in many cases- to seize these assets anyway.

Experts have warned that the ‘deliberate deprivation of assets’ i.e. giving away wealth or property to avoid paying for care are being increasingly challenged by local authorities so is not something that should be recommended. Instead, sound financial advice from an independent adviser, well in advance is the best way to act. Specialist-care-fees advisers are not tied to any particular provider and can therefore offer advice on products across the whole market. Furthermore increased education and knowledge is necessary as to the real cost of care, and individuals should not be lulled into a false sense of security due to the promise of a cap on costs. Research from Prestige Nursing + Carefound that the £72,000 cap on care costs puts the real cost at over £134,000 which many people underestimate.

The Care Bill and the challenges it faces

Monday, February 17th, 2014

The advent of the Care Bill is looming closer with high expectations across the board about the results.  Proponents aim to combat the challenge of long-term care funding in a fair and effective manner – preventing people who have saved throughout their entire lives from losing all they have worked so hard for. However, opponents question whether it goes far enough.

So far, the Government has accepted a £72,000 cap on care costs that will come into effect in April 2016. However, Labour estimates put the true cost of a care cap at £150,000 while similar research from Prestige Nursing + Care last year puts the real cost at over £134,000 as accommodation costs are barely covered by the cap despite them representing almost 51% of the cost of residential care.

Despite this, it is still predicted that the implementation of the Care Bill will add to already overstretched Council budgets with Councils receiving far less than is required from the Central Government to cover the additional costs they will incur by guaranteeing costs over a certain level. Estimates show that boroughs in London could each face a shortfall of £500,000 while areas that see caps hits quickly will face the biggest costs with council budgets already significantly stretched, this is something they can ill-afford. The introduction of the Care Bill can be considered a step in the right direction, however, it is clear to see that there are still a number of key questions left unanswered both in terms of how individuals and the government will cover costs.

Budget cuts lead to elderly flooding in A&E

Wednesday, February 12th, 2014

In the past five years, the number of elderly people taken to accident and emergency departments has doubled, with a 93 per cent increase in admissions for patients over 90. The elderly are being taken to hospital for basic infections, falls, or pains – a large proportion of which could be treated quickly and early at home – and in some cases are spending far longer there than they need to.

The National Care Association blames doctors for their reluctance to visit patient homes out of hours and instead patients are left to call an ambulance. MPs, doctors and campaigners alike are all pushing for greater budget to be allocated to GP services in order to increase home visits in a bid to improve support to the elderly and reduce the number ending up in A & E. While this may be a factor to an extent, at the root of this problem is a lack of funding for social care, ultimately limiting the availability of care to the elderly at home, where many minor conditions could be spotted earlier preventing them from requiring hospital treatment, or even a visit from the doctor.

Budget cuts are limiting the amount of people being cared for at home. Previous Prestige Nursing + Care research has seen spending on adult care fall 2.05% in real terms, year on year. It also found that 54% of Councils across the UK have decreased their spending on adult care which has contributed to the recent flooding of elderly people in A & E units across England as seemingly minor aches and ailments are left untreated until immediate hospital care is required. With the right support at home problems can be spotted and treated early on allowing people to stay in their own homes for longer.

Proper funding would not only provide homecare to those who would benefit from it, but also adequate compensation to the caregivers, ensuring quality care to the people who need it, thus eliminating unnecessary hospital trips for patients that put increased pressure on an already struggling NHS, something they can ill afford. With the proper council and government budget allocation, home care can continue to be an invaluable and viable option for the elderly and their families.

A realistic deadline?

Tuesday, June 11th, 2013

Earlier this week Jeremy Hunt addressed the NHS Confederation Conference in Liverpool and took the opportunity to set a deadline to ‘solve’ the A&E crisis that has so dominated the news agenda for the last few weeks.

The Health Secretary told the Conference that he has given NHS officials 10 months to draw up a plan to help those with chronic conditions, currently the heaviest users of the NHS. Mr Hunt told delegates: “We are putting together a strategy focusing on the group of people who if we help, we can also do the most to relieve the pressure on A&E. That is vulnerable older people, the people who are heaviest users of the NHS, people with multiple long-term conditions. We are putting together a vulnerable older people’s plan with three elements, and we would welcome your input to that plan, which we hope to conclude by the autumn and implement from April next year.”

So far so good, and the fact that it coincides with the current review of emergency and urgent care being carried out by Professor Sir Bruce Keogh is helpful in that it shows more joined-up thinking than had previously been the case. It remains to be seen however whether many of the key stakeholders in such a plan will be able  or willing to implement it in the timescale specified. GPs are still furious with Mr Hunt for his suggestion that their 2004 pay settlement and relaxation of out of hours requirements were to blame for much of the crisis affecting A&E departments, whilst Labour has recently broken the fragile cross-party consensus on the Dilnot care cap and argued that cuts to the primary care budgets initiated by the Coalition have effectively triggered the A&E crisis by reducing the community care capacity.

Most commentators would suggest that the travails of the NHS are not solely due to one thing or another, but a combination of many things, including the botched introduction of the 111 service but even more importantly the remorseless ageing of the UK’s population and the proportion of people living longer but in ill-health. 10 months will probably not be enough time to start making real change to the volumes at A&E and when 100 year-old pensioners like Lydia Spilner are left to die from dehydration in our hospitals, you realise that there is still such a long way to go to get even the basis of care right, let alone a complete re-organisation of health and social care integration.

For change to be effective, there has first to be an acceptance that change is needed. Some have argued that the NHS should act more like a business whose customer base has changed, and reconfigure services accordingly. Certainly the traditional models of delivery are starting to break down, and if Mr Hunt can unite the disparate groups that make up our modern health and social care system and somehow get them to agree there is a problem, and that there is a common ownership of the problem, then he will have made significant progress. Plans are all well and good, but to be realistic they need to involve people and there are still too many siren voices opposing this latest initiative. The axiom, ‘Success has many fathers, Failure is an orphan’ was never more true than when looking at healthcare.

Slipping between the cracks

Wednesday, February 6th, 2013

This is a story that anyone with elderly relatives or friends will have read through their hands as they tried to take in the final shocking conclusion to the life of Gloria Foster. The fact that it involves a lady who lived only a few short miles from where I write this and an agency and County Council our company knew has also added a sense of piquancy to the story. The fact that the mid-Staffs NHS report is also due out today certainly marks this as a bad day for those involved in care, but whilst the scandal at the mid-Staffs hospital took place at an almost institutional level, the consequences of a single unintended error at Surrey County Council have had equally tragic consequences.

The case of Gloria Foster is all too familiar.  Originally cared for by an agency named CareFirst24, her care was withdrawn when the said agency was raided and six people arrested on January 15 amid allegations they had been employing illegal immigrants under the identities of former workers. Used by both Sutton Council and Surrey County Council, the agency had its care packages, of which Gloria Foster was one, transferred to other agencies. In theory. Ms Foster had been receiving 4 visits a day from the agency and when the UK Border Control raid took place they did pass over a list of all those being cared for over to the Surrey County Council, who were responsible for the care. But she never received alternative care and was subsequently left alone for 9 days before being found by chance by a district nurse. Starved, dehydrated and covered in bed sores she was admitted to hospital 2 weeks ago but died yesterday.

The inevitable enquiry into this tragedy will focus on both the agency that was using illegal workers and on the procedures employed by Surrey County Council to effectively transfer care across from one provider to another. But what about friends, neighbours, family even? The sad truth is that unless someone is paid to go and care for an elderly person, in some cases there is no other safety net available. A regular pop in visit by a friend or neighbour during those 9 days might have alerted people to the situation a lot earlier, and possibly saved a life. Before everyone starts pointing the finger of blame at the authorities here, and they undoubtedly are partially culpable, we should perhaps also ask if we ourselves have checked on an elderly neighbour or friend recently to make sure they are OK. This sense of community is sometimes sadly lacking and it easy to forget that we will all be old one day. As a friend of Gloria Foster said “She loved music, she had lots of classical music, she played bridge, golf bowls, she conversation and she liked to go to the theatre. She became ill and the quality of her life was not brilliant but she did not deserve to go out like this – in agony with a total feeling of being lost.” There but for the Grace of God…

Courage of their convictions

Tuesday, September 25th, 2012

As he packed his bags following the recent cabinet re-shuffle, former care services minister Paul Burstow found time to lambast the Treasury over it’s perceived lack of support for the Dilnot proposals.

Accusing his coalition contemporaries, and in particular his own leader Nick Clegg and the prime minister, of lacking the political will to see through the changes proposed by Dilnot, Burstow has shone a light into the murkier aspects of inter-departmental bargaining. In the most damning part of his article for the Daily Telegraph Burstow lays the blame for lack of progress firmly at the door of No 11 Downing Street.

“So, why did Labour fail? And why, despite the signs the Prime Minister had changed his mind over the Summer, could the Coalition fail too? Answer: HM Treasury.

The Treasury’s view is simple: kick the can down the road despite our rising elderly population. There’s no sense of urgency. No recognition that left unreformed there is no incentive for families to plan and prepare.”

Pretty strong stuff, but undoubtedly correct. The Treasury responded quickly, with an admonishment that the £1.7BN needed for the Dilnot reforms would have to wait until the deficit was under control. A convenient putdown, but with  the number of people aged over 85 in England projected to double to 2.4 million over the next 20 years, Burstow’s pleas make absolute sense. The long term-reform of the care sector offers the Coalition Government the chance to leave a lasting legacy, rather than just being seen as deficit-cutters and nothing else.

David Cameron hinted as much in the Summer, when he expressed confidence that a cap on costs could be found provided that the money could be found. The fear now is that the Coalition will water down the original proposals by making scheme voluntary in an effort to make it more affordable. But that, as Burstow and his successor Norman Lamb will find, would be the worst of all worlds. For now we wait to see whether this Coalition really does have the courage of its convictions and doesn’t use the parlous state of the UK’s finances as an excuse.

The brink of collapse?

Thursday, September 13th, 2012

The Royal College of Physicians has released a report today that underlines the tension between the number of general and emergency beds available and the increasing healthcare demands of the population, particularly the elderly. Called ‘Hospitals on the Edge’ it highlights that whilst there are fewer general and acute beds now than there were 25 years ago, the last decade alone has seen a 37% increase in emergency admissions.

The RCP report also demonstrates the changing nature of hospital admissions – 65% of all  admissions are from people who are 65 are over, an increasing number of whom are frail or have dementia. Perhaps the most damning section of the report comes when describing the typical experience of an elderly person in a hospital

‘It is not uncommon for patients, particularly older patients, to be moved four or five times during a hospital stay, often with incomplete notes and no formal handover. Older people are at particular risk as they account for 70% of bed days. Research shows that medical and nursing staff often feel that older patients ‘shouldn’t be there’. Being perceived as the ‘wrong patient on the wrong ward’ has been shown to reduce the quality of care, building attitudes of resentment from both medical and nursing staff.’

The RCP is also calling for a re-organisation of care so that patients can rely on care seven days a week, something made very much harder through the European Working Time Directive’s restriction on doctor’s hours. Better access to primary care and a re-design of patient services are also on their wish list, as well as better training for all hospital staff. Whilst the rather eye-catching title of the report has succeeded in raising the profile of all these important issues, the warnings have already been rebuffed by the Government, which argues that the NHS does have enough beds to cope with growing demand.

Throughout this debate the ghost of Mid Staffordshire NHS Trust still looms large, where up to 1,200 mainly elderly people died there due to substandard patient care between 2005 and 2009. If there is to be no repeat of this tragedy then an integrated solution between primary and acute care is needed, with the focus on prevention rather than cure and  less emphasis on the capacity of gleaming new hospitals but on the capacity of the local communities to care for these vulnerable people, as reducing admissions in the first place would solve a great many of the problems the RCP highlights. Only time will tell if these lessons have been learnt

A missed opportunity

Friday, July 13th, 2012

Andrew Lansley’s long-awaited White Paper on social care has proved to be a bitter disappointment for anyone hoping for a definitive funding statement from the Government. So whilst we have aspiration (reviewing the contribution cap at the time of the next spending review in 2014), and some concrete proposals (deferred loans to individuals to help pay for long term care) elsewhere there was precious little to whet the appetite.

Elsewhere the media have been equally damning, with many rightly arguing that there is financial vacuum at the heart of the proposals and that the Treasury strangled any funding initiatives at birth. The central debate remains about who should pay for long-term care – the individual or the State? Mr Lansley seems to have engineered the worst of all worlds intop the proposals, not enough detail to allow the financial and insurance sector to develop long-term savings plans and not enough funding to allow the NHS or Local authorities to extend the eligibility criteria for care.

Looking out at the Social Care landscape this morning one can sense this is a chance lost, and that the Coalition, like their predecessors, have missed a significant opportunity to both clarify and energise the delivery of Social Care in the UK. It may yet take a tragedy like Winterborne View to shake the Government out of its complacency, but until then it is unfortunately business as usual.