Posts Tagged ‘elderly care’

Social care reform for an ageing Britain

Friday, October 24th, 2014

People are living longer in Britain but little has been done to address how out of touch health and social care is with the needs of an ageing population.

Our current health and social care systems are not designed to satisfy the demands of an ageing Britain, as highlighted by this recent Guardian article. Britain’s welfare state was built during an era in which 48% of people died before the age of 65, which is clearly no longer the case. But it has failed to adapt its treatment of the elderly for an era in which over 80s are the fastest growing section of society, and radical action is called for. With ever more people living well into their late seventies and eighties, care requirements and costs have become far more pronounced – yet little has been done to alleviate the strain that this places upon services and families.

A recent study by Newcastle University showed that the average 80-something has four or five ailments requiring attention. This makes the present system in which GP clinics are designed to deal quickly with a mass of single-issue patients seem redundant, and suggests an alternative approach is needed. Just as important to structural reform, however, is an adjustment in society’s attitude to the elderly.

This societal lack of regard for the needs of the elderly is also apparent in matters of social care. It is vital that more is done to counter society’s attitude towards the elderly. Recently – as highlighted by this Prestige Nursing + Care blog – there have been suggestions that care home inspectors apply a ‘mum test’ and this sort of attitude could be encouraged throughout the sector. By treating the elderly more as individuals rather than a collective we should start to target some of negative sentiments or impressions of being a burden.

The largest concerns about how the care sector and NHS will continue to function come down to cost and lack of resources. An immediate way to counter this is by moving services into the community. For example, domiciliary care can provide an effective alternative. Not only can it significantly save money and increase available space and resources in hospitals, but it also offers a much more personable approach to those seeking care, therefore tackling costs, resources and attitudes. Understanding the needs of this ever-growing elderly demographic, and adjusting health and social care to tackle the challenges head on, is clearly necessary and will be beneficial for everyone.

New system of inspection to tackle failing care and lack of respect for elderly

Friday, October 3rd, 2014

The issue of standards in the provision of care and the role of the Care Quality Commission (CQC) has featured in a number of Prestige Nursing + Care’s blogs. Recent changes in the organisation have led to the Commission’s proposals of a new direction and system of regulation in order to counter past failings. The overhaul of how the quality of care is measured in the UK also aims to guarantee a certain level of protection for those receiving care and ensure that these failings do not happen again.

We fully welcome the admission from the CQC that the quality of care provided to the elderly – both in care homes and in their own homes –has not always been acceptable under its stewardship. In previous blogs we explored the inconsistency of standards across the UK and the need for this to improve.  The past two years alone have seen an increase in the number of complaints made by the public about social care provision increase by 46%, which is indicative of a growing disillusionment with the standards of care. Those receiving care should not be made to feel vulnerable, neglected or abused by those who should be helping them – especially in their own homes.

Attitudes within society towards the elderly are also critical – as demonstrated by this piece in The Telegraph – and the introduction of a ‘mum’ test to ensure better treatment of elderly patients may go some way to improving services. Furthermore, an OFSTED-style ratings system, where every provider of home care is ranked from outstanding to inadequate not only chastises the bad in the eyes of the public but also promotes those that provide excellent levels of care. Services deemed to be providing unsatisfactory levels of care will be given the chance to improve but those that fail to do so will be stopped or shut, with management held accountable and unable to work in the sector again. There will also be greater encouragement of feedback from patients and families as a way to add a further check on the system, which can sometimes appear poorly monitored.

While these reforms are clearly a step in the right direction, it is important that they are implemented effectively and efficiently by the Commission. In the past, multiple layers of bureaucracy have often stifled change and can lead to reforms being carried out inconsistently across the country. Consistent standards need to be at the heart of the issue so that any failing provider of care is penalised swiftly rather than allowed to continue providing sub-standard care unchallenged to the most vulnerable. These promises are therefore an encouraging start, but it would be premature to celebrate too much before they have been successfully implemented.

Council cuts making social care unsustainable

Thursday, September 18th, 2014

An article from the BBC recently brought to light the fact that 89% of councils now only offer care services to adults with needs classed as substantial or critical. The research from the Association of Directors of Adult Social Services (ADASS) shows that this figure has increased from 72% since 2010-11, neglecting those whose needs are deemed low to moderate.  As a result, thousands of people are struggling along without help

It is clear that the system has been affected by cuts that have ravaged social care budgets across the UK. ADASS estimates that over the past three years more than £3.5 billion has been wiped from social care spending, reducing the amount of care councils are able to offer to vulnerable individuals. While the government claims to have provided local councils with an extra £1.1 billion to help with the cost of social care, the fact remains that this figure alone does not make up the shortfall left in social care budgets by such hefty cutbacks.

As a result of these cuts many councils have had to make drastic changes to their social care budgets. Gloucestershire  County Council, for example, has recently announced its need to make an additional saving of £75 million on top of the £114 million savings it has made since 2011. Derbyshire County Council has also recently announced that it intends to cut its social care budget by £11 million this year alone, by raising its threshold for those who qualify for care and introducing means testing.

Ultimately these cuts will have the biggest impact on vulnerable individuals whose needs aren’t deemed serious enough to warrant council-funded care. Not only can this lead to financial trouble for those in need of care as costs continue to increase, but it can also lead to vulnerable individuals having their support taken away.

A previous Prestige blog examined the impact that council cuts have had on the number of elderly receiving care at home who are forced instead to attend A&E. It is clear that council cuts are damaging to the individuals who require assistance, place added pressure on GPs and A&E – who are ill-equipped to handle this – and ultimately end up costing more as those who fail to receive support at home have no choice but to go into residential care. Providing more funding for support at home would act as a preventative measure, postponing the time when permanent care is required.

Falling confidence in the care sector

Wednesday, September 3rd, 2014

A recent article from The Telegraph highlights growing concern in the care industry as only one in four voters believe they will receive proper care in their old age. New research involving 75 charities and voluntary organisations concludes that the care crisis could prove a decisive issue in next year’s general election, with the issue coming only second in priority to health.

It is interesting that old age care has become a top priority for voters and the public after what feels like many years of apathy. The issue has undoubtedly been brought to the forefront of people’s minds following devastating reports and investigations from the likes of Panorama into care home abuses. Combined with years of council cuts – 26% off care budgets in just four years – and tightened restrictions on those who qualify for care, this has left many unsupported and excluded, signalling the need for drastic reform and extra funding.

Previous Prestige blogs have examined various ways to address challenges facing the care sector, ranging from more robust monitoring and tougher inspections from trade bodies, improving the image and pay of nurses to increase retention and counter the growing nursing shortage while also considering the role those typically outside the sphere can play. An article in the Guardian inspired another Prestige blog which looked into the way that communities could help reduce loneliness and provide basic level support.

Community support is one way in which residential care can be postponed by providing basic needs early on. Another is home care. This offers a cheaper alternative to residential care – for which the average basic annual cost across the UK is now approaching £29,000 – while also allowing individuals to remain in the comfort of their own homes for longer. In doing so, it still provides an element of support and comfort, delaying the need for permanent care.

The recent overhaul of the care system – allowing people to defer paying care bills to avoid having to sell their homes and the introduction of the care cap – may be a case of too little, too late. Already senior care chiefs are warning that they may lack the ability to guarantee the safety of those in their care because of the financial squeeze. It is clear that more needs to be done, and quickly, to address the growing concerns and lack of confidence in the sector.

Care workers are underpaid and undervalued

Friday, August 29th, 2014

An article in The Guardian recently highlighted the lack of recognition offered to care workers for their commitment to caring for the elderly and unwell. Workers support care home residents in a multitude of ways, from helping with day to day basics right through to round the clock care, yet seldom get the recognition they deserve for their tireless work. Recent stories of neglect and abuse in nursing homes have dominated the headlines – as they rightly should – but the thousands of top quality care workers who have devoted their lives to helping the most vulnerable get little to no recognition.

Being a care worker is a physically and mentally draining job yet there is distinct lack of fair pay. Currently 78% of staff earn an average of £6.45 per hour, just 14p more than the minimum wage – an embarrassingly low sum for such an invaluable service. It is therefore not surprising that the number of care homes with low morale and high staff turnover continues to increase.

As a result, the Commission on Residential Care has recommended that residential care should become a living wage sector. This move would allow for better pay as well as encourage training and career progression – highlighting two key factors that would vastly improve retention within the profession. Moreover, establishing a minimum level of training would allow for a carers licence to be created. The implementation of a licence would serve to monitor skill, quality and achievement.

Previous Prestige blogs have also called for recruitment challenges to be addressed, at the heart of which lies – as mentioned above – pay and attitudes to the profession. If attitudes towards nursing and care workers as a profession were to change, this would encourage more people to work in the sector and start to fill the shortages.

Better pay and training along with the emphasis on career progression would see more people viewing this as a valued and long term career – encouraging greater retention. Benefits such as flexible working could also help in this regard while at the same time making care a viable career for those with fewer hours available.

Cost of a care home rises 54% more than pensioner incomes.

Wednesday, August 20th, 2014

As recent articles in The Daily Telegraph and The Daily Express highlight, new research from Prestige Nursing + Care has found the gap between pensioner income and care home costs has widened by 54% over the previous year. The annual fees for a room in a care home now average £28,666 across the UK, more than double the average pensioners’ income of £13,993. It leaves a shortfall of £14,666, placing untold pressure on individuals concerned about how they will cover this cost.

Even in the North East where care is cheapest, there remains a shortfall of more than £10,000 while in the South East this increases significantly to £17,526. The mismatch between incomes and costs leaves many with little choice but to sell their homes to cover this shortfall.

Previous Prestige Nursing + Care blogs have commented on the impact that council cuts have had on care funding over the last few years, having drastically reduced the number who are eligible for financial support. Liz Kendall, the shadow care minister, also expressed her concern on this matter during a speech in Ilford last week where she stated how cuts to social care are piling pressure on NHS hospitals and putting vulnerable people at risk.

Care at home can offer a viable alternative to residential care and can be used to assist elderly or disabled people with day to day tasks. Without this sort of support and assistance it could result in individuals having to move into a care home sooner. In essence, support at home can act as a preventative or delaying measure.

Limited access to GP surgeries impacts elderly care

Thursday, July 31st, 2014

Articles in The Independent and The Times this week suggest that over the next year millions of people will be shut out or turned away from their GPs. It is an alarming thought and one that has serious implications for the quality of care provided to the elderly and vulnerable in particular. One in nine people reported being unable to book an appointment at their GP surgery, which adds up to patients being turned away more than 40 million times this year.

This is indicative of endemic failings across the system, and is something that will only accentuate existing problems. As more people are turned away – or have to wait excessive amounts of time – this inevitably impacts the numbers forced to go to A&E instead. With reported waiting times of up to a month it is clear that the system is in crisis, exacerbated by what Chris Smythe calls a “rising population of older and sicker patients.” One danger of this is that patients may give up trying to make appointments, particularly those who are older, frailer and require that much more effort to go to the doctor.

As soon as the care provided by GPs enter into the debate people are far too quick to dwell on the issue of their salaries, which we believe is not what lies at the heart of the matter. The benefits of a 24 hour service or greater availability of appointments at the weekend would quell the problem to some extent. But ultimately – despite numbers being at a record high – there are not enough GPs to accommodate the population and dried up investment means existing resources are overstretched.

There is currently a distinct lack of alternative options to provide the elderly or frail with care outside of hospitals. If this could be addressed it would reduce the burden on the NHS and significantly reduce costs across the UK. Previous Prestige Nursing + Care blogs have considered the role that community care could play. With greater emphasis on this and more encouragement from the government it is a viable way in which the cost and burden on GPs, the NHS and unpaid carers could all be reduced.

Critical to the success of this ambition is an adjustment in attitude among many in the UK towards providing care. By accepting that it is a logical and sustainable solution to a growing challenge of supporting our ageing population, policies designed to bolster community care could really make a difference.

Pension reform clarity still lacking for long term care

Friday, July 25th, 2014

The explanation from George Osborne earlier this week on his Budget’s pension reforms gave greater clarity about the increased flexibility pensioners will receive by easing access to pension savings, lifting tax restrictions, and offering improved competition. However, it failed to address the implications for long term care.

All in all, we agree that the reforms – first announced in March – are a step towards greater independence for those in retirement, but greater clarity in the context of funding long term care is still required.

The Telegraph highlights that the reforms could play a significant role in helping people to pay for care later in life. Under the new regulations, individuals will be able to withdraw their savings – which may otherwise have been tied up in a fixed income that allowed no access for emergencies or unforeseen events – should they need to pay for care services. In previous years, many people requiring residential care have been forced to sell their homes in order to cover the cost, and the Chancellor has previously said the new reforms will not result in more people having to do this.

Despite expanding on how the changes will work, however, he is yet to address concerns that the reforms could result in people having to pay more towards social care. Under the new Care Act, the means-tested threshold for care costs will rise to £118,000 for people with property assets, and £27,000 for those without – anyone below these limits will be exempt from care costs.

Analysis of official wealth and assets data by Prestige Nursing + Care suggests that, under the new rules, more than one in ten (11%) of the 6.05 million people aged 55-64 in England could lose their exemption from care costs by withdrawing the average £25,000 net pension, which might push them over the threshold.

As of today, funds tied up in pensions or annuities are not included in the assessment of how much one has to pay towards care, whereas cash assets and property are. There is little indication about whether savings withdrawn under the new regulations will be counted as cash assets towards means testing for care. This is something the government must address. What is clear is that efficient forward-planning will be needed to ensure that individuals do not find themselves liable for huge care costs later in life as a result of liberating their pension savings

The sustainability of long term care.

Tuesday, July 15th, 2014

The Association of Directors of Adult Social Services (ADASS) has recently issued a dire warning that the care sector is close to breaking point and no longer able to absorb the pressures being placed upon it. This is heightened by ‘extreme public concern’ about the quality of care for older or disabled people in the wake of a series of care scandals.

The Telegraph goes on to highlight a study published last week which shows that 26% of local authorities’ care budgets have been wiped out in just four years putting standards under scrutiny and questioning the sustainability of the care sector. The ageing population, nursing shortages and severe cuts to funding are all negatively impacting long term care for the future.

We have already witnessed massive gaps in the standards and availability of services provided. This directly increases pressure on the NHS and existing staff, who can ill afford it, and leaves huge numbers of vulnerable people without the support they need.

Spending on social care has plummeted by 12% since 2010, according to The Telegraph, with councils and social care departments forced to slash budgets by over a quarter. Previous Prestige research also found that there are significant regional differences in council funding, with the North particularly badly hit by cuts.

A confidential survey of budget chiefs also found that total spending on adult care dropped by a further £266million in the current financial year (a 2% fall on last year). The study showed that many officials accept that cuts they are implementing could force private care homes or agencies out of business, which begs the question of where and how care would be provided.

Despite a realignment of funding from NHS to social care as part of a plan to integrate the two, this is simply propping up the system and (in its current form) is not a long term solution. One idea being floated is that of increasing volunteers to do the jobs currently being done by professionals. While we welcome increased community involved and support to families providing care, it is vital that adequate training is provided to ensure this does not result in any decline in standards.

Ending care home abuse

Wednesday, July 2nd, 2014


Following the Panorama exposé in May a great deal was written – including  a couple of Prestige Nursing + Care blogs – about  the importance of, and ways to improve, standards of care in order to address the issue,.

During this time the Sunday Express has also launched its Care with Kindness campaign. This gained backing from the government as Heath Secretary Jeremy Hunt announced a crackdown on poor quality care in order to better improve standards for the 500,000 residents in care homes in Britain. It stresses that several steps will be taken to protect care home residents from abuse, such as tougher inspections and NHS whistleblowing helplines. Changes had to take place after the Care with Kindness campaign found that complaints of abuse in care homes have increased by 20 per cent in the past year.

While tougher inspections and consequences are a welcome change to tackle abuse, as this case shows low wages and staff shortages are also a key factor in unsatisfactory staff being recruited. This is part of what really needs to be addressed in order to end care home abuse.

To reiterate a point from a previous Prestige blog: the government needs to do more to address cuts to funding so that nurses and care workers have access to better training and higher pay. Improvements in both these areas would change the way that the profession is viewed and increase recruitment, leading to a plethora of high quality and well trained staff.

Evidence of the imbalance between NHS managers’ and nurses’ wages was highlighted by this Independent article and will only reinforce the view that nurses and carers are taken for granted and paid poorly for it, discouraging people from wanting to work in the sector. NHS managers’ salaries have increased at four times the rate of nurses’ salaries while the Independent also reports that in the past two years, NHS spending has increased by 6.1 per cent on executive directors while nurses, midwives and health visitors only saw a 1.6 per cent rise.

It is clear to see, therefore, that the challenges facing the care sector – the shortage of workers, council cuts to funding and poor quality care which leads to abuse – are intrinsically linked. And that, only by tackling them all will the care sector see substantial improvements.