Posts Tagged ‘elderly care’

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.

 

Ending abuse of zero hours contracts and improving pay for workers

Thursday, June 26th, 2014

A crackdown on zero-hours contracts was announced yesterday as Vince Cable lambasted employers who prevent staff on such arrangements from seeking extra work, saying that such measures constitute ‘abuse.’ Employers are to be banned from tying zero-hours contract workers to an exclusivity clause; a move the Department for Business, Innovation and Skills hopes will benefit an estimated 125,000 people, as summarised by this Guardian article.

A six month government consultation on zero-hours contracts found that more than eight in ten people were in favour of banning exclusivity clauses as part of measures to ensure that workers get a fair deal.

The ONS estimates that 1.4million zero hours contracts exist in Britain with around one in eight businesses using such contacts. For many staff who work under these arrangements, it also means they are not offered paid holidays, maternity pay or other traditional benefits.

While poor use of zero-hours contracts by employers – including exclusive causes – can lead to financial instability, there are also benefits in having this option. Those who wish to work flexibly, such as students, older people or those who want to supplement their main source of income are able to do so easily through a zero-hours contract.

What is perhaps more alarming is the poor wage that some workers receive for the hours they do work. The Living Wage Commission released a report focusing on the estimated half a million employees employed in the UK public sector that are paid below the living wage and the importance of addressing this. While a living wage is something we fully support, the UKHCA made a valid point when meeting with the commission. It underlined the need to recognise that for homecare workers to be paid a living wage adequate funding has to be reflected in council rates paid to providers.

As we examined in a previous Prestige Care + Nursing blog, councils across the UK are paying less than the recommended amount to home care providers. The UKHCA recommends an hourly rate of £15.19 to account for wage and benefit guidelines, provide adequate training and take travel between service users’ homes into consideration.

There is currently far too large a disparity in the council commissioned rates and the money required to pay workers a full living wage to a point that it is currently unfeasible to do so. With the average rate being paid at £12.26 an hour and further cuts anticipated over the next few years, quality care is harder to maintain as care providers become unable to deliver sustainable services resulting in additional pressure on the NHS.

Wake up to the carer needs of the UK.

Friday, June 20th, 2014

Last week, new analysis of the 2011 census by the Office for National Statistics (ONS) found just how hard council cuts and nursing shortages have impacted the provision of care and the way it will worsen over the coming years. It found, perhaps unsurprisingly, that the care of family members falls disproportionately on women.

This is an issue that will only worsen as the population ages with girls aged 15 today predicted to dedicate more than nine years over the course of their lives to care for loved ones or family members in the future.  As such, this places a heavier burden of care on them than any generation previously as a result of rising life expectancy and improvements in medicine.

Overall 5.8m people in England and Wales – a massive 10% of the population – provide unpaid care to sick, disabled or elderly loved ones, an increase of 600,000 since 2001. It raises serious questions about the financial burden and pressures families will be placing themselves under in future.

This follows a BBC article showing that while 1.4m people work for the health service, and a similar number are care workers, around 6.5million people identified themselves as carers in the last census. This is a figure that is expected to grow to 9m over the next 20 years – something that could have a dramatic impact on the wider UK economy as well as millions of family finances. Estimates show that 40% of those who will be required to look after loved ones as unpaid carers will have to reduce the amount of paid work they do in order to provide the level of care needed of them.

Previous Prestige blogs have talked about council cuts to social care, something which is obviously a factor in this topic. Cuts to council care have had a devastating impact on the services they can provide with eight out of ten local councils now only funding care at a ‘critical’ level. There are calls for the government to find a way to “fund social care services in a sustainable way” that don’t require millions of people to go without pay. The government carers grant is currently £61.35 a week, a figure that could easily be argued is too low, but more important is the fact most people aren’t even aware it may be available to them.

The nation as a whole needs to wake up to the country’s caring needs rather than brushing the issue aside. Our blog only last week showed how the requirement for carers as a profession is set to increase over the next twenty years but that will not go far enough to satisfy anticipated demand. The government needs to step up to the mantle and deliver a longer-term strategy so that families receive sufficient support to care for older family members without risking financial hardship or exhaustion.

‘From a nation of pen-pushers to an army of carers’

Thursday, June 12th, 2014

 

A recent article from the Independent comments that Britain’s workforce concentration has changed with a new report predicting we will become a ‘nation of professional carers’ by 2022. As the ageing population continues to increase, the demand for health and social-care occupations will grow placing added strain on an already overstretched workforce. Within the next ten years, the number of older people is set to rise by at least 27% and the UK workforce will need to respond accordingly to meet the growing demand for health and social care.

Previous research from Prestige Nursing + Care has drawn attention to the challenges facing the sector as the nursing and care worker shortage crisis worsens, highlighting 20,000 new care workers will be needed in Britain by 2020. Between 2012 and 2013, the median number of hours worked by carers increased by 1.9% indicating that carers are taking on more and more work to make up for the rising  number of people needing care.

Latest figures also show the NHS is short of 12,500 nursing posts and many hospitals are struggling to recruit, especially for highly trained, senior staff members. More than eight out of ten NHS trusts have a staff shortage, demonstrating the severity of the problem.

The Institute of Public Policy Research’s study, as featured in the Independent, revealed that health and social care careers will be ranked in the top three for most in-demand occupations due to increasing life expectancies and a greater number of illnesses or care requirements that come with age. By 2022 the demand for health and social-care jobs will reach 1.6 million. Around 240,000 more jobs are needed in associate health and social-care and 900,000 more in the medical professional field, such as doctors and pharmacists.

Research from Jonathan Clifton, senior research fellow at IPPR, also explains the increase in demand as a result of a high rate of retirement from health and social-care occupations. There is also the suggestion that the role of carers could be enhanced, to improve their status as a major vocation within the British jobs market.

Previous Prestige blogs have called for recruitment challenges to be addressed, at the heart of which lie 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 these shortages. With better pay and training along with greater emphasis on career progression and longevity, more people would see this as the important and long term career it is.

Greater access to home care needed as number of UK centenarians rises

Friday, June 6th, 2014

As latest findings suggest that people who live to be over 100 are more likely to die in hospital in England than if they lived elsewhere in Europe it is yet another indicator of the failing standards and approach to care in the UK.

A quarter of people aged over 100 died in hospital in the UK, more than the 16% in the Netherlands or the 14% in Finland, despite fact that they are unlikely to be suffering from serious illness and could instead be cared for in their own homes or care homes.

Not only is this contrary to many individuals’ wishes but experts warn that hospitals are ill equipped to cope and will be put under more pressure as people increasingly live to 100. A study by King’s College London expects the number of people reaching their 100th birthday to reach half a million by 2066, a monumental increase from the 13,350 people aged over 100 in 2012. It will also intensify the current nursing shortage that Prestige Nursing + Care has commented on in the past.

Palliative care researchers are calling for more care home beds and better planning of health services so that fewer old people have to go to hospital and can instead remain in their homes for the last months of their life. This would reduce the burden on hospitals and nurses while also reducing costs, since hospital admission in the last weeks of life pushes up healthcare costs disproportionately. Increasing the number of care home beds or people to care for you at home could reduce the reliance on hospital care but there need to be checks in place to ensure that these are up to standard.

Britain needs to do more to protect its growing population of over-100s. There is currently a lack of understanding in treating elderly people with multiple conditions and a lack of co-ordinated care planning which can lead to a sudden deterioration in health.

The government and health sector need to act now to improve standards of care to those living into their 100s and ensure that as the number living to this age increases, we are well equipped to support them in a compassionate and effective manner.

Improving long term care products

Thursday, May 15th, 2014

The overwhelming challenge of an ageing population – as people increasingly live longer, but with conditions that require care or hospital support – is relentlessly raising demand and cost in the industry.

This article from the Guardian suggests a number of short-term solutions which could be brought into place improving long term care and prospects for elderly people. These include offering joint personal budgets for health and social care, adopting new funding models and introducing incentives to encourage providers to adopt technology to support the delivery of care

The second of these is particularly prudent and links to a previous Prestige blog on the government’s pledge to reduce the amount of red tape to pave the way for more financial products to cover care. Currently very few advisers or financial companies offer this sort of solution, but given the extent of the problem and its associated costs there is a clear gap in the market for care related products. At present people are not saving enough to cover care, with shortfalls averaging £14,568 per year as demonstrated by previous research from Prestige Nursing + Care, and costs continue to rise. By replacing unknown and variable potential costs with an established premium, products such as these could make planning far easier to understand and greatly more accessible, reducing concerns for individuals and family members later on in life and meaning fewer people are forced to sell their homes to cover unexpected costs of care.

Another proposed solution comes from a new report by the IFoA (Institute and Faculty of Actuaries) which calls for a new ‘pension care fund’ which could run alongside pension schemes. It would remain tax free with an allowance that can be passed on free of inheritance tax to a spouse or beneficiary if the money is not spent on the policy holders’ own care. This could be an effective and comparatively straightforward way of encouraging more people to save.

The development of products to cover the cost of long term care could be particularly important as we wait to see how the Budget announcement affects qualification for long term care funding. Despite the government offering assurances that it will not result in people being charged more it awaits to be seen how this will play out in reality.

Addressing standards of care post Panorama.

Thursday, May 8th, 2014

Following the BBC’s Panorama episode last week exposing gross failings within the care industry, a great deal has been written about possible solutions.

As we touched on in last week’s blog greater funding, a change in attitudes and better training for all those in the care sector would be three steps in the right direction. This piece by the BBC addresses one of the key issues within the debate, that of the quality of care workers. It shows that already there are new rules coming into effect following evidence of shocking ‘care’ provided by some within the sector.

A new scheme will come into effect in March 2015 whereby new workers will have 12 weeks from starting a job to earn a training certificate. This will apply to staff including assistants in hospitals, care homes and those who look after people in their own homes. Training will cover a range of topics: perhaps most importantly, dementia care and patient dignity.

Previous failings include gross inconsistencies in the level and standard of training provided to care workers, yet they are still expected to carry out tasks usually performed by doctors or nurses. Norman Lamb also called for ‘more robust inspection schemes’ which comes back to the critical point of implementation. Responsibility for training lies with both individuals and employers and, as highlighted by last week’s blog, there must be stricter consequences for those seen to be failing.

Panorama’s investigation brought this crucial issue into the spotlight but – as this article points out – it is vital that it remains a topic of concern for the long-term. The importance of delivering solutions must not simply fall out of the public eye once people forget about the programme.

The government needs to do more to address cuts to funding and how this drastically affects the ease in which good quality services can be delivered. But the problem goes further than this. Across the UK as a whole, perceptions of the elderly must change, attitudes to care workers as a profession must improve and the need for a viable solution must be viewed as imperative.

Panorama exposes mistreatment of elderly in care home.

Friday, May 2nd, 2014

This week’s Panorama exposed the worst side of the care industry – filming of elderly patients being mistreated through ridicule, taunts and even physical violence. This has resulted in the suspension of seven workers from one care home and exposes the sector to huge criticism over neglect, amid concerns that this is evidence of a far more wide-reaching problem.

 

The programme revealed that in the last three years 1,260 care and nursing homes have been issued with warning notices by the CQC for failing to meet the required standards of protection.  The CQC has said it will work closely alongside the care sector to improve standards but given their shortcomings in this latest example what is a viable solution?

 

The quality of staff is the crucial factor to consider here. There can never be an excuse for the wilful abuse meted out to these poor residents but again, part of the issue comes back to cuts to care funding. With greater investment in the sector more training could be offered, higher wages could be paid resulting in the provision of better care workers. Greater staffing levels would see more supervision, less strain on those working and a higher level of care to patients.

 

The use of CCTV is fine for undercover investigations of a similar nature to Panorama but as a long term, permanent method it is not a viable solution. In any case, this serves to demonstrate failure of management and the regulator leaving a decided amount of distrust of the care sector when far more preferable would be to improve integral standards. CCTV essentially fails to get to the heart of the matter, solving symptoms rather than the cause. It also throws up privacy issues for both care workers and patients, and runs the risk of alienating both parties.

 

Stricter consequences for failing care homes should also be implemented with CQC rulings currently far too lenient. If a care home is failing it ought to be given a short time to improve and failure to do so should result in the home being shut down. Instead, homes are able to amble along, underperforming and unchallenged, as demonstrated by the case of the Old Deanery and the other 1,260 care homes that have been issued warnings. This is not exclusive to care homes, and should be extended to cover agencies, hospitals and any other providers who are failing in the standards of care being offered. Greater sanctions and more immediate action is needed to improve the culture and attitudes of all those working in the care industry.

 

Loneliness in old age and community care.

Friday, April 25th, 2014

The growing UK social care and ageing population crisis is well documented, including previous Prestige Nursing + Care blogs which have addressed issues ranging from council cuts, the rise in hospital admittance rates and the challenges of funding long term care. However, a new report  out yesterday argues for greater innovation to find alternative ways to address these difficulties with already overstretched services unable to meet the growing demand.

 

 The ‘Generation Strain’ report argues that by 2017 the number of older people in need of care will outstrip the number of family members able and willing to give help, placing further strain onto services such as the NHS and social care.  On top of this, by 2032, the number of older people requiring care will increase by 60% yet the number of carers available will only increase by 20% signalling a drastic shortfall and echoing previous research carried out by Prestige. Given that the NHS is already stretched to breaking point requiring £30bn ahead of 2020 for the social care bill, and eight out of ten local councils are only funding ‘critical’ care, the question remains as to how this will be addressed.

 

Cuts and funding are of course a key factor in the challenges facing the UK but attitudinal changes are also vital to encourage greater community support. As this article points out greater use of community schemes across the UK would serve to increase social mobility for older people, which not only provides enjoyment for those who could otherwise find themselves isolated but also offers alternatives to seeking help from the NHS. It is also invaluable in preventing the number of emergency hospital admissions and allowing people to stay in their homes for longer. With the right assistance at home – be it community schemes, home care or council services – any problems or illnesses can be spotted and treated earlier on before it escalates, reducing the immediate need for hospitals or residential care.