Care homes

So what’s really gone wrong with Care?

As the news breaks today that 200,000 more care homes are needed by 2025 in order to care for the ageing population, we look at what really has gone wrong, and how it affects those we love.

As reported in the BBC News, this isn’t just related to care for older people, but disabled people, and children too, and some are unfortunately suffering more than others.

1. Spending has plateaued

The trend has been that year on year more money has been spent on services. This is due to a growing population, an ageing population, and those with disabilities living longer. Over the past ten years, this has levelled off and Central Government funding for councils was slashed by one third by the previous parliament.

2. Care is being prioritised

In 2015-16, 55% of council budgets was being spent on social care. With this, comes cutbacks to other local services such as leisure centres and refuse collection.

3. The NHS is filling the gap

One third of last years £24 billion budget was spent on children leaving £16 billion for adults. This was supported by a £2 billion grant from the NHS.

Last year saw the biggest grant yet from the NHS, as local authority spending was £900 million less than in 2009-10.

Simply, what happens in social care, directly impacts the NHS.

4. Councils are looking after less people

To save money, care is being rationed to older people rather than those with disabilities.

Between 2008 and 2014, care from the councils for over 65s fell by 25%.

5. Patients are being forgotten

If care isn’t provided in the community, people go to hospital.

Doctors only release those they know will receive care in the community. And if it’s still not available when they’re ready to leave, they’re left on wards.

This means new patients cannot be admitted, directly affecting A&E waiting times and increasing trolley waits.

This has almost doubled over the past five years.

6. People are making their own arrangements

As reported by Age UK, 12.5% of people in care homes now pay for themselves and 30% receive no help whatsoever.

These people still have substantial needs and are unable to dress themselves, and struggle to go to the toilet.

7. Councils are being subsidised

Companies providing the services have reported that councils are being squeezed so much, in some areas they’re working at a loss.

The U.K. Care Association calculated that the cost of helping people at home is £16.60ph, but across the UK, councils are paying on average £2 less than this. Also, the fees being paid by councils are £100 less than the true cost.

This means, those who are self funding, are paying more to make up the difference from the losses ; They’re subsidising the state.

Considering 1 in 10 people has care costs of over £100,000, we are left asking if this is fair?

8. The market is at risk

The Care Quality Commission have highlighted that this is destabilising the sector, as care companies begin to focus on areas where there are more self funders.

This could create a shortage of places in those areas, such as the South East where 54% are self funding.

Over the past six years, the number of homes operating in England has fallen by over 1500.

9. Ageing population

Currently, roughly 18% of the U.K. population is over 65. This is predicted to rise to almost 25% by 2044.

By 65, one in six people have trouble with day to day tasks. By 85, this rises to half.

10. Council tax bills are increasing

Councils have been given permission to raise council tax bills in order to pay for social care.

But it would appear this is limiting, as it is still raising less than 3% of what they plan to spend.

By 2020, the Local Government Association predicts there will still be a shortfall of over £2.5 billion.

Many have tried and failed to solve this, and our current coalition government have suggested a cap on care costs; already pushed back by 4 years.

Will we ever see a solution, or will this continue until the system crumbles and we have nothing left?

Are These The Care Homes Of The Future?

What if care homes were no longer like a home, and more like a community with shops, salons, and cinemas? This could very well be the future for British care.

As reported in the Guardian, Paul Burstow, the chairman of the Social Care Institute for Excellence (SCIE)wrote a report identifying what the government, Care Quality Commision (CQC), investors and providers need to do to change the current structure of our care homes.

Whilst researching for this report, Mr Burstow travelled to the Netherlands and visited a gated village called “De Hogeweyk”. This village is designed for people with dementia.

Mr Burstow reported that nobody wore a uniform, all staff are trained in hospitality, and the village is designed to mimic an actual village with shops, bars and homes.

WCS Care (WCS) has taken this approach, and is now running 12 homes, soon to be 13. The aim here is to encourage them to lead a “normal” life; going shopping, washing up, cooking, setting the table etc.

Their newest home has six households, each with fourteen residents, and their own kitchen. Their meals are laid out in their kitchens, and they’re encouraged to make their choice themselves.

In WCS, everything is run as close to the outside world as possible. The laundrette for example has staff, and they deal with the “customers”, allowing them to do as much or as little as they wish. They also have a Doctor’s surgery, and a dentist, all with waiting rooms and receptionists.

They also believe in residents spending as much time outside as possible and have built in cycle tracks, hairdressers, and cinemas.

These homes are designed around the philosophy that everything is driven by the residents. They only do what they want to do, which ensures they continue enjoying life?

Not only have WCS seemingly improved the quality of care, they’re also overhauling the technology surrounding caring for residents. They’ve introduced overnight acoustic monitoring which monitor the sounds residents make when they sleep. This helps staff assess whether they need to assist the resident, reducing the number of nightly checks, therefore reducing the disturbance for the residents.

This monitoring also offers peace of mind for family members as their loved one is monitored constantly.

This technology has already reduced the number of falls during the night, in one home by 30% as staff can instantly hear when a resident is moving around.

Similarly, using this technology helped staff recognise residents that were struggling to sleep. To change this, instead of ushering them back to bed, they formed a club; chatting, playing games, having their hair styled etc. Over a short space of time, their body clocks adjusted and they were able to sleep.

Due to their nature of keeping the residents quality of life at the forefront of everything, WCS have already received six outstanding CQC assessments.

So can we take their model, their aspirational and innovative model, and make it a reality for the future of British care?

Opera: Can it be used in care?

A number of care homes have opened their doors to the first opera written for the care sector, as reported by the Guardian.

“Six characters in search of an opera”, written by Rachel Barnett is being performed across the South West in care homes, dementia units, day centres and hospices.

The play was commissioned by Davina’s Fund, a charity aiming to bring opera to older people who cannot experience it themselves.

Set up in memory of Camilla Vickers mother, Davina, Camilla saw the effect opera had on her dying mother:

“I could see that my mother felt better, happier, and I, as her carer, did too. It lifted her spirits hugely and there was a lightness to the house again.”

Annie Stevenson, a member of the National Activity Providers Association has commended the play:

“It should be more than bingo or one size fits all activities, and hoping that volunteers come in and do something, which might not be very good. It’s always well intentioned but often activities can be very patronising.

“Professional musicians lift the spirits of the staff as well. They bring so much energy and it’s so powerful for everyone. It’s emotional and can really touch resident’s souls and uplift them. The CQC don’t measure things like that.”

At a particular care home in Dorset (the Old Vicarage), according to the Guardian the audience were said to be enthralled, swaying and conducting with their hands.

The room, full of residents and staff alike was “singing along with smiles on their faces”.

Edna Martin, a 100 year old resident said:

“I really think everyone enjoyed themselves. I used to do a lot of singing, so anything that involves music is up my street. I really have enjoyed this afternoon. It’s been many years since I have been to the opera.”

Although the Old Vicarage proves how successful such activities can be, it is a private care home, and many may not have the resources available to replicate its success.

Jan Millward, the care home’s activity coordinator believes, “There are a lot of people up against it and only have 8p a day to do activities with.”

She’s also called for the CQC to ask more questions and demand better activity provision from homes, “It’s the only way we’re going to get change, because managers really care about their CQC ratings as it effects their bottom line.”

She goes on to say, looking around at all the smiling faces, “This is care at its best, really. The residents are all smiling and happy. That buzz will last, even those with dementia who’ll likely forget the performance, won’t lose how it made them feel.”

Are Care Homes Getting It Right?

In a world where the elderly are living longer, are their basic needs really covered when it comes to their care?

The Care Quality Commission (CQC) are the main regulators when it comes to social care. They examine care homes, giving vital feedback to help those under par, improve their services.

Last week, it was revealed in the Guardian that one in three care homes has failed CQC inspections; not something you want to read if your loved ones are in care.

Overall, the CQC report highlights how fragile our care services are. Promisingly, the message was that the majority of care was good, but understandably, this seems to have been lost amongst the worrying statistics.

Some are improving. Some aren’t. And some are going backwards.

Although these examinations are of great importance, does anyone ask those receiving the care what they think? What the CQC measures, may not be important to those in the system.

Over the past year, Healthwatch have visited over 200 care homes, asking for relatives, residents and staff to share their opinions and aid the debate.

Looking at the initial results, they reported there are no huge scandals. The majority of people are happy with the care they receive, but staff are feeling the pressure.

But looking further, it’s the basics that care homes are failing on.

Residents want clean spaces, and to be made to feel at home. They want to choose what to wear in the morning, and eat at a “normal” regular time.

Although the CQC don’t examine these basics, these simple gripes are clues to the wider picture. They suggest that if care homes, even the best, asked their residents what they want, they could improve their services dramatically.

Despite this, social care providers are still reluctant to take such feedback on board.

In a recent poll of the 152 local Healthwatches in England, two thirds have reported that health providers are seeking feedback from them. Compare this to the one third of social care providers, and the 25% of providers that do not even respond, and we begin to see an opportunity being missed (The Guardian).

Listening to feedback, and using it to make changes, will help make people feel more valued, and help care homes become just that; homes.