By Debbie le Quesne

The brave new order of care alternative

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Last month a director of the International Longevity Centre – a think tank that helps plot how care for the elderly will be delivered in the future – warned that one element of the new Care Bill could have a ruinous effect on the industry.

The thorny issue raised, worth £1bn a year? The potential dismantling of cross-subsidy funding between self-funders and those paid for by local authorities.

Nick Kirwan argued in The Guardian that the legislation will create the perfect storm where the genie will be out of the bottle so to speak, and fee-payers will know what local authorities charge against the figures they may have been quoted.

I blogged about this potential problem at the time. The difference on a care package costs would be about £10.000 a year, Kirwan argued.

Responding to his comments Sara McKee, founder and director of market innovation at Evermore, a new model in retirement living, has some interesting observations about the care sector.

A new model of residential care is needed where people are treated like customers, she argues.

She writes; “It’s a well-known industry fact that this cross subsidy has been keeping many care providers afloat for years but, in our view, it is high time it came to an end. It’s unsustainable but the reality is local authorities don’t have the money to pay market rates in the current model. So, the model needs to change.

“And there lies the crux of the problem. The real threat to care providers in the current environment is their refusal to innovate.”

This is a brave statement and bound to ruffle a few feathers as many care providers have shown a deal of initiative work to keep in business as the financial restraints have taken their toll.

The numbers she quotes to support her argument are, indeed, bleak: The total of people over 85 has been projected to increase from 1.4m to 3.5m by 2035. “Yet the government has less money to support them – local authorities have cut social care spending by around £2.7bn since 2010,” McKee says.

An even bleaker image (if you choose not to address a more balanced view) is created of the care sector by McKee highlighting the following:

“Moving into residential care is still seen as a “distress purchase”, one that happens at times of crisis.

“Research by Demos last year found that one in four people would refuse to move into a care home.

“Quality of service is poor and the reputation of the industry is suffering. One in three care homes inspections result in failure and fear of abuse is a key reason why people don’t want to move into care.”

She goes on to argue that “existing organisational structures and roles should be abolished; there needs to be a greater emphasis on creating a culture based on putting the customer first; and we need to supply a product that meets market demand.”

Easy (well, not really in my world)!

The Evermore model, which McKee goes on to promote, takes its masterplan from the American Green House Project. Here long-term care is designed to look and feel like a real home. The website is worth a browse –


Empowered staff, autonomy, “masters of their craft” and “power to advocate” are expressions used to describe how it could work.

At a glance here’s the proposal.

  • Abolish current organisational structure
  • Change the culture to focus on the customer
  • Respond to market demand
  • A new lifestyle approach for delivering care

I applaud any new model that can make care better and if Evermore is achieving that, I am genuinely pleased there is a new model for us all to examine.

The ‘fine print’ of any such work would need careful scrutiny, but it certainly has whetted my appetite for more research. May be a visit needs to be planned?


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