wmcha

By Debbie le Quesne

Posts Tagged ‘alzheimer’s care

The haves and have-nots: Bizarre economics of care

leave a comment »

The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .

 

Advertisements

Dementia – shocking findings spark new Alzheimer’s Society campaign

leave a comment »

 

Reading the Fix Dementia: NHS and Care Homes report is harrowing.

The decision to move anyone into a residential care setting is never easy and what should make this process less guilt-ridden is an assurance that, in a care setting, the person with dementia will receive at least the same, if not better, access to healthcare services.

The Alzheimer’s Society’s study, conducted in partnership with Care England, doesn’t deliver that much-needed comfort.

According to the Alzheimer’s Society, 92 per cent of people affected find hospital environments frightening and staff there appeared to be unaware of the specific needs of these complex patients.

The report also highlights that too many of these patients are falling while in hospital; too many are being discharged at night; and others are stuck on wards despite their medical treatment having finished.

Alzheimer Society Freedom of Information (FOI) requests uncovered “unacceptable national variation in the quality of hospital care across England” and in response it launched the latest Fix Dementia Care campaign.

The investigation involved FOI requests to NHS Trusts in England and a survey of over 570 people affected by dementia to gather first-hand testimony of dementia care in hospitals.

I read that in one trust, 702 people with dementia fell in 2014 –15, the equivalent to two falls a day.

Last year 28 per cent of people over the age of 65 who fell in hospital had dementia – but this was as high as 71 per cent in the worst performing hospital trust, according to the Alzheimer’s Society.

I cannot imagine how scary it would be for those with dementia being in an unfamiliar place with stressed staff who are just too busy to offer the attention they need.

The falls count is shocking and that fact that some hospital discharges were at night, totally inappropriate. What kind of access to care/nursing homes do hospital discharge officers think is available at night? It’s a time when staff numbers are generally less and coping with an ‘admission’ unrealistic.

In the worst performing hospitals, people with dementia were found to be staying five to seven times longer than other patients over the age of 65.

What is referred to as a “litany of failures” makes heartrending reading.

Just two per cent of people affected by dementia said all hospital staff understood the needs of those with the diagnosis.

Jeremy Hughes, Chief Executive of Alzheimer’s Society, said:

“Good dementia care should never be a throw of the dice – yet people are forced to gamble with their health every time they are admitted to hospital.

“Poor care can have devastating, life-changing consequences. Starving because you can’t communicate to hospital staff that you are hungry, or falling and breaking a hip because you’re confused and no-one is around to help, can affect whether you stand any chance of returning to your own home or not.

“We must urgently put a stop to the culture where it’s easier to find out about your local hospital finances than the quality of care you’ll receive if you have dementia. We are encouraging everyone to get behind our campaign to improve transparency and raise the bar on quality.”

This year Fix Dementia Care will examine the quality of care people with dementia receive in three key care settings: in hospital, in care homes and in the home.

When the report is published, remind me to get a big box of tissues. In the meantime West Midlands Care Association will continue to work closely with the local hospitals to ensure that the transition is as good as possible.

It’s heartening that some hospitals have also invested time and money to improve their knowledge and resources available.

There’s lot of good practice and people are working hard to ensure the issues highlighted in the report are not the case in the West Midlands.

 

 

 

 

Read this, be inspired, be encouraged

leave a comment »

Every now and then I realise afresh why I do my job. Encouragement is a powerful force as I’m reminded, in the words of novelist George Eliot, it’s never too late to be what you might have been.

I have just finished reading a great online piece by Ewan King,

director of business development and delivery at the Social Care Institute for Excellence (see www.theguardian.com/social-care-network/2015/sep/29/despite-finance-troubles-and-media-blame-its-not-all-bad-news-in-social-care).

Acknowledging the care sector is not in its finest hour, King writes: “My grandfather was a minister in the Church of Scotland, and he used to say to his congregation: ‘We must not succumb to hopelessness.’ It was his way of saying that we have to focus on the positives even when times are tough.”

King adds social care is perilously close to “succumbing to hopelessness”, yet despite unremittingly negative news, there are still remarkably good things happening in social care. Oh yes there are!

What I like about this article is that it is earthed in reality and the fears and dire warnings surrounding the care business are genuinely recognised.

Radical changes have not all been bad, he notes, encouraging “it is important to shout loudly about what is working well.”

A whole list of heartening examples follows and as pointed out, they are “the tip of the iceberg.”

King’s words are worth five minutes over coffee. Despite the gloom, media blame, financial turmoil, it’s not all bad. Go on, click the link, be inspired! and if you want more, do a quick search on my blog on the wedding.

Running blind without research into social care

leave a comment »

What a surprise! Austerity measures have created a problem with councils’ ability to carry out research in adult social care.

I read one of the 104 respondents’ comments to the survey which said: “People who supported research and evidence-based decisions have been made redundant.”

Another claimed: “Research in ASC [adult social care] was the first thing to be cut as it is seen as non-essential and will continue to be cut in favour of services and care packages.”

The study, commissioned by the Personal Social Services Research Unit but carried out by the Social Services Research Group, clearly seems to state the obvious as councils struggle to balance their books. We know already that local authorities are between a rock and a hard place.

Focussing on survival mechanics, however, always comes at a price. Expendable research? Probably not, though I’m well aware that duplication is a major problem in the industry and I can understand if local authorities can lock into other information streams their decision-making process on these redundancies.

Without research we have no way of knowing the how and why services are delivered and what difference they make

Without research how can we accurately set budgets and map for the future?

It needs to be done by someone. Without research we are running blind. Finally, can someone tell me please why such few numbers of me ever go into residential care?

Care call times again: Let’s have some vision, please

leave a comment »

Will someone please change the record? We now have the National Institute for Health and Care Excellence criticising short care visits.

Yes, we all know that commissioning visits of 15 minutes and some with even smaller time slots, are under fire. The problem is that most local authorities have outsourced their ‘dom care’ responsibilities and in the same way residential care is underfunded, so is this essential expression of humanity.

Speak to any of my community care providers and they’ll unanimously agree care slots should be longer, but sadly our Government won’t fund them at a rate that represents the true price of the service.

Staff who undertake social care visits to 470,000 mainly elderly people a year must spend 30 minutes helping to keep them well, says Nice.

It wants an end to the situation where many visits are so short and rushed that recipients have to choose between getting washed or dressed. I know, it’s a horrible dilemma.

But it must be noted there is a place for 15-minute calls – check visits and meds calls spring to mind immediately. The economies for employers, however, are mad as travelling time either side of such visits now has to be paid.

If adopted, Nice’s guidance would transform many care calls. I just don’t get it . . . all the evidence points to good social care reducing demands on stretched NHS budgets, but we desperately need a bit of vision here to see how investment with ring-fenced monies at this sharp end could work out.

In its first ever guidance on social care, Nice says that contracts that local councils in England sign with social care providers should allow workers time to provide a good-quality service, including having enough time to talk to the person and their carer, and to travel between appointments. I presume it also says they should be paid properly for this too.

“They should also ensure that workers have time to do their job without being rushed or compromising the dignity or wellbeing of the person who uses services,” says Nice.

It’s all very laudable. Nice describes itself as an independent Government body, but I wonder how much clout it will muster in this latest endeavor and whether politics will eventually see its teeth pulled. After all, isn’t Nice funded by the Government?

With councils facing average budget cuts of 40 per cent, I can’t see much chance of the Nice reforms being carried through any time soon.

I read that between 2010 and 2011, eight councils commissioned 593,000 care visits lasting five minutes or less, and three-quarters of councils commission care workers to visit for just 15 minutes. Goodness knows what the latest figures are.

I find it deeply worrying that already I’m hearing cries of “idealism” over the Nice proposal. Surely our elderly and frail are worthy of proper care and not least, social care idealism.

Can we afford to just carry on they way we are going? I think not. Our careers do a great job in the community, with many giving over and above what they’re actually paid for. It’s been referred to as “emotional extortion” and I hate the term because it infers some kind of financial racket or leverage. Truth is, most carers do what they do because they’re genuinely lovely people working in a financially screwed profession.

The cheap option – cutting back on care package times – is terribly short-sighted as the amount of first line care intervention will reflect, I believe wholly proportionally, further up the care ladder. As I’ve said, it’s all about vision and not least expectations. Often the call time is crammed in a desperate attempt to meet care plan outlines . . . and personal commitments to just trying to do the job properly.

A ‘deepening crisis’ but where is the antidote?

leave a comment »

Like over-prescribed antibiotics, graphic descriptions of the current care crisis fail to have the desired effect when they become a daily prescription of the news.

I fear many are becoming anaesthetised – indeed, almost indifferent – to the digest of chaos emerging from the sector.

In a joint submission to the Treasury ahead of November’s Spending Review, 20 organisations say the care sector is facing a “deepening crisis”.

Yes, it surely is!

They have called for funding to councils to be protected, as is happening with the NHS, a move that my own WMCA has also taken.

Ministers said investment in health would also benefit the care sector.

The government has pointed out that plans were being put in place to ensure greater joint working between the two sectors and that would relieve some of the pressures.

But those putting their names to the latest warning – leaders of councils, the NHS, care providers and charities – are not convinced the future is safe.

They say the market is “fragile” with councils forced to keep fees low and providers leaving the care sector; this, they add is driving up prices for those who fund themselves and leading to fewer people getting state-funded support.

Let me quote The Guardian piece: “While the government has pledged an extra £8bn a year for the NHS by 2020, social care has received no such assurances.”

Ray James, president of the Association of Directors of Adult Social Services, one of the signatories to the submission, is reported as saying: “It is vitally important that this year’s Spending Review understands the importance of our services to vulnerable people,” adding that the “near-certainty” is that without adequate and sustained finances the ability to carry out their duties will be in jeopardy.

The Care Providers Alliance, adds that the challenges are on an “unprecedented scale,” while Rob Webster, chief executive of the NHS Confederation, which represents health service managers, says: “Having a shiny NHS cog will be no good in a broken health and care machine.

“All these services are interconnected and all need greater financial certainty.”

I’d like to know who the other signatories are, but I think we get the message anyway. . . let’s hope those with real influence for change also do.

We have heard so much now of impending doom, I fear our message is in danger of becoming white noise. Prescribing the antidote when the patient is dead presents an obvious problem.

Ombusdsman’s fees report: Providers are not the villain of the piece

leave a comment »

The cost of care is always going to be a hot potato. For a start, many people wrongly think it should always be wholly funded by local authorities and then, of course, there’s a whole load of confusion over fees.

Enter the faithful BBC with its story that families are paying too much for care in England “all too often” . . . because of confusing or incorrect information from councils.

That’s the verdict of the Local Government Ombudsman, which noted that some people were not offered an affordable care option in their area.

It said: “The decision to place a loved one in a care home can be one of the hardest any family has to make, but all too often families are paying too much for their care because they are not getting the correct, timely information.”

Thrown into the mix are top-up fees, one of the main reasons confusion exists, according to Andrew Kaye, from the charity Independent Age.

Care England says top-up fees are helping to mask a funding crisis in social care, with some of the poorest people and their families being asked to fill holes in the budgets of local authorities. I agree, but must add that this is the only way many care businesses are able to survive in these difficult times.

The moral argument will doubtless run and run, but the fact remains until such times council fees paid equal the realistic cost of care I see little changing.

In addressing the moral high ground critics, I would ask them to consider what options there would be for non-top-up residents if homes closed because such fees were not levied.

It really would not take much to push so many of our providers into an economic tailspin.

Professor Martin Green, of Care England, argues care should be available “at a cost which the local authority should be happy to pay.”

Of course that should be the case. It’s important, however, that care providers are not seen as the villain of the piece here.

Central Government with its sweeping fiscal restraint within the care sector has forced councils and the care marketplace into a dire corner, the likes which I have never seen. Mr Cameron and his cohorts clearly know of our crisis and the fact local authorities are between a rock and hard place, They could and should bring it to an end.

Ring-fenced social care monies . . . etc, etc. . .