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By Debbie le Quesne

Posts Tagged ‘care homes nursing homes

Running blind without research into social care

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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?

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Wedding bells tonic brings happier headlines

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A filthy care home described as “a waiting room to die”, more dire warnings on the future of care provision. CQC complaining that too many social care services are not up to the mark . . . it’s enough to make anyone lose heart.

But wait a minute. In a plethora of headlines gloom, I spot a story that sums up so much of the good caring that is never in the public gaze. Contrary to what the media would have us believe, there are good care homes, in fact most of them, and extremely kind carers do exist.

Aileen Sharples, aged 89, desperately wanted to be part of her son’s wedding and was disappointed that she would not be able to attend the ceremony and watch the happy couple exchange their vows.

But staff at the Belong Wigan Care community where she lives were determined she wouldn’t miss a moment.

Aileen was treated to a front row view of the Gloucestershire wedding from the comfort of her home, thanks to the dedication and ingenuity of care staff and a bit of clever technology.

Overjoyed for her son, Paul, on his Big Day, Aileen was disappointed she’d miss the ‘do’. But staff quickly stepped in, making arrangements for the wedding to be seen via an iPad and FaceTime.

But they didn’t just provide the technical link, staff entered into the spirit of the occasion with flowers and decorations in abundance. They also put on their best clothes – complete with hats and fascinators – ­­and ensured residents did the same to share the moment.

A champagne toast followed with wedding cake and Aileen was able to chat to Paul and her new daughter-in-law, Julia, wishing them both a wonderful honeymoon.

This is not an everyday occurrence, but in my experience acts of selfless kindness from carers happen fairly regularly.

This story cheered my heart, and not for one moment do I believe it was a cynical stunt to get some media interest.

Global trend on care not a good one to follow

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In 1969 (too many years ago for me to remember, of course) Mick Jagger strutted onto the stage at Hyde Park wearing a white dress.

Our  parents asked: What is the world coming to? They were both shocked and challenged by what they saw as the Rolling Stones performed their concert.

Today, I’m asking the same question as I read that more than half the world’s elderly lack access to long-term care, though sadly the news doesn’t appear to warrant the same media interest as that legendary 60s’ moment.

The data has been produced by the International Labour Organisation which condemns the “deplorable” situation facing rapidly ageing populations.

A new report from the United Nations agency shows that some 300 million people over the age of 65 cannot easily access long-term care when needed.

The report comes just days after America announced an army of carers aged 75 and over was growing daily and now constitute seven per cent of those who provide unpaid care to a relative or friend, the survey found.

We face a global problem and I’m stunned to learn that the world’s most “generous” countries, found in Europe, spend only two per cent or less of their GDP on long-term care.

It’s cold comfort, I know, given the troubles in our industry, but in comparison to some nations the UK care deals are pretty good.

We have, however, an awesome responsibility to preserved what we have. Reading an article in the New York Times of how a 75-year-old shoulders the role of caring for her immobile husband without a care package makes me all the more determined to fight tooth and nail to ensure care providers get enough resources to do their job properly.

The fact care, as we have known it, is under threat and the changes being forced by market manipulation are not in the best interests of clients of providers.

We need to remain vigilant that long-term care indeed stays accessible to our elderly, sick and frail and does not become another ‘inevitable victim’ of austerity measures. The global trend, if we believe all these figures, is not a good one to follow.

Let us work together to secure the future of care

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Like countless others in the care sector I have joined the chorus in the West Midlands calling on councils to  pay a viable rate for care beds purchased from the private, charity and voluntary sectors.

The care landscape is bleak and my WMCA has warned closures are imminent and there is little regional capacity to take up those frail and needy residents who may be displaced. To this end we are desperate to work with local authorities to find mechanisms that will secure the future care of the most vulnerable and the survival of local businesses.

At an emergency meeting of the association, members heard George Osborne’s living wage directives could “be the final nail in the coffin for care as we know it.”

In an attempt to secure a funding lifeline to the industry, we are calling on MPs, councillors, local authority officers and Clinical Commissioning Groups to meet with us to discuss future ring-fenced funding for social care.

The vast majority of Black Country care businesses rely on placements paid for by councils as a primary income generator and more than 26,300 people across the region receive residential care. A similar number have care at home.

In recent weeks, five care home corporates with 1,200 properties between them have written to the Chancellor warning of impending disaster following his Budget reforms on the living wage.

The big five – Four Seasons Health Care, Bupa UK, HC-One, Care UK and Barchester – look after 75,000 frail, old people. They claim a major provider is likely to close within a year to 24 months unless the Government releases its purse strings. The response: Silence.

The national picture is indeed gloomy, but in our region it’s much, much worse and Osborne’s announcement has caused shockwaves across the region. So many are already in crisis . . . and now this.

The legislation impacts massively on all streams of care as indeed it must doe with many other businesses.

A WMCA impact analysis suggests the Osborne wages regulation will add £23 per week to the care cost of every Midlands person in a residential care setting. But we need to add to that figure a further £50, the current average weekly operational deficit on council-funded places.

If the corporates – HC-One is one of our members – are predicting at best only a two-year survival rate under current economies, what chance have my other members, who have much smaller homes and much-depleted resources?”

As for thepromised autumn Government Spending Review . . . I fear too little, too late.

Residential care occupancy levels throughout the Midlands are averaging 97 per cent and there’s not not a member in the association who is not anxious about the future wellbeing of those requiring care.

For those who think we do not want to pay the living wage, think again, please. All of my members would happily apply the living wage, but there is no financial sleeve left in their business models to do so. Care home companies are not just crying wolf. Care is a minimum wage industry and profit margins are extremely tight, especially where council referrals are the main income.

Do you know that for the last nine years fees have fallen below the viable cost of running a care home?

Over the last five years, for example, Dudley Social services has given rises totalling 8.9 per cent while the Consumer Prices Index is at 11.6 per cent, the Retail Price Index at 15 per cent and wage rises are hitting 12.3 per cent. The rises don’t track cost and we clearly need some Government benevolence to help both councils and care providers.

Recently Sandwell Council’s cabinet met to respond to a WMCA call for a fees increase of 16 per cent – residential care from £378 per week to £438.46; dementia care from £428 per week to 496.48; and residential nursing care from £490 per week to £568.00.

What do we get? A 1.5 per cent rise for residential care and a 2.5 per cent rise for nursing.

Latest figures from Industry analysts LaingBuisson reveal English councils pay £91 a week less than what is needed for fully compliant care.

In 2013 Birmingham City Council commissioned accountants and analysts KPMG LLP to establish the true cost of care through the Open Book initiative where care providers were asked to submit their accounts.

Some 380 homes were targeted and the results showed to meet escalating costs commissioners would need to pay £460 per week.

Two years on, and not including the implications of the living wage, It would take an l increase of six per cent to bring homes to the minimum figures used by the Association of Directors of Adult Social Care (ADASS) as the threshold for safe care announced this spring. An extra three per cent would allow homes to cover increases in operational costs.

Sadly, if a major employer were to make this kind of warning there would be huge interest over the potential loss to the economy. What we have here is a bunch of businesses across the region that create about 125,00 carer jobs for adult social care (figures from Skills for Care).

“That dwarfs the employment stats of say Jaguar LandRover and it’s deeply worrying that few of these jobs are secure under present funding models.

Listen, councils do have choices what to do with funds and government austerity can no longer be an excuse for not addressing the finances of care.

I would call upon our local councilors to make decisions of conscience on funding that will directly impact on the most vulnerable people in the electorate they serve.

It is a fact that a dog walker can earn more than we can pay our carers. There is something radically wrong.

Adult social care a human necessity

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Has anyone noticed that it’s gone spookily quiet on issues relating to the ‘single pot’ budget response to the NHS and social care?

Before the election there appeared to be good display of headlines and news bulletins on this initiative, but now: Silence.

Perhaps I have selective deafness, but if I have the condition is share by Zoe Williams writing in The Guardian.

She too, has picked up the vibes of change, observing that although the care sector was “beset with injustices, and the NHS was often having to fill cracks at vast and unnecessary expense, and services would have to be joined up if they were ever to work,” the tone for public consumption is different now.

Andrea Sutcliffe, the chief inspector of adult social care, has described a sector “under stress and strain” in which an ageing population with increasingly complex needs was “only half the story.” Really!

Regulators receive more than 150 allegations of abuse of the elderly every day, Williams reports. Quoting the response from a department of health spokesperson . . . “Treating somebody with dignity and compassion doesn’t cost anything.” But it does, a point Williams also makes.

The language of compassion, she writes, involves funding care and wages and conditions and so on.

As much as £4.6bn has been cut from social care budgets over the past five years, I read. I’d hoped that the current shortfall might be made good with a single NHS/social care fund, despite misgivings over its administration.

Where has news on the single fund gone? Adult social care is not a bolt-on option. It is a human necessity.

In February Greater Manchester and the NHS announced plans around the future of health and social care with a signed memorandum agreeing to bring together health and social care budgets – a combined sum of £6bn.

The scheme saw NHS England, 12 NHS Clinical Commissioning Groups, 15 NHS providers and 10 local authorities agree a framework for health and social care.

My question: After such a trailblazing start to the initiative, what is happening in the rest of UK, and of course, more specifically, the Midlands?

Dudley and Walsall lead in response to Living Wage bombshell

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There is a deep concern among care providers that the introductions of George Osborne’s Living Wage will sink many independent businesses.

Surveys have offered a whole array of gloomy forecasts with one stating the following:

  • 9% of respondents are deeply ‘concerned’ about their businesses
  • 3% of them felt that the increase would have a ‘significant’ impact on their businesses
  • 72% were very concerned about their ability to continue in business
  • The majority of people responding to the survey did not feel able to pay their staff the Living Wage of £9.00 per hour by 2020 in the timescales without a ‘substantial’ increase from commissioners

And what is more worrying, a press release from the National Care Association claims 24 per cent of respondents indicated that they would consider exiting the marketplace if their local authorities did not make a significant move to increase the fees they pay over the next five years.

The strategy we adopt from hereon is critical, as it will determine the fate of so many providers and their clients.

It is a heavy burden that has not lifted from my shoulders since the Osborne bombshell. I am convinced the care sector was invisible to him when he set in stone his plans.

Let me add at this point, I applaud any move to upgrade the status and salaries of carers, but there must be an impact analysis and a cohesive strategy – funding – to make it work.

Sadly, we’re floundering and again lacking in leadership from Government. The local authorities with which we work are clearly in the same position.

Following the Living Wage announcement, West Midlands Care Association contacted councilors and directors in all the membership authorities and outlined the real impact of the legislation. There has been a deafening silence in response, except for Walsall and Dudley.

Walsall has indicated that unless extra funds are released the thresholds of care funding will have to change. A pragmatic approach, I know, but at least our overtures have been acknowledged and there have been strong indications that they understand our dilemma.

Dudley has been exemplary in its reply. Both councillors and officers recognise the position of our members and the pivotal role of West Midlands Care Association plays in working though the difficulties.

The authority has agreed to meet with us as soon as its own impact analysis is complete. The authority also recognises that it is essential the Government provide “appropriate funding.”

We have enjoyed a creative e working relationship with Dudley for many years and I am heartened at its realisation we need to talk and pool knowledge if we have any chance of delivering a sustainable lifeline to care providers and those who are currently receiving care.

The most basic and powerful way to connect is to listen to each other. If there was ever a time in the care sector when dialogue between WMCA . . . and local authorities was needed, it’s now. Silence is not an option, as the funding issue has become a complication for cash-strapped authorities, as they are obliged to navigate their legal care market management responsibilities outlined in the Care Act.

What can I add? We will do all we can to help and for those who perhaps have nothing to say: Please don’t shut the door on us.

It is true that only those who harm the care industry really make the headlines, Essentially, all the providers I daily meet are good, honourable people. So good, in fact, I worry that for the very best intentions they will carry on to dispense care even without sufficient resources. Cutting corners . . . giving something out of nothing . . . need I say more?

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Care homes . . . and dare we mention sex?

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I’m not one for deliberately grabbing the headlines, or in a knee-jerk way, responding to them. But I just can’t resist this BBC story pointed out to me by a colleague.

Headline: “The taboo of sex in care homes for older people.”

Hooked yet?

A recent study by the University of Manchester found that 54 per cent of men and 31 per cent of women over the age of 70 were still sexually active. Good of ‘em, I say.

The Beeb reported that it was the first nationally representative survey to include people over 80 in its sample, indicating both how attitudes are finally changing and how the sexuality of older people has been historically overlooked.

I find it interesting, though not surprising, that the subject still has an air of taboo, the findings of a study by the Royal College of Nursing a few years ago revealing that sex and relationships are not viewed as a priority in care homes.

“Human contact and sexual need are basic functions of the human being,” Dawne Garrett, older people’s adviser at the Royal College of Nursing, is quoted in the BBC report.

I understand that the subject can be a difficult one and observations in the report that “staff are generally not comfortable with the topic, and not knowledgeable about it either, thus they are powerless to help,” are probably true.

So how do we as care providers facilitate relationships?

I’d like to hear some answers or see a training brief, because sooner or later this is going to be a Human Right Act issue.

Lois Weaver, a performance artist who explores the subject of sex and ageing through her work, is quoted by the BBC: “We have a stigma about age.

“We don’t really treat people like elders. We treat [them] like people [who are] finished with life.”

Her groundbreaking show, What Tammy Needs to Know About Getting Old and Having Sex, seeks to break down the taboo of sex and ageing.

Anyone for a ticket?

Weaver is in her 60s, had been told that losing interest in sex was an inevitable part of getting older, but said she was not ready to accept that. “I was getting different urges and desires,” she was quoted as saying.

Her work is indeed interesting and those wishing to be challenged can find video links aplenty in a Google search. Her attempts to canvas opinion from residents in care homes, however, were generally met with failure which clearly underpins what she has coined the British “maternalistic” approach.

I really do feel I’m opening a proverbial can of worms here, especially as I consider what could happen sexually to dementia patients. We have to assume that homes seeking to have a more liberal approach to relationships sanction only consenting adults with capacity. Even then I suspect safeguarding issues would emerge.

Weaver, a professor of contemporary performance at Queen Mary University of London, a performance artist in her own right, writer, and director, is a seasoned campaigner. It will be interesting to see how she develops this one in the light of the Manchester study.