Caring Choices exposes raw emotions and an emerging consensus – what have we learnt and what next for the debate?
26 July 2007 | Website team, Caring ChoicesIt is three months since Caring Choices was launched, and its public debate has already exposed the raw emotion that underpins the widespread dissatisfaction with the current state support system for older people. “Are our older people worth less than our other political and financial commitments?,” challenges one contributor.
Much of the resentment, both at the nationwide events and on the website, has focused on a social care system that provides little or no state financial support to those above the means test income/assets thresholds. “These people are not the private equity/hedge fund super rich whose presence in London is eagerly welcomed by politicians, but elderly people of very modest means,” writes one participant. “Many elderly people are forced to choose so called ‘budget care’ because they have no other option,” despairs another. And is the government facing up to this groundswell of discontentment? There is considerable scepticism. “The government is continually postponing any decisions on long-term care. However, the longer it is left to drift, the harder the decisions will be,” warns one contributor.
It is, of course, easier to point to the flaws in a system than to arrive at a workable solution. Most significant, therefore, is that the Caring Choices participants have demonstrated a willingness to engage constructively and open-mindedly in discussions about possible reforms, with an enthusiasm that indicates the importance that people place on the subject. The debate has moved on from arguments over free personal care, and many people are willing to consider other options. Indeed, there is an apparent consensus that any solution is going to depend on the state and the individual working together to fund a package for all older people who need support. No one should be cut off the system completely, as happens now, but nor should anyone expect the state to pick up the whole bill, the majority says.
One contributor, a qualified care manager who admits to “finding it increasingly frustrating having to haggle for funding for basic human needs”, also concludes that “we all have a responsibility to contribute to the costs of our care. Certainly more needs to be done to address and acknowledge the harsh realities that many people in need of support and their carers face on a day-to-day basis. But we all have to acknowledge and accept that we all have some responsibility in respect of this.” This sentiment has emerged, amid lively discussion, as the dominant view at all three Caring Choices events so far.
There has also been agreement that the current debate over the future provision of social care must engage with younger people as this is an issue that touches all society, not just the middle aged and those over 65. There are many implications for the younger generations in terms of providing informal care for ageing relatives, helping to fund formal care for parents and then, later in life, meeting the resource implications of their own needs.
Consensus has its limits, however, particularly in a complex funding situation where there is clearly no easy answer. One of the most controversial areas to resolve will be the different attitudes to inheritance. This subject has prompted some of the most personal contributions to the debate. One woman offers what she describes as a “selfish perspective” on the current system. “Now it seems there might not be any inheritance if my father, who has Alzheimer’s, has to go into a home … The alternative could be to give up my job and take on the full-time task, while in my 60s, of caring for him.” Others have seen things from quite the opposite perspective, advocating inheritance tax as a way of helping to pay for care.
A subject on which preconceptions and reality can collide is the prospect of ending one’s days in a care home. For many older people, this option is not attractive: “If only I’d known I had a choice, I wouldn’t have come here to the care home”. But others cast it in a more positive light: “Sometimes it is just the right choice. I have seen many people lonely and depressed in their own homes, unable to go out easily to feel part of the outside world.” Ensuring that care homes are of higher quality and are used appropriately is emerging as one of the challenges for any reformed support system.
So where does the debate go from here? The Caring Choices events will continue in the autumn, and will be an opportunity for participants to address the acceptable split between public and private expenditure on an older person’s support costs. Another area that calls for greater discussion is the extent to which any support system should be determined nationally rather than locally. One website contributor captures the dilemma: “To those people who like local government providing local services, the result is a rich variety; while those who don’t like it say the result is a ‘postcode lottery’.”
The Caring Choices events have affirmed that there is now an appetite for a national public debate on such issues. And, despite the much-repeated sense that the social care system is currently near breaking point, there remains optimism. As one contributor says: “I’d like to think that we’re fighting a ‘winnable’ battle, rather than a losing one.”
July 27th, 2007 at 5:13 pm
The focus of all arguments seems to be concern over rising costs. The way in which care is provided at present, with massive regulation and vast tiers of management both within homes themselves and in the organisations responsible for them, distorts the picture of what care itself costs. For many years now cuts have been made at actual care level i.e. in care staff pay or numbers whilst increases in staff and pay happen at managerial level. Wwhat this has meant in Social services depts.is that the actual care is devolved to agencies . We need to strip the whole thing back to basics and reinvent it at local level, without constructing a care ‘edifice’ We `are after all talking about people who only want to be treated as individuals. I can remember a lady being forced into a care home because the local council could not provide a carer for 1/2 hour each day to help her to put her corset on. That kind of crazy economics impacts on everyone who has greater care needs and leadsto the impression of an unaffordable system.
August 20th, 2007 at 1:54 pm
I hold the registered manager qualification ( as well as other relevent academic qualifications) and have experience in ‘very’ sheltered housing and also both local authority and private residential establishments.
In April this year my local authority revised its charges for community care. The published document detailed the ‘actual’ cost of services for home care to be: £10.86 to £16.91 per hour, resulting in a ’subsidised’ cost of £7.94 per hour.
If a residential home charges the local authority rate of approximately £390 per week (variable dependent on authority) this works out at £2.32 per hour.
Can anyone explain to me how this is supposed to work?
Home care provides personal and practical services only. Residential care has, by virtue of legislation, to provide holistic care which encompasses all areas of need.
As long as we have anomolies of this financial magnitude how on earth can we start to even discuss what future care services should look like and be funded ?
My experience tells me that a system of ‘very’ sheltered housing (villages?) allied to a ‘home for the elderly’ without the nursing or residential tag, but providing apprpopriate care when the time is right for the individual to move on to, is precisely what frail elderly people want and would be willing to pay for
September 6th, 2007 at 6:35 pm
Dementia is the same as any other Diseases, so why do people who have this disease have to pay for their care. The amount that they expect you to find is way out of most people’s capabilities. Younger people today earn much more then most of us older people have earned in a life time of work. It seems this government wants everyone to be on benefits, taking away our children’s inheritance to pay for care puts another generation on benefits. What people get for their money is unqualified staff,coming into our homes,and working in care homes, who can hardly speak a word of English. As we all know now, older people in these awful places do not have the same human rights as everyone else in this country. If you were in a hotel and paying a lot of money for the pleasure of staying there, you would expect comfort. Not so in care homes, forced to eat food you have never eaten before, if you have spirit, you will be given drugs to calm you down, no privacy, no freedom of choice and no proper care because the staff are unqualified and they become more important then the people who they are there to serve and who pay their wages because the home would be closed with out them. Would I send a member of my family into one of these institutions the answer is no!!! If I have said this before it is because nothing has changed and neither has thoughts, they will always remanin the same unitil something is done about it!!!!!
October 14th, 2007 at 3:46 pm
There isnt really an easy answer to this. Many older people that I have worked with as a Care Assistant will accept care within their own homes, as they do not wish to go into a care home. They enjoy the freedom and independance of being in their own home, and also enjoy building a relationship with the carers that visit them. However, I feel that costs and contributions are not thoroughly explained to the service users at assessment level. The huge amount of service users that have confirmed this whilst I have been working with them is vast. The majority of Service Users will keep accepting care for 13/14 weeks. Then, when the Social Worker reviews the care and the service user finds that the care is no longer free and they will be expected to contribute towards the costs, they cancel their care with immediate affect, jeapodising their health and wellbeing in order to save what little they have scraped togather over the years. I can fully understand this from my Service Users point of view. The majority of Service Users take the stance that they have paid their national insurance contributions and income tax over their working years, so the government should fund their care. The majority of Service Users also wish to be able to leave their savings to their family members upon their deaths, to give them a better life. I have met a lot of service users over the years, who feel crushed that they have to spend their savings and sell their homes to pay for their care. I can also see this from a government and a Social Workers view, having worked for Social Services myself. Social Workers come under more increased pressure every day, being put in an awkward position by the government, by having to act as financial advisors when detailing care to service users. They also have to be the bearer of bad news, when the budget is not large enough to fund a Service Users care package. There are views from all aspects, and there will never be an easy solution. Means testing is a good idea, but it does tend to be harsher on those that have saved and worked hard all of their lives. The majority of Service Users’ family members get very disillusioned by the fact that they are going out to work, and saving hard as the government advises people to do, and then they will not be able to financially support their own children in years to come as their savings will be funding their own care. There does seem to need to be a huge reform in means testing, so that it is fair on everybody. The current system does not seem to be fair, and seems discriminative in places. There are new regulatory bodies spring up all over the place to make sure that policies and procedures are adhered to. CSCI was invented a few years ago and this is enhancing the lives of many service users, by ensuring that they live by the minimum standards set out atleast. This not only applies to residential care, but also nursing care and domicillary care. This is good as it means no service user is receiving inadequate care and all service users are entitled to the same across the board, whethere they be in their own homes or within a nursing/resdiential home environment. This is a huge step forward, but the same needs to be done in the sense of the financial side of care.
October 30th, 2007 at 4:08 pm
Social care and Mental health carries an ongoing arguement, some may agree that care should be paid for whilst others may not. I feel that the provision of health care for sufferers or those in need should automatically be provided once needed, free of charge. Under the Natiuonal health service (NHS), the government makes it out as if all services are free; however I feel that, that is not the case. Through my experience in working within the care and mental health field, disempowerment is strongly portrayed; choices are not in option if the care providers agree that you are not in a state of mind to make your own decisions. Some services are too be paid for, although they may not completyley benefit the individual but it may add to their progess. Helping and giving back to our community and society is something I strongly believe, Gate ways were opened for us by certain individuals, some who are now old and are in need of care.
March 22nd, 2008 at 1:45 pm
Thanks for sharing the original article and posting these comments. I am just entering this field and feel that the situation can be much improved upon. Reading the discussion here is really useful stuff for a novice like me.
Again, thanks.
Alec
Riversway Nursing Home, Bristol