Have you planned for care in later life?

We know of abuse and poor care in these homes, and bringing them in front of the public might eventually see better oversight and action although, as with many institutions, there will always, it seems, be bad apples. The prison service illustrates that, as did children’s homes and social care in some authorities (public, not private, organisations).

However, while individual cases are vital to examine we also need an overall picture to see just how widespread, or not, such poor behaviour is before condemning a whole industry. My perception is, from all that has been written, that the majority of the sector is run properly, and that these are exceptions. They must be dealt with, of course.

A headline however, online in the Independent 22/3/18 says “Abuse taking place in 99% of care homes amid “chronic” underfunding, survey shows.“. Can this sort of statement possibly be true? Only 1 in 100 care homes are properly run? Does someone have substantiated figures to give a picture for the whole care home sector?

The thesis above acknowledges the very limited survey on which it was based.

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Malcolm the only reliable source for this data has to be the CQC, they are responsible for dealing with complaints and surely the keep records. I am not sure if they will communicate this to private individuals but I would have thought Which? has a chance.I am of a similar opinion to yourself that 1 poor home in 100 ie 1% is more reflective of the real situation than 99% , we must remember that all local Authority funded residents have Social workers dedicated to them and they monitor the Homes performance, there is also the Council’s “Safeguarding” who.’s job it is to respond to complaints with full investigations ( a newly opened home of mine actual suffered 3 such investigations in a period of 6 months each time 8 inspectors came (Nursing and Social services and reported back that we were totally in order, we found out later during job interviews that the anonymous callers were from a Charity run home which was being closed down by the CQC for mismanagement and were done out of malice.

Malcolm
Hot of the presses from Community Care comes a Legal Interpretation please refer to my conv. below

The reality is, not all private care homes have CQC registration but vulnerable people are still being sent to them by Borough Councils. Social workers will visit but reports are ignored because suitable replacements are difficult to find.

Are you sure, Beryl? The CQC website states the following:

“We monitor, inspect and regulate services that provide health and social care.
Activities we regulate include:
Treatment, care and support provided by hospitals, GPs dentists, ambulances and mental health services.
Treatment, care and support services for adults in care homes and in people’s own homes (both personal and nursing care).
Services for people whose rights are restricted under the Mental Health Act.”

There are no exceptions. So far as I am aware care homes are not ‘registered’ by the CQC but by local authority social services departments if the establishment wish to accept local authority placements and then the department inspects them to ensure that the residents they have placed there are receiving satisfactory care. That is independent of any CQC regulation.

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Beryl, under the care homes act it is iillegal to operate without a license if you know of any home operating without a license you should report it immeadeatly to the CQC and the Local Authoriity and ro Safegaurding at the L A .as far as I am aware there are no exceptions to this rule..
Part of the Regisration procedure includes Building Regulation , Fire Certificates , Health and Safety etc. Etc. I am amazed that the LAs you refer to could be party to whar you suggest,maybe you could start some action to get this matter sorted.

John, if the CQC can’t trace them I think that is proof enough. There is sooooo much stuff coming out of the woodwork now the law is involved its reprehensible.

Its not the CQC ‘ s responsibility to deal with complaints. You can contact them ” telling them about your care” , but thats not a formal complaint. Formal complaints are made to the company who owns the residential home and/ or the local authority who commission the care on behalf of a service user. My recent experiences of Council social care services ( including raising safeguarding issues) is that they’re appallingly unhelpful , unprofessional, uncaring and don’t follow procedures. Re CQC inspections, they’re sporadic and only provide a “snapshot” of a service.
The care agency (commissioned by the local council ) who recently decided to withdraw care for my father because we were asking questions about basic care eg hygiene, skin care etc were rated as Outstanding in their last inspection in 2018. The more recent update states the CQC have no reason to the inspect or to think that the rating will have changed from Outstanding. There simply isn’t enough information out there for people to make informed decisions. The charges are ridiculously high considering the quality of the carers and care and careplans are just a paper exercise .

Interesting article. And comments are useful:
” Saying this is not lawful will not change situation, as far as I can remember it was not lawful 10 years ago when I worked for another authority, however the expectation to meet and manage outrageous care costs of individuals, care packages for some individuals around £700,000 a year has meant that there has been a lot of arguing at all levels over what is the minimal we can get away with ,to meet the client’s needs in a safe and appropriate manner, not about what family demand is their right.

We are responsible to some degree to the public purse through our actions and ensuring that provision of service for other people may be just as needy, have their needs met not whittled down by people perceiving they have a right for this expenditure. Normal dichotomy too much need and not enough money.”

Perhaps the political promise of a cradle to grave coverage needs to changes slightly to include family and their resources. Sooner or later we as a society need to accept that there are practical limits and we need to start the argu mnet soonest rather than later. Medicine marches forward prolonging physical life but not necessarily a fulfilling life.

Unlike you Duncan I do not get involved in topics of which I have little knowledge.I do have some idea however on how to run a business, startingas II did in 1964 and I can differentiate between improving effeiciency in management and reducing costs of service as explained by the MD .
Whilst on the topic of Child Care do you know what has been done by Councils and Police to stop child slavery and prostitution being perpetrated on Children in Care.Maybe Which? Could do a Campaign on this ?

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Duncan , I got what I expected, thank you

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I’ve reversed it. But please let’s discuss the topic 🙂

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Here are some bits of information that might be useful. More important, links to the documents they are extracted from that contain a lot more information that might be of interest.

”The care homes sector is worth around £15.9 billion a year in the UK, with around 410,000 residents.3 We calculate that there are around 5,500 different providers in the UK operating 11,300 care homes for the elderly.4 Around 95% of their beds are provided by the independent sector (both for-profit and charitable providers). LAsgenerally commission care services from independent care providers. We estimate that the average cost for a self-funder in 2016 was £846 per week (nearly £44,000 per year), while LAs on average paid £621 per week.”!

https://www.gov.uk/government/publications/care-homes-market-study-summary-of-final-report/care-homes-market-study-summary-of-final-report

“According to accountancy firm Moore Stephens, one in six UK care homes is at risk of failure.”
http://www.caresolve.org.uk/british-care-homes-facing-collapse/

“• Economic profits 43. The industry, including the local authority and self-funded segments together, has been close to break-even levels of economic profitability between 2010 and 2015 (see Figure 2). We also observe that the local authority segment has generated significantly lower operating profits than the self-funded segment (see paragraph 39). Therefore, it is reasonable to infer that, in aggregate, the local authority segment would have generated economic losses and the self-funded segment would have generated economic profits.”
https://assets.publishing.service.gov.uk/media/59b2bb0ae5274a5cfcda2d18/financial_analysis_working_paper.pdf

Very interesting reading MALCOLM ,it is very clear that without the Private Sector there would be many Council Funded clients who would not find places in Residential Care ,the resultant would be even more bed blocking in the Hospitals at a massive increase in NHS costs and problems.
The front line NHS staff have been struggling with this problem for years but the Local Authorities have continually ignored their pleas Quoting shortage of funding (the LA started thisin 1993 the first year of this scheme) . We have known Councils that have underspent .

Scotland, Australia ,America, etc.etc. For some relevant info Duncan refer to MALCOLM below.

The 2018 Budget is providing a further £400 million to local adult social care authorities to assist in funding placements in residential care homes [among other things]. My initial reaction is that this will barely scratch the surface and there is a real risk of it being misappropriated and not finding its way into the economics of the business.

I wonder how much this has also helped?
”What is the ‘Adult Social Care precept’?
In 2015 the government created the Adults Social Care Precept, which allowed Councils which provide Social Care to Adults to increase their share of Council Tax by up to an extra 2%. In 2016 they announced that for the 3 years from 2017/18 to 2019/20 Councils would be allowed to increase this by up to 3% in any given year, but no more than 6% in total over those years.

The Government has said that this precept must be shown as a separate charge on all council tax bills. The income generated from this charge is ring-fenced, meaning it can only be used for Adult Social Care services.”

That should have helped, Malcolm, but I wonder how much has trickled through to the front line in terms of better staffing, higher standards, and safer care.

I suspect that for commercial reasons there is an excess of places in residential care homes over the normal requirement. This makes it difficult for the operators to squeeze more out of the local authorities but it also means there is a widening gap between what they charge a self-funding resident and one assisted by the state.

It really is about time the government published its much-vaunted and long-promised Green Paper on the funding of adult social care. There will never be a good time – they might as well get it out and under discussion before the Autumn is over. Another casualty of the Brexit hoo-ha, I suppose.

The Government of the day tried ring fencing etc in 1993 cer tain Councils actually underspent or diverted funding and actually returned money to Nat Gov. (we were kept informed by a Member of the Public Accountants Association after his parents were denine funding).To understand this blatant misuse of funding one must remember that prior to The Private Sector the main Providers were the Local Authorities and certain Authorities have been penalised for abusing power to promote their own homes at the expense of others including Charities, Housing Associations, Voluntary Sector.
In spite of being caught out this this by the Ombudsman this practise still continues as old habits are rd to break it appears. Can we really see people such as BT or Railtrack etc ever treating anyone threatening their power “fairly” and just imagine them being given funding to distribute “fairly” – NO CHANCE . Unfortunately it is the service user that suffers in the end and then guess who gets the blame ??
The funding needs to go back on a National level as before and be administered by politically unbiased Public Servants as before ,Medical Assessments need to also return to medically qualified staff (DOCTORS & GPs) who are trained to prescribe and not left in the hands of unqualified pen pushers

Once again John I find myself agreeing with you ,according to Which? own figures there is already a shortfall of £1.4billion .Ever since the Councils have taken over this task they have been found Guilty of misappropriation on numerous instances and I have personally had to deal with the Counsellors who have openly condoned this action .While ever this money is administered by One of the largest providers of Care do we really believe they they will not usurp their power We just need to refer to certain participants in this conversation to get an informed answer.

The majority of ALL care homes are run by small, family own businesses all of them making a living and paying taxes etc. in the UK ,why does Duncan keep referring to places all over the World , can we stick to our system in this Country please.

Thanks for the elucidation GH. I can understand the logictical cleanliness in dealing with a consistent set of requirements.

However I also think it was more likely that local people having a pop at local councillors might have been more responsive to abusive or weak homes management. Whatever else we know is that there is abuse and has been abuse and that staff reporting it have been victimised. This has to be changed.

Hi Patrick glad to be of assistance unfortunately the Councillors you are referring to were party to the underfunding which I have referred to and therefore not uniformly acceptable to criticism. In practise we do find that the whole system is working better for everyone Private, Public Sector Charities etc. Health Authorities, Less Politics, more needs awareness applied across ALL Sectors.

I don’t suppose there is a straightforward answer, Gerald. Perhaps the vacant places in the nursing homes are not suitable for the patients awaiting discharge for some reason. On the face of it, however, it looks like local authority incompetence.

This is one instance where the entire cost can be avoided if the individual concerned signs an agreement to donate their body to medical science upon their death. Medical schools will always need bodies, as do Medical researchers in Universities, and it also relieves relatives of the funeral issue. Universities will cover the costs of a service, so it’s certainly worth anyone considering the option prior to their death or incapacity.

Duncan says – “I hope I don’t hear the usual cries of – we can’t afford it – UK 6 richest nation in the world”.

I agree there should be some provision for assisting with the costs of a funeral where the deceased left no funds, or was not in a funeral plan, or their family has no money.

Those with absolutely nothing and no family are provided for with a ‘public health act’ burial organised by their local council but the council has to explore all possible sources of funding before undertaking such a funeral. It is a basic and decent funeral which observes the faith or personal requirements but, for obvious reasons, it is not regarded as entirely fitting,

The problem seems to be around those with more than nothing but not enough to fund what is considered to be a suitable funeral. I should be interested to know how the Scottish government has managed to work its way around all the questions that naturally spring to mind when putting forward a scheme to make some provision for funeral expenses without opening up inconsistencies of treatment, determining low-income cut-off points, taking account of the obligations of the deceased’s family, the treatment of any property, the question of means testing, and so on and so forth.

People are under a general duty to make provision for their own funeral arrangements and most do so [with or without support from other family members]. Would a basic state scheme change the approach to self-provision? Any scheme would require difficult judgments to be made at the margins: how is that to be managed?

As for the the UK’s position in the world economy, I agree that it is our low ranking and the poor state of our public finances relative to the demands placed upon them that does makes it imperative to consider carefully what should be displaced to accommodate a new initiative like this. There are so many competing claims for exchequer funding in the fields of health, education, defence, housing, and other public services that it is a difficult choice to make. The Scottish example might be a helpful guide to how it could work and be afforded.

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The Scottish contribution will be, in effect, means tested so if they do their job properly only those who need it will be helped. A good principle to avoid wasting taxpayers’ money. Presumably English councils take the same approach when deciding to provide a funeral.

Another way to fund this might be from a funeral fund derived fron a small levy on all funerals.

I’d question, perhaps, funding flowers if that is done through the funeral provider. That can be a very expensive way of providing them, in my experience. Nothing to stop people buying the excellent value flowers and bouquets that many supermarkets, for example, provide.

I think we should means test other benefits to ensure that taxpayers’ money goes just to those who need it; the winter fuel allowance, tv licence (currently free to the over 75s), for example.

The Scottish government is relieved of the burden of providing for the UK’s defence and overseas commitments [among others] so can afford to take a more relaxed view on discretionary welfare spending.

To some extent the funeral trade does subsidise the public health act funerals by being under contract to the local authority to meet a certain specification at a certain price that is generally far less than their regular fees. They probably don’t do it at a loss but there are hardly any profit-making opportunities with such arrangements and it is a sad fact that many of the cases they have to deal with in this way are not in the best of conditions when collected.

Funeral companies have to act in a similar way when directed by the police, acting on behalf of the Coroner, to remove a body to a mortuary or hospital for pathological examination. They perform this function under a low-priced contract that they actually compete for as it gives them an introduction to the deceased’s family in the hope of securing instructions for the eventual funeral arrangements.

In the event of a second Scottish independence referendum that separates Scotland from the rest of the UK with the loss of financial support and with responsibility for new functions like defence and foreign affairs, how would the Scottish government be able to continue to afford measures like this? I believe Scotland should be able to choose its own destiny but it seems to have a lot of expensive programmes that could be unaffordable without a rise in taxes. That aspect never seems to get a mention.