The Cost of Care

(Inside Out BBC1 Monday 15/10/2012)

(http://www.bbc.co.uk/programmes/p00zjzvc)

The programme was an analysis and exposé of how Councils are driving down the price of care to our elderly. The North East Councils were amongst the lowest to pay per hour, at about £10 an hour for care of the elderly at home.

The programme quoted various people describing the Councils cutting the hourly rate further as a time bomb and at some point the providers will withdraw from care of the elderly as they simply can’t afford it, especially as the minimum wage is going up. Often cuts are made overnight and it was evident that the cost was far more important to contracting out, than the quality of the service provider. Home care workers were definitely feeling the pressure, trapped in a low wage industry and often working 60+ hours a week. Even the providers’ own staff are complaining they are on minimum wage and often on minimum training, with claims that they were being asked to perform tasks, medication administration was the example, that they were not trained to do, and mistakes were being made.

One relative (her Mother receiving daily physical care) reinforcing this claim of undertraining or poor training, noted that carers were so poorly trained, using the same flannel on her Mother’s private areas, bottom and then face – cross infection being a significant cause of illness in old and young alike. Another relative claimed her Mother was confused at times and needed help with meals during the day and making sure she is safe, especially with a poor memory too – this was not helped when she could see more than 10 different people in one week. This also meant there was no consistency of care, of communication, of knowledge about how the client wanted her care to be delivered; instead making her more confused, more depressed and agitated, which in turn became a vicious cycle as her cognitive functioning was reduced, resulting in her needing more care. This is not uncommon at all!

Another case was quoted where if the carers didn’t turn up, they would not be able to get out of their bed, use the toilet (resulting in incontinence they would be left in all day), eat, drink or attend to any of their own needs, replacement workers were often not sent. Such occurrences mean some people become emaciated, confused due to dehydration, bed sores resulting in pain, depression increases at being left without human contact. Then I wondered how many of these occurrences resulted in admission to hospital or care home, being labelled as at risk at home, all because their care agency could not find cover? Some people want to stay at home regardless, haven’t they got the right to, shouldn’t we as a society support them to have this last wish implemented? Can you imagine how it must feel to go through what some go through, and I fear this is not uncommon at all!

The programme went through Care Quality Commission (CQC) care provider inspection reports and there were cases of staff being thrown into the deep end without enough support, over working, weeks without a break but this wasn’t the worst. Some providers didn’t even do CRB checks (Criminal Records Bureau), references checks or Child or Adult Safeguarding checks, posing the greatest risks to the most vulnerable, and a complete lack of adequate training. I am aware personally of at least 5 companies that think they can give people foundation training in a couple of days, by sitting them down and getting them to watch instructional DVDs that you can buy over the internet – this is not uncommon at all!

There was also the link back to this shocking state of affairs with tendering processes that absolutely proved the councils used the price of service as more important than quality. The cheapest got the contracts and therefore the price was driven down hand in hand with the quality. I know from my experience you cannot deliver quality, reliable, consistent, legal and highly trained staff based service on £10 an hour. And so the Care Service (I am using this phrase very liberally indeed), turn to the elderly person to top up the hourly rate or charge for additional services, such as washing, feeding, bathing, showering.  So what does the £10 an hour get you when some elderly people reported having to pay £30 to £40 a week on top of all their other bills? This bill goes up further when Councils refuse to pay for vital support services such as day centres, or group support; leaving the elderly person either to stay at home or pay for transport to and from a group and for the group itself, over a £100 extra per week. It doesn’t take much to work out that such financial pressure often results in the person going into a nursing home and their property, often their only asset being sold to pay for this care.

I suspect, although I cannot prove it, many councils are driving the elderly into nursing homes as the costs are set and they can draw health money in to fund it, so effectively it is cheaper, especially where the persons assets are sold off to fund their place, which costs the council zero. But let’s not forget nursing home prices, again through contracting, are being driven down where the cheapest wins the contract, thus leading us into exactly the same poor quality existence for those we should be embracing, cherishing.

The programme came across as surprised and disgusted that this was going on, pointing out that this problem is only going to get worse as people are living longer and therefore will need more care. Well, where have you been for the last 10 years? |The industry has been screaming and shouting that the contracting hourly rates are too low, there isn’t enough money going into caring for people, the quality is being driven down as the hourly rates are lowered. A DECADE THIS HAS BEEN GOING ON and now you spend a few minutes on it – Grrrrrr!!!!!!!!

Well for heaven’s sake wake up will you, Councils have been driving the price down for a decade now and forcing the elderly to sell their assets to pay for their care, even though they are the generation that have been paying their taxes, dedicated to working, paying National Insurance and paying their Council Taxes. But the real twist is that although the Councils drive down the prices and hand in hand the quality goes down, when this results in a mistake by the provider or their employees, the provider is the one hung-out to dry and the regulator CQC is crucified for not spotting the poor quality provider, when CQC themselves have been savagely cut with all other Government Depts. The Council just sit back and say it’s nothing to do with them as they are only the contract management organisation. But the blinking ‘elephant’ in the room, the real issue, the core of the blasted problem is that the Councils treat people as commodities, using principles of business such as “economy of scale” or driving prices low by contract value competition, but these are people we are talking about, both the clients and the carers, what on earth are they thinking about.

As a previous care and rehabilitation provider I refused to enter into the elderly care market because the price was too low, my staff went through extensive checks and selection process, even psychological testing to get the right personalities in the industry (or should that be to also rule out the wrong personalities), and they then spent many weeks in training, having to achieve levels of competencies, working with experienced staff, entering into continuous learning schemes, mentoring schedules, supervision and further development, before they were let anywhere near a client. You can do this for £10 an hour! I have to say you get what you pay for, want the right people and the right quality then this costs more than £10 – of course it does!!!!!

Whether we are in a recession or not we are still one of the world’s richest Countries, certainly in the ‘Western’ World, and I have written before about us, as a British society, donating more to animal welfare than we do to research based on preventing dementia, sustaining people in their own home and research into delaying the onset of dementia combined – yes we put animals before our elders. So we have to change this, and it need not cost us more, the answers are right in front of us as a ‘Western’ culture:

We spend billions on sending things into space, ‘rovers’ the size of cars to Mars, the International Space Station, and yet more satellites;

Now we are spending billions in developing a space system that will clear up the debris, the space flotsam and jetsam, we have left behind orbiting our earth;

Billions on a nuclear defence – what the hell for?!?! Conventional weapons are pinpoint accurate and have a million times less collateral damage than a nuclear missile. I am not in favour of disarming our forces as we need to be able to defend ourselves, but we don’t need nuclear defence systems at all!;

Billions are spent on a war in Afghanistan, haven’t our military given enough after 10 years, they have done us proud and I am an avid supporter of our Military, but we all know that as soon as we leave, the country will descend into civil war, so get our proud military people the hell out of there, they have given enough;

Billions on oversees aid, but shouldn’t we first look after the most vulnerable in our society, keep our elders in our communities, we MUST look after our people first – I am sorry if this sounds heartless but the current situation has to change and it has to be funded;

We looked and marvelled at that Austrian guy skydiving from 23 miles high, on the border of space, breaking the sound barrier by falling over 650 miles per hour, but yet we rarely think about a generation of elders being housed in care and nursing homes or stuck in their own home in their own faeces because a carer didn’t turn up or couldn’t be bothered. I know I am being deliberately provocative but when was the last time you thought about people in nursing homes, how your Mother, Father, or Grandparent is tonight – go and see them.

Nursing homes are not evil, care is not wrong, they both have a place and we should use both facilities, but don’t let your Council drive down the quality and then blame the provider. Let’s push to increase the funding but in order to increase the quality, don’t let your Council focus on the money, make them focus on our loved ones, our elders, our people – lets drive the quality up through training, mentoring and supporting the carers with a decent wage, decent hours, after all they are the front line, why are they on minimum wage?!?!?!

This is fixable, there is the money there to fix it, and if the community is given the money to support their local care providers and nursing/care home and have the community set up independent council to oversee change and increasing quality, engage the community, is this what the “big society” is supposed to be about. If you can have ‘Free Schools’ why can’t we have a local Care Forum to oversee and develop local nursing/care homes and local care providers in response to the needs of their residents, our elders.

We can change this, we really can make a positive difference, we are all going to need such services in the future, do you want it to be quality based and increasing quality of engagement and life, or do you want a future that must be a living hell? You choose and then do something about it. We can stop the Councils driving our elders into care and nursing homes and keep all that knowledge, experience and skills in our society. We can make a difference, we can effect change…….

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