Ageing

Everyone Should Tell Their Story

Joan’s Story

Joan was born in London in 1933, where she lived with her mother and father in a flat in Putney. She remembers the outbreak of World War Two being announced via a town crier who rushed through the streets. Joan’s mother accepted the dangers of living in London, but she couldn’t bear for Joan to be evacuated to an unknown place to live with strangers. So, she took matters into her own hands and made enquiries with a family friend who worked in a vicarage in Hoby, Melton Mowbray. The vicarage agreed to host Joan for the duration of the war and so she went on the train to Melton Mowbray aged only six!

Joan reminisces about her time in Melton Mowbray with fondness noting that the tiny village only had one shop, a small junior school, a church and the vicarage. There was no running water, electricity or toilet facilities there despite these amenities being common in London at this time. Water had to be gathered from the well and a cart came round to collect the sewage. But despite this Joan admits she really enjoyed life there and her 5 years away went by very quickly. She saw animals and fields for the first time and even helped the Land Army girls pick potatoes – they were glad for her help! She got involved with the church, learning lots of hymns and helped pump the organ for 50p.

After the war, Joan’s family moved to Maidenhead in time for her to start secondary school. Joan admits she didn’t always concentrate at school, but she’s always been very artistic. After leaving school aged 15, Joan worked as a sale assistant in Marks and Spencers in Maidenhead High Street and then for British Railways. However, her favourite job was as a wedding photographer, where she often photographed 2-3 weddings every Saturday. She would develop black and white prints in her bathroom for her friends. For Joan, it’s photography that has shown the biggest change during her lifetime, she can’t believe the quality of mobile phone cameras now! Or that mobile phones even exist as she only got her first one about five years ago.

Another one of Joan’s talents is her French language skills. After studying French at school, Joan continuing teaching herself using records. When she met a French lady on the train to work and struck up a conversation with her and they remain friends sixty years later. Joan’s first holiday outside the UK was in 1956 when she went to see her in Paris.

Looking back on her experiences, Joan thinks the most important lesson in life is to always listen. She was taught the importance of listening when she sent to etiquette lessons in London aged 6 and this lesson has stayed with her throughout her life.

Since retiring aged 60, Joan has remained happily living in Maidenhead. Her hobbies now include reading and listening to her favourite singer, Susan Boyle.

£2bn Rescue Package or Sticking Plaster

So, the Chancellor has heard the clamour that social care for the elderly is in crisis by offering a ‘rescue package’ of £2bn in additional funds over the next 3 years. Obviously, it would be curt to dismiss this effort but will this really make a difference? The questions to consider are
• How much of this money will actually make its way to front-line care activities?
• Will we see an increase in the numbers of elderly people receiving care?
• Or even an increase in the rates Councils expect providers (and our staff) to work for?
• Will Councils still expect providers to charge self funders extra to make up the difference between costs and Council rates?

The size of the problem is that while the headlines in this budget are for Council funded care, they only account for 22% of the elderly population over the age of 65 that are estimated in needing assistance with care. On another point, if you didn’t catch it this rescue package is not solely for the elderly care needs but it’s a pot to be shared across both services for the elderly, and younger adults with disabilities!

Any Help Whatsoever for self funders?

I am disappointed that there was nothing in this budget for people who have to pay either fully or partially for their care; Nothing to the 1.5m people that are cared for by family or friends; and nothing for those estimated 1m people that struggle by with little or no help. There was also nothing for providers who face increased costs in pensions, living wages and a huge hike in CQC Registration costs!

Sadly, I fear the elderly care crisis will continue with the most obvious signs being on the viability of providers (and their underfunded care staff) and on the NHS. I’m not even sure that the distance to the potential cliff-edge failure of social care has been increased! I very much welcome the possibility of a Green Paper from the Government later this year but any Paper must consider the whole issue and not just be dominated by Local Authority self interest. We repeat our call for the Government to appoint a Minister for the Elderly for ensure all the elderly in England are considered and that a comprehensive, integrated approach is arrived at.

Loneliness is not just for Christmas

The usual features about loneliness at Christmas and how we all need to be a little more neighbourly will shortly join the John Lewis advert to tell us what time of year it is. However, it seems a pity that a large effort to combat loneliness only appears at Christmas. Although exclusion from the celebrations can certainly amplify the feeling of loneliness, sadly for many elderly people isolation can be a continuous feeling. Like many human emotions there are different kinds of loneliness that affect people to different levels. Some experience loneliness as a vague feeling that something is not right, while for others it is a very intense deprivation and deep pain.
To confuse the matter, loneliness is not the same as being alone. A person may be living in a care home surrounded by staff and patients yet still experiences deep loneliness. Certainly, one type of loneliness for many elderly is related to missing a specific individual because they have died or live far away due their domestic circumstances.
A study carried out by relationship charity Relate in 2014 found 1 in 10 people felt they didn’t have one close friend and that 19% had never or rarely felt loved in the two weeks before the survey. The statistics regarding loneliness for the elderly in the UK are sombre.
• 17% of older people are in contact with family, friends and neighbours less than once a week and 11% are in contact less than once a month (Victor et al, 2003)
• Over half (51%) of all people aged 75 and over live alone (ONS, 2010)
• Two fifths all older people (about 3.9 million) say the television is their main company (Age UK, 2014)
Loneliness is a bigger problem than simply an emotional experience. Research shows that loneliness and social isolation are harmful to our health. 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often. This shows the importance of conquering the challenge of loneliness, but for the elderly this can often be tricky.
The feeling of loneliness is considered a passive state, that unless we make changes will lead to further helplessness and depression. For many people, overcoming it involves increase their level of social contact with others. Unfortunately, for many elderly people, transportation issues and personal mobility concerns make increasing social contact something that they are unable to initiate.
At Halcyon we believe that almost half of the value from our visits, is in the social contact we provide. As anyone who has met our carers will testify they are very capable communicators, interested in and more than able to converse with all our customers. This is crucial as studies have shown that a conversation or even just saying hello can produce a positive chemical response in the brain for most people helping them feel less alone.
It seems clear that the only way to challenge the loneliness epidemic is simply for more us commit to speaking with elderly people. I understand that this might seem daunting to some people, wondering how to start a conversation and worrying about what response we might get. Some people wonder what they might say to someone 40, 50 or 60 years older than them. But it can be done. I truly believe older people are younger people but with more birthdays to their name.
We know from studies with socially challenged children that initiating and holding a conversation is a skill that requires practice. Our tone and physical presentation in a successful conversation is every bit important as our choice of words. How we respond to a simple hello is part of a social convention that without regular use we forget. Therefore, for an out of practice person their response can appear awkward or even rude. But that does not mean that they are not benefitting from the exchange. So, there may be challenges but to borrow the words of Nike “Just Do it!” and not just for Christmas.

Waiting for the Inevitable Collapse in Homecare Provision?

This week the Chancellor released his ‘Spending Review’ and ‘Autumn Statement’, which once more failed to even start to address the crisis of care for the elderly. This left me to question what will it take before the politicians see what is obvious to the rest of us? Once more a sticking plaster will be applied to the NHS, which fails to get anywhere near resolving the burden of the elderly on hospitals. It is only a matter of time until the effect of inadequate home care provisions results in Hospitals being used as poor elderly care providers.
Last year I wrote to our local MP asking for her support in appointing a Minister for the Elderly. She replied that this was all covered by various departments and wasn’t necessary. But I believe the absence of such a cabinet minister has allowed the Chancellor to ignore the consequences of underfunding in the care sector. This is already beyond deterioration in quality of care provided and is now affecting recruitment and even the financial viability of many care providers. The proposal that allowing local authorities to increase council tax by up to 2% to meet the cost of social care simply won’t undo the damage from rates stationary for the past 8 years. Some have estimated that it won’t even cover the increased cost from the imposition of the Living Wage by the very same Chancellor!
There are over 9,000 registered homecare providers across the UK, over 75% of which are independent businesses, the vast majority of which are less than 25 employees. About 70% of homecare visits are funded by the state (usually by local council social services departments) but delivered by independent providers working under contract. Last week the Chartered Institute of Personnel and Development predicted a shortfall of 200,000 care workers by 2020 and a potential gap as high 1,000,000 in the next twenty years, as the number of people aged over 80 is expected to double and demand increases significantly. We need to attract recruits. I personally don’t see the solution as lots of cheap foreign workers. This is a skilled job requiring higher communication skills.
After a thorough commercial examination, Halcyon reluctantly made the decision this year not to accept further work commissioned by local authorities. For us, there was no choice between paying our excellent workforce a decent rate for a difficult, essential job or to continue working on social services contracts. We realised that the consequences of this decision might mean a reduction in choice for people in Maidenhead, who might now need to move into residential accommodation. But we concluded that the reality of being unable to provide staff for these commitments produces exactly the same result as not accepting the commission in the first place.
Whether elderly are supported by social services or funding things themselves, our customers know we need a healthy homecare sector with good, well trained and supervised staff. So I listened with despair at the lack of imagination and application from politicians to help improve the situation.
There were no shortage of suggestions for him to consider, it wasn’t just about giving more money to local authorities.
My favourites include:
-We know that people receiving homecare are monitored for food and fluid intake and other personal care issues that reduce the number of hospital visits, so why can’t they have tax incentives to assist with the funding of their own social care?
-Why not change the VAT status of ‘welfare services’ to ‘zero-rated’ enabling care providers to reclaim VAT on the costs they incur?
-Why not “encourage” insurance providers to seriously consider the introduction of elderly care insurance products?
Really, Chancellor, how much longer can you and other politicians ignore the elephant in the room? Do we really have to wait for a collapse in homecare before you understand that it’s time to do something?

The Case for Introducing Technology to Social Care Operations

We’ve had an exciting time recently, implementing strategic improvements for the business after reviewing what has been successfully and unsuccessful in the way we do things.

Social Care has a reputation for being backward, lacking in innovation and resistant to change. Therefore, a proposal to move to handheld technology to organise staff schedules and record our visits with customers was considered highly ambitious by some of my contemporaries in other care agencies.

Our analysis showed that rescheduling happens frequently, due to customers being affected by illness or accidents, and running an operation based on paper instructions meant the rescheduling system wasn’t that effective. When we looked at the care information we gleaned from a visit, we concluded that we couldn’t expect to be highly responsive when we had to wait for paper copies of the reports to be brought in by the carers. Obviously, critical incidents were reported by phone but this was dependent on the experience and initiative of the carer to deduce that an emergency call was required. We also realised that reports submitted on paper remain on paper unless we transcribe them. Furthermore, without a contact system handwritten notes go into a file and rely on the person that put them there to remember or tell others or to be prompted at that moment when things go wrong!

Our solution has been to reorganise our operations (and our supervision of the team) to reflect the fact that we are a mobile workforce and not an office based team. With new software to design and implement, new phones for the carers, 3g technology, training for all the staff in new ways of working and all in an environment where we simply don’t have the option to fail to make visits to vulnerable elderly customers…. What could possibly go wrong??

But we managed it! We have already received some great ideas for improving the system but it works! And the benefits are already beginning to be realised…

Collecting digital data on the care visit means that the management have a view of the care situation from the time of the last visit. It allows us to proactively respond to a developing situation, either to get more clarity from the carer, to contact the family or health professionals in a timely way. Our next development is to share this data on-line with the families of customers who are often remote from the Maidenhead area offering reassurance of our care management.

The back office benefits of having real-time information on carer progress enables us to answer queries for customers when traffic or acute customer needs have caused delays. We are also able to answer directly requests from families asking for confirmation that the carer has been when their loved one, when they have been confused as to whether a visit has taken place or not.

Mobile technology and the use of 3g enabled tablets has also presented the management with the opportunity to take a lot of their work with them out to the customer’s home. We see this as entirely consistent with our aim to be there to support carers who often spend most of their day working alone with customers.

So, backward? Resistant to change? Not us! It may be challenging to do new things but if the prize is improved care, more effective operations and efficient back-office jobs how can you not manage the risks and make the effort?

 

Time to talk about funding

I was recently asked to consider writing to my Local Authority to respectfully ask them to reconsider their responsibilities under the Care Act, and consequently to increase their fee rates for homecare work.
For me, there is an obvious and predictable direct link between inadequate pay rates and poor quality care. A high percentage of public sector savings are being made at the expense of vulnerable elderly people. This is clearly wrong, but I do not believe that asking the Government to allocate more money to Local Authorities for care will solve this crisis.
Local Authorities have already taken choices over where to allocate funds and clearly they have failed to prioritise elderly care. Cynically, I fear that even if the money was “ring-fenced for social care” the percentage of funds that ended up actually spent on elderly care would not make a significant difference. Social Services Directors would still line up to justify flying 15 minute (or less!) visits and select providers solely on price without reference to quality of care.
But there is another reason why I don’t support asking the Government for more money. That is because I believe that this type of initiative reinforces the misconception that homecare can be defined as that type of service funded by Social Services. It clearly isn’t! Homecare needs are not mitigated by a nominal line in the sand drawn at assets of £23,500. Elderly with more than this figure still need care and still want to remain at home!
Sadly, Halcyon Home Care have experienced more than one exhausted 85+ year old who has been abandoned by the system. After “failing” the financial evaluation, they were left to contact and arrange care (normally from an out of date list of providers) for their spouses at a time of extreme emotional distress. They call us without any understanding or experience, uncertain what it will cost or where they will find the funds, or even what service to expect. Simply, they need someone to assist them through the process.
I believe a lack of understanding of the scope of who might be affected and the costs involved is one of the key reasons that the crisis in homecare has been allowed to develop. Too many people think it isn’t going to affect them and if it does, then, social services will look after them. By the time they find out the truth it is too late.
If things don’t change it will only get worse and the scale of the failings of the system will become a catastrophe in our own society. We do need a discussion about funding… and one part is about social services funding … but the bigger debate is about funding for care for all our elderly regardless of the £23,500 assets cap… and it needs to happen now!

What Value Is The Service From Homecare Providers?

Earlier this month UK Home Care Association (UKHCA) sent an open letter to the Chancellor on the National Living Wage warning that the costs of introducing a “national living wage” (NLW) could trigger “catastrophic failure” in the homecare market. Their argument is not that care workers don’t deserve (at least) the NLW but that who is going to fund it?

“Without increased funding to meet the increased staff costs of the national living wage, businesses caring for people in their own homes mainly serving Local Authorities could go bust”, leaving elderly and vulnerable people with no care or resorting to staying in hospitals longer, straining the NHS further, with the inevitable knock on effect to the wider population. In reality, the situation is similarly true for people funding their own care; only without an Act of Parliament forcing them to accept responsibility some will reluctantly accept an increase in costs and others will decide to struggle on without any care support.

Wow! How has it all come to this?

I could write for hours on my opinions on the history of under-funding and political short-termism with regard to social care in this country but one of the issues raised by the often negative responses in The Guardian was of what value is the service from homecare providers?

There is no metric to provide a value measurement for our services to the recipient of care and their family.

What is the value to someone like Mr M who died recently? He could not have expressed more strongly his desire to stay at home until his end. Despite his considerable pain, his home was where he felt comfortable, with a choice over what he ate and when. He resisted the advice of GPs and friends to go into a home and was only able to achieve what he wanted through the care, support and attention of our carers.

How would you measure the value expressed by one customer’s daughter who thanked us by saying how much more “positive” her Mum was after we started visiting? She thought her Mum’s slide into depression stopped by our intervention. We “provided a structure to her life, as well as regular meals which reduced the number of times she had to hospital and talking to the carers reduced her sense of isolation”. She also commented that she could get on with her life without her mother calling throughout the day when she was at work.

Similarly, how do you assess the worth of providing a service that allows a mother to stay in her family home of 63 years in Maidenhead, where she can look out over the garden she worked in with her husband,  rather than being moved into a granny-annexe in her daughter’s home in Teeside.  In addition, the family is reassured that professional carers provide assistance for her, whether it is prompting for medication and a hot meal in the evening or simply watching out for her.

So we agree that there are benefits of receiving care, but then why aren’t our political leaders encouraging all of us to save for the inevitable time when we need care? Why aren’t they encouraging the insurance sector to develop care related products that we can take out to assist in care purchases?

If it’s of value and needs to be provided, then we have to accept it needs to be paid for… or am I being too simple?

Think Twice: Residential Care Is Not The Only Elderly Care Option

Residential care is too often considered the default option when considering how to manage increasing elderly care needs for a  relative.   I was particularly struck by a comment made at a recent social gathering : “Sadly, Mum has reached the stage where she needs help – so we’re looking at what homes are available.” It was clear that there was little awareness that elderly care alternatives were available.

The story was a familiar one. Following a fall, the lady in question’s confidence had diminished, and the demands on her family were steadily increasing.   The family members already had very busy, stressful lives and many commitments – and were finding it harder and harder to cope.  This is a common issue because, as relatives grow older, the frequency of visits, the number of helping activities and the time that they take, all grow inexorably. It can become a significant burden, which requires action.

The permanence of residential care

Residential care is a well established solution and may be entirely right on occasion – but it comes at a huge emotional, as well as financial, cost.  It is usually an uncomfortable choice for all concerned, because it has a “permanence” which is very difficult to reverse.  Such decisions often carry guilt, because it is so easy to understand that the wrench of leaving familiar surroundings – especially if it is for good – can be terribly distressing.  It isn’t only places and things that must left behind, but memories of good times, lost partners, and the loss of many personal routines. Small wonder that resistance can be high on the part of the individual concerned, who fear (with some justification) that their independence will be compromised.

A more natural transition

In contrast, taking some professional homecare to take over some of the most onerous or regular daily care tasks can seem a natural transition, because it can start at one level and evolve over time. Homecare supports an individual’s choice and ability to live their own lives in their own home, assuring an ongoing independent, safe and healthy life for the duration of their choosing. There can still be some concern or even resistance on the part of the elderly individual, but the ability for home carers to focus are around the choices of the customer makes this less distressing and  it is far easier to allay concerns.

Tailored to actual need

The benefits of continued living at home go well beyond the practical. Home elderly care is very scalable to the individual need – some of our customers require a very few hours of help each week, whereas others require multiple visits each day, unlike the ‘all or nothing’ decision of a move into residential care.  It can be focused on the specific tasks which the person finds most difficult, yet preserve their choice to handle other aspects of life as they choose.

Truly personalised

Home care is not only about carrying out care tasks – a good home care firm supports and sustains general wellbeing and happiness, because it focuses on building relationships too.

In our work, delivering elderly home care in Maidenhead and Ascot, we get tremendous positive feedback from customers because the care we give is truly personal.  Customers get to know a small, steady team of familiar faces who deliver one-to-one care which is not generalised, and which takes their own wishes and needs into account in a way which the many-to-many nature of care in a residential home simply cannot.  We are used to helping people regain their confidence as we firmly believe that care is something we do with our customers and not do to them!

It is not surprising that we are always strong supporters of home care itself but, above all, we believe that people should have choice – and be able to make the appropriate choice at the right time.  The lady who inspired the discussion was neither local nor a potential customer, but I truly hope that she is enabled to enjoy the comfort and familiarity of her own home for as long as she wishes. She has every right to have meals at times that suit her, have a personal say in the care she receives, and to enjoy a continuing feeling of independence.  If, in future, she goes into residential care, it should be a time of her choosing and when it is the right direction – not the only option that is considered.

Dementia Week: Dementia – Tip of the Ageing Britain Iceberg

The realities that highlight an increasing need for a Minister for the Elderly

This week is Dementia Awareness Week, and a great time to reflect on how to help those with Dementia. It is a distressing and debilitating condition which we care about very much, yet, feel that this week carries with it some dangers. Focusing on this one issue in isolation — while it can help communities and individuals step up to help — can create a smoke-screen which masks, or pushes to the background, some very serious associated issues. Perhaps Dementia Awareness Week should not be viewed just as a time to focus on the challenges of now, but should be a time of reflection and vision. Britain faces a very scary future scenario when it comes to its ageing population and that is intimately tied up with the challenges of dementia.

Even the simplest facts should be giving us all pause for thought:

  • One in three people over 65 will develop dementia in their lifetime, according to figures from the Alzheimer’s Society.  This is a startling enough likelihood that we must face, not only for our ageing relatives but as we look towards our own future.
  • The number of UK citizens over the age of 65 is already more than 10.5 million, and this figure is set to increase steadily and dramatically for the predictable future in Britain and around the western world. There will be over 16 million in that age bracket in the next 20 years.
  • Not only will there be more of us in the ‘elderly’ category, we are also living longer, on average. That means that there will be an increasing proportion of the population at the older end of the 65-plus spectrum. The number of those aged 85 and over is predicted to double in the next 20 years – and triple in the next 30. There will be a significant number of people over the age of 100. Where in the past it was exceptional to find the extreme elderly, it will become increasingly common.

Everything must adapt. In such an ageing society, dementia will be only one of the impacts and implications that we must face – yet, to date, remarkably little has been done. Efforts to rationalise (and ration) care through major legislative exercises such as the Care Bill can only, in reality, focus on part of the problem at any one time. The problem of taking a piecemeal approach to such a vast issue is that as you change one part of a system, you can create myriad unforeseen outcomes and still fail to effect positive change.

Who’s Responsible?

There is, currently, no minister with specific responsibility for the Elderly population that exists today or which will come to exist in the future. Instead, it is bundled under the vast responsibilities of the Secretary of State for Health and the Minister of State for Care and Support, who must also grapple with unrelated things such as prison care, and care for every other category of citizen. Not only is this unrealistic, but the problem is that the implications of our ageing do not lie solely in matters of how we deal with the illness that is dementia, organise elderly care, or arrange NHS resources.

The challenges that lie ahead touch on every aspect of Government responsibility, from housing and planning of our future communities and built environment, to the behaviour and expectation of businesses in dealing with older customers, to the provision of key public services like transport, to pensions. The list goes on, of course, and underlying it all is the question of how to fund and finance essential change, and negotiate and balance the demands of ageing Britain against all its other pressing needs.

We must stop being Ostriches

The UK Government has been steadfastly ignoring this issue for years now. The current administration did not act even after it was handed a clear call to action by a cross-party group of back bench MPs in June 2012 who launched a Commons debate after a concerted campaign by action group Grey Pride. Numerous petitions have been started, both by that organisation and others independently. A ‘tsar’ approach was tried under the last Government with veteran actress Baroness Joan Bakewell stepping in, but it wasn’t continued, and no real action was taken – not even her calls for the appointment for, at the very least, a commissioner for the elderly to help fight discrimination and promote awareness of elderly issues. In our view this was focused on the wrong part of the challenge; but even this ‘watered-down’ approach would go some way to equalising the disparity which exists, inexplicably, between the interests of the elderly and children, who enjoy (in effect) positive discrimination. While we would not want the interests of children to be neglected in any way, we believe that the same or more attention and support MUST be provided to the elderly.

To date, we have all been guilty of waiting for others to take action. The Government has said it will ‘consider’ the matter, but some spokespeople have raised spurious concerns around the risks of taking such a step – and ignore both the pressing need, and potential benefits. Public services have been content to deal with current problems, and paid insufficient attention to those which are coming down the line. Each administration has managed to hand off the problem to the next. This cannot continue.

Call to Action: Call for Change

This issue is not going to go away.

We call, firstly, on the elderly population, who are voters in their own right, to stand up and call for action on this vital issue. We call on all adults to do the same, in fact – because this isn’t something that will only affect someone else. It is going to affect you, and significantly so.

We also, most of all, call on the political establishment to wake up, and recognise the critical needs that exist now, as well as in the future. This problem sits above and beyond what any single administration can deal with, but we need someone to step up and start the ball rolling – soon. Every member of the Government, both in power and in Opposition, and every public servant in the UK must recognise this as their own problem – because, like everyone, they will age. If the current Government can be brought to recognise it, the next will still need to recommit. This is no small challenge, but postponing it does not make it any easier to address.

The enormity of the changes that our ageing population will force in our society means that ageing and elderly issues should be part of every policy decision. Failure to do so will mean inevitable needs for knee-jerk, after-the-fact, reactive change in the future, at far higher cost than would have been incurred had they been addressed ahead of time. Whatever it is called: a Minister for Older People, a Minister for the Elderly, or a Minister for Ageing Britain, we need one, and extremely soon.

We will be writing directly to the Home Secretary, Theresa May MP, in her capacity as our own local Member of Parliament, and would exhort any reader to do the same, to ask her to take action on our behalf, and join our call to arms.

 

Sources include: Alzheimer’s Society http://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200120

Halcyon Home Care is deeply committed to excellence in dementia care, and last year appointed a Dementia Champion. Read some of our other dementia articles. such as 6 ways to care for dementia in winter and Connecting to people with dementia