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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!
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.
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?
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?
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?
Our home carers are very special people, who come into the elderly care profession to do more than just a job; they have a deep desire to do good for others and make a real difference to their lives. This was reflected in our earlier published story about Tracy, our Operations Manager and a senior home carer. This week is Dementia Awareness Week, and we’d like to tell you about Ann, another of our amazing carers, who has a very special role to play at Halcyon Home Care. Ann is our Dementia Champion: a Senior Carer with 11 years of experience as a care assistant, senior and operation co-ordinator, she has been developing a best practices programme to support current and future dementia customers in our area. Ann tells her own story about why she became a carer and her journey through to accepting the role of Dementia Champion. She then gives us her own take on the importance of Dementia Awareness Week.
“What motivated me to become a carer was a desire to do a job that made a real difference to people’s lives, and I wanted to do something different with my own life. I found that I really enjoyed helping others.”
A Home Carer Career
I joined Halcyon Home Care in June 2013 after some time away from care. Despite my previous experience as a Care Coordinator I was happy to be doing a job as a Care Assistant in the Community. After a couple of months, Paul, our MD at Halcyon, decided that I would be an ideal candidate to take on the role of Dementia Champion, to support the Dementia Challenge and demonstrate our dedication to both excellence and putting resources in place to support the growing number of people in Berkshire living with dementia. He was looking for someone with an interest in the way we care for people suffering with dementia and how we can make sure that we were doing our best for them. He didn’t want this person to be a manager, rather someone who was actively delivering care in the community and who was very aware of the challenges of caring for people with dementia.
My progression at Halcyon therefore has been swift. Halcyon Home Care has been developing a good reputation and the number of customers and staff across Maidenhead, Windsor and Ascot has grown significantly. At the end of last year I was appointed Senior Carer. This role is mainly about supervising and supporting our staff in the care tasks they undertake, as well as doing quality checks when I turn up unannounced to watch how the carers do their job at a customer’s home. I am also available for the carers to talk to when they have a question or a problem. Once a month I also take the responsibility for the Out-of-Hours On-Call role. When on-call I provide the immediate assurance and support to the staff out caring. This can be from reminding them how to find a new customer through to taking charge and calling the emergency services if there has been an accident.
In April this year I was promoted again to be Deputy Operations Manager. This is much more of an office job but, like Tracy, I will still be out in the community providing care, only not as much. My new role builds on my experiences as a Senior Carer while now including the initial care assessment visits to potential new customers and the weekly allocation of carers to care visits.
I love working at Halcyon because it is committed to meeting the needs of its staff as a way of ensuring they meet the needs of our customers. I have worked at a few different home care agencies around the area and Halcyon is easily the best. We spend a lot of time getting the Care Plans for customers correct so that carers can do their jobs. It was something I always appreciated as a carer and I want to make sure that I continue to do this in the Care Plans that I am writing. Tracy and Paul have given me great support and I have been given some great opportunities in a very short time.
As a career, I think there are three top things that have made caring a good choice for me.
- I love going into someone’s home and feeling that by my efforts I have made a difference to them.
- I enjoy their company and once you know them as a person the little things they ask for are really not too much.
- Knowing that the person you have been to see has been left well and happier from your visit is a great feeling.
Dementia care is special
Caring for people with dementia demands very different skills and knowledge, and that’s why my role is very important. The needs of people suffering with dementia are different from those of elderly where frailty is their main challenge.
Too many people consider dementia in terms of growing confusion and lack of control rather than what capabilities they retain. Care agencies have traditionally treated all elderly customers with similar care plans, based around tasks to be undertaken from a static care plan. We believe that dementia care needs to be something more. I have only just begun to get to grips with my dementia role, but it is to keep challenging our thinking and practices in dementia care and ultimately, if possible, to develop a clear set of standards for providing care for people with dementia.
Dementia is not very well understood and lots of people feel uncomfortable knowing this about something that could easily affect us in old age. The fact that it’s not one single illness and that it is progressive, so a person’s experience in meeting someone with dementia can be a snapshot of how far along her journey she is, also confuses the understanding among the public.
If Dementia Awareness Week helps more people to know about dementia then it will be a success. The message I would want to give is this:
“with the right kind of care, even when a person has dementia,
we can make a difference to the quality of their life.”
It’s nice to see a flurry of interest in Dementia across the media recently, as the PR machine publicising the new Dementia Friends campaign did it’s job.
Of course we strongly support the idea that the whole country and whole community should get involved in helping to support those with Dementia, a debilitating and distressing experience for individuals and their relatives alike. Greater education and awareness, encouraging volunteering and community support for those with Alzheimer’s is undoubtedly vital. It’s wonderful that people like Sir Terry Pratchett are helping to spearhead change, along with a vast array of kind, well-meaning stars.
We do feel it sad, however, that it takes the glitz of media and music simply to make the subject interesting to the media, unless, that is, they are salivating over some dreadful care home shock story. We also worry that — as good an idea as Dementia Friends is — it rather glosses over the far more pressing problems that surround our country’s planning for an ageing society. It is not only support for the 800,000-plus people living with dementia today that we should be worrying about; it is the million-plus who will be living with it by as early as 2021, with those numbers destined to rise further.
We are glad to see that some smart reporters and channels are giving it a wider consideration too, but suspect such stories will receive much less discussion and debate. We love the article by the Telegraph’s Laura Donelly, for example, which highlights a shocking statistic that over 50,000 people in Britain must give up work in order to care for a Dementia sufferer, because there is no other choice or support.
Jeremy Hunt, Secretary of State for Health, is vocal on this issue at present, but is failing to make the next logical connection in his arguments. We should not be looking only to communities and carers to fill the gap without also re-examining the entire fabric of how we deliver care to the elderly population. It is simply not possible or fair to expect families, volunteers and communities to shoulder the entire burden of an increasingly aged, infirm and less able population. Dementia is becoming more and more discussed, but often as a form of ‘shorthand’ for old age, and there will be even greater numbers of those who are simply old who are not even being considered. Handling the challenges even of old age can be upsetting, as people decline in health, strength and energy. Advanced dementia, though, is a serious and very hard-to-manage condition – viewers of the latest BBC ‘Protecting our Parents’ programme will have seen some examples of this.
Untrained volunteers, well-wishers and harassed relative carers simply cannot cope adequately with this condition, and certainly not without a firm underlying foundation supported by the establishment. To cope with both the dementia and overall ageing challenge that faces Britainn, the systems that we have bear a serious rethink. It won’t be possible, and it isn’t right, to shuffle millions of elderly people into residential care as a default option: the ONLY logical way forward is to look at ways to enable them to live in their own homes and communities. But doing so will mean much, much more than volunteers can deliver, fresh approaches to managing limited public resources, and many, many more trained carers who must be attracted, trained, supported and with pay commensurate with this vital work.
Until the government wakes up to the need for a more holistic ageing strategy, and assigns someone to take real and active responsibility for it in the form of a minister for the Elderly, initiatives like today’s Dementia Friends launch will, sadly, remain only a patch and a PR exercise, unsupported by a real and workable social care framework. We need a strategy for dementia care AND we need an overarching strategy for the interests (and care) of the elderly. It’s time to stop assuming someone else will take care of it, and us, all.