Quality of Life

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?

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.

Personal Budgets for Elderly Care – A better choice, or no choice at all?

New research by Coventry University has concluded that the obvious benefits of direct payments are being compromised by a lack of funding and choice, and was highlighted in a recent article in The Guardian. Unfortunately, there is no surprise in this.

Choice – a meaningless promise

The idea that elderly people responsible for their budgets would opt for a visit to the swimming pool over essential assistance with personal care, when the budget being offered for personal care for the elderly is often at a minimal level, is laughable.

Indeed, the very nature of managing your own personal budget as a direct payment means you can only spend the money on services or equipment that meet your assessed needs. In theory this is supposed to mean that you can choose the ones that best suit you and your lifestyle. If the amount of funds available only covers basic needs anyway, then there is no true choice, and the statement is meaningless. This is very likely to be the case in most local authorities, since all have had to cut their budgets significantly.  Furthermore, the move towards direct payments is so far outside the cultural assumptions under which social services departments operate that it would be akin to suddenly switching to metric units after a life time of imperial. Advising people to be more independent is a difficult concept for local authorities to think through, let alone implement.

Personal decisions – compromised

The Guardian points out that the research found that a quarter of older direct payment users said decisions about when they ate, went to bed or had a bath/shower were compromised. There was never enough money to allow choice over different care arrangements or leisure items and it is made worse as personal budgets have been frozen.

Local authorities have crowed about the savings to Community charge rates, while bleeding care providers through restricted pay rates, often arrived at with a complete lack of commercial understanding. Many local authorities, including our local Royal Borough of Windsor and Maidenhead, have frozen rates each year for domiciliary care since 2009. Although inflation was only between 2.2% and 4.3% in the past five years, the impact of inflation alone to providers is a cost increase of 16%. The impact of cost rises on care workers is even greater, with petrol price hikes and a stubborn, continuing refusal by local authorities to pay for any travel time.

The net result is a reduction in the number of providers that are willing to quote for Local Authority work. No wonder Coventry University discovered a lack of innovation among providers for personalised budget holders!

Elderly care needs – different from those of others?

Another issue raised by the research is whether personalised budgets which were driven by the younger disabled lobby — where the budget is sometimes managed often by fit, healthy adults on behalf of the care recipients —  is appropriate for the elderly. Among the younger disabled recipients there is a much more positive view of personalised budgets than amongst the elderly, who feel much less confident when faced with managing their own budgets.

The care situation for the elderly is likely to deteriorate further: most of the information about personal budgets for elderly persons can be a challenge to access for older people, since they are primarily placed on web platforms, and there is the administrative burden of Local Authority bureaucracy to deal with. However, the biggest difference may come from something that was not made explicit in the Coventry research at all: the vast difference between elderly care packages and those for younger adults.  The baseline for the elderly care packages is care visits based on a miserly 15-minute slot – for others, it is often from longer, person-in-attendance type of care calls.

Budgets – making things worse?

Outcomes of other independent assessments this year, as reported in Pulse, a publication for GPs, attest that the personal care budget scheme was not only inadequate but could actually make matters worse for elderly care. It states that: “The assessment by experts at the University of Glasgow and King’s College London finds that on average personal health budgets cost £4,000 more per patient than usual care, but that in some cases it had a ‘negative impact’ on patient outcomes.” This is in direct contrast to what the Department of Health believes and the line it takes publicly.

In my experience giving control back to an elderly person to manage their care, although it is in many cases exactly what they want, can be pointless or even counterproductive if it is not accessible, sufficient, and realistic in relation to their real needs.

Only the lonely…

… really understand the devastating power of loneliness.

Loneliness has a major effect on our wellbeing. It has been linked to the development of physical as well as the more obvious mental health issues. It can also start a downward spiral in self-esteem where our ability to communicate with others diminishes with lack of practice, making it more difficult to initiate and optimise contact.

Communication is key

Towards the end of a recent presentation I did on home care jobs, which had largely centred on hours, pay, training, and the like, I was asked why I was so insistent that Halcyon home carers are  good at communicating. And why I rated the ability to hold a conversation in clear English as the key skill I look for at interview, even over previous care experience in a care home. I explained that the main reason is to be found in the role we play to help combat loneliness for those people choosing to remain at home, by bringing a bit of the everyday world into their home during our visits. Obviously, while not an exclusively elderly experience, an inability or reluctance to leave the home, loss of a long-term partner, family living away or with very busy lives, all contribute to the growth of loneliness, which some, including Tom Watson, Mirror Online’s Labour political panelist, see as an epidemic. He points out in his article “Loneliness is a modern epidemic that shames our society” that there are currently 8 million people living alone, with the majority made up of those over the age of 75, and calls for action. But – what action?

Technology can help – up to a point

There is no silver bullet for this problem, but many things might help. I personally believe that technology can bring us closer to each other. Initiatives by organisations such as Housing Solutions in Maidenhead to provide free broadband in sheltered accommodation centres have seen a significant growth in the use of iPads and other devices to connect with family and friends using Skype and Facebook, and to share photos and short videos. It also helps bury the idea that the elderly can’t utilise technology after a little help. This is a far more productive solution than, for example, promoting more volunteers, often with no or only limited training. While this is one of the more popular political solutions to elderly care (popular, because it costs nothing) it will not produce the right results and do little more than mask the problem. That said, The Campaign to End Loneliness and other bodies that understand and support the issue, such as the Royal Voluntary Service, are carrying out valuable roles in raising awareness and garnering a caring society.

Home carers play vital role

Home carers know only too well about the impact of loneliness on people’s lives. Very often we are the only real person they will see in the day and it therefore needs to be a pleasant experience as well as a functional one. It is why we allocate our resources into customer “rounds” so we get to build relationships across a number of carers, each with their own personalities and life experiences. Our Care Plans are designed to take a person’s current level of social inclusion into account. It is why we refuse 15-minute “flying visit” calls and train our carers in the difficulties of communicating, especially with people hard of hearing or with other sensory difficulties, and to arrive with a smile on their faces. By choice, we have carers that are able to leave their troubles outside work at home and could easily talk for Great Britain and probably win Gold if it was an Olympic event! Communicating in a respectful way to help keep loneliness at bay is an essential part of their job and woe betide anyone reported as being “not very happy, today” when they visit!

Action requires leadership

The growing number of people reporting loneliness is an unwanted feature of modern living and we need to do something to improve the situation. But people move around more often, change jobs more regularly, change partners more regularly, stay single, choose not to have children or have children that have to live in a more globalised world. We cannot try ‘Canute-style’ to plead for a return to village-community behaviours without imposing controls on all these contributing factors.

At the least, we need a Minister for the Elderly that can raise the plight of loneliness in society at the highest level of political thinking. If we accept loneliness as simply a factor of ageing in a modern society, shame on us all.