Care home crisis: the shape of things to come

Antony Mason looks at why the long-term care of the elderly is now causing serious concern

Not one, not two, not three but FOUR major news items this past week have drawn attention to the impending crisis in the long-term care of the elderly.

This may, on the face of it, look like a crisis for the present elderly, or for those “baby boomers” who now swelling the ranks of the retired. But on the contrary, it is a major intergenerational crisis, because it is the younger generation who are going to have to pay for the care of the elderly – given that public provision and funding is likely to prove utterly inadequate to meet future needs.

And if the younger generation can’t fund it financially, they are going to have to roll on their rubber gloves and do the caring themselves.

1. OECD Report

The Organisation for Economic Cooperation and Development, which represents the most industrialised nations in the world, has published a report entitled “Help Wanted? Providing and Paying for Long-Term Care” in which it estimates that elderly care costs will double, if not treble, by 2050, when 10% of the population will be over 80.

It asks many pertinent questions, such as: “Can we attract and retain care workers – is it just a matter of paying them better? Will public finances be threatened by the cost of providing care in the future? What should be the balance between private responsibility and public support in care-giving?”

It points to the failure in planning for future care, citing in particular the high costs of staffing. But low pay in that sector, and the hard working conditions, make staff retention a hazard that few countries have managed to overcome.

But this not just an issue for the future. It’s already here:

2. Financial crisis at Southern Cross

There are concerns that Britain’s largest private provider of care homes for the elderly may be about to go into administration. Southern Cross, which operates 750 homes and looks after more than 30,000 residents, recently posted a half-year loss of £311 million. Like other homes offering residential care, they have been badly hit by local authority cuts of around 10% in social care spending.

That is sounding alarm bells among all the care services:

3. Open letter to the Coalition

On 31 May an alliance of charities, think-tanks and councils sent an open letter to the Daily Telegraph urging all political parties to unite to address the crisis in care for the elderly and disabled. Among the signatories were the Joseph Rowntree Foundation, Age UK, Bupa Care Services, and the Local Government Association.

The bottom line is that Britain is just not addressing the issue. Councils are so stretched by the need to reduce spending that they are cutting services like meals on wheels and home help – and funding for care home placements (see above). In other words, it’s not as if the answer is going to come from the public purse.

But private individuals have not got the resources either. Care homes can cost up to £50,000 a year. Is your pension scheme worth £1.5 million (what you would need to cover the annual cost from income)? No? Join the club: each year some 20,000 elderly people have to sell their homes to pay for care.

4. Failing hospitals

Many elderly people spend their final days (or months) in hospital. But even in hospital, care of the elderly has been found wanting. A report by the Care Quality Commission (CQC) – the new health and social care regulator in England – found that three NHS Trust hospitals (out of 12 so far inspected) were failing to meet essential standards required by law in their treatment of the elderly.

The CQC was looking particular at compliance to standards of “dignity and nutrition”, and found poor monitoring, poor communication, even failures to provide enough water. It is not difficult to picture just how distressing this is for patients, and – perhaps even more so – for their families.

What is to be done?

Much now hangs on the Commission on Funding of Care and Support, due to report in July. Chaired by Andrew Dilnot, Principal of St Hughes College, Oxford, the Commission is looking at all options.

Younger generations would be wise to watch that space.