To wonder (setting aside immigration) how the elder care sector can be improved?

I was chatting to a friend of mine the other day, and we were saying that if we are single/widowed we should move in with our friends when we get old.

I know of so many elderly people who live alone and who don’t have family close by- they could do house shares like students and share costs of cleaners/carers. They’d also have company.

I hear you about the frail 93-year-old with dementia, but what if that 93-year-old is still as sharp as a tack mentally? Presumably you wouldn't be advocating the difficult conversation then?

Not meaning to interrogate you, it's just that I get the feeling you're speaking for an assisted dying agenda where dementia is in the mix (although people in the early stages of dementia can still have quality of life, just saying). If that's the case - and even there I still think it's problematic - presumably your remarks don't extend to elderly people who are simply ill and don't have dementia?

Insurance package sounds a good idea, but if you don’t need care in a care home then what happens? Do you get a nice lump sum to pay for holidays, luxuries, a bungalow , live in carer?

I mentioned immigration because an obvious issue is whether migrants will continue to be a major source of care workers or whether we will focus on recruiting people already here, or a combination. There's clearly a terrible shortage of workers so it will need to be fixed somehow. As I said, I didn't want this to get sidetracked into an immigration debate, but I thought it should be acknowledged.

I worry about this too. Other threads I've read on MN have given me the impression that some people think the economically inactive are dispensible. It's giving off strong dystopia vibes.

(Not talking about anything I've read on this particular thread btw, although I haven't read every single post.)

Less than 10% of people end up needing to go into care homes. Compulsory insurance deducted from the wages of everyone over 40 would fund this. I believe there's a similar scheme in Germany.

And improve our NHS - so it's on a par with France and Scandinavian healthcare. Then people get hip and knee replacements on time to help maintain their independence. Physiotherapy to help rehabilitate after a fall/prevent further falls.

Care workers: lots of people don't want a profession - just a decent contract of employment instead of zero hours, fair pay and paid sick leave.

There’s a fixation with keeping people alive. Just because modern medicine can keep someone’s pulse going and air moving in and out of lungs doesn’t mean it should. People have to die from something.

Will this also be applied to disabled people and those being kept alive by technology and who are unable work?

You'd be surprised how many people get no visitors dispite having 3 or 4 children, it's heartbreaking because they do know

Don't consider moving into sheltered housing. If you need to downsize, just buy somewhere smaller, you can have an alarm system fitted and bath aids. Retirement complexes are awful places.

Shipping someone abroad is not going to do them any good. Imagine being frail, elderly and with dementia and suddenly you’re surrounded by people who don’t speak your language and you never see a familiar face. Never mind the risks of the flight to get them there.

I know, no easy answers. Personally I think it's more important young children grow up with their mothers, than adult children and elderly parents get to see each other regularly. If I put myself in that position, I would rather see my young children every day and my elderly mother once every two years than see my tiny children once every two years and my very elderly mother every day. I can't see this 'trade' ever going the other way though because we're the ones paying the bill and basically we don't give a shit and the children of the Filipino care worker never seeing their mother.

Before choosing a move to a care home we have had a twice a day carer service - one 30m and one 45m. The carers were excellent and of course my husband and I were here as wraparound for Dad.

I checked before engaging that the staff were adequately paid above NMW and looked after - paid for travel time, mileage at a proper rate etc. The charge rate was £30 for 45 minutes and sort of prorata for more/less which, of course, takes account of the additional admin and management costs.

However, the main help was for me to be honest! Their visits achieved an objective but the number of times they were late because theyd attended a visit that required them to stay with the client due to finding them having fallen. Carers don't really stop issues happening but they do act as a daily oversight and, I guess, makes sure medication is correct, and food and fluids are being offered.

Carers call at strange times. Dad might be eating his supper at 5pm, or been awake since 7am and they call at 10am. It.was all fully understandable as they have to see lots of clients but its not a great quality of life being bundled up to your room so early or left lying in.

And so weve take then extraordinarily hard decsion to move Dad into a care home.

Why isn’t dementia automatically treated as continuing care on the NHS,in cases where the person is obviously needing complete care, washing, feeding etc, instead of relatives having to go through hoops to get it, often refused and having to appeal ?

Higher staff ratios. Even when fully staffed carers have so many patients to look after that even if they are kind and compassionate people, the residents needs are not all going to be met. There are too many competing needs even if the carers are working flat out. If you have multiple residents that all need something at the same time i.e toileting, feeding, washing, repositioning, reassurance/activity, then they need to prioritise the most urgent need first. Therefore jobs which take longer, or have less priority or require more staff such as showering might never happen as they are constantly being called away for more urgent things such as incontinence or meals that are going cold if the patients aren't fed. Of course people may be understand that in these circumstances staff are doing their best and are happy to have a strip wash instead of a shower. But if staffing is always at this level and therefore it happens again and again each day, then that person hasn't had a shower for weeks which obviously is unacceptable.
Basically the workload is not actually possible if carers are aiming to provide what most of us would consider a good standard of care. This in turn drives away kind and compassionate staff as it is heart breaking to see people's needs not being met such as people being incontinent as they have waited so long.

I was chatting to a friend of mine the other day, and we were saying that if we are single/widowed we should move in with our friends when we get old.

I know of so many elderly people who live alone and who don’t have family close by- they could do house shares like students and share costs of cleaners/carers. They’d also have company.

Expression of wishes becoming as normal as wills.

GP and community health services taking the time to have that difficult conversation.

Harder, shifting the cultural expectation that everything needs treating. That will need public education campaigns.

Shifting behaviours so that the GP that covers the care home out of hours doesn’t recommend hospital admission for a wheezing, frail, 93 yr old with dementia ‘so the family don’t complain’.

Probably empowering nursing home matrons to adjust medication themselves, and not needing to put it all through a GP who doesn’t have the context or understanding of the patient.

I find it disturbing that OP wrote so much about assisted dying. To me, elderly social care & assisted dying don't connect at all.

OP wants : 1. deprivatisation, 2. higher pay & 3. training & status. Also much 4. more [stringent] checks on quality of homes.

Yeah... coz closing down more care homes will do so much to increase capacity in the residential care sector.

Anyway, everything on OP's list means raising taxes. British public have consistently voted against any party that proposed raising taxes to fund social care. Theresa May tried & failed. So nothing on OP's list is feasible.

I’d far rather take a pill and check out as soon as my faculties have gone . The indignity of old age fills me with dread .