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

Privatisation of the care sector has been such an outrageous failure. The problems simply cannot be solved until it’s nationalised. Everything else is tinkering around the edges.

I’ve yet to see a remotely compelling argument otherwise.

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.

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?

Care workers are badly paid, badly treated, are looked down on in society in general, and have to have great people skills to be any good at it.
They do crappy hours on crappy contracts for crappy pay and are so overstretched they cant give the level of care that would give them real job satisfaction.

Even if you pay more, if the business is owned by an an investment firm they will look to cut costs.

Agree there’s something about following the money. No way are the private sector not making shed loads from care homes (and nurseries). If they weren’t they’d offload them pronto. I guess having care homes as part of the NHS / local authority system might help albeit the costs would be higher.

I think that is because you don’t recover from dementia so it is considered part of the aging process. I think in assessments the word ‘frail’ is used a lot. People are not awarded continuing healthcare for frailty. I think basically the local authority will try to get out of paying if they can but you really can’t blame them. They have very stretched budgets.

Pay more for the care. You can then attract & retain better staff, have higher ratios, provide better activities etc.

But people don't want to pay it, local authority included.

The stakeholders only care about making money and not getting sued. They don't care about their staff or the residents sadly. The staff get a poor deal (overworked, underpaid) and as such so do the residents.

Yes, I see the logic. But based on my experience in this sector, hell freezes over before I send a family elder abroad where I can't check up on what's happening.

I think this might be what's needed given falling birth rates. I've heard in Japan they have a system of 'young old people' and 'old old people' and the young old people look after the old old people.

There is a logic to this. Instead of importing (usually) young women, often away from their own children, to look after our elderly, send our elderly their so these carers can provide for their families while still getting to raise their own children.

Better still a 2% death tax paid by everyone who dies over retirement age whether they ended up needing care or not.

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.

What do you envisage 'more realistic expectations, more difficult conversations, and more appropriate care paths' looking like in practice?

The biggest thing, is more realistic expectations, more difficult conversations, and more appropriate care paths.

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.

Next, focus care inspections, funding and requirements on things that matter. Drop the fixation on privacy. Shared rooms between patients where it’s a good match make things so much easier for staffing.

Reduce the money merry go round. National insurance on salaries. Council tax rates. All of which goes round in circles but with administration costs incurred at each stage.

As a starter, need to start paying staff at least 10% above minimum wage. It is hard work both physically and emotionally and a fair days wife for a fair days work.

I couldn't agree more. The difference between the way cancer care, and even MND care, and dementia care are treated is cruel and unjust.

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 ?

That sounds easy, but it’s not.They may be in the early stages of dementia but deemed to be rational when they made their decision “ helped” by relatives! They may be rational, but pressured to sign.

Back in the late 1960s - early1970s an elderly friend of our family - no close family of her own, and a spinster - was in a sort of foster family arrangement, funded by the local authority. From what I remember, physically she wasn't too bad but declining a bit mentally.
She was living in a family environment, with the stimulation that provided, and was very happy.
I don't know what happened to her eventually.

How do you check the care they’re being given? They could be assaulted, robbed etc. How would you know? Bundling them off abroad to the cheapest option comes with all sorts of risks!

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?

P.S. UTIs in elderly people worsen dementia. They speed up cognitive decline, and if not treated quickly, the cognitive loss from the UTI can be permanent.

I do entirely understand reservations about over-aggressive medical treatment of elderly people, but treating UTIs is not such a case.

It starts with the attitude of the people receiving the care, who at the moment appear to see it as something that you should avoid paying for as much as possible while simultaneously hoarding cash to give to your kids.

Care workers generally aren't valued anywhere near as much as they should be.