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

A big part of it is shift patterns, and I can't think of a way around it. Our clients need continuity of care, which is why we work all day shifts. But our shift requirements exclude people with their own family responsibilities, and they're some of the best at caring. We end up depending on women too young to have children, or men of various ages who are able to work all hours because they don't fulfill their own family responsibilities.

I would much rather have a part-time mother-of-two on shift than some of the full time staff I have as colleagues, but I don't get a choice in that.

Erlingen99

I would also bring in euthanasia for those who made a rational decision to end their own lives with dignity.

I don’t want to be around if I have dementia. My friend’s mother, who had dementia, ended up in a terrible state. She was in torment. My friend said that she would have been prosecuted if she had let her horse live like that.

I did read that a few people in Germany were sending their relatives abroad to places like Thailand or the Philippines where care was much cheaper!

The hours carers work are back breaking. Shifts that are 14 hours long, finishing at 10pm and back on shift at 8am. Awful if you catch a bus as you might only get 5 hours sleep before you have to leave for your next shift. Alot of carers will be clocking 60 to 70 hours a week there are many that do more. There is no sick pay. There is a huge responsibility within the job and they give meds out like nurses do. Unlike nurses they get around £13-15 pounds an hour if they are lucky. Pay staff properly, give sick pay. Improve conditions so you can employ enough staff and stop burnout and high turnover.
Domicillary care is even worse and you can work 14 hours and only get paid for 10. The care industry is a disgrace. Staffed mainly by good people who are exhausted.

The adult social care system in Germany is much better funded and managed.

Everyone pays a social care element as part of their health insurance so there is much more money in the system to start. You pay this whether or not you will ever need social care.

There are far fewer small privately run care homes - most are large scale (though divided into smaller households according to need) and run by foundations on a not for profit basis.

Care staff are better trained. Many are recruited from abroad but they train for several years before being let loose on vulnerable elderly people.
Care staff are better paid, and retention rates are higher.

I think the UK should look seriously at insurance packages for adult social care. Care fees should be capped at say three years fees - so around £200,000. This would allow insurance companies or the state to design and sell packages which could be marketed to everyone.

I think Teresa May floated something along these lines but opposition parties dismissed it as a dementia tax. Political parties should work together on this and stop trying to score points at the expense of the vulnerable.

I would also bring in euthanasia for those who made a rational decision to end their own lives with dignity.

Care homes should be publicly run like the NHS is - its expensive enough to care for elderly, especially those with dementia, without adding in a layer of profit

I do think an acceptance thst we aren’t meant to get really old will help. Especially for those with severe dementia, I will be filling out a living will to say I only want palliative care if develop dementia. I’ve had quite a few relatives thst have dornt 20 years at great expense slowly withering away in care homes.

I saw a thread several months ago from a care home owner talking about the eye watering costs to run. Some seem to make lots though.

I think in practice most are just massively under resourced, so someone has a urine infection and falls and is then placed in a wheelchair for safety losing mobility. Someone else is put in nappies as there is not always time to help them to the toilet. It is such a ridiculously, poorly paid sector.

Education over healthier choices could help, but how does that stop faster deterioration over things like lack of access to health and social care? There is mounting research over the link between covid and early onset dementia, along with other impacts on the brain. There are young children who have had a number of covid infections already - the ones with health conditions or behavioural changes following that can’t get help now. For older (not old) adults where repercussions leads to dementia, what are we meant to say? I’m sorry that you should have fought harder to stop schools/government telling people to attend with covid and your children brought home regular infections. Sort your own dementia out?

That’s primarily from shutting homes and selling property off for housing.

Introduction of a National Care Service, like the National Health Service. No more private care agencies or residential homes. Everything managed by a local trust. This strips away the profiteering side of it.

It would also allow for care to be seen as a career in the same way that health is. You could start as a carer and have career progression via on the job training opportunities that could then see you go into occupational therapy, adult social work, or DOLs and other legal work related careers. Defined salary scales etc so it's not just minimum wage with no pay for travel between calls. Make it appealing to people and they'll do it.

However, as a nation we also need to take some self responsibility. I work for Adult social services. A lot of our service users would not require so much input if they had led relatively healthier lives whilst they could.

There’s a podcast on BBC Sounds about a care home with a preschool in it, that’s an interesting concept.
https://www.bbc.co.uk/sounds/play/p0m6jqyq?partner=uk.co.bbc&origin=share-mobile

A woman I worked with had her Mother in a care home who had dementia plus many other health issues and was close to 90. She had 3 bouts of pneumonia in a couple of years. She was treated every time. Why not let someone like that be given pain control but be allowed to die. She had no idea who she was or where she was.

I work as an ACP in the community and have done so for 27 years. I have had many similar conversations with my Consultant colleagues and the problem with not giving antibiotics is that the symptoms can be severe in terms of suffering. It is not just about pain relief. We are not trying to prolong their life but reduce their suffering. A lot of decisions come down to relatives though.

I hate to say this and will probably get called cold hearted but it amazes me how many relatives still insist on hospital admission and treatment for their elderly loved ones. I work in a team that tries to reduce admission to hospital we are consultant led and can give so many treatments and care at home nowadays. I went to see a patient a few days ago in a care home, advanced dementia, doubly incontinent, unable to express needs, nursed 24/7 in bed. I had a long conversation with their relatives and they were pushing for admission. I know if this person goes in they will likely die or come out worse than they went in. They admitted them overnight to hospital when we were off duty. It is tragic that they would not let us try and treat them at home and if they deteriorate we go onto palliative care. That poor person will now be lying in a hospital bed with limited care which they could've had in the comfort of their own homes, at that stage though it was not our decision.

In all of my years I have only ever seen 2 advanced directives which were put in place by patients and both were respected by medical staff.

Many many relatives cannot 'let go' even if it prolongs the life and suffering of their loved ones who have a very poor quality of life, because they love them but the vast majority of the time it is not in the best interest of that person.

I think the attitude here is part of the problem, I'm not saying this in a horrible way, but as an observation that when the pp has described the level of care their relative receives your assumption (as is so many) is that the carers are at fault -
Why do the workers neglect the activities? Burnout? Compassion fatigue? Just don't care? None is an excuse, I'm just trying to understand why ..

But ime of working in care homes, quite a few different ones through agency and bank jobs as well as permanent positions the main reason that activities don't get done is not enough people to actually meet the residents every day needs appropriately, like feeding, toileting, bathing, Dr and nurse/allied visits, medication rounds etc. Not doing an exercise class doesn't have anywhere near the same impact that someone not getting fed, or toileted, or showered, repositioned does, so what would you prioritise if you were in that position? Who don't you shower, or take to the toilet so you can do some activities? Which resident?

The last place I worked was cqc rated as 'good' it was a locked unit caring for people with dementia, there were 20 residents, and 4 care staff. At least half of the 20 residents needed 2:1 for personal care and mobilising. Medication rounds happen 4 times a day, with the 'heaviest' being breakfast and tea time, taking up to an hour and that's when everyone was 'compliant' and it went smoothly. So that's 3 care staff now on the floor, and someone must remain on the floor at all times for safety, two people who need 2:1 for mobilising need the toilet at the same time.
The best training, progression and a hundred times the pay, and every person working in social care being the epitome of caring for other people and having the highest standards does not make them able to be in two places at once. Nothing can do that.
While I do agree with the points of better pay, progression and conditions, we need a more realistic approach to how many people are needed to actually provide the level of care expected.
And although this may have changed since I did care last, providers get to choose the ratios of staff to residents. The one I described above was 1 staff to 5 residents, when half of those need 2 staff for most aspects of their care. And that was rated as good.

Those conditions do drive the ones that really care out, I want to care for people properly, I'm good at it, but I can't when I have a lack of resources to do so, I'm a human being, it affects me to be in that situation and then to get blamed for the systematic failures and lack of resources is the icing on the cake really, especially when you're running yourself ragged, doing unpaid overtime and paying for your own equipment to do the job to try and mitigate against those failures. And who does that leave? People who are burned out by the above, who don't care enough to be bothered by it and those forced into it because it's a job.

I'm assuming most of the carers are female? Would male carers be needed then for lifting etc? Ofc this could bring other issues...

Physical bodily lifting should not happen, full stop. Even if you take out of the equation the damage it does to the carers bodies over time (which now I'm older is taking it's toll, it shouldn't have happened when I was even starting out in care, but it did because of lack of resources) it's dangerous for the person being lifted.

Equipment has been designed for this reason, but it's expensive, time consuming to use and frankly if you've ever experienced using one, frightening when you know what's happening never mind if you are confused or disorientated already and refusal to use it has to be respected does it not?
We don't need specifically male or female care workers or even particularly strong people - we need enough so that time can be taken, reassurance given, enough staff and equipment that people who need that equipment and staff to use the toilet or get showered aren't in an endless queue waiting for it to be available.

The problem as ever, is that the resources don't match the expectations, and it's easy to blame those who are actually doing the job and decide they're lacking the skills that mean the job is done properly, rather than look deeper and realise that no one can provide excellent levels of care with the bare minimum of resources.

It's a huge, complex, highly emotive topic with no easy or cheap answer. Some of the things which could help are:

• helping the elderly to remain at home / in the community by ensuring they live near or with family, live in a suitable house rather than holding on to a larger unsuitable home, providing at home GP visits and physios, providing grants to help adapt current homes, improving public transport and local services.

• bringing the care system into the remit of the govt, whether that's as part of the NHS or in its own system. De-privatisation and significant investment in supported living and new, purpose built care homes (too many care homes are in unsuitable old buildings).

• a mandatory qualification and professional standards system for carers, similar to that for nurses, doctors etc. Offering apprenticeships and on the job training to get these qualifications. Offering branch off qualifications and training such as in physiotherapy or mental health support. People going into the sector need to feel like there is some sort of career progression available, at the moment I think that is lacking.

• Lastly, and this is the part which is very uncomfortable to think about, an acceptance of the fact that, as a species, we're not really designed to naturally live into extreme old age as standard. Our modern technology and medicine allows us to do so but in many cases, this is at great cost to our quality of life. My poor grandmother spent the last ten years - ten years!! - of her life, completely distressed, in a care home. It was a good care home. However she had severe dementia for the last 15 odd years of her life, and was constantly reliving deaths of loved ones and constantly confused and upset about where she was. She was in and out of hospital more times than I could tell you with urine infections and similar. She was desperately unhappy and unwell, but not actively dying. It was a horrific thing for her to go through. 15-ish years of pure torture. Frankly, it would have been better had she been allowed to slip away years earlier. I don't think we're comfortable being honest about the fact that people are being kept alive in pain and in terror purely because we're uncomfortable with the moral issue of death, which is a natural process which happens to everyone on the planet. For my part, I'll sort myself out before it ever gets to that point while I still have control.

Re your specific question about wishes, OP, yes, it’s possible to make your wishes crystal clear, if you have a Health and Welfare P of A. A DNR covers only resuscitation in case of the heart stopping.

You can add a paragraph to your P of A. Dh’s and mine read roughly:

‘If I should develop dementia, or any other condition where I am unable both to care for myself, and speak, with full mental capacity for myself, then I emphatically do not want any life-saving or life-prolonging treatment. I ask for palliative care only.’

State ownership with minimum standards throughout including wages, staffing level and level of care. Enforce those standards.

It won't happen though as privatisation has been such a success, hence why our provision of water, gas, electricity and public transport is the envy of the world.

Always a great idea to have someone creaming off the top for money and at the bottom for standards.

A woman I worked with had her Mother in a care home who had dementia plus many other health issues and was close to 90. She had 3 bouts of pneumonia in a couple of years. She was treated every time. Why not let someone like that be given pain control but be allowed to die. She had no idea who she was or where she was.

The attempt at escaping the inevitable has reached a level where people expect to be kept alive at all costs. My Mother lived till her mid nineties, she even asked me to help her on her way, obviously I didn’t. She was on 14 meds a day and had zero quality of life for the last 4 years of her life.

We have become too squeamish about death, when someone dies over 80 they have had plenty of years on this earth.

What can be done to make people want to be carers? No idea because even if paid with exceptionally good wages it still requires someone who wants to actually do a caring job and that is just something that comes more naturally to some than others.

Yes. It breaks my heart how my DDad was wheeled into the lounge pre-lunch to be sat in front of Loose Women every f*(!1^9 day. And not just my dad. He was such an intelligent man, he wasn’t a vegetable, he just had advanced Parkinson’s. But he assumed the position of the stereotypical senile vegetable when he was put in front of these things. And we were paying full whack for this. No funding for my dad. That was 12 years ago. So sorry to hear that this is still happening. But my uncle (and now his wife) have had had a much, much better experience in their nursing home. They seem to have got the balance right there.

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.

Im soon to be admitting my father to a care home. Luckily, he is local to it and has had respite there before. Locally its known as the place youd want to go - if you had to. However, its the cheapest locally. So why is this?

Well, its charity run. And run very very well. The staff are paid above NMW and given good training and support.

Even then, they do have issues recruiting. I understand why - ive been full time carer for my Dad for 2 years. Its a hard job.

So what we need to do is for councils to actually run homes again. On a not for profit. So the eyewatering £££££ are not lining greedy owners pockets and the managers get budgets they can spend on the boots on the ground staff and facilities instead. The managers should have experience in the care sector not just in management.

Thats my view. The sector - much like student housing - has found an opportunity to rinse the clients for private gain.

The fact is that the care sector has been hugely underfunded for decades.

Similar to childcare funding, the government/councils claim to be offering something (e.g. the funded hours) but in actual fact are paying a below cost rate which means those paying privately make up the cost, or are providing a service far below what is necessary.

Carers who do home visits are scheduled 4 x 15-minute visits in an hour, with no travel time accounted for. In those 15 minutes, they may have to get someone up, give them a perfunctory wash, dress them, or get them breakfast. They don't have time to take time, or perform niceties because they're on a tight schedule and if they know if they take an extra 5 minutes to reassure Mrs Jones about a horrible dream, they are taking time from Mr Smith who is the next appointment.

It is no wonder that decent carers leave when these are the conditions they work in. And for that most don't even get a living wage.

Remove profit from the equation - care home providers should operate as non-profits or registered charities. Once you introduce profit as a possibility it drives down quality because in this sector the provider will be paid regardless of quality of care. The idea of a company making excessive profit from vulnerable people is abhorrent.

Some despicable pale, stale male toad in The Telegraph was addressing this in the telegraph’s special way a while back. This is all women’s fault, obviously, for wanting to work in other jobs and no longer being able, or wanting, to do this care work for free in the community. So he was saying women should get back in the home and kitchen basically. And he means other women, not his daughters, wife (maybe) and his sister was probably playing up as well.

And nowadays as it’s hitting more men (sons) in n the pocket (inheritance or direct payments) and heaven forbid they lift a finger to help, god no, this is a problem to urgently solve.

Make this work attractive to men first. Even toad Farage has said that visas for care workers are needed, that’s how much pale stale males think this is work for “others” lessers.

It will never be sorted. So make sure you have accommodated yourself, either you pay for a top notch home yourself, or your family pays, your family look after you or you throw the dice at council funded accommodation.

There are residential flats, good ones you tend to purchase with a service charge, but you generally have to move into them as an able bodied person, and many older people won’t leave their family home in time.

So keep your brain healthy, much harder as we all have microplastics in our grey matter now, there’s no escape they are in tap and bottled water, either nurture caring children or use the money you don’t spend bringing up kids in savings to fund your own care, and be willing to move before you “need” to. Obviously if you are in social housing this might be harder but again if you have had lower rent for decades you could’ve saved.

But people think the state should look after them cradle to grave.

It’s going to get worse if Reform get in, they will make women do this caring one way or another so if you are female or have daughters start making sure there is no way they can take away your independent income, because they will make you take care home jobs or even better remove employment rights (they are doing this by making it simple to sack pregnant females watch that birth rate plummet) I wouldn’t be surprised if they tried to pass a law that adult female children have to give up their assets to pay leaving male offspring to keep their house and revert inheritance to just the male line of the family. They want to, they just need to figure out how.

Any “solution” will be dreadful for women and great for men, in a nutshell. Just as it used to be back in the good old days eh!

Much higher staff ratios. Higher pay with a proper career path and progression. Recruiting the right people. It would be less popular but I think that there are certain sectors that shouldn't be run by for profit companies, with elder care being one of them. my mother moved into a care home this summer. While there have been issues, it is an excellent home and they're doing a good job. It is consistently highly rated by the care commission and two of the things they have been commended for are their high staff ratios and their selection process which helps weed out people unsuited to care work. It isn't cheap (£2100 per week for residential dementia care; nearer £2500 for dementia nursing care) but it's clean, the staff are Chosen carefully and trained well and it shows. I've been dropping in at random times throughout the day and night almost every day since August and I have never heard the staff being anything other than kind with residents (even when they don't know that anyone is there). I've been there on difficult days when one or more residents are having a bad time and have been so impressed by the way that it's handled, so for example I've seen a resident sitting on the floor in the corridor because they were hallucinating and scared about something and a carer plonking herself down beside him holding his hand and chatting for a couple of hours to keep him company there until he felt reassured enough to move. I've never seen (or smelled) anyone being left in a mess. On the occasions when my mother or one of the other residents has had an accident they've been cleaned up instantly and in as unobtrusive and dignified manner as possible. Mum's showers happen every day without fail. She's been paying for private physio twice a week and, unprompted , two of the carers asked the physio to show them how they could support mum to do her exercises in between times. The activity programme happens. There are regular visits from animals ranging from office staff dogs to miniature horses and even some from the zoo. I can take mum's cats in to visit her. They could do more external visits - they're struggling to recruit a minibus driver at the moment, but they do arrange outings, and I'd like to see a more varied menu for vegetarians, but the food is excellent - cooked from scratch and presented carefully, and staffing ratios are high so they are able to sit with residents encouraging them to eat.

Why only over 40?