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

How am I going to sell up and move to very expensive sheltered housing now the chancellor wants cgt paid on primary dwellings? I can't afford it so I will just have to stay in my drafty semi that has gone up considerably in the last 30 years.

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.

The work needs to be more attractive, whether this is pay or shift pattern planning or career progression.

We are only going to need more and more carers. I know your op said to leave aside migration, but the reality of the situation is immigrants don’t even want to do these jobs. As soon as their five years are up, they are applying to other jobs. It’s not sustainable.

Also, I had to laugh further up thread at the idea care home bosses aren’t taking home a packet. I know a couple who inherited and run a chain of care homes. They are doing VERY well for themselves…

Someone is doing very nicely out of it. Care home groups had an average 18% rise in profits in the pandemic.

Runwood Homes made a profit of £28 million in 2024, up from £15m the year before. The CEO takes home £5m a year. They received £12.3m in Covid grants in 2020-21.

And that's only the sixth largest group. No profits my absolute arse.

Setting aside immigration would certainly be one way to break the care sector. My mum's palliative care team at home were all Indian women and absolutely wonderful with her.

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.

The reality is the days of care homes making a ton of money is long gone. Costs are huge just now. Heating bills, food bills and wages are all increasing dramatically year on year. A significant number of care home buildings are shockingly inefficient and poorly maintained.
Staffing is also a massive issue, it’s almost impossible to run a care home without agency back up which costs hugely. Bear in mind care homes are staffed 24hrs a day.

Care homes on average have to be 90% occupied to break even. Councils don’t pay for residents whilst they are not in the home. So if someone is taken into hospital they stop paying until they return. Despite the room being reserved for them.
Private clients are also massively subsiding clients who have their care paid for by the council.
people dramatically underestimate the cost of providing decent care. It takes approximately 4 full fee paying clients in a care home to pay for 1 care home carer (not agency) for 24hrs. Not including any of the other costs. A lot of people require 2 or more carers for tasks such as washing, dressing and moving around.

In terms of making care cheaper in the long run, keeping people fit and well and mobile for as long as possible will massively help. Building new modern care home which are more efficient to heat. I also think we should be building more retirement complexes and encouraging the older demographic to move out of their larger homes and into smaller homes. This would be far more efficient for care providers to provide a better a more efficient service.

It's the same with nurseries

Who is making all this money???

It needs the state, care homes and people all to do their part. More stringent regulations and better trained more empathetic staff are only part of the equation. People need to be as healthy as they can be going into their latter years. That responsibility should be placed directly on peoples shoulders.

We need to start using robot carers like those Pandas in Japan.

I don’t have any answers, but I do know that it is possible. My father is in a private, family-run (in the 4th generation) care home and it is brilliant. It is £1200 a week, which is a lot cheaper than newer ones with all the bells and whistles, but crucially it is staffed by people who genuinely care and have enough time to properly look after all the residents.

Regulation of care homes and the companies involved needs to step up, hugely. Any company that neglects those in their care needs banning for good. The directors of companies need banning for good.
When concerns are raised, inspections and investigations need to happen urgently.
I'd stop the importation of carers, thats wrong on so many levels, but as a society we need to see care as a profession.
Thus it needs to be paid as such. I'd recommend the companies divert some of their profits to staff training and pay to make it more attractive.
I do think elder planning is something we should all consider, and we need to change how we see old age.
I think there needs to be a change in building so elder flats, supported living, and downsizing is seen as the norm rather than waiting for people to die in these big drafty houses with meals on wheels a few times a week, waiting until they need 24 hour care then off to a home.
And assisted suicide I think should be a viable option. I would hate to reach a grand old age and be in nothing but pain, rattling from my daily pills, and just waiting for a big heart attack or something similar.

£1,000 per week = £5.95 per hour for 24 hour residential care.
Advance directives, ie. outlining what you would want, in advance of you needing it, should you lose mental capacity or be in a situation where you cannot make your views known, are already here and some people have already done these and have them logged in their NHS records via their GP.
The main issue is, IMHO, that people generally don't think about this stuff until they need it - and then, it's too late.

Much more stringent checks is an absolute must. My mum’s care home’s list of weekly activities is a work of fiction. They are sat in front of the tv all day and all evening. The exercise class does not exist. Not many of the carers are strong enough to do showers so they get missed for weeks if you miss your slots. They are literally disabling her refusing to help her walk to the toilet and instead putting her on a commode. Ive had social service/ and physios round and the staff then say theyll take her… then dont. Staff turnover is high. And it is costing £1k a week.