Care home fees. Why does it cost £1000+ per week?

[flashbac]

Why does it cost so much and how much money is being made?

Nosferatussidebit Thu 09-Sep-21 11:30:53

"godmum56
"Nursing Vs care home is immaterial as the NHS pays the nursing element - you can't go in to a nursing home unless the funded nursing team of your CCG agree you need it, whether you are paying privately or not."

Yes you can if you will pay for the nursing care yourself"

Possibly in your LA, but not in ours - our funded nursing team only pays nursing fees to homes that don't take private nursing clients. As it's a key area for them and the private market is small, they don't take private clients. I'd assumed all areas were the same (as the 2 I've worked in have been) however that clearly isn't the case.

I don't think that's the case here but haven't looked into it recently....bit surprised as that would mean that someone who is prepared to fund their own social/residential care is limited on where they can choose to go and still get the non means tested health care payment that they are legally entitled to?

Constantly having to replace clothes and shoes, glasses, hearing aids is very expensive for relatives. It is time consuming to have to have a visiting rota just to ensure your parent eats and drinks. Of course we want to visit, but it is hard when you have a family and a job to juggle.

@Samcro

not all people living in care homes are old. most are disabled people. mine need 2 people to do their manual handling, all their care needs need to be met. and as they have been disabled since birth they don't have money...oh but they do pay towards their care. all their ESA bar 24.50 a week.

I think many people miss out on this point. Nearly half of social care is for working age people who need it for their entire life because they have disabilities or other illnesses. They often have very little in the way of funds or assets - so the cost is huge. Most of the elderly in nursing homes are there for an average of 2 years and all their income/savings/assets is taken except for £23k of assets. Of course this does not get widely known as the 'elderly' have become an easy target to accuse of being too costly to look after.

When you compare the cost per day to the cost of a reasonable hotel locally, just B&B, it may not seem so excessive.

They are getting all meals and drinks, all laundry (often a lot, especially if there’s incontinence), help with washing and dressing, maybe with eating and drinking too, and 24/7 supervision, nearly always including someone on duty at night.
Plus of course usually more heating than normal, since old and largely sedentary people feel the cold considerably more.

Might add that I’ve been familiar with several care homes where elderly relatives were staying - my mother’s was a dementia-only home - and they were all very good. And by no means the most expensive, either.

I don't think that's the case here but haven't looked into it recently....bit surprised as that would mean that someone who is prepared to fund their own social/residential care is limited on where they can choose to go and still get the non means tested health care payment that they are legally entitled to?

They can privately pay for the care home/ residential side but NOT the nursing. They couldn't enter a nursing home unless they'd been assessed by the NHS as needing nursing care. Once assessed as needing nursing care they can choose whatever nursing home they like if they are self funding/ paying a top up. If the funded nursing team does not feel they qualify for nursing care, they can only choose a residential care home.

@flashbac

Slightly off your point but I am horrified that the sneaky BJ says that the £86000 cap applies - not to the total cost of the home - but only to the "care" element. Food and accommodation extra and uncapped!

[quote Thelittleweasel]@flashbac

Slightly off your point but I am horrified that the sneaky BJ says that the £86000 cap applies - not to the total cost of the home - but only to the "care" element. Food and accommodation extra and uncapped![/quote]
People are in for a shock!

It's so hard to plan ahead for these things as well. My dad and I were talking earlier this summer - he said that he has become a devotee of the "slow medicine" concept for elder care in the process of his own parents' deaths (he was the POA and executor for both). Once he turns a certain age - he says 80 as this is when both his own parents started going downhill - he says he will turn down any medical interventions they may offer him like a pacemaker or flu jabs, and that his ideal course of action would be euthanasia before he needs any care.

Of course this assumes he doesn't develop dementia etc, and it's one thing to make promises to yourself when you're fit and well in your 60s, and quite another to make those choices in the moment. Also my mother is 100% not on board with this, and will keep his head alive in a jar forever if it's up to her, so I told him he needs to write a living will to express his wishes since I have no desire to fight with her about it.

@FedNlanders

Staff usually on minimum wage and often unskilled. Its a shame the staff at bottom of list take the brundt of the work

And usually the blame too, because no one listens to the reasons why bad care has been delivered, lack of staff, training or equipment, they are thrown under the bus and as they are believed to be unskilled, automatically dismissed as saving their own skin.

godmum56

If the person is deemed to require nursing carethe NHS funds it. This is countrywide.

You can pay for nursing care in the absence of assessed clinical need, or you can pay more to the home for 'nursing care' as they haven't been transparent with you regarding FNC element paid directly to them.

Irrespective of this, no extra money ends up in the nurse's bank account. Nurses earn £16-20 per hour no matter where they work in the industry. There are precious few exceptions.

Are you taking the piss OP?

If someone needs 24 hours care, based on minimum wage it would cost over £1500 per week on one member of staff being with them alone. And there is rarely one carer on duty alone. Then there is everything else. Granted not everyone will need 24 hour care, but it gives you an answer.

Same with childcare, people expect top notch service on pound land prices.

Just think how much you pay for an all inclusive holiday ( without alcohol )….., same provision , obviously different standard but reasonable .
Eg butlins basic room en-suite week in dec plus full meals - getting towards £600. Then 24hr care…. £400 ie 2.50 an hour for everything other than bed and board

@PepsiHoover

Are you taking the piss OP?

If someone needs 24 hours care, based on minimum wage it would cost over £1500 per week on one member of staff being with them alone. And there is rarely one carer on duty alone. Then there is everything else. Granted not everyone will need 24 hour care, but it gives you an answer.

Same with childcare, people expect top notch service on pound land prices.

I don't work in a care home but I do run a childcare business and you see exactly the same discussions and commentary - it doesn't cost that much, the owners are creaming huge profits off the top...and it mostly just isn't the case. People do back of a fag packet estimations covering only the really obvious costs and miss out so much that they just don't think about. Yes you can make a profit but the idea that it's some vast % is really far off and it takes a lot of hard work.

Care homes strike me as being similar in many ways. Off the top of my head people forget about
-the cost of the building (most that aren't council run will have required finance to build/purchase them and they're generally pretty large!) meaning there's usually some sort of debt repayment

• the staff who aren't providing direct care; managers, cooks, admin, cleaners, maintenance staff, and so on

-the fact that staff don't just cost the headline hourly rate (NI, Pensions, sick pay, holiday pay (yes that's in the hourly wage but you need enough people to cover absence so it's something people forget)

• the cost of running and maintaining the buildings and grounds; heat (they need to be warm), light, constant upkeep, gardeners, regular inspections of electrics, etc
• insurance

-staff training

• equipment
• Health and safety supplies
• transport

I could keep going but I won't! Like childcare it is an industry with a lot of misunderstood costs.

It’s £90 per day at our nephews nursery. That’s for 8-6pm, so £450 per week for 50hrs, or £9 per hour. That’s included care and three meals and snacks. Obviously housing, clothing, home utilities, extra food on top at home.

If that was 24/7 care it would be 168hrs per week and equal £1512 per week for full time care.

£1000 per week, 168hrs (24/7), would work out at £5.95 per hr.

@PepsiHoover

Are you taking the piss OP?

If someone needs 24 hours care, based on minimum wage it would cost over £1500 per week on one member of staff being with them alone. And there is rarely one carer on duty alone. Then there is everything else. Granted not everyone will need 24 hour care, but it gives you an answer.

Same with childcare, people expect top notch service on pound land prices.

Well the op didn't come back

@PepsiHoover

Are you taking the piss OP?

If someone needs 24 hours care, based on minimum wage it would cost over £1500 per week on one member of staff being with them alone. And there is rarely one carer on duty alone. Then there is everything else. Granted not everyone will need 24 hour care, but it gives you an answer.

Same with childcare, people expect top notch service on pound land prices.

Thing is though, the ratio in a residential care home (not nursing) is usually around 1 staff member for around 7 residents, depending on where you work and the purpose of the home (EMI, or pure residential) The CQC regs say that homes must deploy adequate numbers of suitability trained staff to meet the needs of the people they are caring for - but there's no hard and fast rules.
I have never worked anywhere that deploys extra staff when residents needs increase (although understand that some people will have) which by definition they do, to needing more care, like someone becoming too frail to walk alone anymore, but who cannot understand that, or on end of life, or needing 2 care workers for moving and handling procedures by law, someone needing feeding when they previously ate independently. We incorporate that into the shift, and unfortunately, that means having to prioritise by need a lot of the time. Not fair on the residents who don't have higher care needs, for example, to wait while the 2 staff complete a toileting procedure, using a hoist, which 2 staff have to be present for. My home charges one rate, regardless of care needs, so some people are getting a lot more value for money than others. Some homes charge more as needs increase - but the question is, do they provide more for that increase?

I hope some decent journalists dig down into this new plan and expose what it really means.

I understand that in Germany care home management is seen very much as a vocation and there are degree courses specialising in care home/elderly care management to provide a career path and a pipeline of good quality managers/operators.

It’s a shame that we don’t take that approach here in the UK, where I’ve only come across owners who see it as a business opportunity (although there must be some who really do want to help).

It is a dreadfully difficult business. I always remember visiting a care home just in case my mother needed one. The grounds were huge, with a converted manor house. However few could access the grounds, some rooms were tiny with high up windows so you couldn't see out, entertainment was only TV apart from patronising people who sang Roll Out the Barrel and WW1 songs to people who'd been in WW2. Two people I remember - a highly thought of artist who was going slightly mad from being stuffed into a room and not allowed to paint, and a sad old language professor who sat reading newspapers in the lobby to avoid mandatory television. But we all live longer and the last days are not great. I am so hoping there will be a vote for voluntary euthanasia in my time and that people will ratify their wishes for end of life care. Only the rich can go to Switzerland and then under their own steam. BTW there is an excellent book, Mrs Palfrey at the Claremont.which describes how people sort of sorted themselves if they didn't have families to care in the Fifties.

[quote EmeraldShamrock]It's just a shame you have to go to Switzerland to have this as an option.
The dying with dignity campaign is worth signing. There is a UK platform too.
It has moved to committee stage in Ireland and hopefully up for referendum in the near future.
www.dignityindying.org.uk/[/quote]
That is not an option for anyone with dementia, though. You would need to have full mental capacity for the Swiss option.

I can see that the costs are very high.

But one family in Rich House Poor House, or the holiday version, had made multi-millions owning care homes.

I don’t think the costs are transparent and a lot of people paying the fees don’t realise that there is an NHS contribution on top, plus the various benefits that are paid in addition to the bill to the resident or relatives.

It is a very opaque economy.

I used to work for a guy who owned several businesses and his cash cows which funded all his other ventures were two care homes which enabled his empire which were/are extremely profitable. He was very flash drove an Aston Martin and spent an inordinate amount of money on cocaine, escorts and strippers (not judging, just saying as these are all expensive hobbies) - these care homes usually generate vast amounts of profit.

@Xiaoxiong

It's so hard to plan ahead for these things as well. My dad and I were talking earlier this summer - he said that he has become a devotee of the "slow medicine" concept for elder care in the process of his own parents' deaths (he was the POA and executor for both). Once he turns a certain age - he says 80 as this is when both his own parents started going downhill - he says he will turn down any medical interventions they may offer him like a pacemaker or flu jabs, and that his ideal course of action would be euthanasia before he needs any care.

Of course this assumes he doesn't develop dementia etc, and it's one thing to make promises to yourself when you're fit and well in your 60s, and quite another to make those choices in the moment. Also my mother is 100% not on board with this, and will keep his head alive in a jar forever if it's up to her, so I told him he needs to write a living will to express his wishes since I have no desire to fight with her about it.

Dh and I both have sections added to our Health and Wrlfare Powers of Attorney. They state that in the event of our developing dementia, or any other condition where we are unable both to care for ourselves, and speak with full mental capacity for ourselves, then we emphatically do not want any life-prolonging or life-saving treatment. We ask for palliative care only.

If more people did this, maybe there would be fewer people kept alive just because it’s possible to do so, regardless of quality of life - tablets for this and that, in and out of hospital, on drips, etc.

Even being badgered and pestered to eat and drink when the person no longer wants to do so - in my mother’s dementia-only care home I witnessed this more than once. I know it was with the best of intentions - the care home was very good - but WTF is the point, when someone very elderly already has well advanced dementia with double incontinence - every shred of dignity has been stripped away, and despite very good care, their quality of life is so poor?

6 years ago I had an admin job in a care home for adults with various additional needs.
Huge fees then (£5000 a week plus), challenging behaviour etc.
Staff were on minimum wage and turnover high due to very challenging behaviour.

The profits for the group care homes was HUGE

It's such a thankless job, underpaid, over worked. No wonder it has such a high-turner. Abuse both from residents and lack of support from management. I'd go so far as to say 95% of care homes are utter shit shows for all involved.