...to ask how we fix the care system?

[TheABC]

The furore over the NI tax rise has obscured the fact that little will change on the ground for anyone giving or receiving care. AFAIK, there are no changes or help for the unpaid family carers and no extra cash, training, or appreciation available for the staff in care homes.

The number of over-80's is forecast to double in the next 10 years (ONS), so the demand for care is only going to rise. AIBU to say we need a National Care Framework, in the same spirit as Scotland's?

||www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/august2019||

I'm 63. I really don't feel that in seven years I'll be ready to "pop off" I might feel differently if I get an incurable illness I suppose.

I find some posters willingness to write off other people quite terrifying. Any assisted dying must be an individuals considered choice. It sounds as though some of you would be applying the pressure to anyone you consider to not have any value.

@Akire no-one has said that 🙄

What is annoy is that people who work and have saved end up paying for a care home and those who either don't work and live on benefits or have had the money and gift it or spend it under the threshold level get it all for free

That's not very fair is it?

@Otherpeoplesteens

We cannot have a sensible discussion about the entirety of care costs without a sensible attitude to assisted dying.

Everyone wants the taxpayer to spend half a million quid keeping grandma in existence (note, not 'alive') for five years. Very few willing to reach into their own pockets for the same.

My last surviving parent has made it abundantly clear that his wealth must not be used simply to keep him alive with no quality of life, and that all other considerations are secondary. He lives in a place with no government funded care, so recognises that he will probably die in Switzerland.

I agree. I’d rather people got to live a decent life not crushed by an unbearable tax burden, and live a few years less, than spend a fortune that society cannot afford keeping people alive long beyond the point where they have what I would call a decent quality of life.

This thread has shocked me. Before reading it I would have have thought we at least needed a conversation about assisted dying. .but now I see very clearly how others see it....its a way to fix the care system. It never even entered my head before that the two could even be framed together.

There is no easy fix to the care crisis. ...yes it needs more money, and it , to me appears to be a bit of a postcode lottery. it seems incoherent.

I dont think we can tackle the care crisis without addressing other crisis, housing, obesity, nhs , wealth inequalities etc

above all we need a societal change in attitude to caring, as evidenced by this thread.

Gingerandthebiscuits thank you for answering my question.
It must be hard to prove sometimes - what if the children live abroad for example.

My last surviving parent has made it abundantly clear that his wealth must not be used simply to keep him alive with no quality of life, and that all other considerations are secondary. He lives in a place with no government funded care, so recognises that he will probably die in Switzerland

Otherpeoplesteens what happens if he is too immobile to get to Switzerland or if he lacks mental capacity?

I think that people think assisted dying is a great idea until they reach old age. I don't know if it's human survival instinct.
My DM said 'Oh, stick me in a home if I get like DGM' , her mother, then when the time came she assumed I would take her in and look after her (despite me living abroad at the time). It seems to be the way the brain works.

So if someone sells their house, buys a smaller one and gives the difference to their children, can the council chase the children to give the money they’ve inherited to pay for their parent’s care home fees?

If the Gov puts a limit on how much anyone spends on Care Home fees then that would be fine if it covered the amount. At the moment they're talking about 80,000.

@Andante57

Gingerandthebiscuits thank you for answering my question. It must be hard to prove sometimes - what if the children live abroad for example.

I guess it will be a cost-benefit decision for the council. If it’s a substantial sum that’s been deprived then it will be worth pursuing. If it’s a few grand it then recovery costs might outweigh that and not make it worthwhile.

@Stircraazy

So if someone sells their house, buys a smaller one and gives the difference to their children, can the council chase the children to give the money they’ve inherited to pay for their parent’s care home fees?

If the Gov puts a limit on how much anyone spends on Care Home fees then that would be fine if it covered the amount. At the moment they're talking about 80,000.

That’s an interesting thought - I wonder how deprivation of assets will be dealt with, whether the threshold at which councils pursue it would have to be greater than 86k?

@Candleabra

Assisted dying won't make a dot of difference to the costs and the two shouldn't be put together.

Of course it would make a difference. With my mum, fir example, she has lived at least 18 months longer than she would have wished. All involving huge amount of social care, and NHS resources. But I'm not saying this on the basis of cost.
I know it seems like a slippery slope, but I would honestly rather end my life whilst I'm in control. Maybe this is after being involved with a close relative. Dementia in particular is a completely dehumanising experience. We treat animals with more dignity at end of life.

I have posted about this on elsewhere (care home costs) but after far too much family experience of dementia, dh and I have added to our Health and Welfare powers of attorney, more or less like this:

‘If I 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.’

There is IMO far too much ‘striving to keep alive’. I heard of someone of over 90 with at least moderate dementia, who was fitted with a pacemaker. This was at the insistence of the relatives, not the medics, who (when asked) said that the person would otherwise most probably have drifted away peacefully in their sleep.

My DM had dementia from her very early 80s until she died at 97, in a most pitiful state for her last few years. In her case there was no striving to keep alive, she had the constitution of a rhinoceros, but we had agreed with the care home staff (she was there for nearly 8 years) that there should be no such ‘striving’ - it would have been IMO verging on cruelty to try to prolong her life when her former self would have been utterly appalled at what she’d become.

Made all the worse now that the carers are being forced to have the vaccine or leave their job. Those who don’t want it are leaving for better paid jobs and prospects in the supermarkets and other companies.

@GETTINGLIKEMYMOTHER yes I agree.
I'm not advocating euthanasia for everyone over a certain age. Of course not. I wish my own parents had lived to a good age. And they may have needed some care, but if a good quality of life can be maintained then that is to be expected as one gets older and more frail.

In my situation, for my relative, I have seen a prolonging of life beyond a point where meaning exists. She is as functionally low as it is possible to be, whilst still being awake and alive. I have tried to have discussions about treatment but it is shut down by the carers and doctors. They will treat as the default. Mum is at the position now where she is on antibiotics most of the time to treat recurrent infections. I think it would be kinder to let her slip away. But as she continues to eat and drink she keeps existing.

My DB is in a care home with parkinsons and dementia - I am sure that dying early would be a blessing. He is not happy, angry - this affects his care (much he refuses) and as he is a big strong man, scares some of the staff. Miserable existence for someone who spent his life working in the open air.
There is so much outcry if a resodemt in a care home falls and breaks a hip/ falls out of bed, basically anything untoward happens to them that it means they are coddled in cotton wool and have sad empty lives.
Were they at home, moving around, or attempting to move around, unaided chances are an accident would probably shorten their life. This can't happen in a care home so they go on and on. Look at their protection from Covid. If they were at home with their family that would not be the case . They are kept alive at any cost. People are quite irrational about accidents in a care home - a demented patient falls out of bed - sack the manager!!!

I'm so shocked so many support assisted dying.
Devastatingly so...
Religious beliefs aside I find it horrifying though I can read some value into the reasons some give here.
God I'm depressed at this

Well I’m depressed thinking about my lovely grandmother who had to spend years just existing a miserable existence.
I don’t want that fur myself.,

@Stircraazy I agree. The people I nursed in the care homes had terrible, dismal lives and weren't permitted to do anything which might compromise their safety - not allowed to smoke, drink alcohol, try to mobilise, eat proper food (fed on mush and thickened fluids), go out with friends or relatives, have proper doses of pain relief, get out of bed etc. They were literally just existing as a nutrition in/ waste out biological organism with no heed whatsoever to their comfort, dignity or function of their mind.

People who haven't witnessed this first hand have no idea about just how bad things can get in so called social care.

Assisted dying might not benefit the government or save money, but it would give a dignified end and some peace of mind to those of us who wish to avoid spending their closing years with the quality of life akin to a neglected pot plant.

There are aspects of the Dutch system that seem to work quite well. One aspect (neighbourhood care) here: www.spectator.co.uk/article/to-solve-britain-s-social-care-crisis-follow-the-dutch-example

The other is financing. I don't think there is a distinction between public/private provision of care. Instead, everyone pays a proportion of their income/wealth. So if you're on a state pension you pay less than if you have a good private pension. If a person lives in a nursing home for more than 2 or 3 years, then the value of their house (if they still own one) is also taken into account (although not necessarily if the other partner still lives there). To me it seems a logical and fair way to do things, although I assume some will still complain that they're expected to pay more than others.

There is a massive problem with recruitment and retention right across health and social care. We need:

1. Bursaries or grants for all health/caring qualifications including nursing, medicine, occupational therapy, social work, carers etc
2. Ongoing CPD funded by employer or state
3. Increased wages for carers
4. Career development pathways for carers
5. TV campaigns about living well in old age - keeping active and sociable and involved in communities
6. Public information campaigns about what proper care looks like (eg much more than just dressing, feeding and washing - helping someone stay active, independent and sociable), and encouraging people to go into a caring profession, like those ads encouraging folk to join the army, or to volunteer as befrienders etc
7. More funding (either through taxes or by redrawing the public spend to divert more money from other things) to achieve the above

There's probably loads more but those are the first things that came to mind.

There wouldn't be a problem with recruitment if we could fix the retention!

@Andante57 If my Dad can't get to Geneva under his own steam I will drive him there which is handy as I'll be able to sort all the paperwork out at the bank while I'm there. As for mental capacity - it's not an issue. He has already made the directions and absolutely everyone who might have something to say about it knows exactly what he wants. Repatriation, funeral all planned and paid for more than twenty years ago.

Failing all else, there's a 12-bore shotgun next to his bed which is how several of his friends and neighbours have gone.

@TooExtraImmatureCheddar

There is a massive problem with recruitment and retention right across health and social care. We need:

1. Bursaries or grants for all health/caring qualifications including nursing, medicine, occupational therapy, social work, carers etc
2. Ongoing CPD funded by employer or state
3. Increased wages for carers
4. Career development pathways for carers
5. TV campaigns about living well in old age - keeping active and sociable and involved in communities
6. Public information campaigns about what proper care looks like (eg much more than just dressing, feeding and washing - helping someone stay active, independent and sociable), and encouraging people to go into a caring profession, like those ads encouraging folk to join the army, or to volunteer as befrienders etc
7. More funding (either through taxes or by redrawing the public spend to divert more money from other things) to achieve the above

There's probably loads more but those are the first things that came to mind.

YES!

These are the things that are missing. The debate has got so hung up on the costs of care that it's completely overlooked the people who are doing it.

You can have a million pounds in the bank, ring-fenced by the Government, but the money's pointless if there is no one available to hire as a carer. At the moment it's one of the most disregarded professions around, despite their direct importance to their client's lives.

@Candleabra, I’m sorry to hear about your DM - it’s awful that you’re unable to have any input about treatment. An aunt of mine with dementia had recurrent UTIs that affected her very badly, and eventually I was asked about yet more antibiotics/hospital/drips when she was once again refusing food and drink.

Of course it was a horrible decision to have to make - I could only ask the GP what he’d do if it were his much loved aunt. He said he’d leave her where she was (care home) where they’d keep her comfortable - it was only going to happen again, and probably quite soon. Especially since hospital is a terrible place for anyone with dementia, when they can’t understand what is going on, or why.
I sat with her a lot during her last days. She continued to refuse food and drink and drifted away quite peacefully after about a week.
Although I agonised about the decision at the time, I’m 100% sure it’s what her former self would have wanted.

@GETTINGLIKEMYMOTHER thank you. Sorry about your aunt.
I know there would be no aggressive treatment but I'm not even sure antibiotics are appropriate now.
We're in a cycle where mum stops eating and drinking, they prescribe antibiotics and she picks up a bit. It's happened a few times where I think it would be kinder to let her slip away.
If the antibiotics don't work there would be no next step of IV treatment in hospital, but oral meds seem to be a grey area.

Fucking hell, I cannot believe how many people are genuinely suggesting assisted dying as the solution to the social care crisis. That's a large part of the problem, right there. Assisted dying should be a completely separate issue. Are we really suggesting we end people's lives rather than pay to give them the help and support they need to live well?

These attitudes, and the consistent prioritisation of health over social care are crucial in this debate.

The Scottish approach is not the answer, social care is a mess up here too, although currently a lot of work going on which, if done right, would really make a difference. Derek Feeley led some fantastic work through the recent independent review with over 50 recommendations to solve the social care crisis in Scotland. I believe if they were all fully implemented it would have a huge impact but again, that is another problem because there are no easy or cheap solutions.

Fundamentally, if we want a decent social care system, which by the way is not just for older people but anyone who may need support to live their life, then we will need to pay for it. Seems many people would rather just eliminate the need.