What to do about future of care in the UK?

[Flawedperfection]

I just wrote a v long post which I lost due to phone battery fading!

In a nutshell, what do we do when there are no longer any carers or anyone willing/able to care for our elderly and those in need of support?

I currently work for a care provider in a finance/admin role and it’s scary how: understaffed we and many other care providers in the area are; few people want to actually work in care and ;few younger people want to do it, and will only do so if threatened by sanctions etc.

In my company, most carers are aged between mid-40s and late 50s.

I previously worked in care on and off for much of my working life partly because (not going to lie) I couldn’t find anything else and was over or under qualified for other career paths. I know it’s crap in many ways: the pay, the hours and working conditions and the personal care is not for the squeamish (this was my issue!), but how do you get people to want to work in care?

Seriously, what do we do when the numbers fail to tally: many people in need, too few carers? Do people go off to hospitals long stay? But we also have a nursing recruitment crisis…

And before anyone suggests that I rejoin the carer ranks, as said I’ve done it before (for years), and it wasn’t for me. That’s kind of my point- no one really wants to do it!

Yes, but who is the 'assistant' to the suicide - the long lost son who will inherit the big house, your doctor, one sibling but which one???

Yes, but who is the 'assistant' to the suicide - the long lost son who will inherit the big house, your doctor, one sibling but which one???

But we don't want to pay more to provide care that's the problem

Thats not true, its the Govt that wont pay them more... however, thats understandable, a substantial pay rise for Carers would put them above HCAs and very close to fully trained nurses with 3 years in Uni and a degree!

My DD did care work whilst at Uni, its highly skilled with a great deal of responsible, people are living in the community, who ought to be in a medical facility.
You need a car, extra insurance, no help with wear n tear, she got paid travel and mileage rate but even so, her agency was handing back council contracts.
The owner wrote to Johnson and Hancock (it was a brilliant letter) and received no reply.

But we are also an aging workforce, its not a problem that will go away and its causing the NHS huge issues as folk are not being discharged appropriately.

[quote BettyBag]@Bringsexyback

How is it a solution?

Draw me a line from assisted suicide to better social care.[/quote]
For me I’m not specifically looking at assisted suicide but I am going to weigh up very carefully what life prolonging treatment I accept. I think more people will do that too. I have life insurance that pays out until I’m 80 and I intend to win that bet.

[quote BettyBag]@Bringsexyback

How is it a solution?

Draw me a line from assisted suicide to better social care.[/quote]
a handful of the terminally ill killing themselves isn't going to make the slightest difference, Covid killed far far more and made no difference.

Perhaps better health prevention would help but thats a very long term thing.

@BellatrixOnABadDay

I think it is a generational thing, but not in the way you are suggesting.

Younger people see older people as different to them. They don't know that many and the ones they do come into contact with seem broadly the same. Being elderly seems a long way off and horrifying. It's easy to make pronouncements about how you will off yourself rather than become frail when it's some distant thing for the future.

I wonder how you would feel if you or one of your friends was struck with a stroke or injury that gave you the physical ailments of the elderly without the old age. Quite differently I would l. Indeed, as I said, I work in this sector and young people with those needs tend to demand good care (and rightfully so) rather than an overdose of morphine.

To the PP who mentioned assisted dying. We don’t need to go that far….we could just stop keeping people alive who are trying to die. This country has a huge issue with allowing people to die…..and I don’t mean 30 year olds with terminal cancer I mean over 80 year olds with dementia living in nursing homes with 24 hour care. How about we stop all their medications and, shock horror, don’t treat their urinary tract infection or chest infection (or give them Covid vaccinations)and allow them to die as opposed to treating it to keep them alive but in an ongoing negative trajectory in terms of quality of life until they get an infection that we can’t treat. 20 years in health care and I’ve had 4 families ask me to allow ‘nature to take its course’……the rest say ‘do everything’…..so the misery of living with dementia in a care home can continue for the patient, the relative, the carers and society at large.

@Bringsexyback

But the OP is what to do about the future of care in the UK. Not what you will do when you need care.

So many people are suggesting assisted suicide as a solution and yet I am still unclear on how they think this will improve the social care sector.

@Bringsexyback

But what about now? What about the people who are in need of care now, that can't get it because there's not enough people willing and able to provide it? Or the people that are currently recieving care that's patchy and delivered by people who are overstretched?
This has been an issue for a long time and it's been brought to a head by covid and Brexit. Part of the workforce sent home, part of it burned out because of the pay, conditions and workload and part gone due to mandatory vaccination - no matter what you think of those things, the number has been significant enough to cause a bigger problem than already existed, and there isn't an influx of people coming in to replace them.

I agree that AS is a discussion to be had, but as there are currently no plans to introduce it, it won't help the crisis now, and you can't suddenly start making decisions for people that already have a diagnosis that means they lack the capacity to make that decision themselves.
I could almost guarantee that if you asked every one of the people I care for if they wanted to die they'd be as horrified with the idea as I would be should I be asked now - because by and large they have little concept of what is wrong with them due to the illness, they are all going home soon, they are getting up and getting ready for work, wanting to go and pick the kids up from school - would you have someone like me hold them down to make it happen?

Talking about AS is not going to solve the problems now, that are going to get worse in the next few years unless something changes, and part of the issue is that people would rather bury their head in the sand and insist that a solution that is not yet being considered is the answer, rather than see that we've got a serious problem right now and it urgently needs addressing.

@Disfordragon

To the PP who mentioned assisted dying. We don’t need to go that far….we could just stop keeping people alive who are trying to die. This country has a huge issue with allowing people to die…..and I don’t mean 30 year olds with terminal cancer I mean over 80 year olds with dementia living in nursing homes with 24 hour care. How about we stop all their medications and, shock horror, don’t treat their urinary tract infection or chest infection (or give them Covid vaccinations)and allow them to die as opposed to treating it to keep them alive but in an ongoing negative trajectory in terms of quality of life until they get an infection that we can’t treat. 20 years in health care and I’ve had 4 families ask me to allow ‘nature to take its course’……the rest say ‘do everything’…..so the misery of living with dementia in a care home can continue for the patient, the relative, the carers and society at large.

I am going to keep pointing this out because people really need to understand it.

75% of adult social care funding is spent on people under the age of 64.

The NHS refusing life prolonging treatment to 80+ year old is not going to make the difference you think it will. Its a drop in the ocean. And FYI they very often do this anyway.

The biggest issue we are facing in my rural area is that there are far more elderly here than young people to look after them,

This is really important & is only going to get worse.

"In the next 25 years, the number of people older than 85 will double to 2.6 million"

@BettyBag if your numbers are correct then it’s going to make a 25% difference in fact, which could potentially be an enormous number - I don’t know.

@BettyBag don't presume to know that I would want treatment if I had a stroke tomorrow. I have my own thoughts and feelings on the quality of life I would want at any age, young or old. Of course not everyone feels like this but I feel how I feel for numerous reasons; possibly as a result of witnessing 'life' for my grandparents and also knowing what my own mental health could possibly tolerate.

If I'm lucky enough to be elderly, I know I'd rather die quickly rather than live with no quality of life. I've seen too many young people in my family die- all of these things probably contribute to my feelings on this. I'm not articulating it well but I know what I mean anyway.

@OneTC

I don't think the business model (charge loads and pay peanuts) is sustainable or ethical.

If pay was realistic then people would do it gladly I think

yes. wave my magic wand: there is a national care service, well organised, with recognised qualification and career progression, and suitable pay. free at the point of need. financed by levy on higher rate tax payers. this would encompass both residential care and domiciliary.

[quote Bringsexyback]@BettyBag if your numbers are correct then it’s going to make a 25% difference in fact, which could potentially be an enormous number - I don’t know.[/quote]
My numbers are correct and publicly available.

Your numbers are wrong.

I thought you were suggesting stopping life prolonging treatment for 80+ I a care home with dementia. Not killing all over 64 year old who have social care support, because that's what you would need to do to hit that 25%.

Your original suggestion would be a fraction of 25%.

75% of adult social care funding is spent on people under the age of 64.

Is it?

I know working age have more spent on them but there are more older people so as a whole just under half of the costs are spent on working age.

@douper

75% of adult social care funding is spent on people under the age of 64.

Is it?

I know working age have more spent on them but there are more older people so as a whole just under half of the costs are spent on working age.

About 50% is spent on children, young people and adults with complex health needs.

[quote BellatrixOnABadDay]@BettyBag don't presume to know that I would want treatment if I had a stroke tomorrow. I have my own thoughts and feelings on the quality of life I would want at any age, young or old. Of course not everyone feels like this but I feel how I feel for numerous reasons; possibly as a result of witnessing 'life' for my grandparents and also knowing what my own mental health could possibly tolerate.

If I'm lucky enough to be elderly, I know I'd rather die quickly rather than live with no quality of life. I've seen too many young people in my family die- all of these things probably contribute to my feelings on this. I'm not articulating it well but I know what I mean anyway. [/quote]
My response was to your suggestion that support for assisted saying is a generational thing. I was just pointing out that the reason for this isn't as simple as young people having different ideals but rather this being an issue that only affects young people hypothetically.

@hugr

No, none of Adult Social Cares budget is spent of children.

About 50% is spent on children, young people and adults with complex health needs.

yes that was my understanding, not 75%

digital.nhs.uk/data-and-information/publications/statistical/adult-social-care-activity-and-finance-report/2020-21

The link below implies that over. Half if spent on the 18 to 64 and the rest on the older
75% is the proportion spent on long term support
Children are not mentioned

@douper

About 50% is spent on children, young people and adults with complex health needs.

yes that was my understanding, not 75%

Your understanding is wrong. 0% of Adult Social Care funding is spent on children, the clues in the name.

*My response was to your suggestion that support for assisted saying is a generational thing. I was just pointing out that the reason for this isn't as simple as young people having different ideals but rather this being an issue that only affects young people hypothetically.
*
Fair enough, I get that, but depending on what younger people have witnessed, they may well have drawn the same conclusions as me. Seeing what happened to my grandmothers and what is currently happening to my GF is horrific. My mum and uncle both say that with my other GF, they were so relieved he didn't survive when he had his stroke- he would have been left with no quality of life and would have absolutely hated it. He already struggled a bit mentally with aches and pains, not being able to do everything he did when younger. Far kinder he went. I think it's sadly very unusual for the elderly to have quick, kind deaths the way he did and it has been awful witnessing what has happened to my other three grandparents.

I agree with the PP about treating every single ailment and just prolonging the suffering. Until we questioned the ethics of it, HCPs were still giving my GM medication for cancer (not pain relief) after she suffered a horrific accident in her 90s which resulted in her being paralysed from the neck down and in a lot of pain- she died as a result of the accident 4 months later. It's the treat everything culture that I just do not understand.

I've worked with a lot of elderly people and personally cared for two elderly relatives. It's familiarity with what many suffer, particularly those with dementia, that makes me pretty certain that I'd rather not have any lifesaving/life-prolonging measures in place if I had a very poor quality of life.

What my Grandmother suffered with dementia was 100x worse than death. It was barbaric. Thankfully a fall meant that she developed pneumonia after breaking her death and died very peacefully, just when we were at the stage of having to look at nursing homes because her dementia was rapidly advancing.

I have another relative who is currently in a care home with dementia and though the staff are great with her, she has very little quality of life and is nothing like her former self. She's constantly distressed and agitated. The sooner she dies, the kinder it'll be for her.

I've watched quite a few former clients(I haven't worked in care for years) begging and some literally screaming to die. No, they don't all feel that way but a significant number with dementia or severe health issues do. I had another who was so distressed, scared and confused that she seemed to regard everything we did to her(basic care) and to be honest, it felt like we were torturing her, especially when giving her medication prescribed that'd prolong her life.

It isn't just an age thing either. There are conditions that I'd find utterly intolerable now in my 30s let alone in my 80s. Of course what's intolerable for one person may be tolerable for another so you can't have blanket policies but I do think that we need to consider that prolonging the lives of people with dementia with antibiotics and heart medication may be causing more suffering than good.