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!

@HoldingTheDoor you articulated in much better than me, agree 100%.

@BettyBag your link doesn't mention children?

75% is the proportion spent on long term support

yes that what I read.

www.kingsfund.org.uk/audio-video/key-facts-figures-adult-social-care

My mistake to include children.

Whilst i see that assisted suicide is something i would want when my quality of life had reduced to a certain point, there would presumably be a number of years before that point where, with good quality care, I would still enjoy life. Therefore assisted suicide isnt much of a solution.

I think improved pay and conditions are the obvious answer, alongside proper career pathways backed with training. I also think 'status/respect'. People dont view it as having value because you dont need lenghty academic qualifications so are suggesting things like anyone who cant get a job, all school leavers etc.

It's interesting that when there is a shortage of lorry drivers there are 5k "golden hellos" and rising wages, and when there are a shortage of carers ideas are "force someone to do it or lose benefits".

I can't help but think the female work force has a lot to do with poor conditions - why no fixed shifts that allow people to manage their own family life and caring responsibilities, why no fixed days in a 24/7 industry - supermarkets can do it why not care? Why no company cars or at least pool cars for jobs that are on the road/fuel cards?

What people don't seem to realise is for privatised providers massive staff shortages probably suit the owners and shareholders very well. It provides a justification for short, rushed visits when people are paying for more and they are supposed to just be grateful they get any visit at all. Less staff training costs as less staff. If staff on a zero hour, or 9 hour or 20 hour contract are off sick they are paid based on their contract not the 60 hours they actually work saving money (if they het any sick pay over statutory of course). Also holiday pay. Despite the law saying holiday pay or amount of holiday should include regular overtime I haven't known this to happen so holiday entitlement based on 20 hours when you work 60 resulting in staff that can't afford to take a weeks holiday due to the pay drop. They take holiday for one shift and work other one so no week off.

A care home running a shift 2 staff down is saving the wages of those 2 staff. If that's the case on every shift that is a lot of money saved = profit.

There are many solutions to encouraging people into care but the very basics start with decent contracts for a regular working pattern so that people can be a carer and also have a home life and get the sick/holiday pay that they are entitled to.

I worked in a care home last year. Some people were paying over £1000 a week to be there. The building was run down. The place is subject to yearly inspections and has been for years because it scores so low every single year. There's rarely hot water. The food is shit. Damaged things like doors or light fittings aren't repaired. (At all, nevermind in a timely manner) There weren't enough basic items for each client, from essential washbasins to suitable drinking cups that they can lift by themselves. The equipment is still not regularly inspected yet the law says any worker using an out of date inspected hoist, or a sling with an unreadable label is in danger of a £5000 fine and up to 2 years imprisonment if anything goes wrong. We still had to use them.
There were (and I believe still are) often just two workers for a dozen clients and most require two people to move, clean and dress them.
Carers go to work knowing full well that they'll be doing a 12 and a half hour shift with not a single break for a measly tenner an hour, AND payroll won't pay them for break times totalling over an hour which they don't even get.
Between your 12+ hour shifts of slogging your guts out and breaking your back trying to lift a whole person by yourself because there's no one to help you, you're expected to do untold amounts of unpaid training. You've to pay for memberships and accreditations of certain organisations too. In house training for new staff consists of following other inadequately trained people around and picking up what they do each day because management won't pay you to have real training days. You're just expected to work and follow rules you don't know about from day one. Management are under pressure to comply with Care standards so will berate staff each shift for not doing the work needed despite the fact that there's no way in hell the poor staff can get it done by themselves in the time they have. The clients suffer. The carers suffer. The owners drive the latest Teslas.

No wonder they can't get staff in the care business.

I've just applied for carer's allowance, £67 per week which will be split with my sibling and spent on petrol to drive to Dparent's, spend 4 days a week with them (sib does the other 3 days), do cooking, cleaning, shopping, some personal care including emptying commode, cleaning up after toilet accidents, all legal/banking/household management, dispensing 8 medications, looking after ulcerated legs etc etc etc.

We thought we'd be able to cope on DH's wage but with prices for everything skyrocketing, we can't. So I will need to get a job. So DParent will have to have carer's going in several times a day, or will have to go into care. At a much higher cost than my paltry £67 per week.

If we, as carer's for a family member, received say £200 per week, we could probably manage. But not on £67. Risible.

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 asked this once when being trained in end of life care by a specialist as it's something that I feel strongly about.
His answer was that it's not clear cut, when looking at something like a chest infection for example, the antibiotics can provide symptomatic relief to the person by removing the infection, same with a UTI, and there's no guarantee that the infection will kill them if they're not treated, especially in someone who is otherwise physically healthy, leaving someone with a painful and distressing set of symptoms that further reduce quality of life, without ending it quickly. Even good quality care without medical intervention can extend someone's life, being offered food and fluids regularly for example. The Liverpool pathway sought to address this, but from my understanding is now deemed unsuitable because people were further suffering towards death by being thirsty or hungry and those needs not being met.
There are massive safeguards around eol medication, so much so that I believe that it's swung too far towards letting people suffer so the administrator or prescriber doesn't get into trouble for giving medication that effectively ends their life peacefully. And I think the same applies to sedation medication in people who are distressed with something like dementia, it's become about the carers not wanting to deal with the behaviour (without enough resources to do so btw) rather than alleviating the symptoms of the illness.

I 100% agree that assisted suicide should be available. How is it acceptable to have people woefully cared for by understaffed agencies or have carers who sometimes don't give a shit about them, they can be upset, terribly confused, angry, violent, have no recollection of any of their family and yet they are made to stay alive in this sort of hell - for what? Why don't people have a choice over how they die?

@DockOTheBay

Also unpopular opinion but make assisted suicide legal and allow people to sign to say they want AS if they get to a certain stage of e.g. dementia

You’re telling me! I find this repugnant. And I say that as a full-time carer for my 90yo old mother who has advanced dementia.

@Maverickess we had those conversations about my gran when she was getting infections etc- so I can understand treating with antibiotics if the infection is just going to cause discomfort etc. it was things like cancer medication etc that was surprising. Although after the conversation, they did stop this.

The point about carers allowance is very good. It is so low that people cant live off it, yet it could increase significantly and still be cheaper than carers coming in. (Being able to build yoir own pension is another elephant in the room here) The lack of respite also stops people caring for their own relatives. One of my relatives husband is able to be her carer but needs support but they have found it really hard to get this. What he needs is someine to do lunches everyday and one weekend a month but everything seems set up with all or nothing.

What to do about future of care in the UK?

What we should do is the same as what we should do to address a lot of society's ills i.e., redistribute wealth. There are no reasons to have the issues we do around health care, education, and poverty other than the violently disgusting greed of a few and the severely misplaced hope of many (aka the "oh I don’t want support wealth redistribution in case I'm one of phantasmically small number of people who go from average to super wealthy and end up doing myself out of a few quid" brigade).

If we're talking about care specifically then I think an easy way of ensuring it is properly funded and run would be to make it a law that at the age of 75 everyone, no matter their wealth or health status, has to move into a state run care facility. The second those at the top are faced with the prospect of living like those at the bottom will be the second they're happy to contribute to improving care for everyone. Until then it will be sticking plasters and punting the problem into the long grass until total collapse (something else my generation will have the pleasure of dealing with).

[quote BellatrixOnABadDay]@Maverickess we had those conversations about my gran when she was getting infections etc- so I can understand treating with antibiotics if the infection is just going to cause discomfort etc. it was things like cancer medication etc that was surprising. Although after the conversation, they did stop this.

[/quote]
I think the key is that there's a lack of communication and awareness from those involved and the system is disjointed, it's supposed to be a seamless system but it's often a mix of needing input from several different areas to achieve something.
Care home has to attempt to give what's prescribed and GP will issue the repeat when it's requested, care home has to request because no instructions not to have been issued, original prescriber is often no longer involved, or review is done few and far between so unaware of the deterioration of the patient. GP needs the input of the original prescriber, family unaware that these meds are still being prescribed and given so can't question it.
Imo it's the red tape and clunky system that is contributing to these types of scenarios, as well as the default to treat everything regardless of the quality of outcome - and that, yet again, comes down to money.

DearlyBeloathed

DockOTheBay
I've no idea. Some sort of conscription? Every school leaver has to do 2 years of elderly care in order to be eligible for it when they're older?

An increase in pay and conditions would be an obvious draw, but not easy to achieve in an NHS setting.”

What an awful idea.

Yes, isn’t it. The sort of awful idea usually put forward by someone older, who’s in no danger of ever having to be conscripted themselves.

@MrsSkylerWhite

Yes carers, above all have to have patience and a caring nature, few possess these qualities and it would appear the rest of us don't value them.

@Onionpatch

Whilst i see that assisted suicide is something i would want when my quality of life had reduced to a certain point, there would presumably be a number of years before that point where, with good quality care, I would still enjoy life. Therefore assisted suicide isnt much of a solution.

I think improved pay and conditions are the obvious answer, alongside proper career pathways backed with training. I also think 'status/respect'. People dont view it as having value because you dont need lenghty academic qualifications so are suggesting things like anyone who cant get a job, all school leavers etc.

I think it's two pronged. We need both. We need to stop keeping people alive way beyond the point where they have any quality of life and when most of them wouldn't have consented to it. That doesn't necessarily have to look like assisted suicide but it does at least mean examining the defaults when it comes to medical treatment. We also need to do exactly as you say here, and improve care. This is going to cost more money.

Carers will be recruited from abroad. It's happened before - from the Philippines, Eastern Europe.
Sadly I can't see there will ever be the funds available to massively increase wages & also sadly, I can't see caring for the elderly being a chosen career path for many school leavers.
This comes from someone who has worked in care delivery & still works in an associated role.
Going back more than 10 years, care providers have attended job fairs in other countries offering jobs & documentation necessary in return for a couple of years of their work.

@Smellyporcupine

My MIL hires private carers they might have 2-3 clients in total, rather than ones that have multiple jobs a day. They get paid pretty well, I think its £20 - £25 per hour.

@Smellyporcupine I doubt the carers are receiving that rate. If there's an agency involved, they'll be taking their (hefty) cut

we want the industry to be recognised as a good carer choice and something to aim for, not as something that people do when they are not good enough for anything else

@pringlelips, as a graduate, your words above are exactly how I was made to feel when working as a carer- ashamed, undervalued and like I couldn’t get a ‘career’. It’s truly awful, isn’t it?

For us it starts with the LAs paying a rate that allows us to pay what the staff are really worth and stop using the care providers as scape goats when something bad happens because they decided 15 minutes was all the service user needed 15 minutes was all they were willing to pay for

Ha! Do you think this will actually ever happen?

The simple solution is to pay well and give carers the respect that they deserve. At present nobody aspires to being a carer. If a teen went into a careers meeting and said that's what they want to do then they would likely be redirected towards nursing or similar. Nobody respects what we carers do.

Until we have the respect and salary to match the important job we do there will always be too few good carers. I went self employed 3 years ago and up until now have made enough to scrape by on. I'm now loosing my home because I can't afford the rent increases the landlord wanted and my clients couldn't afford the massive hike in prices I would have had to have charged.

It sucks. I love my job but still have to work 6 days a weeks to keep a roof over my head. Yes we need to pay more for care but it also needs to be prioritised by government in a way it has never been before.

@Cherryade8

Make it a requirement of claiming unemployment benefits that if roles like care are available then then you can't claim dole? I often see care roles advertised with flexible hours etc, people shouldn't be paid not to work.

I don't think forcing people to take care roles is a good idea. I've seen far too many undercover shows of vulnerable people being ill-treated by carers who've chosen to work with them. Let alone making someone do it at risk of losing benefits? It's not stacking shelves, it's CARING for people, and that takes a certain kind of person.

@notanothertakeaway they are but they are self employed, so they would need to save for their tax out of that rate (if they earn over the tax threshold.) My MIL does have agency ones in too, but as it's privately funded they aren't so pressurised. They are well off, although as her DH needs a lot care it is rapidly eating the saving.

It really breaks my heart thinking of people on their own having to be rushed and only their basic needs met. And the stress and pressure the carer is under. In that sense a care home seems a better option, but I know many don't want that and the care isn't perfect there either. Plus more costs.

One of the school mums does this type of thing too. She's more a companion type one through not through an agency as she runs a craft business too.

@D1ngledanglers

Carers will be recruited from abroad. It's happened before - from the Philippines, Eastern Europe. Sadly I can't see there will ever be the funds available to massively increase wages & also sadly, I can't see caring for the elderly being a chosen career path for many school leavers. This comes from someone who has worked in care delivery & still works in an associated role. Going back more than 10 years, care providers have attended job fairs in other countries offering jobs & documentation necessary in return for a couple of years of their work.

Not anymore, migrant workers have to fund their own healthcare, cannot bring over a spouse or children.

EU workers have left the UK even though they could have stayed and avoided health care charges.

Covid has changed everything, other countries are valuing their HCP's

Though perhaps on hearing Ukrainian refugees are mainly women, Johnson saw an opportunity to get them picking fruit and wiping bums?

I used to be a carer and so did my sister
Reason I left ( back in 2016) was the following

• unfriendly and unreasonable hours. No matter what agency you worked for , it was always a weird shift pattern and they would beg you to work more
• some unreasonable clients. This wasn't often but occasionally you'd get grief from family members, the clients when you were just trying your best. Tonnes of paperwork.
• bad pay and not being paid between clients. I then worked in a supermarket and I ended up getting more money on the whole because I didn't have those driving gaps. I get a lot more money working in an office and a lot less stress