To ask what we do to help with the cost of social care?

[AdultsSocialCare]

Adult and childrens social care takes up the majority of all council tax spend. This leaves a small amount for everything else that councils do.

What is the solution?

I feel like ultimately the central government need to give more money to councils but the chance of that has to be next to nil.

So, what else?

If everything coming back into council control / nationalisation would stop people making a profit from social care and allow the local government to control their own costs, why isn't this being done?

Because the mindset of too much government enterprise means they're not capable of controlling their own costs

As I've experienced too often, by the time they've paid "partners" to help with delivery and commissioned yet another to "oversee" the project, it can often end up costing far more for far less result - especially where the partners are merely funding hoovers with little real interest in the actual role

That doesn't mean that nationalisation can't work of course, only that it would need to be structured very differently to what's so often the case

If everything coming back into council control / nationalisation would stop people making a profit from social care and allow the local government to control their own costs, why isn't this being done?

Because it didn’t work last time round which is why the system was changed in the late 90s/early 00s.

And what you've already paid doesn't count. I have an elderly relative in a dementia home for six years, by next year she will have paid nearly £700k but not one penny of it will count towards the £86k cap.

@christmas2022

I really hate to break it to you but I actually think it should cost more. Who pays for that is another question and that sounds absolutely ridiculous because the fees are already extortionate. But if you think about everything that’s being paid for it’s crazy.

24/7 365 round the clock carers, seniors to manage meds and team, cleaners, laundry, chefs, management, maintenance & secretaries so family can contact.

And then each of these areas require equipment and resources - everything to a high standard unless you are in one of the awful state homes. Decent butter, decent wine, decent jam etc, all adds up. Really good cleaning materials (home I worked in didn’t have any outbreaks of COVID as we had Zoono 30 day surface cleaner and 24hr hand sanitizer). Electric pressure beds, slings, hoists - maintenance and checks for these. Weeks of training. Sprinkler systems & special P50 fire extinguishers so you don’t have care workers running around deliberating on the best fire extinguisher to use when faced with a resident in a burning room next to an oxygen tank.

Heating! And cooling because residents don’t like windows even a crack open for the draft. A fully running kitchen to commercial grade. Not just a fridge from Argos.

And thats all before you get to quality of life. Do you want TVs, trips and activities, books, magazines, cinemas, fresh flowers every now and then, a nice garden, nice interior decor, supplies for sports, arts and games. Hairdressers, nails, physical therapists etc.

You have to think of it that the residents are not only funding their own lives and everything that entails -, they are also employing all of these people to care, clean, cook and provide nice and safe living environment and paying for their lives too (because they too have to live somehow or can’t possibly work there).

It’s a lot. I get it’s a lot. And sure we could just shove everyone in a dark room and then get them up and plop them all in the same room for the rest of the day staring at a tv and give a shitty school dinner meal and then toast but that’s disgusting really. And I have seen those homes and I walked out of them.

Privitisation of the care of the vulnerable will always be a disaster. It shouldn't be in the hands of for-profit businesses.

And on the point of cqc it’s really not as simple as people think. All the best homes I have worked in didn’t have the best ratings necessarily.

The best one ironically had requires improvement whilst the worst one I walked out of had Good.

The way they mark them doesn’t necessarily actually translate into all the areas which are important to residents or reflect care given IMO.

And you get this strange paradox that in better homes you have better people, these carers strive to always give more, always do better and so will complain more about all manner of things whether that’s a one off mistake or because they are educated enough to know when management are trying it on . In homes with carers who don’t care they say everything is great because they don’t care, they don’t see where improvements can be made either through inexperience or not giving a shit, they might even be neglectful themselves and obviously don’t want to raise flags.

So it’s not simple. CQC play a role but it’s the answer.

My mother worked on this issue for years before she died.

First, all local councils need to audit their adult social care costs, and deep dive into all the existing contracts (if they can find them). It is very likely that money is "leaking" all over.

Second, local councils need to identify exactly what they need, and be firm about it. There are cases of crazy management of facilities and services all over the country, more so after COVID. This needs sorting out sharpish, and councils are going to need to resort to legal action if need be.

Third, local councils need to either build or encourage the building of low to medium assistance developments for the elderly: complexes with self-contained small flats, but with communal areas and maybe a cafe or bistro on site, with a 24 hour warden and/or nurse. This will take the pressure off the "home help" budget, where councils are paying carers to attend elderly people in their own homes all over a borough, sometimes up to four times a day, when really all those people need is someone to look in on them and check they are alright.

Local authorities that have taken the third route do not have an adult social care crisis.

The problem is that a lot of LAs are stuck in this binary of "expensive care home vs. keeping people in their own homes", when what we really need most of all is a middle way. Not everyone needs a care home if they can't quite manage in their own home anymore. Sometimes, they just need to be in a flat in a complex in an area they know, where there are no steps, some nice green space, and there's some community and stimulation around them that is easy to access, and maybe somewhere very nearby that they can get a hot meal.

And providing care to people in their own homes is very expensive. It means a carer has to travel to the home, spend an hour or so there, and then travel to another home, spend an hour or so there etc. It's wildly inefficient. If these people were all in the same community complex, carers who need to attend get three times as much actual care work done, purely because they are not driving around all day -- and any emergencies are noticed by the warden.

We have a number of these complexes in my borough. The waiting lists are over five years long, which is a long time for someone who realises at 82 they can't quite manage in their own home anymore. There's a massive demand for them, and dementia development rates are lower within them as are typical elderly injuries (such as hip fractures etc).

That is where I would start.

That just isn’t true. Paying gives you choice if you have the money to do so. I’ll fight tooth and nail for my right to pay for the quality care I want should I need it. I don’t want to be consigned to whatever squalid, lowest possible standard for the cheapest price accommodation the state sees fit to provide me. I haven’t spent my working life providing security for my old age only to have my choice to have the best taken away from me.

What would you suggest could be part of a solution?

Transform CQC so it picks up more than it does currently?

Paying more is fine, as long as the money isn't going straight into profits - which seems to be the case.

Paying more is fine, as long as the money isn't going straight into profits - which seems to be the case.

Look for non profit making organisations!

An excellent post, Torunette, though IME the bit about "local councils need to identify exactly what they need, and be firm about it" - while perfectly true - is where it all falls down

It comes down to accountability, and its lack unfortunately means that providers know perfectly well that a council contract's a licence to print money

If I start on too many local examples I'll never stop, but just the latest one involves the handing over of our libraries to community management/ volunteer personnel. A huge saving you'd think, but not by the time they've paid various "partners" to (mis)manage the initiative, which has led to £2000 in PPE funding producing just a few bottles of sanitiser and £10,000 (no that's not a typo) being billed for one ordinary internal door

I'd ask where the money really went, but experience teaches that the missing accountability means I'll never get a sensible answer

I don’t know @christmas2022

Its a fundamental flaw in the system and I don’t see how you can solve it.

Besides the paper trail, They can only go on what the carers tell them.

An example being in the good homes I spoke of getting poor results the team would complain as felt underteamed and so said that to cqc. They are actually well over the minimum team member requirements, but they love their residents. They want to chat to Barbara and take time to do their hair in the morning, give Sally a long bath that she enjoys, take Neil for a walk round the garden for half an hour after each meal time like he wishes.

Whereas in the well rated awful homes these team members don’t feel understaffed. They are wham bam and done, not chatting to Barbara or doing her hair nicely, not giving sally a long bath but gaslighting her into 5 minutes being half an hour and refusing to take Neil for walks.

Do you see what I mean? One homes carers are striving to do the best and wants more time and the other couldn’t give two flying fucks.

And I don’t believe it does go straight to profits in the way everyone believes. Go and have a look at the individual home of a big name private care group accounts on companies house. They are really not making as much as you think. I personally wouldn’t be taking on that amount of responsibility, liability and stress for those profit margins. Sure when it’s a group and you add all the individual homes together it’s not bad, but home by home your talking a pittance when you factor in what percent of that profit needs to be retained to cover future big building related works.

What? There are day services for older people in my and many other places.
Who told you they were closed? (COVID lockdown periods excepted)

@entropynow

I was responding to @reesewithoutaspoon post.

@christmas2022 They closed in the area where I live years ago. I know because my mother worked in one for years and lost her job when they closed.
There is some private provision now that has replaced them, but not the council run ones which provided this service to its elderly clients at only a minimal cost for their lunch.