How do we solve the social care crisis ?

[Worriedddd]

We have complex needs patients being stuck in hospital for up to 2 years. Some even more they are ready to leave just there's no social care placements and they can't get the right staff anyway. For minimum wage carers will have support people with very challenging needs. There is high risk of assault in many care settings employers don't offer the right training like de-escalation and breakway. . You could get more money working for Lidl and aldi. Even with immigration people leave and find another job. What's the solution to this ?

We need a social care tax and better pay. Also increase inheritance tax so everyone shares the burden of the cost of social care, not just those who are unfortunate enough to get dementia or other age-related conditions and need it. If I get cancer the NHS will look after me - generally speaking. But if I get dementia or Parkinsons, I am on my own. How is that fair?

Also as a pp said, people need to downsize where feasible. That doesn't mean going into a retirement flat, but if you are rattling around a 5 bedroom house for goodness sake move to something smaller with a smaller garden which is easier to maintain if it's possible to stay in the same area with bus links etc. Preferably with a downstairs loo. Then you might manage for longer in your own home with cheaper home care, rather than needing to move into a care home.

My elderly SIL lives in a terrace house and she really needs to move to a flat somewhere in a nicer area. But she won't move because of local bus links. But she's in London, all of it has decent bus links so she could easily move somewhere else. But if she becomes infirm she will be stuck in an unsuitable house.

And given we have thousands of illegal immigrants, maybe some of them can work in our care sector (on a paid basis, I don't mean for free, I mean on the same (improved) wage that anyone would get), even if it's only on a temporary basis until they are qualified to do something else.

I can see a time when Euthanasia is a legal option if people sign up for it while mentally well.

If one is still enjoying life, even in diminished form, that’s very different to if one is suffering from dementia and doesn’t recognise anyone and is unhappy .

This is what scares people- having dementia and zero quality of life- Euthanasia is allowed for much loved animals to spare them unnecessary suffering - But for humans?
We have to ( If dementia hits) endure years in a care home.

Would scores of young men who don’t speak English be suitable to work in a care home?
Feeding and personal care?
Not fair on the residents
People being coerced into care work would be a disaster.

Unfortunately this attitude towards social care is one of the things that keeps the wages low, the conditions awful and therefore the standard of care lower than it should be. And that drives out the people who genuinely want to do it too, making matters worse.

Advocating for 'anyone' to do this job is half the problem, because then anyone does and can (or is pushed into doing it) it's just about getting it done, to any standard, not investing in the sector as a whole to ensure it's done well.

A nurse I know says similar- People are living far too long with zero quality of life.
A mentally astute person in their 80’s who is physically active is quite different , of course.

How can you expect to employ large numbers of young migrant males in care when there are no ways of verifying their background or to check for a criminal record? Care staff here are subject to an enhanced criminal record and background check. Many migrants enter the UK without papers. I doubt many of them would be suitable or would even want to do it.

Eastangular2000 · Today 14:59
These are exactly the situations where family support should be the default. 65 year olds should not need to be in nursing homes to recover from an op unless there is no other option.

Family cannot always step up, l look after my elderly parents DF and DM with dementia. It is undeniably hard.
They live in an annex up 12 stairs in our house but luckily they can manage stairs.
When my Dfil had his hip operation there was no way we could also accommodate him, not a room free, too may stairs, we are beyond stretched with my parents, full time jobs and teenagers.
Plus he needed physio in his area for months etc.
There are many who for various reasons cannot manage to take care of relatives for obvious reasons and some have no family either.

@cptartapp they'll be a whole host of reasons why someone who is mentally astute will refuse to pay for carers. From wanting to save money, fear of money running out to simply not wanting to admit or believe they need them.

Carers should be publicly funded then it removes the 'I'm not paying for something I don't think I really need' mentality and probably allows some off-spring to continue working.

Someone who is mentally astute even if their body is done still as some quality of life they are able to engage in conversation, watch TV etc. Therefore I dont think euthanasia is the right answer for those people but then I've never watched someone be in a care home long term with body issues, so I might be talking shite.

@Eastangular2000 I don't agree 65 year olds should be relying on family. Some 65yos might not have any family or some who had their children in their 40s those children are just starting out in life, potentially just left Uni or have very young children of their own.

We need a proper safety net for people of all ages who need it nobody should be fighting the system for care.

It's a huge, complex and costly conundrum. MIL with dementia is about to return to her care home, which costs her £4,200 per month, for end of life caring, probably in the next day or two, after a month in an acute bed in hospital. Two thirds of the patients are DNR, and most have dementia; they mostly don't know where they are or why.

She was a fervent advocate for assisted dying, but now lacks agency to declare it. If she were my dog or cat or horse, the vet would been called to end the suffering several weeks ago.

@XingMing I hope the end for her is soon 💐

Thanks @Dinoteeth, I am very fond of her, but it really can't come quickly enough. Her heart is failing, her lungs are filling with fluid and she will be bedbound from here on. But she will be better in a quieter place.

I'm sorry to hear this, we have just been through a similar situation with my mum (but exacerbation of chronic illness through covid rather than dementia). She was late 80s.

I couldn't believe it when I asked her doctor to have a conversation about DNACPR with her. He literally said "if you have a further heart attack and your heart stops, would you like us to restart it" for you.
I mean, good grief, as if! CPR would be very very unlikely to work for her and she had close to zero quality of life to start with.
But yes, hero doctor, you go ahead and perform the barbarism that is CPR on a frail elderly person, so she dies in agony or survives requiring maximum care at a cost to all of us.

It's do difficult but I honestly think there needs to be a cut of age fir treatment

They have to ask @NameChangeForARaisin. My mum was 96, six stone with osteoporosis and dementia, although I said even attempting CPR would be insane because it would kill her, the GP still had to ask her. We took her “I’m a very old lady and I’ve had a good life” as consent.

Yes, I think there needs to be a conversation about how much or how active medical treatment should be for the very geriatric and infirm. One of the many lovely doctors treating her told us very early on that fewer than 50% of nonagenarians would see their next birthday after the fall MIL had.

However, where is the line between palliative only care and treating infections or cementing fractures?

It is extremely hard caring for someone with dementia at home, DM was diagnosed in June in her mid 50s . She’s now in a specialist unit .

I cared for her at home for as long as possible but from January onwards she needed 24/7 supervision and assistance with all activities of daily living - showering, dressing, toileting, meals made etc .

We got a carer for 15 mins in the morning at 10, again at 12 for 20 mins, 10 mins at 2, 20 mins between 4 and 7, and 15 mins at 8 .

Mum would get up 5am, and didn’t sleep much at night, wandering, hallucinating, screaming out at night, left the house more than once . I couldn’t do a single thing as I couldn’t leave her . I couldn’t even get a shower or go to the bathroom with the door shut towards the end . I went three weeks without more than an hour of sleep at a time .

People don’t know unless they live it how hard it is . It’s very easy to try and get on with it behind closed doors - guilt, shame, fear, you think you should be able to deal with it, it’s your mum/dad but bloody hell . My family got involved at crisis point, they took over everything for me - but I never told them before . It gets normalised after a while .

With the best will in the world it becomes impossible . I was literally begging and begging for help . We had hours and hours of meetings - one that had around 20 people present - and dozens of different adult protection referrals . Even after I rang 999 threatening suicide there was still very little help in the immediate days after - I remember one night being told there was zero beds in the entire county - in the end I had to take Mum to hospital and walk away. As long as you’re there to pick up the pieces, my experience was social work didn’t care .

It can’t fall solely to relatives without very intensive support, because doing it like I did is hell on Earth . I’ve been left with PTSD - nightmares and flashbacks - which is also costing the NHS a fortune to help me manage - on top of the massive bill for all the care mum has had and is now receiving .

And yes, I’ve spent the last year looking at my darling mum and thinking, you wouldn’t let your dog suffer like this . I don’t want her to die but this has been at times a living hell for her .

But I don’t know if that’s really the answer either .

@tomissmymum that sounds dreadful for both you and your poor mum.

This!!

The more my company take on carers with a 9am-2.30pm availability, the more of the unsociable shifts I have to do - at no extra pay.
I'm leaving my house at 6am and not getting home till 11pm, for a real-time pay rate of around £5p/h.
This is why recruitment is non-existent. Who in their right mind would do this job? (Apart from me 😂).

Seriously, we deal with acute mental health issues, aggression, bereavement, death, dementia, medication, family dynamics, immobility, incontinence...
We work against the clock, trying to provide care in a tight timescale, battling traffic between calls, in all weather conditions. We need to be knowledgeable enough to spot what needs to be reported to the District Nurses, because if we miss something, it can be life threatening.
We need to deal with families - for eg, sons who want one thing, and daughters who want another.
We get reprimanded if we arrive at 1.15 for a scheduled lunch call at 1pm, due to traffic, or an emergency at a previous call.
We face intense pressure to work 15hr days, because of staff shortages.
We don't get rest breaks to use the toilet or have something to eat.

And we are totally devalued by the whole of society.
Why?

Care homes shouldn't take huge profits & pay staff minimum wage.
There should be minimum qualifications & training and a career path and a good pay structure. So professional staff who care are employed and not anyone who might turn up for an interview.
Convalescent homes should be opened to take patients who do not need hospital treatment, staffed by physios, OTs and nurses.

So very sorry @tomissmymum. My experience with my mum was a walk in the park compared with that.

🌸 it was hell, I wouldn’t want a single soul to go through it . I worked as an HCA for a few years before and I remember seeing patients who you’d question why we were preserving life when often all that meant was preservation of brain stem functions, digestion, eyes open, respiration, but little evidence of any sort of higher level functioning . Never thought for one moment I’d be looking at my mum and having the same thoughts . It’s incredibly difficult .

Vote labour

@Eastangular2000

You're talking about an ideal world where

Family members like in the same country/county
Family members love each other
Family members have the funds to be able to give up work to do this
Families have homes large enough to be able to do this
There are 2 parents in each "caring" family

In most scenarios I see around me in my life this wouldn't apply.

Family members live several hours away from each other.
A single mother with 3 young children working 2 jobs to afford rent would not be able to do this.
Most people I know are in small 2-3 bed homes without ground floor bathrooms.
Many people cannot afford to live on one income, so could not afford to have 1 adult acting as carer.

Also, have you ever cared long term for an elderly family member with dementia, incontinent, and who is completely immobile and sometimes violent, and needs a hoist to be moved?

I've seen a close family member of mine attempt to care for their elder in this situation. They attempted suicide as they couldn't cope, and we're completely broken as a person.

In reality it's very very very difficult to provide care for an elderly family member.

They probably have some time off work to recover and then go back... state pension age is now 67/68.

Throwing money at the problem isn't helpful if you just hire a bunch of people who aren't RIGHT for the job. That said, there is no respect for care staff nowadays. It's seen as a low-paid, "clean up people's shit" type of job and therefore why would anyone want to go into it?

A few things that need changing:

Salaries: If you want to attract people into the job you need to pay decent rates. I can make more working at Tesco than I do dealing with difficult, challenging individuals with complex needs. It must be seen as a profession and be rewarded as such.

A standardised vocational program for all care staff: We should equip carers to be professionalised, and this means a set standard that all social care staff must meet. This means a code of conduct, training and support to progress.

Stronger emphasis on informal carers: Why are we relying on state funded social care (or even privately funded) when we could fund people to look after their own family members? We already rely heavily on care givers of family/friends - support people to care for their family/friends by funding it adequately. If I have a sick relative, I can't work and look after them simultaneously. This needs to change.

Nationalisation: We shouldn't be throwing away billions a year to private providers. They skim off profits and give dividends to shareholders. Social and Health Care should NEVER be for profit because that's when corners are cut. Money spent on publicly owned services eventually get pumped back into the system through taxation of employees etc. It would also be FAR cheaper. Hence why privatised services get given back to the NHS when private companies can't compete (price vs service provided).

On a side note, there needs to be a REALLY heavy focus on the fact if we want a service, we MUST have an adult conversation about how it is paid for. Because this country is full of people who want a service but aren't willing to stump up the funds for it. We haven't got a bottomless pit of money, and it has to be paid for.

The other thing is we need to be MUCH more radical re: the culture in the UK of not taking care of ourselves. Much of the issues facing social care are at least in part related directly to people not taking good decisions re: their health. For example, obesity is a HUGE crisis, leading to diabetes, heart conditions etc. the fact is we have to take much more responsibility over our bodies and health if we are to stem this problem. Just throwing money at it isn't enough. We need to value the services we have, and that means not needlessly causing ourselves more physical ailments that will cost the system billions a year.

I am NOT talking about neurological conditions/disabilities or other problems that are beyond our control. I am talking about the fact we spend hundreds of billions on preventable conditions that need social care support. Diabetes, hypertension, alcohol or drug related conditions etc are all HUGE drains on the system. Have a stroke, you may need 24-hour care. We need to drive the message that a stroke is something which is at least in part preventable and that it is a responsibility of each one of us to avoid these things happening. That isn't to blame those who have strokes, though if you smoke 40 a day, have a few take aways a week, barely move from your sofa etc it is hardly surprising you have one.

I've worked in the sector for decades. NOBODY seems to want to face up to their own responsibility to society re: doing everything they can to avoid needing extra care and support services. If you want the righ to "free" health and social care, then you must also have a responsibility to avoid needing it unless necessary. This shouldn't be controversial, but people will scream about it.