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 ?

But you could argue why should the next generation pay inflated taxes to provide care for the elderly who have assets, when that same generation has been lumbered with student loans and little chance of ever owning their own homes. It's grossly unfair.

Somebody has to pay for it.

I agreed with the dementia tax.

@Dinoteeth

So how should it be paid for?

Is the idea of advertising evening only or night only shifts really that bad. I'd have thought there would be loads of parents wanting to tag team their work hours to save on childcare, like one parent having an early morning job and doing school pick up so the other one would be looking for evenings.

I think people fail to realise that 35% of people needing social care are in the 18 - 64 year bracket, so they will need care for many, many more years than people over the age of 65.
Do people recommend euthanasia for this group as well as the older group ? Thought not !!
This is such a complex situation that will never be resolved unless we are collectively working together to find a solution for this crisis, which is worsening day by day.
Until it affects you personally, you don’t think about it, but it is affecting everyone by default. No beds available for operations, no beds available for respite care - for any age, no staff, families at the end of their tether - unable to cope physically, emotionally and financially with caring for someone.
I don’t profess to know the answers, but we really do need to find a workable solution, but we all know no one wants to pay for it, by an increase in their taxation.
People with learning disabilities in the younger age groups do not have properties to sell to fund their care, many older people also do not have properties to sell to fund their care either.
Even if people do sell their properties, what happens when that money runs out?
Where I live, there are not millionaires in opulent houses, this is a very working class area, where the majority of people struggle with the cost of living. Where will they get their money from to fund their care?
This is such a nightmare for everyone concerned and must be so worrying for people who desperately need care and support.

The rolling shifts availability requirements are ridiculous and doesn't just apply to the care sector - there are plenty of customer service/call handler/retail jobs that want people available across varying shifts 8-8, 7 days a week. There are probably plenty of people willing to work only evenings and weekends to reduce childcare requirements but can't work week days, and others who could work evenings, and still more who could do 2 or 3 long days during the week.

The employers offer no flexibility, then wonder why they can't get staff.

I agree with this. We shouldn’t be trying to prolong people’s lives as long as possible when they can no longer look after themselves and have little quality of life.

I had this argument when my Nana was ailing.

She had dementia. She was at the point where she had to be fed as she couldn’t remember how to lift a spoon. She was doubly incontinent. She’d forgotten how to form sentences, and on they very rare occasions she could she’d be frantically trying to find her parents.

She kept getting regular chest infections and every single time the Dr was called, he’d prescribe antibiotics and the care staff would have a fight every single day trying to get them into her. Inevitably she’d end up in hospital, on drips that she pulled out every day.

She ended up in hospital having hip surgery as she fell. Whilst in there she had another stroke and then got an infection. I was treated with massive suspicion by the hospital staff after my reply of “chance at what?” when they said we should try a different antibiotic to “give her the best chance”. You’d have thought I’d suggested murdering a heathy, happy woman rather than just not aggressively treating someone who had zero quality of life (in fact if we’d kept an animal in those conditions we’d have been in trouble)

You are in a minority if you want to work nights. I know that from years of doing recruitment. The people who do it will normally do it for a limited time while childcare is an issue but very few want it on a long term basis. The same with weekend shifts, for a limited time for certain situations e.g the students I employed, but a constant turnover.

It doesn't work anyway, local care agency are currently advertising flexible shifts, fixed shifts, part time, full time and they can't get staff. If it works where you are that's great, I can assure you it is counter productive where I worked.

Many homes are closing, the struggle with costs is acute but LAs and NHS aren't increasing fees in line with inflation so increasing pay is impossible unless the fees increase.

Who agreed to the surgery and antibiotics? I have LPA for an elderly relative and I had to agree to the surgery and the surgeon was very realistic about the fors and againsts, I'm consulted on all med changes. I've agreed things like a DNR, vaccinations only if she isn't distressed. Maybe you need to talk to whoever is agreeing to these things?

There is a middle ground between aggressively trying everything possible and PTS like an ailing animal.

The difference is caused by a different culture among staff. The staff dealing with JustLyra's Nan didn't sound at all open to not giving treatment, it wasn't lack of communication.

@JustLyra that's horrible and so sad that her life was prolonged when quality was no longer there.

Is it right not to treat infections? Is their a risk infections could be passed on?
Infections can be very painful, is that maybe why they treat them?

IME (end of life care, not medical) antibiotics can be the best way to manage the symptoms of an infection as well as treat the infection itself, I've known people treated for an infection as part of symptom control alongside fluids and pain relief as the person treating feels they're the best way to alleviate the pain and discomfort that comes with an infection.
I guess it depends on the person, the symptoms and the infection though.

I completely support people paying for their own care. We laugh about our “care home fund” but it’s not a joke, we hope it won’t need to be used for care but it’s there if it’s needed. It means there’s more money in the system for people with no money and it means that we will have some choice.

I have to agree with all these sentiments. It's a really hard road to tread though. Step Dad, triple bypass, prostate cancer, catherterised, vascular dementia. Because of his bag, he regularly had infections. He had sepsis three (!) times and survived due to fantastic care by NHS. He had annual stents to his urethra. He finally had a DNR, additionally Do Not Treat or Hospitalise, and died in his care home of Covid. DM was not particularly unwell, just old and tired. She also had a DNR, additionally Do Not Treat or Hospitalise. She also died of Covid in the care home. Both had declined the vax.

Why is it right that people who die from cancer get their end of life care paid for by the state, yet people who have dementia are expected to pay their own end of life care? 🤔

That is a very pertinent question @Dinoteeth, and I look forward to reading the justifications. It's not right IMO.

I'm not 100% on this but think those with advanced dementia who don't have long to love can get full CHC funding. I can't remember when the criteria kicks in.

*excuse the typos. Long to live.

www.dementiauk.org/get-support/legal-and-financial-information/guide-to-continuing-healthcare-funding/

With dementia it’s because very brutally there are very little medical interventions available

so drugs to alleviate dementia symptoms free on the NHS, any medical palliative care would be free but unfortunately much of what people with dementia need are things that are deemed non medical - help to dress, help to wash, help to eat etc they fall under social care

and social care isn’t necessarily free if you have cancer Marie curie

continuing healthcare funding is an utter dogs breakfast & always has been

In her case the infections were treated because they’d have killed her.

i think there’s a balance to be found. They said they had to be treated because she’d be in pain and die if they didn’t - but her having to be forced into taking them (which caused massive distress multiple times a day), being often carted off to hospital and given drips also hurt.

For me there was an irony that she could be given sedatives so they could move her round, give her drips and the likes in a pain free and peaceful way, but that couldn’t be done to alleviate discomfort from the infection.

In her case doing the “right thing”, and medical staff understandably not putting themselves at risk of being accused of anything, was put before doing what was actually the best thing for her as a person.

If she had capacity, she could have refused antibiotics and hospital treatment. If she did not, you along with other involved parties could have have had a discussion with her GP and a collective decision could have been made on her behalf not to give her antibiotics and hospital treatment.

This is why advanced directives are so important!

But, of course, HCPs will always err on the side of caution and treat because, well, they don't want to lose their registration, livelihoods or go to prison!

She didn’t have capacity. She thought she was covered by a DNR and LPOA. The care home and GP wouldn’t enter into discussion with the family. Even the ambulance service and hospital tried to intervene with the constant trips. If they hadn’t ended up keeping her in at one point and having tbt conversation I’m fairly sure the home and GP would still be coercing and manhandling her into taking antibiotics.

im well aware of why the hospital staff would err on the side of caution. My point was merely that that was one of the many things that superseded actually thinking of what was best for her.

Hmmm, it's usually the family that push for ongoing treatment, not the GP/care home. I wonder what the care home/GP's side of the story is.

Anyway, there's a RESPECT form that GP's can put into place that can help address these kind of issues.

www.resus.org.uk/respect/respect-healthcare-professionals

In this case the complaint was upheld against them over it all. They pushed it constantly and they were later slated in their next inspection over their obsession with preservation at all costs.