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 ?

Its really tough because anything that needs investment requires money to be found. The money has to come from somewhere (and saying "make shit more efficient" rarely works). It can come from teachers, roads, police, fire, defense, charity support to other nations, benefits, higher taxes... but it can't come from thin air.

So what we need is more and better social care provision for patients with complex physical / mental care needs. Better pathways to the support, more supported living places, quicker transfers out of hospital, more joined up provision etc.. I agree that a career pathway in caring, an NHS style pay scale, the building of more dedicated care homes with equipment and staffing suitable for complex cases etc.. Personally I'd take the money out of defense and I'd increase taxes but there are plenty of arguments for why those 2 options are also bad for growth, investment, national security etc..

However I don't think you can make an argument about what the government SHOULD do without facing the consequences of how they should pay for it (And it's billions not thousands).

It needs money. Better pay and training for staff and better facilities. However, we don’t want to pay. People will say ‘I paid in all my life’ but working 18-65 on below a certain income does not pay back everything you have used throughout life (health/education/ any benefits) and cover you for a lengthy old age of 15/20 years pension/health/carers. There aren’t enough people paying more than they use in their lifetime meaning money is running out. It is running out even faster currently due to a large aging population.

It would be hugely unpopular and therefore never happen but we need to stop supporting people to stay at home with all that entails and 4x day double care package. Very expensive and if those 2 carers were working in a care home it would be far more efficient (no time travelling between patients/ make 6 lunches at once etc.) There would be less ambulance call outs to falls. Less broken hips from those falls meaning less beds and theatre slots taken up. They could have a GP visit fortnightly to review all those small issues that come up, it would relieve the pressure on district nurses having patients all in one location. If those care home were funded with someone arranging activities and trips out they could be amazing options.

However, lots of people don’t want to leave their homes and live in houses that are literally falling down around them. Expensive care packages and being found on the floor. Ambulance to A&E sitting in A&E for ages. Taking up a bed whilst social worker recommends placement for them to refuse as they say they can cope. They go home and fall 3 days later. The whole scenario repeats again.

@Newnameoclock really? that's great! In my village, it's an elderly population (I would say about 70% are retired) and they built 100 homes last year on one development, 150 on another development and no joke, they included ONE bungalow on the latest plans.

This village is literally full of single pensioners living in 1970s 4 bed detached houses that are falling apart, and in desperate need of modernisation. But no one wants to move because they understandably want to remain in the village, so it's a vicious circle.

It’s a good point around the attitude of ‘I’ve paid my lot in’

I think it’s 40k a year you need to earn for your entire working life to not be a drain on the NHS as an adult.

I think when you retire you should get a breakdown of what you’ve paid in and what you’ve already taken out to set expectations early on.

@AluckyEllie

Care at home has been the entire focus of govt initiatives for as long as I can remember.

That is what all the health care strategies focus on. Providing care at home.

The huge draw backs of this strategy are obvious for all to see except apparently those enforcing it.

And we're all seeing the consequences now.

Acute hospitals completely blocked because there is no care in the community and they closed all the downstream beds

I agree with this despite having very few GCSEs myself. Would I fuck want some of these people 'caring' for my relatives.

Agree. Pay people to reflect the difficult and essential job that it is.

Not all those who require care are moribund!

Carers need better pay, and perhaps an arm of NHS pension

The form for Attendance Allowance needs to be simplified (it's a barrier to claiming) and Cares Allowance increased to at least the local living wage (or minimum wage if there isn't a living wage for that area). So that more people can live supported at home.

This also needs augmentation of district nursing.

And I think convalescent homes could be a good idea - if patients are otherwise suitable for discharge, then they wouldn't need on-site doctors so could be run by senior nurses with care assistants and a fast-track hospital link if there is unexpected deterioration.

But, we're short of nurses. Is it time to reintroduce a non-degree tier between nurse and care assistant? (like the old SRN/SEN system0

🤣

I worked in care to get experience before going onto a nursing degree.

I left the job after 2 years and didn't ever enroll because it was exhausting, thankless and most other colleagues (thankfully not all) should never have been in the job. They did it because it was all that they could get, and had an air of "well they won't sack me as we're short staffed" attitude that made them untouchable no matter how shoddy their work was.

I also agree with the PP who said about medicine keeping people artificially alive with no actual quality of life. We seriously need to address this as a society.

We all know what the solution is. Better pay, conditions and training for staff, and a greater level of funding from central government. We also need to start valuing the contribution to society that people working in this industry deserve.

But that isn't going to happen any time soon, is it?

Lots of people moan about the current situation

These people also (ime) avoid tax and care home fees wherever possible

Oh, and we could also do with some new players in the warden-assisted retirement complex sector.

At present, there are one or two big names, lots of non-obvious charges and onerous T&Cs.

If they were a more attractive option, I think more people might downsize in a timely fashion.

And yy to more bungalows (where land prices not too high) or maisonettes (elderly in the ground floor, anyone in the upper one)

People need to take more personal responsibility. So look after their own health better, they might still need care but for a shorter period of life.
They also need to plan for old age, so downsize when they are still young enough to move and sort everything out.

There does seem to be a weird mentality that people are independent their whole lives, but as soon as they get to elderly age "why should I pay for myself, the state should pay for me and my care"

But a big problem is because the NHS is so bloody good at keeping people alive and living longer, so this is always going to be a crisis that was going to hit at some point.

Social care should not be provided privately, there should not be a middle man making money out of people's taxes or people's private payments for those who can afford it. Social carers should be employees of the state, NHS or something similar, with career progression, proper training, decent pensions, etc.

No, we used to have step down/rehab beds so people could have a lower level of care to get them ready to go home when they no longer had a clinical need fr a hospital bed. It worked really well. Obviously the NHS management in its infinite wisdom closed them all, despite a huge generation of ageing people coming down the road.

Council run care homes and carers would be a good start!

Cost of care at home, unless live-in care for one person, is less than the cost of a place in a care home.
We should therefore be doing more to support this model where appropriate. Increase carers allowance and remove the maximum income requirement from it. Allow it to be split between more than one carer.
Incentivise elderly to move from inappropriate homes to safe and more compact environments, especially sheltered accommodation.
Increase the use of DNRs when people lose capability. More publicity around setting this up in the same way that a power of attorney is set up - should be explicitly included on the health and care PoA.

I would completely be in favour of much higher tax on all income if it covered all education including undergraduate uni, police, fire, a comprehensive health and social care system, cleaning and refurbishing town centres and public buildings, roads, drainage infrastructure, other major public services, and a universal basic income of about £400 a month over which we all work to earn money.

As it stands they don’t have enough money to meet people’s needs and the private sector can’t do it in a unified way on the scale we need.

This.

They have this already. It's called care homes. Patient will be sent to a care home on a short-term rehab placement where they may have input from physio and/or other services. Some end up staying in the care home, some will go home, some will go on to another care home for a longer term placement depending on their needs.
A lot of care homes aren't able to meet capacity for this due to staffing and funding. Also, a lot of these patients are very high needs-need feeding, personal care, may or may not be bedbound, may need 2-4 carers to assist, may need wound care, oxygen, etc..

We also need to understand the breadth of what social care entails. It is not just old, sick people in need of care. Plenty of young, healthy people too.

£££ and training urgently needed. A massive change in societal attitudes too. Flip the narrative. We all belong. Maybe if we had respect for people whatever their level of ability/need it wouldn't attract the bullies and people desperate for any job.

More day centre/ activity / drop in provision.

Better support for family carers. If Carers Allowance worked more like a wage/ income would that mean more people across a family could reduce working hours and provide care rather than it typically falling on one female family member who does it all

I also like the idea of a national social care service as well.

Why would they give a shit for a job that pays minimum wage?