To wonder (setting aside immigration) how the elder care sector can be improved?

[PrincessSophieFrederike]

There's been so much recent coverage of how bad the situation in care homes is. Short-staffed, owners pocketing money that should go to the staff, elder abuse...

I don't want this to be an immigration debate. So setting aside that, what I wonder is how can we improve the care sector? Whatever amount of immigration we have, we will need workers from here as well.

It's very difficult as elder care is just the kind of job for which you need a specific type of person. The government can't just put people in it in some big initiative to get people into work. Two big things that would help would probs be higher pay (and probs deprivatisation of the care sector) & higher prestige, making it a job you train for & can progress in. It's disgusting the comments one can see in discussions (mainly nor here, but elsewhefe) where caseworkers are dismissed as interchangeable bottom-wipers. Our society needs to make changes so they are properly valued.

This ties in to attitudes to old age. I sympathise with people who supported assisted dying due to their personal experiences. But it feels very dangerous for the government to bring this in (even if in a limited way) without better safeguarding for elderly people. If the only government effort to help them is assisted dying, then it gives a disturbing impression...

I noticed that many people who supported assisted dying spoke of terrible experiences with family who had severe & irreversible dementia, & wanted to avoid this. The assisted dying Bill doesn't cover this though ad you need to be of sound mind. Is it not though possible for people to write their wishes down, making clear that if they develop dementia in that way, they don't want to receive excessive treatment? Many families speak of parents who wanted to not be given medication for repeated UTIs & pneumonia if they had severe dementia, but as they hadn't recorded their wishes, medication was repeatedly given. Surely this could be changed in other ways apart from assisted dying bills?

Another issue is at-home care vs care homes. One problem is that lots of elderly people now live further from family- maybe more extended families could help? But this ofc wouldn't change quickly, and would only be possible for people with relatively mild medical needs, or at least not ones which involve potentially dangerous behaviour like dementia. And there's ofc plenty of reasons why people might not want to live with a healthy patent, let alone one needing constant care.

. Some family friends can afford live-in carers for their parents, but obviously this isn't possible for a lot of people. And care agencies can be just as risky as care homes...

TLDR : What can we do to improve care homes, (leaving immigration issues aside)? The main things I can think of are deprivatisation, higher pay &training & status. Also much more stringent checks on quality of homes.

Much more stringent checks is an absolute must. My mum’s care home’s list of weekly activities is a work of fiction. They are sat in front of the tv all day and all evening. The exercise class does not exist. Not many of the carers are strong enough to do showers so they get missed for weeks if you miss your slots. They are literally disabling her refusing to help her walk to the toilet and instead putting her on a commode. Ive had social service/ and physios round and the staff then say theyll take her… then dont. Staff turnover is high. And it is costing £1k a week.

That's terrible, I'm really sorry... I know quite a few people with grandparents in that kind of position...

Why do the workers neglect the activities? Burnout? Compassion fatigue? Just don't care? None is an excuse, I'm just trying to understand why ..

I'm assuming most of the carers are female? Would male carers be needed then for lifting etc? Ofc this could bring other issues...

It definitely seems like overstretched physios etc offload back onto carers homes often, who also don't do what's needed... This needs to be tackled too.

Incredible the kind of prices owners are getting away with. This kind of corruption needs to stop...

£1,000 per week = £5.95 per hour for 24 hour residential care.
Advance directives, ie. outlining what you would want, in advance of you needing it, should you lose mental capacity or be in a situation where you cannot make your views known, are already here and some people have already done these and have them logged in their NHS records via their GP.
The main issue is, IMHO, that people generally don't think about this stuff until they need it - and then, it's too late.

Regulation of care homes and the companies involved needs to step up, hugely. Any company that neglects those in their care needs banning for good. The directors of companies need banning for good.
When concerns are raised, inspections and investigations need to happen urgently.
I'd stop the importation of carers, thats wrong on so many levels, but as a society we need to see care as a profession.
Thus it needs to be paid as such. I'd recommend the companies divert some of their profits to staff training and pay to make it more attractive.
I do think elder planning is something we should all consider, and we need to change how we see old age.
I think there needs to be a change in building so elder flats, supported living, and downsizing is seen as the norm rather than waiting for people to die in these big drafty houses with meals on wheels a few times a week, waiting until they need 24 hour care then off to a home.
And assisted suicide I think should be a viable option. I would hate to reach a grand old age and be in nothing but pain, rattling from my daily pills, and just waiting for a big heart attack or something similar.

I don’t have any answers, but I do know that it is possible. My father is in a private, family-run (in the 4th generation) care home and it is brilliant. It is £1200 a week, which is a lot cheaper than newer ones with all the bells and whistles, but crucially it is staffed by people who genuinely care and have enough time to properly look after all the residents.

We need to start using robot carers like those Pandas in Japan.

It needs the state, care homes and people all to do their part. More stringent regulations and better trained more empathetic staff are only part of the equation. People need to be as healthy as they can be going into their latter years. That responsibility should be placed directly on peoples shoulders.

It's the same with nurseries

Who is making all this money???

The reality is the days of care homes making a ton of money is long gone. Costs are huge just now. Heating bills, food bills and wages are all increasing dramatically year on year. A significant number of care home buildings are shockingly inefficient and poorly maintained.
Staffing is also a massive issue, it’s almost impossible to run a care home without agency back up which costs hugely. Bear in mind care homes are staffed 24hrs a day.

Care homes on average have to be 90% occupied to break even. Councils don’t pay for residents whilst they are not in the home. So if someone is taken into hospital they stop paying until they return. Despite the room being reserved for them.
Private clients are also massively subsiding clients who have their care paid for by the council.
people dramatically underestimate the cost of providing decent care. It takes approximately 4 full fee paying clients in a care home to pay for 1 care home carer (not agency) for 24hrs. Not including any of the other costs. A lot of people require 2 or more carers for tasks such as washing, dressing and moving around.

In terms of making care cheaper in the long run, keeping people fit and well and mobile for as long as possible will massively help. Building new modern care home which are more efficient to heat. I also think we should be building more retirement complexes and encouraging the older demographic to move out of their larger homes and into smaller homes. This would be far more efficient for care providers to provide a better a more efficient service.

Higher staff ratios. Even when fully staffed carers have so many patients to look after that even if they are kind and compassionate people, the residents needs are not all going to be met. There are too many competing needs even if the carers are working flat out. If you have multiple residents that all need something at the same time i.e toileting, feeding, washing, repositioning, reassurance/activity, then they need to prioritise the most urgent need first. Therefore jobs which take longer, or have less priority or require more staff such as showering might never happen as they are constantly being called away for more urgent things such as incontinence or meals that are going cold if the patients aren't fed. Of course people may be understand that in these circumstances staff are doing their best and are happy to have a strip wash instead of a shower. But if staffing is always at this level and therefore it happens again and again each day, then that person hasn't had a shower for weeks which obviously is unacceptable.
Basically the workload is not actually possible if carers are aiming to provide what most of us would consider a good standard of care. This in turn drives away kind and compassionate staff as it is heart breaking to see people's needs not being met such as people being incontinent as they have waited so long.

Setting aside immigration would certainly be one way to break the care sector. My mum's palliative care team at home were all Indian women and absolutely wonderful with her.

Follow the money, indeed...Though as pp said, costs are much higher now

Someone is doing very nicely out of it. Care home groups had an average 18% rise in profits in the pandemic.

Runwood Homes made a profit of £28 million in 2024, up from £15m the year before. The CEO takes home £5m a year. They received £12.3m in Covid grants in 2020-21.

And that's only the sixth largest group. No profits my absolute arse.

The work needs to be more attractive, whether this is pay or shift pattern planning or career progression.

We are only going to need more and more carers. I know your op said to leave aside migration, but the reality of the situation is immigrants don’t even want to do these jobs. As soon as their five years are up, they are applying to other jobs. It’s not sustainable.

Also, I had to laugh further up thread at the idea care home bosses aren’t taking home a packet. I know a couple who inherited and run a chain of care homes. They are doing VERY well for themselves…

Less than 10% of people end up needing to go into care homes. Compulsory insurance deducted from the wages of everyone over 40 would fund this. I believe there's a similar scheme in Germany.

And improve our NHS - so it's on a par with France and Scandinavian healthcare. Then people get hip and knee replacements on time to help maintain their independence. Physiotherapy to help rehabilitate after a fall/prevent further falls.

Care workers: lots of people don't want a profession - just a decent contract of employment instead of zero hours, fair pay and paid sick leave.

How am I going to sell up and move to very expensive sheltered housing now the chancellor wants cgt paid on primary dwellings? I can't afford it so I will just have to stay in my drafty semi that has gone up considerably in the last 30 years.

Why only over 40?

Much higher staff ratios. Higher pay with a proper career path and progression. Recruiting the right people. It would be less popular but I think that there are certain sectors that shouldn't be run by for profit companies, with elder care being one of them. my mother moved into a care home this summer. While there have been issues, it is an excellent home and they're doing a good job. It is consistently highly rated by the care commission and two of the things they have been commended for are their high staff ratios and their selection process which helps weed out people unsuited to care work. It isn't cheap (£2100 per week for residential dementia care; nearer £2500 for dementia nursing care) but it's clean, the staff are Chosen carefully and trained well and it shows. I've been dropping in at random times throughout the day and night almost every day since August and I have never heard the staff being anything other than kind with residents (even when they don't know that anyone is there). I've been there on difficult days when one or more residents are having a bad time and have been so impressed by the way that it's handled, so for example I've seen a resident sitting on the floor in the corridor because they were hallucinating and scared about something and a carer plonking herself down beside him holding his hand and chatting for a couple of hours to keep him company there until he felt reassured enough to move. I've never seen (or smelled) anyone being left in a mess. On the occasions when my mother or one of the other residents has had an accident they've been cleaned up instantly and in as unobtrusive and dignified manner as possible. Mum's showers happen every day without fail. She's been paying for private physio twice a week and, unprompted , two of the carers asked the physio to show them how they could support mum to do her exercises in between times. The activity programme happens. There are regular visits from animals ranging from office staff dogs to miniature horses and even some from the zoo. I can take mum's cats in to visit her. They could do more external visits - they're struggling to recruit a minibus driver at the moment, but they do arrange outings, and I'd like to see a more varied menu for vegetarians, but the food is excellent - cooked from scratch and presented carefully, and staffing ratios are high so they are able to sit with residents encouraging them to eat.

Some despicable pale, stale male toad in The Telegraph was addressing this in the telegraph’s special way a while back. This is all women’s fault, obviously, for wanting to work in other jobs and no longer being able, or wanting, to do this care work for free in the community. So he was saying women should get back in the home and kitchen basically. And he means other women, not his daughters, wife (maybe) and his sister was probably playing up as well.

And nowadays as it’s hitting more men (sons) in n the pocket (inheritance or direct payments) and heaven forbid they lift a finger to help, god no, this is a problem to urgently solve.

Make this work attractive to men first. Even toad Farage has said that visas for care workers are needed, that’s how much pale stale males think this is work for “others” lessers.

It will never be sorted. So make sure you have accommodated yourself, either you pay for a top notch home yourself, or your family pays, your family look after you or you throw the dice at council funded accommodation.

There are residential flats, good ones you tend to purchase with a service charge, but you generally have to move into them as an able bodied person, and many older people won’t leave their family home in time.

So keep your brain healthy, much harder as we all have microplastics in our grey matter now, there’s no escape they are in tap and bottled water, either nurture caring children or use the money you don’t spend bringing up kids in savings to fund your own care, and be willing to move before you “need” to. Obviously if you are in social housing this might be harder but again if you have had lower rent for decades you could’ve saved.

But people think the state should look after them cradle to grave.

It’s going to get worse if Reform get in, they will make women do this caring one way or another so if you are female or have daughters start making sure there is no way they can take away your independent income, because they will make you take care home jobs or even better remove employment rights (they are doing this by making it simple to sack pregnant females watch that birth rate plummet) I wouldn’t be surprised if they tried to pass a law that adult female children have to give up their assets to pay leaving male offspring to keep their house and revert inheritance to just the male line of the family. They want to, they just need to figure out how.

Any “solution” will be dreadful for women and great for men, in a nutshell. Just as it used to be back in the good old days eh!

Remove profit from the equation - care home providers should operate as non-profits or registered charities. Once you introduce profit as a possibility it drives down quality because in this sector the provider will be paid regardless of quality of care. The idea of a company making excessive profit from vulnerable people is abhorrent.

The fact is that the care sector has been hugely underfunded for decades.

Similar to childcare funding, the government/councils claim to be offering something (e.g. the funded hours) but in actual fact are paying a below cost rate which means those paying privately make up the cost, or are providing a service far below what is necessary.

Carers who do home visits are scheduled 4 x 15-minute visits in an hour, with no travel time accounted for. In those 15 minutes, they may have to get someone up, give them a perfunctory wash, dress them, or get them breakfast. They don't have time to take time, or perform niceties because they're on a tight schedule and if they know if they take an extra 5 minutes to reassure Mrs Jones about a horrible dream, they are taking time from Mr Smith who is the next appointment.

It is no wonder that decent carers leave when these are the conditions they work in. And for that most don't even get a living wage.

Im soon to be admitting my father to a care home. Luckily, he is local to it and has had respite there before. Locally its known as the place youd want to go - if you had to. However, its the cheapest locally. So why is this?

Well, its charity run. And run very very well. The staff are paid above NMW and given good training and support.

Even then, they do have issues recruiting. I understand why - ive been full time carer for my Dad for 2 years. Its a hard job.

So what we need to do is for councils to actually run homes again. On a not for profit. So the eyewatering £££££ are not lining greedy owners pockets and the managers get budgets they can spend on the boots on the ground staff and facilities instead. The managers should have experience in the care sector not just in management.

Thats my view. The sector - much like student housing - has found an opportunity to rinse the clients for private gain.

Before choosing a move to a care home we have had a twice a day carer service - one 30m and one 45m. The carers were excellent and of course my husband and I were here as wraparound for Dad.

I checked before engaging that the staff were adequately paid above NMW and looked after - paid for travel time, mileage at a proper rate etc. The charge rate was £30 for 45 minutes and sort of prorata for more/less which, of course, takes account of the additional admin and management costs.

However, the main help was for me to be honest! Their visits achieved an objective but the number of times they were late because theyd attended a visit that required them to stay with the client due to finding them having fallen. Carers don't really stop issues happening but they do act as a daily oversight and, I guess, makes sure medication is correct, and food and fluids are being offered.

Carers call at strange times. Dad might be eating his supper at 5pm, or been awake since 7am and they call at 10am. It.was all fully understandable as they have to see lots of clients but its not a great quality of life being bundled up to your room so early or left lying in.

And so weve take then extraordinarily hard decsion to move Dad into a care home.

Yes. It breaks my heart how my DDad was wheeled into the lounge pre-lunch to be sat in front of Loose Women every f*(!1^9 day. And not just my dad. He was such an intelligent man, he wasn’t a vegetable, he just had advanced Parkinson’s. But he assumed the position of the stereotypical senile vegetable when he was put in front of these things. And we were paying full whack for this. No funding for my dad. That was 12 years ago. So sorry to hear that this is still happening. But my uncle (and now his wife) have had had a much, much better experience in their nursing home. They seem to have got the balance right there.

A woman I worked with had her Mother in a care home who had dementia plus many other health issues and was close to 90. She had 3 bouts of pneumonia in a couple of years. She was treated every time. Why not let someone like that be given pain control but be allowed to die. She had no idea who she was or where she was.

The attempt at escaping the inevitable has reached a level where people expect to be kept alive at all costs. My Mother lived till her mid nineties, she even asked me to help her on her way, obviously I didn’t. She was on 14 meds a day and had zero quality of life for the last 4 years of her life.

We have become too squeamish about death, when someone dies over 80 they have had plenty of years on this earth.

What can be done to make people want to be carers? No idea because even if paid with exceptionally good wages it still requires someone who wants to actually do a caring job and that is just something that comes more naturally to some than others.