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.

The biggest thing, is more realistic expectations, more difficult conversations, and more appropriate care paths.

There’s a fixation with keeping people alive. Just because modern medicine can keep someone’s pulse going and air moving in and out of lungs doesn’t mean it should. People have to die from something.

Next, focus care inspections, funding and requirements on things that matter. Drop the fixation on privacy. Shared rooms between patients where it’s a good match make things so much easier for staffing.

Reduce the money merry go round. National insurance on salaries. Council tax rates. All of which goes round in circles but with administration costs incurred at each stage.

What do you envisage 'more realistic expectations, more difficult conversations, and more appropriate care paths' looking like in practice?

Expression of wishes becoming as normal as wills.

GP and community health services taking the time to have that difficult conversation.

Harder, shifting the cultural expectation that everything needs treating. That will need public education campaigns.

Shifting behaviours so that the GP that covers the care home out of hours doesn’t recommend hospital admission for a wheezing, frail, 93 yr old with dementia ‘so the family don’t complain’.

Probably empowering nursing home matrons to adjust medication themselves, and not needing to put it all through a GP who doesn’t have the context or understanding of the patient.

Better still a 2% death tax paid by everyone who dies over retirement age whether they ended up needing care or not.

There is a logic to this. Instead of importing (usually) young women, often away from their own children, to look after our elderly, send our elderly their so these carers can provide for their families while still getting to raise their own children.

I think this might be what's needed given falling birth rates. I've heard in Japan they have a system of 'young old people' and 'old old people' and the young old people look after the old old people.

Yes, I see the logic. But based on my experience in this sector, hell freezes over before I send a family elder abroad where I can't check up on what's happening.

Pay more for the care. You can then attract & retain better staff, have higher ratios, provide better activities etc.

But people don't want to pay it, local authority included.

The stakeholders only care about making money and not getting sued. They don't care about their staff or the residents sadly. The staff get a poor deal (overworked, underpaid) and as such so do the residents.

I think that is because you don’t recover from dementia so it is considered part of the aging process. I think in assessments the word ‘frail’ is used a lot. People are not awarded continuing healthcare for frailty. I think basically the local authority will try to get out of paying if they can but you really can’t blame them. They have very stretched budgets.

Agree there’s something about following the money. No way are the private sector not making shed loads from care homes (and nurseries). If they weren’t they’d offload them pronto. I guess having care homes as part of the NHS / local authority system might help albeit the costs would be higher.

How often will the elderly be able to see their family though? It's a tough issue but don't think that is the answer...

Even if you pay more, if the business is owned by an an investment firm they will look to cut costs.

Care workers are badly paid, badly treated, are looked down on in society in general, and have to have great people skills to be any good at it.
They do crappy hours on crappy contracts for crappy pay and are so overstretched they cant give the level of care that would give them real job satisfaction.

There’s a fixation with keeping people alive. Just because modern medicine can keep someone’s pulse going and air moving in and out of lungs doesn’t mean it should. People have to die from something.

Will this also be applied to disabled people and those being kept alive by technology and who are unable work?

I know, no easy answers. Personally I think it's more important young children grow up with their mothers, than adult children and elderly parents get to see each other regularly. If I put myself in that position, I would rather see my young children every day and my elderly mother once every two years than see my tiny children once every two years and my very elderly mother every day. I can't see this 'trade' ever going the other way though because we're the ones paying the bill and basically we don't give a shit and the children of the Filipino care worker never seeing their mother.

Privatisation of the care sector has been such an outrageous failure. The problems simply cannot be solved until it’s nationalised. Everything else is tinkering around the edges.

I’ve yet to see a remotely compelling argument otherwise.

Caring for the elderly is a job that not many people want to do and with good reason: poor pay, stressful, employees probably run ragged in an understaffed care home or client’s own home (and often with poor working conditions). And, generally, there’s a pretty poor attitude towards the elderly further impacting the likelihood of anything improving.

I worked on the periphery of the NHS until fairly recently organising services for elderly people in and coming out of hospital. Over a ten plus year period, I watched EVERYTHING (hospital and respite care as well as social services) decline immensely. The whole health and care system is now a complete shit show for everyone and not likely to improve for decades (if at all).

So, although I have huge reservations about assisted dying, I’m hoping it will be available for me when the time comes because I’ve seen ‘care of the elderly’ close up and it’s often very frightening.

More sheltered housing and what if it could be say one live in carer for 2-3 elderly - split thr cost

I think the problem with these difficult conversations is that they're not even allowed to happen.
I read about Jill Sinclare, the wife of Trevor Horn, she was in a coma for years after an accident and then awake but extremely poor state, unable to communicate, walk, toilet or eat and seemed to only be in pain. She died eventually of breast cancer. I always wonder if her cancer was treated or just allowed to take her.
It's an absolute tragic story.
en.wikipedia.org/wiki/Jill_Sinclair

DD works in a care home and she loves her job, however some of the staff do as little as possible and spend ages outside smoking. The owners are not saying anything because they need to keep the staff as most homes are short staffed at the best of times.

There arecalsi regulations regarding supplies especially in Dementia care homes with the amount of pads they can get from the NHS and they aren't nearly high enough so the home has to either buy more or leave them on the people who live there until the very last minute

I assume care homes have minimum staffing ratios? What happens though if you just can't fill that ratio?
If it was a nursery, worse case scenario, you could just close for the day. You can't do that in a care home though.

Plan A is ring round all the staff you have and see if someone can do overtime.

Plan B is agency staff.

Plan C is grit your teeth and get through the day understaffed.

Yes.

We should all be given the opportunity to live with good quality of life, and with dignity. Where that line is drawn will be different for different people (as has come out very clearly in the assisted dying debates).

This isn’t about knocking people off before their appropriate time, but it is about not prolonging life beyond that just because of fear of complaints or to postpone family upset.

Looking at areas where it’s state run, and the comparative performance of those facilities and their running costs might give you some insight.

(Spoiler - no cheaper, and not top performing).

Having seen my dad wither and die in a care home - one considered to be one of the better ones - I am utterly determined never to end up in one, even if it takes a short visit to the nearest tall cliff.

People are not being allowed to die with dignity. Their lives are viciously, artificially prolonged with the force feeding of antibiotics. No thanks.