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.

How do the not-for-profit care trusts perform? Honestly curious on this point, as I've only worked in the private sector.

More options for Independent living for older people would be a start! A flat, with a lift if not ground level, with a walk in shower, would reduce the number staying in hospital because their homes are unsuitable. The right housing, with support, if and when needed, has been proved to delay the need for residential accommodation.

Living in the right housing can reduce isolation and loneliness, a scourge for many elderly people rattling around in family sized homes with family long gone. Unfortunately there are not nearly enough, and many owned by the private sector are not only expensive to buy, but have hefty charges on top.

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.

My elderly mum was recently in hospital. When I arrived to see her, she was on a trolley in the queue for x-rays. Every person in that queue was very elderly, and they all looked not just ill, but like they were one foot in the grave, and I couldn't help wondering how many of them would truly benefit from the procedures they were getting.

My mum has had poor quality of life for the last few years, and over the last few months she has deteriorated greatly, and now is barely eating. When I mention this to people, they say, "Well can't they put her or a drip? Or give her liquid food?" But what for, really? So that she can have an extra few months of pain?

I would be very reluctant to buy one of the purpose-built flats for the elderly, for myself or a relative, due to the issues in reselling and in paying huge service charges even when the flat is empty.

Sorry, this was a poor choice of infection to mention...I was thinking of cases I've read where people are probably naturally approaching the end of life imminently and UTI treatment seemed to only prolong pain. Should have made that clear...

You keep on about leaving immigration issues aside and I cannot for the life of me see what immigration has to do with the subject in the first place.

It's up to us to decide what we want to happen to us when we get old, we need to think about while still in our right minds.

Also remember that many elderly people stay quite fit well into old age and don't need care.

I know I don't want to go into a care home, if I am in need of assistance I can have it at home, so can most people if they don't develop dementia which requires 24/7 supervision.

Make time for the elderly people in your life, ensure that they are safe and comfortable. If carers are employed, get to know them so you're satisfied they are kind and do their job properly. Set a good example to your children.

Keep yourself as healthy as you can with good diet and hope for the best.

Don't consider moving into sheltered housing. If you need to downsize, just buy somewhere smaller, you can have an alarm system fitted and bath aids. Retirement complexes are awful places.

Probably an unpopular opinion but I don't want to live to past 80 with health problems and costing anyone over 1k a week. Bring in dignitas and let us chose how we die with grace.

I can tell you from working/visiting independent living homes and domiciliary care homes. If you are paying for 30 mins care the average you will be getting is 15. Most of the carers do not care and the ones that do carry a very unfair weight of the load. The comments I have heard from managers when they didn't realize I was there or did not share their humour have been vile. One of the schemes I worked at had a manager that ran 2 of the schemes close to each other. One resident there was a lovely lady so polite, her daughter used to do most of the care anyway as she rightly it turns out, didn't trust them. I walked into the office one day and the scheme manager was joking with the 2 assistant managers with other staff present that she must be having a good old play every night as her pull ups kept being found twisted, was one of the most shocking things I have heard. I reported back to head office who did not do a lot and as far as I know she still works there. I am tempted to tell the ladies daughter, but it would upset her so much. So I wait and wonder what to do for the best. I am thinking of getting her daughter to change care company. It was vile. Totally dehumanising.

As someone who works in a care home, one word staffing, never enough I care so much but can only physically do what I can do and it upsets me so very much I haven't got time to spend with people that I should some people in bed have no radios no tvs as it's not standard to provide them, weeks with barely interacting with people unless needs been met it's terrible

You'd be surprised how many people get no visitors dispite having 3 or 4 children, it's heartbreaking because they do know

I’d far rather take a pill and check out as soon as my faculties have gone . The indignity of old age fills me with dread .

Me too. Renting from a housing association, local authority, or almshouse charity would be preferable. But those are in short supply, especially for homeowners.

Out of curiosity, if someone is over 80 and completely healthy would you also consider them to have had 'plenty of years on this earth'?

Tommy Tiernan did a hilarious bit about cutting off healthcare at 80 if you have time. I do think that it’s not necessarily sbout age I know some 70/80 year olds who are in good health, fitter than me, enjoying travel and retirement.

It’s more about the growing gap between a healthy life and death. I think there’s little point keeping people with advanced dementia propped up by lots of medication, kinder to withdraw and shift to palliative care. I’m pretty pragmatic though and would be happy enough to be treated like a beloved pet.

Hopefully I’ll of had a good innings but once the back end goes, in a decent amount of pain and quality of life declines then I’d much rather be euthanised than have to go through a long decline.

I find it disturbing that OP wrote so much about assisted dying. To me, elderly social care & assisted dying don't connect at all.

OP wants : 1. deprivatisation, 2. higher pay & 3. training & status. Also much 4. more [stringent] checks on quality of homes.

Yeah... coz closing down more care homes will do so much to increase capacity in the residential care sector.

Anyway, everything on OP's list means raising taxes. British public have consistently voted against any party that proposed raising taxes to fund social care. Theresa May tried & failed. So nothing on OP's list is feasible.

So many more women living longer with no quality of life. Horrible not to even have the choice to go with dignity.

I see where you're coming from, but I disagree. I think the trend to try and extend our lifespan way beyond what is natural, healthy, or enjoyable is inextricably linked to the increasing demand for elderly care and the debate around assisted dying.

But then perhaps what I'm talking about isn't so much assisted dying as it is keeping people alive?

I fully agree with you on the tax point.. I don't honestly know how it could all be paid for.

I was chatting to a friend of mine the other day, and we were saying that if we are single/widowed we should move in with our friends when we get old.

I know of so many elderly people who live alone and who don’t have family close by- they could do house shares like students and share costs of cleaners/carers. They’d also have company.

I hear you about the frail 93-year-old with dementia, but what if that 93-year-old is still as sharp as a tack mentally? Presumably you wouldn't be advocating the difficult conversation then?

Not meaning to interrogate you, it's just that I get the feeling you're speaking for an assisted dying agenda where dementia is in the mix (although people in the early stages of dementia can still have quality of life, just saying). If that's the case - and even there I still think it's problematic - presumably your remarks don't extend to elderly people who are simply ill and don't have dementia?

My friends and I considered a commune style set up too. The trouble is everyone would need to put in similar amounts and ownership when one/two die becomes very legally complex if you have Wills and children etc.

Agree and also absolutely everything that has been done for the resident has to be documented , which is time consuming and takes the staff away from the residents.

Because there isn't enough money and if they properly and fairly funded everything for everyone the country/LAs would go bankrupt overnight.

Women are already doing free social care labour worth £183bn, yes BILLION by "carenting". It's been so badly underfunded because women will do the work free. But then you have the cut in hours in other sectors and the rise in AI and I worry where this is all leading.

Unfortunately you might find that a care home is not much better, in terms of bedtimes and eating times. When my mother-in-law was in a care home a couple of years ago, the residents were given their last meal of the day at 5.00pm and the putting-to-bed routine started at 7.00pm.

There was a chronic shortage of carers, so it took them quite a while to get all of the residents undressed and into bed. That's why they started at 7.00, so everyone was in bed by 8.30 when the daytime carers finished their shift and the night-shift workers arrived.