How do we fix social care?

[MalteserGeezee]

Inspired by another thread about long ambulance waiting times (and we'll documented general concerns about the state of healthcare in the UK) it seems that a big factor is the way social care is decoupled from the NHS.

It means that people who are well enough to be discharged, but who require a card package to return home, or a place in a care facility are often "blocking" beds, causing a crunch at all other layers of the service.

How can we solve social care? How can we ensure older people are treated better and with more dignity? Do we need "convalescent homes", where they can continue to recover outside hospital in a less acute medical environment, acting as a super-hub for the services that will need to support them subsequently? Do we nest social care back under the NHS to ensure true cradle to grave care?

We used to have ‘rehabilitation’ wards where bed blockers went. They have been got rid of. Reinstate them, run by HCA’s, so cheaper than a fully staffed ward.

Pay social care staff properly so more want to do the job. There are homes where people can go for six weeks of rehab - create more of those.
the whole system needs more money, more social workers, more council care home places. Also, families are big blockers themselves… some are quite happy for so and so to stay in hospital a while longer

We have three , they are blocked by people waiting for care packages. Lucky to get one or two a day going home out of 60

MONEY to provide the following
Staff
Premises funded by state not private

Also families need to take some responsibility of there elders if possible.

Every situation is different I know but if you can look after your elders for a short time you should.

I've got no idea how to fix social care. The LA I live in seem to have lost all common sense and I don't want to derail the thread by talking about specifics.

I honestly feel like someone sat at a meeting and told everyone "The family" are the magic bullet we need to lower costs while at the same time "Any level of capacity is enough capacity". This attitude is what led to my DM spending 5 MONTHS! in a hospital bed waiting for all the pieces to come together to be able to put her in a home. The signs were there for years before, this was poor management and probably maybe just playing the odds? Maybe she will die and not become a problem?

I spent the previous 4 years taking care of my mother (recently diagnosed with dementia), while slowly burning out. result I have anxiety and depression and needed time off work. It's been an utter disaster from all sides, which could have been resolved with a decent care plan and support (For my 89-year-old mother).

Any request for support was blocked and I was made to feel like a bad daughter and a burden on society for not coping. The pandemic stopped everything in it's tracks even more.

My advice to anyone who has to access Social care or Social Work for elderly parents to do so from a distance and take no responsibility, because you don't get any support if you do.

There are still rehabilitation wards / units, they still exist. As someone upthread has said, the bed blocking ends up happening there, which then means no beds for this that need to be transferred from the acute ward to rehab.
Secondary care rehab isn't appropriate for everyone. Rehab at home is much more preferable if the right support is available.
The bottom line is social care funding needs to improve massively, which goes back to the OPs original question of how would this happen?

Sadly modern medicine means that people live longer, but that doesn’t mean they can live longer without significant support.

An ageing population, a bigger population and a growing mental health crisis is adding to the pressure.

The cost of living, particularly housing, means that typically both adults in the household have to work, making it very difficult to care for elderly parents.

I look at all the new housing going up in my area (Essex) and yet no new hospitals are being built. It’s a travesty and I worry for the future of the UK for many reasons, but particularly the dire situation of our health and social care system.

What can we do? First and foremost, do everything we can to look after ourselves by way of making healthy lifestyle choices. The current government needs to go. The rich need to contribute far more. Tax and NIC needs to be spent wisely, more accountability is needed in respect of hospital trusts - less senior managers, more staff on the wards. Controversial, I know, but if you can’t support yourself financially at the point you plan to have a family, surely it’s not unreasonable to have a maximum of two kids. Create strong communities in our towns and villages - care, compassion, respect, tolerance but also an intolerance for antisocial and dangerous behaviour. Allow more volunteers to work in hospitals and care environments - I think every adult of working age (with an enhanced DBS) should be required to volunteer one day a year at a minimum. Those adults of working age who don’t have an enhanced DBS could volunteer in other sectors (community based).

A complete overhaul and mindset change is needed, but sadly I doubt it will happen.

Anyone getting on a bit should have a plan in mind for when they can't manage - and that can't be DCs will fix it - the problem of caring for the elderly has been with us for decades but the oldies don't always do things such as downsizing, releasing funds to be used for private carers, move to supported living. Somehow the badly paid carers are expected to turn up several times a day and sort them out ...... and there are fewer and fewer of them.

Hadn't considered that bed-blocking just gets displaced from hospital to rehab centre 🙃

God, this is such a conundrum to unravel. Cash clearly a massive part of it, but the whole structure needs a total rethink.

Can't believe the PP whose poor mum was 5 months in this care purgatory

Basically it needs money, to pay for care homes that will accept " bed blockers" , money for ambulances, my mother-in-law has had a few falls recently and in most cases the ambulances have taken so long that she's needed hospital admission. When an ambulance has arrived quickly she's been lifted and checked and left at home .

Carers at home often need support, were lucky we can afford someone to come twice a week for personal care but if you're only on carers allowance there's no way you can afford it. Brexit also meant that a lot of carers had to leave the country.

more Social care staff are desperately needed. People can’t be discharged to care homes or on home care packages if no staff exist for them.
care workers in the uk are paid terribly and work under horrific conditions. Until this is tackled it won’t get better. Brexit and the mass exodus of workers back to Europe has not helped.
and then we have childcare - so poorly funded and thought of in the uk. How can people work unsociable hours when they can’t access flexible care and holiday time care?

the tories are hell bent on driving it all to the ground so they can privatise. It’s already slowly starting with little bits of nhs care here and there being delivered by private companies.
this is what the nation voted for, apparently!

It needs care work to be given status.

currently it's something people are made to do by job centres if they can't get any other work.

make it a proper career like it should be. Proper training, decent shifts, paid travel, formal routes of progression if people want to progress into senior carer or management roles or even progress on to social work, OT or nursing.

money is obviously a factor but most of the jam in the system at the moment is that there simply isn't enough people willing to do care work, (even for good rates of pay - in my area carers can currently earn more p/h than social workers). it's got worse since Brexit and Covid combined in a perfect storm but as a career it's been increasingly devalued for decades.

There's a real shortage of social care workers. Jobs are advertised and no-one applies. But then round my way that's the same with quite a few sectors, more vacancies than available workers.

As PP said we really need to up the status, opportunities and pay of social care workers

A national training scheme for care workers with recognised qualifications that offer additional pay etc.

A national social care provider, like the NHS, but for social care, so that Councils aren't always tendering out to the lowest bidder who pay their staff peanuts and with massive turnover.

Loads more preventative work to prevent people developing type 2 diabetes and all the complications that come with that. My step Nana is in her 90s, and still living independently because she has exercised every day of her life and eats well. I work for Adult Social Services and we have people needing care in their 60s often because of their poor lifestyle.

More integrated working between the NHS and social care so there's less of "well that's not our responsibility". Housing could be included in that as well.

Lots more respite places to prevent carer breakdown.

Essentially it comes down to money, and lots of it. We need to really think about how we want to pay for it. Look at the arguments over the 1% increase to National Insurance recently. If the population are unwilling to pay via tax, then they need to move away from the idea that the state will fund it all. Perhaps we should have funds we pay into that are similar to pensions but specific for social care. Either way, we need to pay for it, and we need to accept that first and foremost before anything can change.

We need to start way before people are at the point of being in hospital. Increase community services, more community nurses to visit to do admission avoidance work and advanced care planning, more social care, that works 24 hrs a day that is quick to access and put in place same day.

For that we need data to demonstrate why and when people go in to hospital - you can do a lot during the day, but at night, when it's dark and people are feeling unwell and scared on their own, there needs to be an alternative to 999 - rapid response health and social care teams who can respond to help people in the middle of the night without needing to go to a&e or a 999 call. Rapid response social care for those who end up in hospital because they can't look after themselves and social care isn't available for 3 weeks. Some services exist, but they are small and easily overwhelmed.

Cheaper than a hospital admission and stay, but more money goes to hospitals than the services which could keep people in their own homes.

We need properly funded social care. That includes funding to pay carers a decent wage.

Bed blocking is an awful term. We need to ensure that older people are cared for properly, not seen as a blockage!

It’s depressing this article is still so relevant 10 years on!

As hyacinth2 suggested , older people need to plan ahead: downsizing, releasing funds to be used for private carers, move to supported living.

I am fortunate that my parents were able to do this. There are more of these communities being developed, my parents are in a community run by extra care. We are all been so pleased with it. The flats and houses are designed well for reduced mobility such as big wet rooms, doors wide enough for wheel chairs, alarm systems, care packages which can be bought using the same familiar carers and social spaces and activities.

More pay and status for care workers is also needed, none of this unpaid travel time between appointments. This needs to be discussed in schools as a worthy career path.

Proper support and respite for family carers which of course comes down to money.

This will be more controversial. We need to get rid of the idea that we need to pass on a huge inheritance to our children when we need that money to support our living, which goes back to my first point. I know families who are not prepared to or able to (work commitments, child care commitments) care for their parent but are resentful that the state will ‘take’ their inheritance. We can’t have it all ways.

I've just finished a 12 hour night shift in a care home. I've had few breaks, been sworn at, scratched and punched in the face, I'm lucky in that I work in one of the better homes that pays above minimum wage, but it's not much above. It's exhausting mainly because they have trouble getting and retaining staff. It's the hardest job I've ever had, truly it's so hard, but if we all quit our residents (who we love despite everything) would suffer.

We really do need more funding, but we also need the services to really work together and fast to sort out problems when they arise. There are residents who would be better off in specialist care where they're better equipped to deal with the more challenging behaviour but they're few places and everything is so slow.

It's pretty crap actually and I don't know why I do it tbh.

fishbowlswimmer I think your job takes real skill and it is underestimated. You should definitely get more recognition and pay for your work, but as a society we need to recognise that this is valuable work and be prepared to pay for it.