Dignity in old age comes at a high price

Dignity in old age comes at a high price

Without radical reform of the way the elderly are cared for, we face an uncertain future, writes Joan Bakewell.

Caring for the elderly: the crisis has arrived

By Joan Bakewell

12:00AM BST 01 Jun 2011

Although many of us knew it was coming, we didn’t expect it to arrive quite so soon. But here the crisis is, presenting us with exactly the problem this country has long failed to face when it comes to caring for the elderly.

If Southern Cross Healthcare fails this week to persuade its landlords to cut its rents, then, at the end of June, some 31,000 of its residents will face possible eviction from the place where they believed they had found comfort and care for their final years. How brutally cruel.

Southern Cross is the biggest care home provider in Britain. It runs 98 care homes in Scotland and 100 each in the North West and the North East. But it doesn’t always do it particularly well: Sefton Park Nursing Home in Lanarkshire is earmarked for closure because the place was found to be in a bad state of repair and local BBC news reports have exposed poor standards at other Southern Cross homes.

The reason for the desperate situation seems pretty straightforward. For some investors, old people have become a prime target: as the population lives longer, there are more and more of them and their needs are expanding. They are a captive and continuing market and thus have the elderly been commodified.

The trouble is that investors climbing too greedily on the care bandwagon risk falling off. America’s Blackstone Capital Partners acquired Southern Cross from another private equity firm in 2004, then sold it on in 2007. According to The Financial Times, Southern Cross made a series of “misguided property deals to fund rapid expansion” and in the last half year the company made a loss of £311million. It is an object lesson in what can happen when “any willing provider” from the private sector appears to treat a national care service as a source of guaranteed income.

But this is only a symptom of what is wrong with the entire care system in this country. The whole sector is operating at too low a level. Money is scarce on all fronts, and what little money there is is being cut. The state is obliged, under the 1948 National Assistance Act, to care for the old, but this has always been on a mean-tested basis. Now that local authorities are being squeezed, the availability of care packages which once went to those with “moderate” needs is being restricted to those with “critical” needs. Private care homes have their own budget-related problem. Given similar spending concerns, they often pay low wages and have a high turnover of poorly trained carers. Many of the homes are dependent on immigrants to provide this labour and the Government’s projected targets for reducing visas will bear heavily on services which rely on such workers.

We can’t continue to ignore the fact that the caring profession needs major re-evaluation. Evidence keeps pouring in. Age UK’s recent report, Care in Crisis, revealed that, of two million older people with care-related needs, just 800,000 receive formal support from public or private agencies. In a report last April, the Care Quality Commission found that one in seven privately run-homes were rated “poor” or “adequate”. Given such statistics, carers are never going to be out of work, which offers the prospect of jobs for life. Why, then, aren’t there enough training schemes and apprenticeships for such a career, along with a decent scale of pay and prospect of promotion? It might well be a field in which the early-retired could retrain and find a welcome in communities which have little in common with the young.

It should be said there are many fine and welcoming care homes – it’s just that the country needs more. The present policy of keeping the old in their own homes as long as possible, often until the direst, most distressing moment, is not always suitable. Old people can get cut off, isolated and depressed and a 15-minute, daily visit from a harassed carer with an overloaded schedule is no substitute for regular and friendly human contact. Good care homes must remain a major part of planning for the future.

But who will pay? The answer is: we all will. Either as taxpayers through the state or as individuals with assets. Many old people live alone in houses that are too big for them. I know: I’m one of them. Across the country, this amounts to great unused wealth. The myth persists that we have the right to hold on to those assets even in our hour of need, in order to pass them on untouched to the next generation. Yet at the same time, the next generation is going to have to pay for our social care from their own income. We are going to have to find a way of resolving this paradox.

The Dilnot Commission on Funding of Care and Support reports next month, with its recommendations as to how we might make some progress on that front. It is likely to suggest a mix of state and personal funding, the latter provided through an insurance scheme paid into throughout our working lives. In 2009, there were 1.4million over-85s. By 2035, there will be 3.5million. The growth in numbers is relentless and we will not – either as individuals or as a society – be able to cope unless we accept new responsibilities both for ourselves and others.

Meanwhile, residents of Southern Cross Care Homes have to consider a future in which they are shunted around, dumped among strangers, and lose friends. It is not how any of us would want to spend our final years.

Baroness Bakewell is the former Government Voice of Older People.

http://www.telegraph.co.uk/health/8548807/Dignity-in-old-age-comes-at-a-high-price.html