A future for residential care
At present, a quarter of people over the age of 80 are likely to spend their last years in a care home. With more and more people living longer, often with increasing frailty and dementia, and with the growing mobility of families who can only care from a distance, the need for residential care will continue. This is contrary to predictions. Government, for instance, favours ‘extra care’ sheltered housing in its long term plans for social care, expecting older people to continue to live at home for as long as possible before moving into sheltered housing. However, the ability of sheltered housing, even with extra care, to meet the needs of very dependent older people is highly questionable. There is a strong argument which suggests that properly resourced, high quality residential care is always going to be required.
There are, however, endemic problems associated with residential care, to do with quality and cost. Over five years ago, there was hope that the Care Standards Act 2000 would herald a new era of quality and standards in the registered care home sector. A new regulatory authority was established and national minimum standards were introduced for the first time. But as we know, these developments were undermined almost from the start. The demise of the authority was announced within a month of its establishment and some of the standards were almost immediately watered down. The successor body (the current Commission for Social Care Inspection) has now also been given a near-death sentence (with the announcement of its forthcoming merger with the Healthcare Commission) and the national minimum standards are under review. The maintenance of quality and protection through regulation has been destabilised yet again.
The cost of residential care, too, remains problematic – particularly to the third of residents having to pay for care themselves. Information for the year 2002-03 published in March 2004 by the National Care Standards Commission1 showed that care home fees ranged from around £220 to over £600 with some falling within the £700+ range – a huge amount for self-funders to have to bear. The government continues to reject suggestions that the cost of personal care should be met by the state (as recommended by the Royal Commission on Long Term Care in 1999). The number of self-funders is likely to increase with levels of owner occupation in older age rising. For house-owners, the family home will continue to be a main source of funding for long term care. In the case of people supported by the state, local authorities seem set to maintain a tight grip on the level of fees they are willing to meet. This means, increasingly, that relatives are going to have to dip into their own resources to pay top-ups (to augment the amount that the LA is prepared to pay) to ensure that an older person can go into the home of choice and expect a decent standard of care. Thus prospects for the future are worrying.
Older people needing care, along with their relatives, have several basic expectations that as citizens they deserve to have met. They expect care to be available when it is needed. They believe that the concept of choice – so popular with government ministers in relation to the NHS – ought to extend to social care and that it should, where appropriate, include residential care. They expect high quality care delivered in pleasant and nurturing surroundings. They want assurance that people who are frail and vulnerable will be protected from harm and kept safe from abuse in whatever setting they live. They also think that it is unfair that the most frail and vulnerable section of the population is expected to pay for all this themselves. The same rule is not applied to other sections of the population with regard, for example, to education or maternity services.
The Relatives & Residents Association supports these views and is committed to campaigning for well-regulated, high quality long-term care. It believes that:
• residential care has an important part to play in the spectrum of care provision;
• many older people will choose residential care at some stage in their lives;
• the current system discriminates against older people, as a generation, and is unjust in the way it unfairly treats frail older people with assets;
• this society – with the fourth richest economy in the world – ought to be willing to devote more resources to supporting its frailest and sickest members in decent surroundings and providing high quality care to suit their needs and preferences.
1. Dalley, G, Unsworth, L, Keightley, D, Waller, M, Davies, T and Morton, R How do we care? The availability of registered care homes and children’s homes in England and their performance against national minimum standards 2002-03, National Care Standards Commission, March 2004