Recently in Residential care Category

Public understanding of the social care funding system remains problematically low with the effect that too many people believe services are free when they are anything but.
One thing that should help turn this round is the significant increase in national media coverage of adult social care in recent years.

However, I've spotted a couple of pieces in the national press recently that have inaccurately described the system of means-testing care in England. Unfortunately, the error in question makes the system appear far more generous than it really is.

Both pieces claimed that people with assets of £23,250 or less do not have to pay for care at all, and that the Dilnot commission report last year proposed increasing this threshold for, in effect, free care to £100,000.

However, this is wrong - £23,250 is the threshold above which people must pay the full cost of their residential care; it doesn't apply to community-based services, and the threshold below which people do not pay for their care is £14,250. (Check out the latest Department of Health circular on the issue for the details).

People with assets of between £14,250 and £23,250 must pay a charge related to their assets (£1 a week charged for every £250 in assets above £23,250). This means that people with assets of £23,250 pay a charge of £36 a week; not much compared with weekly care home costs of £400 plus per person but not insignificant.

Moreover, Dilnot's proposal was to extend this system of charging up to £100,000. Thus, someone with £100,000 in assets would be charged £343 for their place in a care home - almost the full cost.

And it's worse. People with assets of £14,250 do not receive their care for free. They must give up all the benefits they are entitled to, including their state pension, except for a minuscule personal expenses allowance of £23.50 a week.

I'm as glad as anyone that the mainstream media are taking more notice of adult social care than ever before and I imagine it's having a net positive effect on public awareness. But it's vital that they - or should I say, we (I haven't forgotten my silly error the other day!) - use our platforms wisely.

(Image on Flickr from katerha)

All those with an interest in Winterbourne View, safeguarding or advocacy may want to take a look at this report from major advocacy provider VoiceAbility about why advocacy is so important to the response to the scandal but why provision is at such risk at the moment.

It includes some good analysis of the Care Quality Commission's inspection reports from its review of learning disability provision launched in response to Winterbourne (the latest reports from which were published yesterday). VoiceAbility found:-

• Service users often had to request advocacy, rather than have advocates available to go to.
• Users and families lacked accessible information on how to access advocacy, raise a concern or make a complaint.
• Advocacy was rarely used to help service users make decisions on their care and support.
  

It also raises concerns about the bigger picture for advocacy, including:

• A warning about the trends for councils or the NHS to commission issue-based advocacy, often on a spot purchasing basis (i.e. when issues arise). VoiceAbility warns that advocates need to build up relationships with people before they are prepared to disclose abuse or other safeguarding issues. A purely issue-based approach would prevent this.
• Existing commissioning arrangements sometimes leave insufficient scope for advocacy providers develop skills and expertise and train staff, because they have to focus on direct client work.
  
• Existing advocacy qualifications, while useful, have insufficient focus on safeguarding, and must be reviewed.
  

(For more on cuts to advocacy services see Action for Advocacy's Advocacy in a cold climate report last year)

The VoiceAbility study is designed to influence the Department of Health's overarching review into Winterbourne View. Hopefully civil servants will have picked up a copy.

(Image courtesy of Action for Advocacy)

I've been contacted via Twitter about Sharne the dog, the fine looking German Shepherd pictured above, whose owner has gone into residential care in the Leeds area.

Unfortunately the care home aren't able to take the dog and so a new adopter is needed before 3rd October or Sharne will be put to sleep. Apparently a local adopter would be good so the current owner can maintain contact with Sharne.

There's a bit more info here and if you're interested you need to contact UK German Shepherd Dog Rescue.

If you do end up adopting Sharne do let us know.

Martin Green, chief executive of the English Community Care Association and government dementia champion, could face the sack if pro life campaigners get their way.

Over the weekend Green told the Telegraph he backed the legalisation of assisted suicide for adults with capacity, with appropriate safeguards. He argued it was a logical extension of the choice and control mantra of the health and social care sectors.

Now the Society for the Protection of Unborn Children has lashed out by calling for him to be fired from his government dementia advisor position.

Paul Tully, general secretary of SPUC, said: "Mr Green is clearly not interested in caring for some dementia sufferers. He seems to want them dead.

"Not only would legalising assisted suicide for the elderly create insecurity and a sense of worthlessness among older people, it would also provoke discrimination and prejudice among carers and care home staff. Imagine a government advisor on race relations saying that immigrants found it difficult to commit suicide and so should be helped to do so," he added.

I don't think it's likely he'll get the sack and here's why: Green was expressing a personal view. A view, which doesn't necessarily conflict with his role and ECCA or the DH and, in 2011, is fairly mainstream.

What the Telegraph article doesn't mention mention is that Green has previously suffered with cancer. So it's understandable that he should have a strong view (Green rarely has anything but strong views) on what should be allowed at the end of life as I imagine most people faced with such a diagnosis would find themselves giving it some thought.

Therefore, I suspect that he has given it a more detailed appraisal than most. Adding that to the debate, which is a heated one on both sides, can hardly be seen as irresponsible and whether you agree or disagree with him surely forthright reasoned voices are just those that you want advising the government on assisted suicide, dementia or any aspect of policy.

In a sign of the times, care home group Choices, has called in administrators Zolfo Cooper.

The group, which runs care homes throughout the North East and Scotland, provides supported living, domiciliary care and residential services to around 800 individuals with learning disabilities and employs 1,400 staff.

Zolfo Cooper says it has received numerous inquiries for the residential and domiciliary care aspects of the business, while the supported living business has already been sold to Mears care Scotland Limited, saving 500 jobs and ensuring continuity of care.

I'm not sure of the reasons for the administrators being called in, though I wonder if this is another example of councils forcing operators to reduce costs. Zolfo Cooper says the business has faced ongoing cashflow problems.  

It has been a good week for the Care Quality Commission. On Tuesday it released figures showing inspections of adult social care services grew by a third over the last three months.

Today, it announced that it is partnering with Age UK, Challenging Behaviour Foundation and Choice Support to provide experts to help with its work. More partners are to follow.

It'll be a welcome move from those who have voiced concern over lack of expertise at the regulator following the Winterbourne View abuse scandal. Several people have told me that they believe one of the reasons the CQC was not quick to act when a whistleblower told it about the abuse at the hospital, was because it no longer has learning disability experts on the books, who might have kept staff alert to the dangers of learning disability hospitals.

Private eye has an excellent piece up on its website last week, but I only saw it today, about what a certain former Southern Cross employee has been up to since the companies demise.

Philip Scott, who as chief executive oversaw the introduction of the lease-back model which proved to be Southern Cross's Achillies heal, has apparently been peddling the same trick with his new employer - Priory Group.

The eye, naturally, fears that the results may be the same.

Today's report into all of Castlebeck's facilities is far from encouraging. Nearly half of  their services are not up to scratch.

However, they are not the only ones.

This morning the BBC carries a story revealing that concerns about Winterbourne View, the hospital where alleged abuse was uncovered, prompting the Care Quality Commission's inspection, were not listened to by the local council.

Nineteen complaints about staff behaviour were logged in the previous five years.

It begs the question, now we know that Winterbourne View was not an isolated case, what's the chances that this happened elsewhere?

I've just read through the Dilnot report and while it can't be faulted for its clarity, I'm left with a few questions. This of course just could be me being a little on the thick side and if you have any answers to these please let me know. Here they are anyway:-

• What if any reform does the commission propose to the charging system for non-residential services?
  
• What account if any would be made in the proposed cap on care for the different costs of care in different areas? With one national figure is there a danger that people in more expensive areas will receive state-funded care before people in less expensive areas? 
• Will people have been judged to have met the cap based on what they have actually spent on care or what their local authority expects them to have spent in line with their notional package of care? People who fund their care themselves tend to spend more on care than local authorities so may well have spent up to the cap figure before they are deemed to have done so by their council?
  
• Will people who have needs below the national eligibility threshold but who spend money privately on care be able to count this spending towards their cap figure? 
• How far does the cap apply to people who receive means-tested support from the state but are charged for that support (either through the system of contributions to non-residential care services or through "tariff income" charges in residential care) - will they be deemed to have met the cap when their total level of charges for care over a lifetime reaches £35,000? 
• How will the system of means-testing in residential care apply to people who have met the cap but have assets of between £14,250 and £100,000? Would they be eligible for means-tested support with their general living costs? 
• The report says that people who have met the cap and are in residential care should no longer receive attendance allowance? Would they have any other benefits withdrawn?
  

Here's our full Dilnot coverage.

(Image on Flickr from purpleslog)