A matter of life and death

The deaths of older people after being evicted from care homes
have, predictably, turned up the heat under the simmering care
homes crisis.

Violet Townsend, 88, was moved out of Magdalen House in
Gloucestershire in February because its owners said the fees being
paid for her were insufficient. She died a few days later. Winifred
Humphrey, 102, died in similar circumstances last month 16 days
after being forced to leave Bradley House rest home in Whitstable,
Kent, where she had lived for nine years.

And there is suspicion that an increasing number of frail, older
people are being caught in the crossfire between residential care
providers and the local authorities buying that care. Care home
owners claim they face an impossible choice between militant action
against vulnerable people or simply selling up. Local authorities
say they simply cannot pay what care home owners are demanding.

So what is the answer? Here, five experts on the crisis suggest
their preferred solutions to this intractable problem.

The MP
Paul Burstow, Liberal Democrat spokesperson on older
people
“We need a couple of radically different approaches to tackling the
problems facing the care home sector.

There should immediately be a full independent assessment of
care home fee levels similar to that undertaken in the Wanless
Report for the NHS.

At the very least, this would give us a picture of what the true
state of funding is, and what needs to be done in order to
stabilise the sector and prevent the unplanned and unstructured
care home closures that have left vulnerable people forced to fend
for themselves. It has also cost too many older people their lives.
Yet, in answers to parliamentary questions tabled by myself, the
health secretary John Reid has dismissed the calls for this.

This then leads on to my second proposal, which I introduced as
a bill in the House of Commons in mid-July. Care home residents
have fewer rights than council tenants or private tenants. It can
take as long as three years to build and open a new care home, but
just 28 days to close one. Frail elderly people’s lives are put at
risk by these care home closures. My bill, if passed as an act,
would ensure that older people in care homes would be given the
same rights as people who rent their homes in any other
circumstance.”

The charity chief executive
Gary Fitzgerald, Action on Elder Abuse
“There are three factors influencing the financial
eviction of older people from care homes. First, the care sector is
grossly underfunded, an issue not being directly or urgently
addressed by central government. Second, older people have become a
commodity within a social care market that has no long-term
commitment to their individual health or social care needs. And
third, society has a perception of older people which accepts
abusive practices perpetrated against them that are intolerable
when committed against children.

Society has a duty to ensure that adequate care is provided to
those who are most vulnerable or in need. The argument about
whether someone should contribute wholly or in part is a
distraction from this obligation. Residential homes should either
be part of the overall health care provision – and thus directly
provided by state bodies – or they should be ‘subcontracted’ in a
co-ordinated manner that includes agreed costs and charges.

The social care market has failed. This needs to be acknowledged
and accepted. And the obvious implication of this acceptance is
that taxes or national insurance costs must rise to fund adequate
care.

In the interim, it should not be acceptable for any older person
to be evicted because of fee disputes.

The situation has been caused by the belief that market forces
would regulate costs, a strategy adopted by the Thatcher
government. The current government must take responsibility for the
solution, and that includes establishing a system to agree fee
increases that are regionally appropriate, and to top up the
difference if unavailable from other sources. Legislation should be
used to prevent financial evictions, with safeguards to ensure this
does not become a ‘blank cheque’ for less scrupulous
homeowners.”

The social services director
Glenys Jones, Sunderland, ADSS chairperson of older persons’
committee
“A fair price for care in a profit-making residential care market
cannot be considered without a view on what constitutes a
reasonable profit. Should this be left to a free market when this
sector is a monopoly provider? Both the details of the price and
the profits of care should be transparent to the user and any third
party. There should be a national price-and-profit framework, which
could be based on an agreed formula and which would be reviewed
twice a year to adjust for price variations.

Direct payments should be available towards the cost of personal
residential care. Users and third parties should be considered as
stakeholders in a partnership with providers in a transparent
agreement. This would be a public and private partnership within
the social estate of the state – a direct contract between the
user, third party and the provider. This should have clear rules
for contract termination which are nationally accepted and legally
binding. Fines could be paid back to users in the case of any
breach of contract.

A public sector workforce should provide a needs assessment for
anyone considering residential care, options should be discussed,
and financial and social risks made transparent. Reliable public
information on all care homes should be available including access
to individual National Care Standards Commission reports and annual
business accounts. A wide-ranging advocacy service including
financial advocacy should be easily accessible before admission and
for all existing residents.

Finally, commissioning partnerships should focus on the new
stakeholder economy. This would seek to develop new public-private
partnerships to share financial risks, make land available, and
develop workforce plans across all sectors in the local health and
social care economy. We have to think out of the box for
residential care, and a public-private foundation community might
have much to offer.”

The academic
Jill Manthorpe, University of Hull
“The price paid for residential care is clearly felt to be too high
by some and not high enough by others. How to resolve this impasse?
Notions abound – from nationalising the system to letting market
forces run their course. My particular plea is that, first, we
should not panic. I cannot argue that homes should not close. In my
experience some should, and closure will always take place
regardless of ownership or funding regime. The process, however,
needs to be carried out as humanely as possible.

Second, we should make the role of the social services care
manager more constructive. There is much scope for them to be
involved in promoting and protecting the welfare and quality of
life of residents, especially those who do not have family members
or others involved in their support. Care managers should be
involved in setting out robust contracts with care providers which
alert them when things are going wrong.

The advent of the single assessment process should free up some
care managers’ time. Let’s use this opportunity to enable care
managers to keep a much closer eye on the well-being of residents
being paid for by local authorities, and possibly even by the
NHS.

This development should enable them to support residents if
closure is threatened or if a move is likely.

Although not everyone has a care manager, many residents are
funded by local authorities and we need to extend this relationship
beyond financial assessment to include the monitoring of care.

We rarely hear of residents who benefit from moves, but this can
and does happen. There is knowledge about the best way to manage
moves, though it is not widely communicated or considered.
Voluntary sector groups might like to publicise such knowledge
further, if the Department of Health is not able to do so. Local
services, such as intermediate care, should also be prepared to
advise and work together with care managers to help them make any
move as positive as possible.”

The care home owner
Ronnie Cairnduff, chairperson, Hampshire Care Association
“Sadly, the care of the elderly is almost at the bottom
of the pecking order for funding. It’s been that way for decades,
and while the two-tier funding system continues this will always be
the case.

On the one hand there is the NHS, funded nationally on the basis
of need. On the other we have old age care, whose funding is
decided individually by more than 170 councils. Needless to say,
very few authorities come to the same conclusions. This needs to be
tackled – can you imagine the uproar that would echo across the
land if those same local authorities were allowed to determine how
much the pension should be in their local area?

For care homes, a few yards over one county border or another
can be the difference between viability or failure. This is no
basis on which to build committed care provision.

There is no other commercial industry in this country that is
told what it will be paid for its services, regardless of the
actual cost. This mindset means that the ball is batted between
local authorities, which say they don’t get enough money from
central government, only for central government to say, ‘oh yes you
do’. Piggy in the middle is, of course, the providers of care and
the unfortunate folk who have to use their life’s work to pay for
their care. Successive governments have found it beyond them to
work out the cost of care on a national basis – yet this is what is
needed. Demographics show the problem is likely to get worse in the
coming years. It now needs some radical thinking to avoid an even
bigger problem in the future.”