Debate on how deaths of older people moving care homes can be prevented

We asked for people’s views on how the deaths of older
people moved from one care home to another can be
prevented.

A recent Community Care article on the subject with views from five
experts

These are the responses we received:

“I agree with Gary Fitzgerald when he says that
the social care market has failed. This may mean a rise in taxes
etc as he suggests, but surely an alternative is to begin a planned
re-investment by the public sector in care homes. This may not be a
cheaper option, but the quality of care (assuming we are able to
learn the lessons of the past) is likely to be easier to assure.
The investment should be through partnership between NHS, local
authorities and either the private or preferably the not for profit
sector.

The problem with the ‘no older person’ should be evicted line is
that it strengthens the position of those who would seek to have
the state over a barrel, and make no mistake there are some
exorbitant fee levels out there that bear no relation to the
quality of care that is actually received. I would not however
argue that the current fee levels set by LAs are adequate. My
experience of working with not for profit providers makes it clear
that they are not.

The problem with nationally set rates is that it takes no
account of local variations in costs (labour, property etc.), but
it should be possible to arrive at locally agreed fee levels within
a national framework. Is it really that difficult to calculate the
true cost of caring for older vulnerable people and then to apply
that as a contract fee? It would also benchmark the costs of public
sector re-investment and ensure best value.

Finally, I think it is important not to neglect the role that
housing with extra care can play in increasing capacity and
improving choices of older people. Well planned and managed schemes
can in my view offer a viable alteernative that can fill the gaps
in capacity, and perhaps make it less likely that the tragedies
that your article highlights will happen in the
future.“

Brian Ironside
Team Manager
Older People

“It seems a pity that, in your otherwise
excellent analysis of the closure of care homes, you failed to ask
a representative of the benevolent fund care home sector. We are,
of course, non profit making. My fund’s residential centres each
average 75 per cent local authority funded residents, and our
operating costs exceed our income by 38 per cent.

Since residents with adequate funding pay our full fees, the
shortfall is almost entirely caused by local
authority underfunding. This seems particularly ageist when many
authorities pay two or three times more for children in care than
they do for old people.

Charities that operate as we do have three options:
First to increase their percentage of full fee payers to ensure
they cover the costs of everyone.
Second to shut their homes, thus forcing residents to move,
Third to fund-raise specifically to subsidise the shortfall.

We have put over £2 million p.a. into our care, but how
long can we sustain this? More importantly, should we sustain this
when we are no longer able to promise that people will not be moved
when their care needs change.

Like many benevolent funds, our centres provided seamless
continuing care between housing, residential and nursing. People
could move between the sections as their needs changed. Short term
dependency could be covered from higher dependency departments.
Nobody need ever leave except for hospital treatment and even then
they could quickly return home to our care rather than blocking
hospital beds. Now regulations forbid us to operate
in this flexible way unless we add more and more staff. We cannot
afford this – who can? So instead of answering the problem posed by
your article, under-funding, over-regulation and academic myopia
are exacerbating it. The answer, then, is easy. Learn from what
worked in the past and fund it properly.“

Geoffrey Atkinson OBE
Chief Executive
BEN-Motor and Allied Trades Benevolent Fund

“Your article gave interesting insights into
the problem, as well as providing a variety of possible solutions.
The present market in care home places has been operating for more
than 12 years, and one of the claims made then was that it would
remove the ‘perverse incentives’, that had enabled
people to have the cost of their care met by the state if they
‘passed’ the financial means test – even if their
care needs were not so serious as to warrant living in a home.

Now we find ourselves debating what constitutes a fair price on
the basis of what purchasers can afford, and what providers need to
meet their costs, while delivering a return against capital
invested. But surely the challenge is to broaden that discussion
into what’s fair and reasonable as an outcome for the older
people – after all their needs are the reason why the industry
exists in the first place, and it was intended that they should be
at the centre of policy and practice.

Many people – friends and relatives, not just the person
making the move – become anxious and confused at the time when they
face up to the need to make a new home for themselves. They deserve
more from us than meaningless statements such as
“commissioning partnerships should focus on the new
stakeholder economy”.

Owners of homes must comply with minimum requirements relating
to policy, practice, premises, staffing and administration –
it’s now time for purchasers to be given a minimum standard
relating to fee levels. While I don’t support the idea of
fining local authorities who fail to place older people after an
episode of hospital care, there does seem to be a much better case
for doing so where they defy the nationally agreed minimum standard
fee level – in pursuit of ‘value for money’.

Policy consistently promotes person-centred care, and aims to
eliminate age based discrimination, yet there remains a huge
disparity between the fees paid for older people’s care as
against any other group of needs. After a period of caution it
really is time to enforce change.“

Les Bright
Interim Director
Relatives and Residents Association