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Who cares for our elderly (and who will pay)?



I am sure that I was not the only one who noticed the juxtaposition of two stories in the press last week – the demise of Southern Cross Healthcare and David Cameron’s policy statement of involving the private sector in the provision of essential services. Does this not set alarm bells ringing for those who are creating the policies that are being proposed?

Who will provide and pay for the care of the elderly continues to be a problem without a solution for successive governments, and with our ageing population, it can only grow. The Southern Cross business model seemed to be a golden goose that could not fail. There was a long queue of potential investors willing to back the company but the company is now in administration.

With many residents receiving a large contribution from local authorities towards the costs of their care, the homes have suffered the double whammy of a marginal increase in the income from the local authorities and a large increase in the minimum wage that they have to pay many of their staff. Add to that the 20% hike in energy costs and trouble was inevitable. It is difficult to understand how local authorities pay a fixed amount per week to private homes for each resident who qualify for assistance with their fees, but are unable to provide care for that price in the homes that they run themselves. It now seems that there is a delay in moving the elderly from hospital beds (funded by the NHS) into nursing homes (funded by local authorities) leaving occupancy in the nursing homes at less than a sustainable level.

The Dilnot report goes some way to suggesting a solution to the question of who should pay for the care and there are many who will argue about the rights and wrongs of that. But it does not address the issue of who provides that care in an environment that is financially sound and gives residents the peace of mind that their homes will not be closed. There are excellent homes whose owners and staff work hard to provide the best care for their residents, but unfortunately this is not the norm and our current system of monitoring care is not good enough.

Even if this question could be resolved fairly, it will not deal with the issue of the quality of care for the elderly. It is a very expensive business to provide good care – at the moment the quality of care provided by the day to day carers is not consistently good. Whilst the pay offered to these carers is often the minimum wage, the industry will not attract skilled staff. In fact, it does not even attract sufficient home grown staff and have to recruit staff from overseas – typically from the Philippines and Poland. The culture of these and other countries respects their elderly citizens and this is reflected in the quality of care those carers provide. Staffing ratios will reduce in cash strapped providers affecting the quality of care and safety of the residents.

The problems will increase – like the NHS, the costs could escalate as standards are pushed up and as the elderly population grows. Private provision has to form part of the picture. But without strictly enforced high standards of care and some form of government backed guarantee, the provision of good care will continue to be a very hit and miss affair. This will affect us all one day, some of us sooner than others – I hope that the issues are resolved and a sustainable model found before I need to test the service!


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