Creating Solutions in Care for Older Adults

We’ve seen a lot of discussion over the past week or so about the ‘problems’ created by older people who sometimes remain in hospital when there are no appropriate and suitable services in the community to assist in their rehabilitation goal – which is callously referred to in policy-making ivory towers as ‘bed blocking’ – a term I’m wholly opposed to.

Last week, Mike Farrar, the Chief Executive of the NHS Confederation stated that 1 in 4 people who were in acute hospital beds could recover at home if better support were available.

Over the weekend, the government in their own now predictable fashion, entered the ‘policy making’ platform by flinging £170 million at the ‘problem’ of older people taking up these valuable hospital beds. That computes according to this article in the Guardian as a one off payment of £1m to each council to help deal with this awkward problem.

The thing is while not wanting to scoff at money offered, it’s hardly the best targeted or thought through way of delivering a better system of care for older people.

Until we stop thinking of older adults as a ‘problem’ and their need as a developing ‘crisis’ it’s hard to imagine how we can move on from where we are – where one-off payments will need to be launched towards local authorities who are struggling in the face of having to cut services.

There needs to be a real change in the systemic process of both health and social care rather than a shifting of funds between one and the other.

The Telegraph refers to a letter published from 60 charity directors, independent experts and government advisors demanding a reform to home care services in England and urging the government not to abandon Dilnot’s proposals to change the way that adult social care is funded.

Dilnot is a start. The problem as I see it ‘on the ground’ as it were is that as the costs of social care are rising, people are less willing and able to pay for it.

This means that people are more likely to refuse preventative care or care which will avoid a more hasty deterioration which will end up being much more expensive in the longer run (not just in terms of cash but in terms of quality of life and stress to carers).

I’ve had far more people turn down services that I have assessed them as needing due to the costs involved and this is the hidden ‘secret’ of the rapid extension of the personal budgets agenda is that they are chargeable and some people end up being charged the same amount that they will receive which makes us all wonder about the level of paperwork and documentation required in the meantime.

We need to look at answers rather than just see problems and my solutions would be as follows:-

Implement the Dilnot recommendations. I don’t agree wholeheartedly with the report, to be honest, but it’s better than what we have

More synergy between health and social care budgets – whether that’s by better links at the ‘top’ or by implementing cash incentives, we can’t have the constant shift of budgets between one and the other.

If money is going to be thrown at supporting hospital discharges, please please can it be well-planned and not just hurled at the situations which are easiest to manage.

A genuine desire to implement the principles of personalisation in residential and nursing care for older adults – which can’t be done ‘on the cheap’. As a nation, we should be embarrassed that we care for older adults in residential homes that have 60+ residents. More and different models of caring must be piloted and tried.

Personalisation agenda must move away from the ‘delivery of direct payments at all cost’ as the ‘best’ outcome. Yes, that works for some but there needs to be greater consideration of other models of developing individual budgets, namely through Individual service funds and trust funds and perhaps other models.

Most importantly, as I mentioned at the start, we need to move on from the explicit ageism that occurs when we only see older people as a ‘problem’ to be solved.  That is where the loss of dignity comes from. We have allowed it to happen because we don’t want to look and see it but as we get older, we will have to, and we will remember how our generation cared for our own parents and grandparents and wonder why our children and grandchildren don’t do better for us.

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4 thoughts on “Creating Solutions in Care for Older Adults

  1. Lot of sense here…though not sure about the comment on the size of residential provision…have seen some new well thought out provision in the Netherlands..over 1000 beds…industrial scale…but well designed,( this being the key). The provision had access to community facilities, cited in the centre of a city, school childrens route to school was actually through the provision, bringing generations together on a daily matter of fact basis), basically it is well designed, inclusive and quality.

  2. Fully agree with most of this, especially the hypocrisy of the personal budgets agenda. Like Ken though I am not sure that big = bad for residential provision. The large homes I know have far better facilities, such as hairdressing and treatment rooms, choice of places to sit, can provide more choice in terms of menus, activities etc due to economies of scale.

    When Mr Farrar says 1 in 4 could recover at home I suspect he means 1 in 4 could just be somewhere else and not in my precious beds. Those whose care needs are unstable and unpredictable need 24 hour care and that either means staff doing 3 shifts a day at home, with perhaps 2 care staff (do the math),.or some kind of residential provision – it is never going to be cheap.

    The Today programme this morning was full of doom and gloom about how awful care in the community now is, people suffering terribly etc. I dont recognise this picture. Maybe we are lucky in our area and no doubt things do go wrong. I do wonder however if the shroud waving approach of some charities is simply going to give more ammunition to the anti NHS, anti Council bridgade and create unreasonable fear in the old.

    As for throwing £1m at councils as a one off payment, typically this money will not be used as effectively as it could be , since there is now no time for thoughful planning and commissioning. It will no doubt be thrown at buying up spare beds in nursing homes where people will be shunted with little consultation or thought, leading to some inevitably feeling they are at the end of the line and may as well give up. A sudden increase in the dom care market will mean staff will be recruited in haste, poorly experienced and trained and put in to look after vulnerable and unstable clients with inevitable consequences We need medium term, reliable adequate funding to do proper local planning and find what works. A month ago or so I offered to do some planning for proper purchasing of step down provision but was told there is no more money.

  3. I’ll happily accept that I may be wrong about big=bad but was speaking merely from my own experience. I don’t think big should be the necessary default provision though – I worry that it turns into some kind of warehousing of older people and is not given the same consideration that is given to younger adults who have equivalent needs (because funding streams are different).
    I am very pleased to be proved wrong though!
    I agree re: the £1m – it is the lack of planning that frustrates me just as there was a lack of planning re: cuts.

  4. I couldn’t agree more about personal budgets and the need for more ways to manage then than Direct Payments. My parents were two of the first older people in the country to have a personal budget via Direct payments and I managed them on their behalf. Personal budgets transformed their life but my parents would be the first to agree they could never have enjoyed the flexibility and tailored solutions it brought them, if I hand’t been able to manage the budgets for them. While working for Social services I was involved with the introduction of personal budgets and did a lot of work around individual service funds which I believe offer a really good alternative. Sadly my Local Authority have responded to the funding crisis by returning to a prescriptive model for allocating resources and removed the flexibility that is the essential if personal budgets are t be truly ‘personal’

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