The Financial Times today had a series of articles on standards in care homes for the elderly in Britain. The two most powerful things the articles sought to get across were that there were serious failings and that these were more common in the private sector care homes than in those run by local authorities or, best of all, the voluntary sector.
It may be worth giving the actual figures cited by the newspaper. “According the Financial Times analysis around 13 per cent of care homes were rated poor or adequate by the industry regulator during the 2009/10 financial year”. Lumping together ‘poor’ and ‘adequate’ sounds like the newspaper was trying to reach a bigger number than it would have if it confined itself only to ‘poor’. But of course I do not dispute that there may be a worrying number of care homes which are, indeed, poor. I have visited three nursing homes – which are somewhat different of course – and all of them were deeply depressing. Not that the homes themselves were entirely to blame. The inmates were naturally physically and mentally near the end and, understandably, pretty depressed, too.
But I want to get back to the association made by the FT between poor care and the private sector. I would like to suggest that this may be because the main customers of these care homes are not the elderly people in them or even their relatives. The customers are the local authorities. They are the ones who supply the money. Everybody in the care homes know that if Mrs Goggins does not have someone come within five minutes when she rings the buzzer, she will nevertheless remain in the home. But if she and her relatives were the ones directly controlling the funds, the care home and therefore all its staff, would know it was important to keep Mrs Goggins pleased with the standard of care. This would affect the whole approach.
It is a matter of concern that ‘private’ and ‘for profit’ get a bad name when the root cause of the problem does not lie in the supplier being either of these things. The problem lies in the person receiving the service not being the one who controls payment for it.
The brutal truth is that care homes are paid for by local authorities who, in turn, get their money from central government. Money is tight and has been cut. The private care is probably cheaper, per person, certainly than local authority care. But it has this ‘customer problem’.
Here is an interesting passage from one of the FT articles. It is good, incidentally, to see this area of the welfare state getting some media coverage.
Trends in the care home sector also shifted. Councils tried to meet old people’s wishes to stay in their own homes as long as possible rather than be moved into care homes. As a result, occupancy rates declined and the people who did move into care homes were older and sicker and so more expensive to look after. The average stay in a care home is now about nine months.
“People’s image of a care home is people playing chequers in a conservatory with a cat running around their ankles . . . that’s just not what they’re like any more, these are subacute healthcare facilities,” said an investment banker.Then came austerity: the government cut funding to councils, which in turn cut or froze the fees they paid to care homes. With inflation at 4.5 per cent, many operators’ costs are rising faster than their revenues. Companies that also have high debt payments or rents to support are under extra strain.
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Full text here.
- “Two thirds of the adult population are frightened by the prospect of having to move into a care home”. Hypocrisy, selfishness and vanity are reflected in the way we care for the old. Care homes made ‘normal’ by the welfare state.
- Dealing with the argument that the private sector is incapable fo providing emergency care
- Do the railways prove that private provision does not work?
- “The right to undercut is the privilege of the poor – of poor individuals, poor countries, poor businesses. It should not be undermined.”
- Poor treatment may contribute to one in six deaths in intensive care