2014/15 was not a particularly good year for care homes, and not just care homes for older people but also those who are vulnerable due to physical or mental health difficulties and especially those with learning difficulties. There were lots of closures with a disturbing amount of closures following CQC inspections – I think people of all ages have been shocked at the level and type of abuse inflicted on those who are needing care. It should be remembered that many of those people are paying for their care – in London it can average over £32,000 per year and that is without basic extras such as laundry etc. As a point of interest – if you are paying over £32,000 per year and the CQC do not accept that the home or care is good – can you get a rebate? You can for almost every other service which falls short – why not here?
The other main cause for closure is the lack of funding – we are not talking about providers making vast profits but in many cases just to break even. The care industry has a choice – planned or unplanned exit from the unsustainable, publicly funded care market or move into the self funders market.
The predictions are that at least one major large scale provider will fail in respect of funding and this is not taking into account any CQC intervention. Already some care providers are turning their focus onto self funders or even converting their homes into housing stock. The impact of these developments will vary across the country with the more wealthy areas such as in parts of the South East where there are more likely to be self funders sustainable services are more likely to be provided for this group – this can work well providing for the needs in that community but in the poorer boroughs and parts of the country such as the North East where there are likely to be fewer people able to self fund – what happens to those people? Will relatives be expected to ‘top up’ the fees? And if people are expected to pay ‘top up’ fees for parents – how are they going to save for their own care or is it anticipated that each generation will pay ‘top up’ fees for the older generation? What if people do not have children/family who are able to provide this assistance?
The Local Authority has an obligation to act as providers of last resort – so how will they provide services if there are not the care homes for non self funders on the ground? One of the major difficulties for both the care providers and the councils is that council placements do not and cannot afford to pay the going rate so it is essential that homes have a high percentage of self funders who are charged double to subsidize the council placement but self funders are beginning to object to this. So if homes stop taking council placements as it makes the home unsustainable – where does the council go? Will they have to go back to providing in house residential care (many of them were excellent and people were very disappointed when they were taken over by private firms) Where will they get the funds from to provide this care?
The other major concern is what happens when homes close particularly in an unplanned way? It should be remembered that these places are people’s homes and many have lived there for years – they have their own things, their friends and activities just as you and I do in the community. The impact of these unplanned moves is enormous on the residents and their friends and relatives and it has been noticed that following unplanned closures there is an increased death rate; well how would you like to be tufted from your home unexpectedly – even moved late at night after 10pm to a place you don’t know, you have not seen and away from your friends and the home you know and in most cases not given a choice in being moved or where you will be moved to? Once again the stories that have emerged are horrifying and certainly care, compassion, choice and dignity do not feature at all. Whether you are paying thousands of pounds for your home or your entire state pension – this is no way to treat people – all are making a contribution to the service. Animals in care get better treatment.
What would councils/government do if there was a mass of closures of care facilities – not just for older people but also those with disabilities? Care home providers are so concerned that they have raised the issue with the government particularly after the dictate that all staff must be paid the living wage which will enormously increase the staff bill. We have not heard that they have received a helpful response. It is to be hoped that the government is not yet again burying its head in the sand in the hope that the situation will go away.
Where residents do benefit is when the closure/move is well planned with the residents actively participating in the process and decision making. Where there have been detailed discussions, viewing of new homes perhaps with friends so that they can move together and even getting excited about the move – just as you or I may be excited about a move to a new flat/house/ area. Under these circumstances research has shown that the move is mostly very successful with many added benefits to the resident and the important factor – they choose the home so they feel more in control that it is their choice.
So where do we go from here? Do you know what the situation is in your borough? How many people in your local borough are council placements in the local homes and are those homes still happy to take council placements or are they now saying they will only take self funders? As usual let us know and maybe question your own councils – increasing the awareness of the possible situation may motivate them to start planning for these sorts of eventualities.