Crisis in care

Is there really a crisis in the care-home sector? At the “Fair Rate for Care” conference on 13 November 2003, the Parliamentary Under Secretary of State for Community Care, Dr Stephen Ladyman, told the delegates that there was no capacity problem in the care-homes sector. According to ECA’s spies this caused many of the delegates to nearly choke. It will also surprise many ECA readers given the level of complaints on capacity aired within these pages over the last nine years. Philip Spiers of the National Home Fees Association (NHFA) takes issue with Dr Ladyman.

Dr Ladyman repeated the statistics he cited at the “Fair Rate for Care” conference in an article for This Caring Business, November 2003, issue 173. Using Laing and Buisson figures, he quoted that there are 10,000 care-home places available. He argued at the conference that the 10,000 places exclude block-contracted beds local authorities have reserved. I would note that these places, if agreed to be real, would be most appropriately distributed evenly throughout the UK, but sadly they are not. I would also ask about self-funding care-home residents who at best, if there are 20,000 homes in the UK, can expect choice limited to half a bed per home. Then, if they are lucky enough to find a vacancy, that home may not be appropriate to meet assessed needs.

As an argument against investment in the care-home sector, Dr. Ladyman quoted from a survey of older people that 80 per cent would prefer care in their own homes. Therefore, investment must be in the home-care sector.

What about the other 20 per cent? According to the 2001 population statistics, 7.5 per cent of the UK population is over 75. This equates to 4,350,000 older people and, if around 460,000 currently live in care homes, this equates to 10.57 per cent. Therefore, in my mind, if 20 per cent wish to live in care homes, we have a massive under-capacity of 73.34 per cent on expected demand if there are currently 501,900 total beds available. As the older population increases so will this demand.

Care-home capacity is falling dramatically. During the 15 months to 1 April 2003, 745 independent-sector care homes closed with 15,100 places lost. That is equivalent to 12,000 places per year or 1,000 per month (Laing and Buisson). There are hot spots, particularly around the south east of England. MP Paul Burstow has been challenging the government on this subject. He has carried out his own research and predicts that the lines of capacity and demand will cross in 2006, which is a very serious worry.

I submit that an increase in capacity investment is needed. One of the best ways of achieving this across the sector would be to give local authorities greater purchasing power through having more money. Setting a fair rate for care with ring-fenced funding from central government would be one way of achieving this.

The other problem of equal weight the suggested investment would solve is that of choice. One of the most common problems the NHFA advice line has to deal with is the relatives of older people who are faced with trying to find a care home at the rate their local authority is prepared to pay. In some parts of the country this is impossible. In some instances, it can cause fatalities if older people who were once self-funding are forced to move to cheaper accommodation. We have already seen two cases of Violet Townsend from Gloucestershire and Winifred Humphrey from Kent both who died shortly after being forced to move care homes. Gloucestershire County Council set up a public inquiry into Mrs Townsend’s death, which laid the blame on the government for the enormous gap between the funding provided by government for care-home places and the cost of those places. There are probably hundreds more tragic cases that have not been publicised.

The National Assistance Act 1948 (Choice of Accommodation) Directions 1992 clearly state that local authorities must not set an arbitrary figure on what they are prepared to pay for a care-home place and routinely expect third parties to top-up, but this is exactly what the NHFA observe they do. Many authorities now even produce lists of care homes with the amount of top-up required for each home. This unlawful approach appears condoned by central government.

Setting a fair rate for care would solve the crisis and would not be difficult. We already have regional offices of the National Care Standards Commission, which, through its financial-viability studies on care homes, has access to the operating costs of this sector. I do not think that it would be hard to analyse the audited accounts of care homes, ascertain average operational costs per bed, per region, and add to this a reasonable profit margin to arrive at the fair rate for care. The next step I would suggest is the removal of the disparity between self-funding residents and state-funded residents. If local authorities were to pay more for social services funded clients then we would expect the fees of self-funded residents to reduce accordingly, as the current unfair cross subsidy would no longer be required. All sounds so simple doesn’t it?

Further free information and advice on paying for care can be obtained from NHFA, St Leonards House, Mill Street, Eynsham, Oxford, OX29 4JX. Telephone 01865 733000 E-mail enquiries@nhfa.co.uk, freephone Care Advice Line 0800 99 88 33, website, www.nhfa.co.uk.

References:

Fair Rate for Care conference: Text of Stephen Ladyman’s speech to the Fair Rate for Care conference on 13 November, www.doh.gov.uk/speeches/nov2003ladyman.htm
Capacity of care homes fell by nearly 10,000 beds to April 2003 (Laing and Buisson)
Occupancy rates of care homes at April 2003 stood at 92 per cent (Laing and Buisson) any more than 90 per cent will restrict choice
During the six months to 31 October 2003, the NHFA care advice line received over 6,000 calls from individuals with worries about obtaining and paying for care
The care fees advisory service from NHFA provides free advice to anyone entering or already in care, regardless of means. By combining specialist financial advice with information on local authority charging procedures, health authority responsibilities, DWP disability benefits and legal matters. The service is able to illustrate the long-term affordability of chosen care aiming to enable older people retain their independence, dignity and right of choice.

Editor’s comment

What would the public reaction be if the deaths caused by the care-homes crisis were of children? It is submitted that by its continued inaction the authorities both national and local are accepting that the value of the lives of older people is less than those of others. It is hoped that readers will continue to press for reform supporting the choices, independence and dignity that older people deserve.

Philip Spiers of NHFA can be contacted at philipspiers@nhfa.co.uk