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Keeping Mum#1 – We need to talk about care homes

In our new blog series, Keeping Mum, we’ll be reflecting on a whole range of topics and subjects. With care homes high on the agenda, Annabel wonders why we seem to feel how we do about them.

Care homes are back in the spotlight thanks to the Government’s lack of response – infact their apparent total disregard – for the amazing John’s Campaign challenge; the issue centres on Govt guidance over family visits to care home residents during and after lockdown.  This has set me thinking about care homes. 

John's Campaign

From early March BoJo, Matt et al kept telling us that the elderly and frail were most susceptible to Covid-19 and care homes in particular needed to be protected.  And yet here we are 6 months on with a terrible Covid related death toll in care homes; only the first inklings of the emotional and physical damage lockdown has had on thousands of residents;  the shambles that was PPE supply and now testing in care homes not a priority; and appallingly, nearly two months since shielding was lifted, so many families still unable to visit their loved ones. 

I know, I know, unprecedented times and all that.  But seriously. 

In part I wonder if it’s something to do with how we collectively think about old age and care. Very few people –if any – make a plan to end their days in a care home; certainly no-one wants to put Mum into a home unless absolutely necessary.  Most of us want to stay in our own homes and ultimately “be carried out in a box”. How many of us have “the care conversation” with our parents/relatives before it becomes an emergency?  

Perhaps this contributes to a perception that care homes are places of last resort, end of the line, where dragons might just be. 

The history of care homes is itself fairly bizarre and as such also may contribute to how we reached this point. Before 1914, those who needed care but couldn’t afford it were sent to the local workhouse. These institutions were originally introduced in the 1830s under The Poor Laws in response to mass unemployment caused by the end of the Napoleonic Wars and the industrial revolution.

In a weirdly but possibly predictable Victorian way, many were impressive buildings and the healthcare was free, but the conditions were harsh, partly to act as deterrent. The more rural workhouses soon only housed “the incapable, elderly and sick”, and in 1905 a Royal Commission decided they were no longer serving their initial purpose.  However, workhouses continued, well past a change in law at the end of the 1920s when local authorities took over their control, alongside new legislation including the introduction of pensions and of course the start of the NHS in 1946.

Local authorities over time turned workhouses into municipal hospitals or care homes for the elderly, with improvements in living conditions and healthcare through the decades.  The next transformation came with privatisation under Maggie Thatcher at the end of the ‘80s, since when a whole sector has emerged.  Today, it is a ££ billion business, with 11,000 homes owned/managed by over 5000 operators from small owner managed businesses to large national private equity-backed providers.  Almost half a million elderly people are residents. 

Local Authorities now only account for 10% of care home ownership across the UK. This, along with a rise in the numbers of elderly people with serious medical and care needs, and a decade plus of austerity has meant the economics of care homes are increasingly complex, with self-funding residents making up the difference in fees paid by local authorities – for the same care in the same care home.  

There seems to be more than a lack of joined up thinking by local authorities who remain responsible for the planning and delivery of care with those who now provide care homes.  The PPE fiasco was a good example of this; a fragmented and competitive market in normal circumstances resulting in many homes and small providers left to fend for themselves in the rush for PPE,  in direct competition with eachother, and with the NHS.

AgeSpace Keeping Mum blog

When we talk about value and service,  emotional or financial, what we’re really talking about is parents, relatives and friends who we love, who have worked all their lives, contributed to their communities, raised their families etc – who get to a point where they need specialist care and help.  How best can we enable them to live out their lives as happily and comfortably as possible?   A care home provides the answer for some.  And when it is the answer, it’s not a place of last resort, but the only place to be.  There’s a subtle difference between the two that we can’t ignore when we finally get around to talking about the future of care.

As restrictions tighten up families must be able to visit loved ones in care homes; it’s not just a human right, but a vital part of the care of our frailest and most vulnerable.  Whether family members become key workers and follow the same stringent rules as care home staff, or other measures are put in place: from screens to bubbles or worst case, weather-dependent garden visits; as a humane society we just cannot consign hundreds of thousands of frail elderly people to places of last resort.  

More information about John’s Campaign is available here:

Annabel James is the founder of AgeSpace. All views are her own.

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