A bad week for older people
You can't help thinking last week was a bad week for the Department of Health. Fresh from the Social Care Green Paper, which setting out a shiny new vision for a national care service, and basking in the glow of the voter friendly Personal Care at Home Bill, announced in the Queen's Speech as giving hundred of thousands of the neediest older people free personal care at home, the QCQ went and ruined the party with their untimely review of residential care homes. Perhaps the new regulator, replacing the CSCI, wanted to stamp its authority as not to be messed with in this first review. Either way, this year's review seemed particularly harsh, with a quarter of homes judged adequate or below par.
The government now faces a conundrum. Residential homes are expensive - local authorities regularly pay upwards of £600-700 a week for a bed; they are unpopular - every survey of older people and their care choices find over 90 per cent (understandably) want to stay in their own homes; and now, horror of horrors, they aren't very good either. Visions of another undercover TV documentary showing vulnerable old people being tied to their chairs and shouted at must be flashing before Phil Hope's eyes. So in one sense, it must be very tempting to roll down residential provision, expand the Personal Care Bill and get more and more people looked after at home. A vote-winner to boot.
But here's the dilemma. Residential care is vital. Older people with intensive needs simply cannot be looked after at home - it's impractical, hugely expensive, and often works out worse for older people as the facilities and standards of care they get from home carers doesn't match what they can get from a nursing team in a properly equipped home. Moreover, residential care is becoming more important - not less. Rising numbers of older people in this country is also leading to rising numbers of very old, with complex physical and more importantly mental health needs, needing round the clock care. There are also growing numbers of single older people, particularly women, who are feeling increasingly isolated. Two thirds of older people in a recent survey said they hadn't seen friends or family for over a week. Residential homes could be the answer to this problem.
The government is now at a critical juncture. They can go the easy, vote winning route of putting more money into home care, and reduce the size of the residential sector by decommissioning those homes falling foul of the CQC review and simply not replacing them. Or they can think long term, and whilst supporting home careers and preventative measures ALSO put money into better quality, more flexible residential options, like ‘extra care’ homes and intensive units, to meet the wider variety of needs of tomorrow's older people. But what government, or opposition party for that matter, wants to suggest something unpopular and long term on the eve of an election? Last week could well be the death knell for residential homes - a very bad week for older people.