Social Care













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Paying for Care

Dignity Tzar

Anti-psychotic drugs

Liverpool Care Pathway

Avoiding the means-test

Scandal of Care at home

CQC 'serious flaws'

Deferred Payment

Assisted Dying, not this year














Someone once said that the degree to which a country might be considered civilized could be judged by the number of people it had in prison. A better measure would be the way a country treats its elderly citizens. Oh, dear!

What's required is a National Care Service for the Elderly but the current Government does not have any plans for that.

 Elderly care in England is in Crisis

The number of elderly care places has been falling for several years. There are now 70,000 fewer places available than there were when New Labour came to power in 1997. 11 million of the UK population are pensioners, 1 million are over 85 years old.

About 5% of pensioners need a care home. On present numbers, by 2020, three quarters of those in need will not be able to find a place in a care home. Translating the numbers into something meaningful; half a million elderly people will be left in their own homes to rot quietly - New Labour had a new idea in response to this crisis - quality care in your own home.

New Labour's plans for the elderly into the future, notwithstanding bleating about "it's better for old people to be cared for in their own homes", are an acknowledgement that they had no intention of properly funding local authority elderly care. All very worrying when you consider that one in twenty people over 65 has dementia. Will the ConDem coalition respond differently - their big idea was that citizens cough up £8000 on retirement to secure quality care in the future. What happened to that idea?

Paying for Care

Self-funders typically spend four years in residential care, with 12 per cent staying there for eight years.

It is estimated that some 171,000 of the 419,000 residents of care homes are self-funders. In 2011, 25,000 people sold their homes to fund their residential care.

Currently, anyone with assets over £23,250, including the value of their home, has to pay for their own care with costs today averaging around £700 a week.

By 2030, the number of pensioners is forecast to rise by 51 per cent with the number of people over 85 more than doubling. The number of disabled older people is expected to rise by 61 per cent to four million.

Following the Dilnot Commission's Report, the coalition finally announced that they would cap the cost of a care home place at £75,000. Dilnot recommended £35,000. This will not come into effect until 2017. Bills for services such as help with washing will not be covered by the cap. And the difference between Dilnot's figure and the coalition's will mean that around 2 million pensioners will lose out.

New health secretary, Jeremy Hunt, said this would end the "scandal" of elderly home owners being forced to sell their home to meet nursing care fees. Under the new proposals, people will be deemed "self-funders" only if they have assets of more than £123,000. Currently, those with assets of £23,250 or more – and in many cases this will include the value of their home – are expected to pay care bills in full.

Given the average cost of a residential home is now (2013) £580 a week – and more than £700 a week for a nursing home – people's assets can be quickly exhausted if they spend their last few years in care.

25% less over-65s, are being helped in the past 5 years
“This covers the council-funded services provided to disabled and elderly people, such as care homes and help in the home for daily tasks such as washing and dressing. 

People have to pay for their elderly care whether that's round-the-clock help in a care home or support with tasks such as washing and dressing in their own home.
Currently only those with low means - under £23,250 in savings and, in some cases, the value of a home - get help towards their costs. The rest have to pay all their care costs. For one in 10 these can exceed £100,000.

What about those all ready in residential care?

The 400,000 elderly people already in residential care will receive no financial assistance.


The latest news on care costs tells us that the Government are doing nothing until 2020 and some say that Andrew Dilnot’s proposals are now a dead duck. They have also been looking at schemes whereby people meet their own social care costs by saving throughout their working life. They have been considering a ‘care Isa’ and or tax incentives for people who want to take money from their pensions for care costs. 

Reminder: From Jeremy Hunt in January 2013

"I want this country to be one of the best places in Europe to grow old and that is why in July we announced the most extensive reforms of care and support in over 60 years. As part of the reforms, we are committed to taking action to ensure people do not have to sell their homes to pay for care."

CQC Report

The Care Quality Commission (CQC) in its published report (2009) highlighted the deep failing in elderly care in Britain in this the 21st Century. Yes, much good work is being done but up to 25% of local authorities are deemed to be failing in their duty of care for the elderly. Failing, here means, providing 'poor' or 'just adequate' care.

The biggest crimes highlighted by the CQC report are lack of respect and having no regard for personal dignity.

Good intentions

Beware talk of schemes to care for the elderly at home. Local authorities have been cooking the books for years in their assessments of individual elderly care needs in order to make the till balance. Councils have become very clever at under-estimating individual care needs, so that no intervention is called for.
Why should we believe that anything is likely to change unless there is a massive increase in funding. Indeed, Help the Aged have suggested that some people could end up in care homes earlier than needed because it will be cheaper for Local Authorities. Now, with the ConDem cuts to council grants it's clear that councils will follow one or two paths on elderly care, ignore the problem or find the cheapest provider.
You can read the full report and associated documents on the Care Quality Commission's website - it's a jolly good read, enjoy. Also see the Queen's speech, 2009, for an outline of the care in the home Bill but please be sure not read this whilst eating, you'll choke yourself.


Care Homes: Waiting Rooms for Death

Michael Parkinson, acting as New Labour's 'dignity tzar' described 'care' homes for elderly citizens "as little more than waiting rooms for death".
Parkinson's report makes you wonder why people bother with this waiting room system and don't just go straight to the undertaker. Picture the scene, up and down every high street throughout the land, old duffers, well passed their sell by date, sleeping rough outside the Co-Op Funeral Directors. No doubt Parkinson will be there, handing out free biros and touting over 50s’ insurance schemes.

Of course, becoming a death squatter requires an element of free will, unlikely when your nerves get all tangled up like rats' tails. Fact is, when you or those close to you begin to sense that some of your responses are becoming a little odd, nothing will happen. You're getting old, forgetful; the medics wont want to know. Come back when you are completely ga ga and then they will start prescribing. By then it will be too late and your fate will be out of your hands. You never did take out that 'lasting power of attorney', now those who care about you don't have much of a say about what happens to you either - your life will be the hands of the insidious Court of Protection.

And if you end up on the Liverpool Care Pathway, they probably wont know that you are being helped on your way out, being denied food and drink. Where's the honesty in that kind of killing.

Neglect of the elderly, in 'third world' Britain

A Department of Health spokesman said:

"Every older person is entitled to high quality, safe and dignified care, whether it is provided in their own home or anywhere else. Anything less is unacceptable."

"The new Care Quality Commission has tough powers to penalise or close down providers who offer substandard care. We expect CQC to use these powers to crack down on cases such as those highlighted by Panorama."

So, the new Care Quality Commission (CQC) are able to crack down on sub-standard care providers. Well, no, not exactly because Local Authorities are able to 'interpret' the required care standards in their areas. Penny pinching councils are only offering critical care, meaning that those with moderate needs are overlooked. The CQC pops in and inspects the councils good work and says, well done, you're meeting your stated care targets. The CQC says itself, "the current system of assessing eligibility for care lacks clarity, transparency and fairness."

Stating the bleeding obvious will not disguise the signal fact that the elderly are being neglected - not cared for - in third world Britain.


The Truth About Elderly Care

The truth about elderly care is that nothing happens until it's too late to help and so-called care homes are nothing of the sort. Government knows the scale of the problem but instead of treating it like a national emergency it chooses to make the problem disappear within a maze of bureaucracy.

Needless use of anti-psychotic drugs is widespread in dementia care and contributes to the death of many patients, an official Government sponsored review suggests. Anti-psychotic drugs do not benefit many dementia patients.  About 180,000 patients a year are given the drugs but estimates suggest that only 36,000 benefit from their use.

The government agreed to take steps to reduce use of the drugs. These include: improving access to other types of therapy, such as counselling, better monitoring of prescribing practices and the appointment of a new national director for dementia to oversee the measures.

There are currently 700,000 people in the UK with the condition, but this is expected to rise to one million in the next 10 years because of the ageing population. This review reveals that over the past 30 years doctors have been prescribing anti-psychotic drugs for dementia just to keep old people quiet.

The review into the use of these drugs took place under New Labour and one action was to establish a National Clinical Director for Dementia to audit progress. In fact, an army of Clinical Directors were established, known as tzars – who oversee the implementation of a National Service Framework (NSF). The Dementia tsar has a blog but he's not saying much about progress on reducing the use of these drugs.

Cuts - the new challenge of caring for the elderly and vulnerable

It's estimated that 370,000 more people will need care in the next four years. The £14.4bn allocated by government for adult social care spending by English councils is in the firing line for cuts, this is local authorities' single biggest controllable budget.

And you don't need a crystal ball to guess that the Rolls Royce of care packages, the Independent Living Allowance will be drastically cut. This type of package can cost upwards of £100,000 per person.

Ministers have said that there will not be big cuts to Adult Social Services (Adass) and have hinted at additional funding in this area. However, these sound biters overlook even the £1 billion suggested increase will not be enough to cater for the increasing numbers requiring care. The president of Adass has said he expects real cuts of the order of 40% over the next four years. The blunt reality is that people in need of social care will in future get less State help. Individuals will have to do more for themselves and take part in Cameron's "big society.


Liverpool Care Pathway

Old people have much to worry about once they become dependent on the care provided by hospitals and care homes.

The pathway, designed to ease the suffering of patients in their last hours or days of life, has come under intense scrutiny in recent times. It can involve the removal of drugs, nutrition and hydration if they are judged to be of no benefit to the patient.

But a number of families have complained that their loved ones were put on the pathway without their knowledge, while some doctors have claimed it can hasten death. A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn
The Health Secretary insisted the protocol was far better than alternative arrangements and allowed those close to death to be comfortable and to spend their last hours with their families. 

Hunt told LBC radio:

“It’s a fantastic step forward, the Liverpool care pathway, and we need to be unabashed about that."


“It’s basically designed to bring hospice-style care to terminally-ill people in hospitals. Inevitably people do die in hospital but they weren’t getting the quality of care in those final few hours.”

Mr Hunt said many patients did not want to die “with lots of tubes going in and out of their body” but would prefer their final moments with their families to be “dignified”. How does he know these things?

The Pathway was developed with Marie Curie, with Macmillan, with Age UK and a number of other charities to try and bring dignity to people in their last moments. Last moments, now there's an interesting phrase, lingering moments, is a better one. How would you like to linger for days without food and water and medication? Well, there's nothing dignified about dying in pain and it's about time all these agencies of good intentions grew up and, instead of killing people on the sly just passed the dying person a Mickey Finn.

About 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped, also thousands of dying patients were not given drugs to make them more comfortable.

And the idiot, Hunt, now in charge of the nation's health, says he hopes that one or two bad reports do not end up discrediting the concept of the Pathway.

Perhaps Mr Hunt's handlers should have informed him that his hopes were behind the curve of public opinion, it seems likely that any mention of the Liverpool Care Pathway will soon disappear. Use of the term will be phased out and some new term, without any connotations of State sanctioned murder will be introduced to replace it.

Avoiding the means-test

Some people confuse Inheritance Tax (IHT) with Care Fees Means Testing and think that if they dispose of assets 7 years before they die they can avoid costs associated with care costs. Well, they can't because the local authority will be looking for 'intent' to avoid the means test associated with the act of giving. Under the law this is referred to as the 'deprivation of assets', i.e. that means you attempting to deprive an agency of the state of its due payment.

Age UK tells us:

"Under section 21 of the Health and Social Services and Social Security Adjudications (HASSASSA) Act 1983, where a resident has deliberately deprived himself or herself of an asset the local authority can recover any sums it consequently has to pay towards the resident’s care costs from the person who the asset was transferred to, as long as the deliberate deprivation occurred within six months of the resident approaching the local authority for funding."

What the above statement from Age UK doesn't mention is that if the local authority challenges a claimant within the six month period, the claimant has to prove their innocence, after the six months, the onus shifts onto the local authority to prove its case. So, in essence, there is no time limit for deliberate deprivation of assets.


Care Homes, not badly managed, just not managed!

There are more than 500 different operators running care homes and they were told to appoint a registered manager by April 2011.

The new Health and Social Care Act 2008, which came into force on the 1st October 2009, makes it a requirement for all care homes to have a registered manager. The old legislation, brought in in 2000, also carried the same stipulation. Yet, despite this, almost 1,000 care homes have no registered manager. A cynical person might question what the point of a watchdog is for when ten years can go by without care providers heeding the rules.

The CQC said it had placed conditions on those care homes without a registered qualified manager, requiring operators to appoint one. If they fail to do so, they will be breaking the law, yes, but they were all ready breaking the law?

Another 200 care home providers have had conditions placed on their registration for other "compliance issues," the CQC said.
Chief executive, Cynthia Bower, said: "It has been recognised in the care sector for some time that there is a shortage of experienced and qualified managers. While we have been undertaking the enormous task of re-registering thousands of care services, the scale of this has become clearer." In other words, who ever did the earlier registering, did the job badly.

The Scandal of Care at home

One in eight adults, or more than 6.5m people, are carers and every week that passes their numbers grow. Every week, another 8,000 people have a stroke, a heart attack, or have a sick relative released from a crowded hospital that needs care.
There's no mention of this new form of slavery on the Anti-Slavery Society's website, perhaps there's something among Dave's cunning plans, then again, perhaps not because carers are saving the government £118bn a year in unpaid services. (figures from Carers UK)

Home carers are being paid £1.70 an hour based on a 35 hour week. Let's ignore the fact that in reality we are talking about a 24/7 occupation and that their real wage is actually 35 pence an hour - but their obvious wage is £59 a week in benefit and it's taxable. Since very many carers are trying to hold down part-time jobs as well as caring, or subsisting on meagre 
occupational pensions. Some 20% of home carers will give up their working life altogether to become full-time carers.

Local authorities spend £22 an hour on home care and even the corner cutting private sector in home care are spending £10 an hour on providing so-called home care.

The government is very happy with this situation. It's also very happy to allow the private sector to provide the 70% of the home care neglectfully for communities that local authorities have washed their hands of, or, put another way, that local authorities can't get the slave labour of home carers to do for nothing.

The Institute for Public Policy Research (IPPR) has produced a useful report on this troublesome social problem for the politicians to ignore.


CQC 'serious flaws'

Is the maltreatment of elderly citizens in hospital and so-called care homes the product of a sophisticated modern high tech developed society, is it a natural development, with everyone excused by being too busy striving to care, too busy to do anything about it? And how sophisticated is this society, that legislates against assisted suicide and yet tortures old people to death in hospital with its Liverpool Care Pathway?

Is Health Secretary, Jeremy Hunt, the right man for the job, telling people:

“It’s a fantastic step forward, the Liverpool care pathway, and we need to be unabashed about that."

How did Dave forget that it was Jeremy Hunt who told the Leveson enquiry, whilst he was Culture Secretary, that he didn't know what the people in his own office were doing. Then, two months into his new role, he appeared as an expert on a procedure discredited in the public mind by press stories of elderly people being denied food and water because some twit in a white coat decided they were ready to depart the world.

Then there's the Care Quality Commission, who should be better informed than Hunt, it's their job to inspect and report on what's happening inside hospitals and care homes, yet time and again the CQC has failed in its duty.

Care and Support Minister Norman Lamb spotted there were "serious flaws" in the current system that needed addressing:

"Confidence in the regulation regime has been shaken, but we have turned a corner. I welcome the chief inspector's new commitment to protecting people vulnerable to abuse and neglect."

More turning of corners, Mr Lamb is here referring to the government's intention to introduce a new Ofsted style inspection regime in 2014. This new scheme may involve installing cameras in care homes and hospitals to keep an eye on the carers, as well as, using mystery shoppers to get the inside track on what care homes are offering. The CQC will also introduce larger inspection teams, which will include members of the public.


Backtracking on elderly care costs

Dave is wondering if anyone will notice the small print in the 'deferred payments scheme' that explains how the goalposts have been moved. Dave recalls the coalition headline on the subject of paying for care costs in old age. That fine Mr Lamb set it out for us, saying he wanted to "bring reassurance to millions of people by ending the existing unfair system so no one need face the prospect of selling their home in their lifetime."

Dave knows since the coalition have now moved the goalposts very few individuals will benefit from the 'deferred assets' scheme. Also, few will ever reach the proposed £72,000 cap on care costs, on average most people expire after two years after entering these waiting rooms for death.

Not that they have finally made clear what their intentions are in terms of long term care funding. Suffice it to say there are votes at stake here.

Be clear, the coalition's backtracking on the 'deferred payment scheme Under the Care Act 2014 local authorities in England have a duty to offer deferred payment agreements, so people should not be forced to sell their home in their lifetime to pay for care.

Local authorities must offer a Deferred Payment Agreement (DPA) to people who have local authority-arranged care and support, and also to people who arrange and pay for their own care, provided their eligible needs are to be met by care in a care home. The person must have less than (or equal to) the upper capital limit, £23,250 for 2015/16 in assets, excluding the value of their home, and their home is not disregarded, i.e. not occupied by a spouse or dependent relative.”

This can only be found in the smallest of print under their boastful headline about people not having to sell their homes. And importantly, all this nonsense does not address the slavery of home carers (including tens of thousands of children who care for sick parents) or the disgrace of the care system provided by local authorities via useless private providers. These are also issues that Dave is failing to address, at the moment he prefers to focus on the economy - he believes he has some good news there. His people may be misleading him.

The final word on the deferred payment scheme was spelt out by Lord Lipsey: "There is now a huge restriction which will mean that very few people will take advantage of the deferred payment scheme. "You are only eligible for a deferred payment loan if your other assets in total come to less than £23,250.

Assisted Dying, not this year

All the Lords a leaping spent ten hours (18/07/14) discussing Lord Falconer's Assisted Dying Bill and ended the day by nodding the notion through to a second debate.

Arguments were put forward in equal measure for both sides. Those against trotted out the usual stuff about those near to death's door being coerced and, those for, argued for empowering people to decide when it was time for them to die. However, Falconer's Bill is not about introducing Dignitas to the high street. Neither is it about sanctioning state euthanasia, well, not beyond the 1000 killings a year currently taking place.
Precisely, the assisted dying bill would allow doctors to prescribe a lethal dose to terminally ill patients judged to have less than six months to live. The dying soul would be given 14 days to reconsider their decision before any action was taken by the medics.

What needs to be highlighted here is that the medical profession, certainly at the level of all the professional bodies representing all involved are opposed to Falconer's Bill. This apparently has something to do with having taken the Hippocratic Oath not to kill their patients. The strength of opposition from this quarter may well damn any progress that the Bill might make towards a more civilized approach to killing old people. The medics have monopoly rights when it comes to dying and will not be giving them up any time soon.