Social care, the market and the prospects for a National Care Service

John WoolhamJohn Woolham is Senior Research Fellow at the Social Care Workforce Research Unit. (524 words)

Professor Guy Daly, Executive Dean of the Health and Life Sciences Faculty at Coventry University, Bleddyn Davies, Emeritus Professor of Social Policy at the Personal Social Services Research Unit and I spoke at a Research in Specialist and Elderly Care (RESEC) seminar on 10 March at the House of Lords. RESEC is a national charity whose principal aim is to promote research and teaching in social care by identifying priorities for funding and teaching and securing funds to invest in these priorities. It provides finance for agreed projects and ensures findings and outcomes are publically disseminated. Continue reading

Beyond measurable outputs: What matters in social work practice with older people?

Valerie D'AstousVal D’Astous is a PhD candidate at the Institute of Gerontology, King’s College London. (969 words)

As I walked past a small group of men for the second time, in search of the location, a cheery, ‘Can we help you luv?’ was offered. Paper in hand with the address, I knew I was close, but gladly accepted their offer. Two gentlemen ended up walking me around the corner to the place I was seeking, the Burrell Street Sexual Health Clinic. ‘Hope all goes well for you,’ one gentleman wished me, as I thanked them and said goodbye. I laughed as I entered the building, the site for the Making Research Count Conference: Rethinking Social Work Practice with Older People: Threats and Opportunities. I knew I was in for a great day! Continue reading

Where next for integration and funding?

John Woolham

John Woolham

Martin Stevens

Martin Stevens

It is estimated that the NHS faces a shortfall of at least £30 billion a year within a decade and possibly a deficit as high as £50 billion. Martin Stevens of King’s and John Woolham of Coventry University report on an event last month where experts debated funding and integration in health and social care. (1,369 words)

At a SSRG-SSCR event on Integration and Funding of Health and Social Care held at the LSE on 18 June José-Luis Fernandez of LSE opened with a statistical review of the decline of social care service provision since the 1980s, which had become especially marked since 2008-09 with the contraction in public spending—despite increases in the numbers of older people over this period. While this could in small part be due to better targeting and more effective services, his conclusion was that there was a great deal of unmet need in the community. Continue reading

Letter from Sarasota: support services for older people

Valerie Lipman

Valerie Lipman

Dr Valerie Lipman is a social gerontologist and independent researcher. She reports here on support services for older people in Sarasota, Florida and particularly on the growing trend there toward ‘board-and-care’ arrangements in private homes. Could we see more of this in the UK?

I’m in the old age capital of the world. Sarasota on the Gulf Coast of Florida, USA boasts a total population of 386,147 of whom 32.5% are over the age of 65 years. And a third of that grouping is over 85 years. In the UK, the equivalent would be a town such as Christchurch in Dorset where 30% of residents are aged 65 and over. The national figure for the 65+ population in the USA is about 13%, and just under 18% for the State of Florida as a whole. This makes Florida fairly similar to the UK where the equivalent figure is just under 17%.

Older people come to Florida from across North America, and some from Europe to live here*. The sun shines most days, though it’s been a bit like England lately—teeming, non-stop rain and colourless skies. But freak days aside, it’s mostly a pleasure to wake up to.

With such a large older population the scope for delivering and trying out new support services feels almost endless. The general aim is to encourage ‘ageing in place’ and there are scores of home agencies, as well as ‘homemaker companion’ services, providing friendship and support. The former are registered services, the latter are not.

But just the same, many want or need the certainty and security of residential care. From continuing care retirement communities (CCRCs) to nursing homes there are innumerable private registered bodies in the Sarasota area offering services to older people. CCRCs offer a full range of housing choices and services on one campus—from independent living to assisted living to skilled nursing in an attached facility. The skilled nursing option costs $4,000-$8,000 per month in addition to entrant fees ranging from $150,000-$600,000. Assisted living facilities (support centres are called ‘facilities’ here) and memory (dementia) facilities/homes average around $3,000-$4,000 per month. There are also State-run services. Classically these are nursing homes, for which you have to demonstrate income below a certain level to qualify for what’s known as the Medicaid waiver.

But what do you do if you find yourself caught in the old eligibility trap of being too rich for Medicaid and too poor for the private homes? You could take a risk at one of a growing number of ‘private care homes’—also known as board-and-care homes. They are not the private homes of the UK that can serve any number of older people. Homeowners offer long-term personal and less regimented residence in a family friendly environment for one or two elders as a home business. These homes are not, however, regulated by the state.  They don’t have to meet any of the rigorous requirements that apply to group homes and assisted-living facilities (see Barbara Peters Smith, ‘Private-home care could become more common for elders’, Sarasota Herald Tribune, 23 January 2014).

They do, however, fill a huge need when it comes to cost. People will tend to hand over their pension to the homeowner to take care of them. No one knows how many of these homes exist. Most operate by word-of-mouth referrals and are private-pay only, but they are on the increase in an area where there is pressure on affordable places for the growing 80+ population. And like any other home the residents are dependent on the good will, attitude and behaviours of the owner/manager. Without family or friends to check out what’s going on, the scope for abuse is endless—at every possible level.

Yet, with some regulation and light-touch inspection, could this be added to the options of support for older people in the UK? It may be that Shared Lives is our take on this—an adaptation of what used to be called adult placement or adult fostering, but with the critical difference that Shared Lives arrangements are registered and regulated.

Sarasota is dealing with the complexities of an ageing population that we will have to meet in the UK in time. How to provide sufficient and varied enough facilities capable of offering security, safety and care in a homely environment that are not strangled at birth by hide-bound bureaucracy or slip into becoming exploitative ‘senior farms’?  Watch this space!

Dr Valerie Lipman is undertaking an investigation of how recent government changes in public services in the UK are impacting on BME elders. You can contact Valerie on valerielipman2003@yahoo.co.uk


*Projections from the University of Florida’s Bureau of Economic and Business Research (BEBR) show the percentage of the 65 and over population increasing to over 35% by 2020, and almost 40% in Sarasota County by 2030 BEBR, Florida Population Studies, Volume 44, Bulletin 159, June 2011.

 

Expectations and reality: social care support in old age

Jo Moriarty

by Jo Moriarty

Two weeks ago I went to Greenwich Pensioners Forum. Last week I was at the Hackney Older People’s Reference Group. In the last month, Unit Director Jill Manthorpe and I must have spoken to almost 500 older Londoners at various meetings. Without exception, the discussions have been lively and well-informed but running through them has been uncertainty about the future of social care support for older people.

These experiences made me question a widely held assumption about how baby boomers, those born between 1948 and 1964, will experience old age. I have lost count of the times that I have heard commentators, policymakers, and researchers tell me that services for older people will improve because baby boomers have higher expectations and will demand good quality support. So that’s why reports such as ‘Close to Home’, undertaken by the Equality and Human Rights Commission, express concerns about the quality of care services and Age UK organises a ‘care in crisis’ petition. It’s simply a question of older people upping their expectations!

Some years ago I was sitting next to a member of our Service User and Carer Advisory Group listening to yet another lecture looking forward to this new dawn. She has been a campaigner and activist throughout almost all her life. I asked her what she thought of the views being expressed. ‘Oh, I don’t think the baby boomers will find it so easy’, she replied.  ‘They don’t know how to act collectively’. Perhaps she is right. After all, individualism has been identified as a core value of the baby boomers.

Recently, in a discussion on the radio programme You and Yours about the proposal to allow 16 and 17 year olds in Scotland to vote in the referendum on independence, Ben Page of Ipsos MORI said that if their turnout was anything like that of 18-24 year olds, their votes would be unlikely to influence the result. Perhaps it’s significant, he added, that older people are more likely to vote and benefits for older people such as the winter fuel allowance have remained untouched. This discrepancy between older and younger voters is especially high in the United Kingdom where in the last general election, 84 per cent of people aged 55 and over voted compared with 61 per cent overall.

It’s true that many older people don’t feel that they have enough information about what support is available and how to access it and the increasing reliance on websites alone as an information source means there is a risk that the digital divide will widen. At the moment, less than a third of those aged 75 and over have ever used the internet, an important statistic in the light of proposals for online information and advice in the Care and Support White paper.

However, we also should not forget that public knowledge of how social care is funded remains very low. The literature review carried out as part of the Dilnot Commission on the Funding of Care and Support  quotes one survey reporting that a third of people still think that local councils provide free home care! As changes take place as a result of the Care and Support White Paper and as local councils tighten their eligibility criteria, I wonder how many baby boomers envisage what their future care needs might be and how they will be able to fund them.

Jo Moriarty is a Research Fellow at the Social Care Workforce Research Unit at King’s College London and tweets as @Aspirantdiva. Jo is speaking about her research project, Social care practice with carers: an investigation of practice models at the School for Social Care Research on 7 November.