Two tier care-We already have it!

June 11, 2012 | By | Reply More


Care costs

Cuts have started to bite in the care sector but the state still expects care home owners to provide acceptable care when the fees it pays don’t meet the costs, writes Blair McPherson

Three years ago I was a director in a large local authority social service directorate which had as its stated aim to close the gap between what we paid residential homes and what it cost for a bed in one of our few remaining homes. We had long recognised that the quality of care we wanted to buy could not be provided at what we paid. We accepted that it cost up to a £100 a week more to provide a bed in our local authority run care home.

Like many local authorities in the north of England we had been able to keep prices low locally because there was an over provision of care homes for older people. Most of the homes were small businesses in which the owner calculated better to have a local authority funded resident than an empty bed. This meant that those residents who were funding themselves were in fact subsidising those funded by the local authority.

In the budget each year we introduced additional money for quality premiums as a way of narrowing the gap and getting improved quality. We paid more for a bed in a home that employed over a certain percentage of NVQ qualified staff that could demonstrate low staff turnover and had achieved Investors In People status. We hoped that in order to retain experienced and qualified staff and attract the premium, homes would pay above the minimum wage despite the local employment situation.

Then we were hit by the financial crisis. Budget cuts meant the policy of narrowing the gap could no longer be afforded. Residential care fees were frozen; at first, just for one year but as it became clear that the period of austerity was going to last maybe five years then, despite the agreement to review fees annually, realistically the freeze had little prospect of being lifted.

I am therefore not surprised by a recent survey that reports homes are focusing on wealthier residents – those who can afford to fund their own care. Nor am I surprised to learn that local authorities are delaying the admission of elderly people in to homes such that the difference in life expectancy between the self funder and the publicly funded is measured not in weeks or months but years.

The report, which surveyed members of the National Care Forum and English Community Care Association, which represent care providers in the voluntary, private and not for profit sectors, warns of a two tier system of care for older people but there is evidence in many parts of the country that it has already arrived.

Homes that have relied on local authority funding for the majority of their residents have been going out of business and homes that took a mixture have increasing only been willing to accept a local authority funded older person provided the family will pay a “top up”. A few years ago this top up might have been £20 or £30 a week but as the gap between what it costs to provide care and what the local authority is able/willing to pay has got wider so top ups have got bigger – much bigger.

Not everyone has family who can or who are willing to pay a top up so the choice of homes for someone relying totally on local authority funding is very limited. There may be nowhere in their locality, there may be nowhere near where family members live. Where there is a place it is probably in the least desirable area, in a shared room with no en suite facilities and little access to green space.

There will always be some people who need residential care in the later stages of their life, there will always be some people who don’t have savings or a house to sell to fund this care and who don’t have a family able or willing to help out financially. So in these circumstances the state will provide but how can the state expect care home owners to provide acceptable care when the fees it pays don’t meet the costs?

Blair McPherson writes his own blog or follow Blair @blairmcpherson1

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Category: Care Home Finance, Care Home Funding, Care Home News, Care in Wales, Care Industry News, Care Operators, Care provision, Care Quality Commission (CQC), Elderly care, Nursery care, Residential Care

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