Services for elderly people
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The National Health Service and Community Care Act 1990 made some important and useful changes, but over-reliance on contracts with the private sector has resulted in serious problems both for individual elderly people and for the sustainability of residential services. Previously private residential care was often funded through social security benefits without a professional assessment of need, and many of the people receiving residential care could have continued to live in the community if the relevant local authority had provided appropriate home care. The Act gave the full responsibility to local authorities to assess care needs and then, subject to means testing, to pay for the prescribed care package. Many of the care providers were and still are in the private sector. This was partly from policy and partly to prevent services from being rationed by the limited capacity of the services provided by local authorities. As the government paid a modest residential care allowance as a contribution to the costs of residents in private homes, this was a strong financial incentive to local authorities not to provide new homes but to rely on the private sector for any expansion. This legislation was passed at a time when local authorities were being required to expose more and more of their services to compulsory competitive tendering. The approach to community care was different. Local authorities left the choice of home or home care provider to the elderly person but set their maximum contribution according to prevailing market rates. Relatives who chose to do so could pay the extra cost of more expensive care from their own resources. During the 1990s as home care expanded and fewer care home placements were used, competition drove down the prices that local authorities were prepared to pay for residential care. Over the same period new homes were required to comply with conditions requiring adequate space, single rooms and en suite toilet facilities. Attempts to impose these conditions on existing homes led to widespread closures of both private and local authority homes, as the cost of improvement would not be recouped from the charges that local authorities were prepared to pay. Eventually the government revoked the new standards for existing homes, to avert a catastrophic reduction in the number of places. Current prices are unsustainably low, temporarily maintained by use of substandard accommodation and by wages in the private sector being lower than those paid by local authorities. Staff turnover in the private sector is high, and this damages the quality of care. Elderly people are often forced to leave care homes, and in many cases they have died very shortly after being moved. Some moves may be unavoidable; if a home is upgraded to modern standards the building works may be impracticable while elderly people are in residence. Other moves are for financial reasons that are a fundamental flaw in the legislation. Elderly residents have had to leave because their relatives are no longer willing to top up the charges, or because home owners are no longer willing to charge the local authorities' prices that have not kept pace with the homes' costs. Shortage of available places (as well as overspent budgets) led to elderly people being kept in hospital when they no longer needed hospital services. The government has legislated to require local authorities to meet the cost of bed blocking, but where the problem is lack of facilities this is not a quick solution. Recent legislation to pay without means testing the cost of nursing care has frequently been disregarded. My experiences with my mother include:
My main concern with the Health Service was the difficulty in getting treatment for my mother at all. But she was neglected in similar ways, including:
I also found that when my mother was in a nursing home her GP resisted my attempts to admit her to hospital when she had pneumonia and could not swallow antibiotic tablets. Nurses in a nursing home are not allowed to administer drugs intravenously, which would have been the only way of saving her life, but the doctor was content to let her die in the nursing home. In the end she was admitted to hospital, but survived only one more week. Visiting a hospital ward in 2003 I found that some of the faults have been corrected. In particular patients who cannot feed themselves get one-to-one attention, and beds for patients who are likely to fall out have a cot side and are positioned next to a wall. |
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Sheila
Porter-Williams |