January 27, 2010

UK: Care for older people is not all about keeping them out of hospital

. LONDON, England / The Guardian / Society / Older People / January 27, 2010 Plans for a national care service must be based on some fundamental principles, says Stephen Burke There are worries of a financial imperative to keep older people out of residential care at all costs. As councils finalise their budgets for 2010-11, the cost pressures on care are worrying. The harsh winter has already increased concerns about tightening budgets and the lack of support for some older people in their own homes. With the imminent publication of a care white paper and a general election, there are worries that an ambitious agenda for reforming care could be replaced by a financial imperative to keep older people out of hospital and residential care at all costs. Better care at home is what most older people want – and if it's free, then even better. But we need to ensure that proper support is available in local communities so that staying at home doesn't mean loneliness, isolation and neglect. It has to mean more than four 15-minute visits a day, rushing older people in and out of bed with no support to eat proper meals, chat or enjoy life. And it must recognise that a care home will still be the option of choice for many older people and their families. Free care would be a popular pledge at the election. People want to know what care they will get and how much they will be asked to pay. And it needs to be set in the much wider context of family policy, with an ambitious vision for a reformed care and support system that is fairly funded. The recent green paper on families acknowledges the role of grandparents. We now need to go further and look at families of not just three but often four or five generations and their mutual caring responsibilities. Grandparents in their 50s or 60s increasingly do not only provide childcare for their grandchildren but also care for their own parents – some while trying to continue working. A new care system must reflect this reality. It has to reflect the fact that older people's and carers' lives don't just depend on social care but also better housing, transport, safety and community facilities as well as adequate income. That can only be achieved by housing and health and other partners working closely with local government. So when the forthcoming care white paper maps out plans for a national care service, it must be based on some fundamental principles: universality – creating a system that everyone uses and providing support such as information, advice and advocacy to all. Portability – a national assessment process that is consistent wherever you live and that doesn't change if you move. Personalisation – giving older people and their carers real choice and control, a real voice and a chance to contribute themselves. Quality and equality – better care for all wherever they live, delivered by a better paid and trained workforce. Prevention – investing in home adaptations, telecare and other early interventions that are increasingly recognised as paying dividends. Support – for family carers and other social networks in local communities. Integration – shared local priorities reflected in pooled budgets and joint commissioning, building on the Total Place pilots. Value for money – getting care and support at the right time and in the right place. Underpinning – a national care service must be a transparent funding system. Free care could be paid for by introducing a care duty on estates, generating the extra funding needed. This would be seen as fair and simple, much fairer than losing your home to pay for residential care. The potential rewards are huge. The economic and social benefits would far outweigh the costs. And despite looming cuts in public spending, with older people and their carers making up the majority of voters at the election, no party can afford to be less than ambitious in its manifesto. [rc] • Stephen Burke is chief executive of Counsel and Care. © Guardian News and Media Limited 2010