Fundamental reset for social care?

Also LA staff are paid at a standard rate, get increments, annual leave, sick pay, etc, so it costs more to staff an LA run facility

Well, I think that's a mindset we have to dispense with. I don't care for private providers skimping on staff costs to enhance their profits.

Care workers in care homes also get increments, annual leave, sick pay etc and compete to attract staff- equivalence.

LA do not seek to make a profit, private providers absolutely do.

With you all the way Maizie ... one of the reasons that the LA homes were so good was because of the properly paid, trained and supported staff with decent working conditions. Happy staff give a better service.
I don't mind us paying for good care and staff conditions ... I do mind paying shareholders for poor care.
We cannot base our services on the lowest common denominator.

Continuing Health Care, has always had a very strict criteria and you practically had to be on deaths door to get it. I know nurses who were assessors
and filled out the paperwork for it and even they said the criteria was too strict.
My personal thoughts are:
1)Paid carers need to be properly trained and regulated. Travel time between calls should be paid time and allowed for.
2) Unpaid carers need to be heard and their health ( mental & Physical )checked up on regularly( 6 months?)
3) Respite care for those that want should be re-introduced , day centres and longer.
You hear so many horror stories about paid carers practically running in and out of calls, being aggressive to clients , when you are infirm , young or old you can't be rushed. But also some clients will also be aggressive to the carers too unfortunately.

MaizieD

^Also LA staff are paid at a standard rate, get increments, annual leave, sick pay, etc, so it costs more to staff an LA run facility^

Well, I think that's a mindset we have to dispense with. I don't care for private providers skimping on staff costs to enhance their profits.

I agree, but there is no doubt at all that it costs more. The other cost to LAs that I forgot to mention is the capital and maintenance costs of buildings, which are kept to a higher standard than in the private sector. It’s not that that isn’t what we should want, it’s that it comes with a price tag, and the public need to understand the full implications of the options.

62Granny

Continuing Health Care, has always had a very strict criteria and you practically had to be on deaths door to get it. I know nurses who were assessors
and filled out the paperwork for it and even they said the criteria was too strict.
My personal thoughts are:
1)Paid carers need to be properly trained and regulated. Travel time between calls should be paid time and allowed for.
2) Unpaid carers need to be heard and their health ( mental & Physical )checked up on regularly( 6 months?)
3) Respite care for those that want should be re-introduced , day centres and longer.
You hear so many horror stories about paid carers practically running in and out of calls, being aggressive to clients , when you are infirm , young or old you can't be rushed. But also some clients will also be aggressive to the carers too unfortunately.

You make some excellent points 62 Granny.
1) The Care Quality Commission as regulator does inspect and regulate all care homes . It is mandatory for private care homes to ensure that their carers are properly trained. Every care home is rated by the CQC- see their ratings on the care home website.
2) All family carers are entitled to their own carer holistic assessment- ask GP and/or DN.
3) Respite care is available for self funders in some care homes if they have bed capacity, ie an empty bed attracts no payment. Free availability is very patchy plus private care homes don't want empty beds ie keeping a respite bed free in case someone requests respite. It's expensive- who pays? Needs to be considered in new model.

Yes, patients with dementia can be both verbally and physically aggressive to carers. Patient should have a behavioural risk assessment completed and the carers should receive training in how to care for patients with dementia. Ongoing Community MH engagement might be necessary and behavioural modification medication can be requested. and prescribed by GP.

Travel time between domiciliary calls, particularly in rural areas or city centre areas with heavy traffic and parking restrictions- is a key issue.

I’ve been thinking a bit more about the role of Local Authority managed care homes. My recollection is that the ones in my area at least, were residential homes, with no medical input other than through GP visits, and nursing input only for individual people through the district nurses. It would require a huge model shift for LAs to take on people with more complex needs. Residential care is no longer the preferred model for older people, who are now supported in the community for as long as possible, so if the an LA managed residential homes model was re instituted, presumably it would need to be very different to previously.

LA care homes in my area traditionally were either dual registered for both Nursing Beds and Residential Care (as would now be known as Social Care now) beds.

Or registered as a Nursing home or a Residential Care Home. That is there was a mix. Nursing Homes were equipped and still should be today, to care for patients with complicit care needs.

Nursing Homes or dual registered homes with nursing beds would have to have a Registered Nurse, on site/duty at all times to gain registration. Residential homes need not necessarily have RNs on site and depend on NHS ancillary nursing services to come in- e.g District Nurse, Continence Nurse, Tissue Viability Nurse, Diabetic Specialist Nurse, Parkinson's Nurse etc.

The 1960s and 1970s was known as the Residential Era a heavily paternalistic care environment. There were many so called Geriatric Beds in the NHS delivering free care. My Gran used to work at Salford Royal Infirmary as a care assistant on a Geriatric ward and I remember going to see her at the end of shifting to walk back to her house together in school holidays.

Rising costs and the desire for a better quality, less institutionalised care model led to the Community Care Era in the 1980s/1990s. Governments heavily invested in domiciliary support and home care and there was a strategic push to help older people age in place. Our Primary care Trust had a Strategic Care for Older People (SCOP) plan. There was a big push to close down all the older care hospital wards and get all the patients out into care homes. This coincided with many, many private care providers coming into the care home market to accommodate this shift. All the staff on those wards had to be interviewed for jobs in the remaining complex care/rehabilitation ward beds but many went to work on care homes opening up or other settings.

The NHS CHC National Framework legislation emerged to determine care needs, ie whether predominantly health or social care. The rest followed as in posts to date.

Time for another new Era?

Definitely time for a new era.
The current system has been tried and found very much wanting.

I do need to disabuse people if the seemingly intractable idea that to get CHC funding you have to be "practically at death's door." This is not so ... you simply have to fulfill a number of criteria over different needs to qualify. I have obtained it for young disabled people ... predominantly with brain injuries ... whose life expectancy is normal.

Yes, that’s what I am used to in terms of registration as well Lemonjam, but I’ve never come across a dual registered home with nursing beds that was run by a LA, only privately owned establishments where that happens.

Luckgirl "I do need to disabuse people if the seemingly intractable idea that to get CHC funding you have to be "practically at death's door." This is not so".

I completely endorse this.

Luckygirl3

This for instance .....

The Scandinavian model

Denmark is often regarded as the gold standard.

Older people are supported at home for as long as possible. Municipalities are responsible for:

home care
personal care
rehabilitation
nursing care
equipment
housing adaptations

District nurses, therapists and care workers work together as one local service. The municipality receives tax funding to provide both health-related community services and social care, so there is much less argument over "whose budget" something belongs to.

I would have thought Andy Burnham might be interested in the way Denmark does this. It sits well either his ideas on devolution. Thanks for the research Luckygirl.

with not either!