Care homes get a bad press, sometimes deservedly. But the bigger issue is chronic underfunding and rock-bottom pay for their staff
Very few weeks go by without an abuse scandal rocking the care system. Writing this after a BBC Panorama documentary broadcast hidden CCTV footage of the alleged abuse of older people in residential care homes, there is now the grimly recurrent debate as to whether such cruelty is becoming endemic in a system in the grip of a financial crisis.
This crisis isn’t so much a big bang as an inexorable decline, thanks to years of underfunding, followed by unprecedented cuts to local authority budgets by the coalition government, topped off by its lack of urgency over a new funding settlement.
According to the latest survey by Lang & Buisson, the healthcare market intelligence provider, local authority fees for care home beds have fallen by 5% in real terms in four years. Councils are buying care beds at between 5% and 10% below the market prices.
Cross-subsidisation means care homes are charging self-funders on average 13% above market prices to stay afloat. But for an increasing number, pulling out of the state-funded care system entirely is the only way to longer-term financial survival.
This may mean a wholly two-tier system in years to come, but in the meantime, much of the sector is blighted by low-pay, low-status work. It is the home of the zero-hours contract, the minimum wage agency worker and the 20% turnover rate.
Of course, low wages and low morale do not make people cruel or abusive. But such conditions do exacerbate staff shortages and high turnover that can lead to less rigorous recruitment practices, lowered standards and people being thrown into stressful, understaffed conditions without the training – let alone the personal qualities or temperament – to cope.
Working in care is a very demanding, emotionally draining, highly skilled vocation. It’s not interchangeable with cleaning, shop work, or other minimum wage jobs, nor is it possible to do well with a day’s induction. Those who excel love it and stick at it despite the poor pay and low regard in which the public holds their profession.
They must surely despair, then, when they see another TV exposé of abuse. Because, while each instance of abuse represents a human tragedy and a fundamental failure of a system designed to care, the exposés feed our negative perceptions – indeed our fear – of the care system. And this does the vast majority of dedicated care workers an injustice. Instances of abuse represent a tiny proportion of the hundreds of thousands of care interactions taking place every day, but the media coverage these cases attract, the subsequent unpicking of responsibility, follow-up prosecutions and so on means that these loom large in the public imagination.
In polling by Demos for our Commission on Residential Care, chaired by former care services minister Paul Burstow, three-quarters of the public said they wouldn’t consider moving into a care home at old age. Of these, 54% said this was because they feared neglect or being abused, a significantly higher percentage than those who didn’t want to have to sell their house to cover costs (33%) or lose contact with friends and family (31%).
With a disproportionate focus on failure, and scant regard given to the exceptional work carried out every day by care workers, is it any wonder that the public feel abuse is rife?
The same survey found that while 24% of people on average said they would consider moving into a home in old age, this rose to 39% among care home workers. While a care home will never (nor needs) be a first choice for the majority, those who see one every day are more likely to consider it as an option for themselves.
We are presented, then, with a catch-22 situation. How do we root out abuse in care, without vilifying the entire workforce and terrifying the public? When we read of physical or sexual abuse by a teacher, we do not fear to send our children to school. And this is because everyone has been to school – we know such cases are an exception to the rule. But care homes are mysterious places, few of us pass through their doors until we or our parents have to. They are associated with frailty and a loss of independence. We have little to go on other than what the papers – or Panorama – tell us.
Why should any home strive to be better? How can they be encouraged to innovate? Care homes need fair funding and acknowledgement of their vital role in a care system where the numbers of the very old, and those with dementia, are soaring. Outstanding achievements need to be celebrated with the same vigour as failures are exposed. Without this, residential care settings will lack confidence to open their doors to the community – some are already offering day centres, GPs and MPs consulting space – and ask what future generations of would-be residents expect from communal living. No matter what resources are committed to improving the quality of care, without proper recognition, the sector will stagnate.
Claudia Wood is the chief executive of Demos
This opinion piece was first published in the June edition of Public Finance magazine
