This is a post about a very British problem known as ‘bed-blocking’. I’ve just read yet another article on the crisis in social care. How older people are staying longer in hospital than they should because there is no ‘social care’ out there to allow them to return to their own homes, thus reducing the number of beds available to even more older people. This time in chasing a solution, the government apparently set up something called the Better Care Fund, which brought together NHS England, the Department for Communities and Local Government, the Department of Health and the Local Government Association to plan and implement seamless health and social care services across England. All of this with, btw, a £5.3bn budget that aims to fund ways that the NHS and local government throughout England can work more closely together.
Hmm, I’m using some of their jargon there, so, note that this is about ‘aiming’, ‘planning’ and ‘implementing’. In other words, people at the top level with (no doubt) a lot of goodwill and enthusiasm, are meeting to plan these things. But down where older people are in hospital or worse, in their own homes, waiting for a carer to appear to help them out of bed and into their clothes, put a wash on and make a sandwich (all in 15 minutes) what exactly has been implemented?
Look. It’s the same old, same old. The government gives x amount of money to councils to give y to the NHS (or the other way round) or, in this instance, money to both together. And all of this to unblock beds. But it is always insufficient, so z, or ergo, there is a crisis.
Sigh. I’m so bored by these articles. ‘Angst, angst’, ‘oh, no, what a disaster’, ‘terrible situation’, ‘no money for it’, ‘what a calamity’, ‘what a crisis’ etc., etc. This. Is. Not. News. The current increase in older people needing help and assistance is not current at all. This increase of older people with the consequence that some of that number will need ‘social care’ has been known about for decades. I clearly remember taking an Open University course and looking at this demographic ‘surge’ in older people (please read in an ironic tone) when I was all of 35, so that was (coughs and clears throat) 35 years ago!!!
So, let’s unpick this absolutely and totally known and foreseen ‘crisis’.
The increase in older people has been a given for many years. But what happens as we age has not been tackled by anyone, least of all older people themselves. I am not, however, putting blame on any older person, but I am going to look at how political and societal choices create false crises. Also, I’ll look at how there are, at some point, decisions to be made about, not retirement (when everyone hopes to have a really jolly time) no, I’m talking about, the decisions that need to be taken about what we do when we are frail.
OK, so what exactly is ‘bed-blocking’ which is, btw, a horrible word casually used by all and sundry.
Bed-blocking occurs when people who are medically fit for discharge cannot go home because there is no care in place for them to manage at home. So, people stay in hospital causing wards to be full and adding to the strain on A&E, and adding to the length of waiting lists for operations because there are no beds available. And incidentally, with the bed-blockers losing the will to live, and certainly the use of their legs. Just think about it!
So, it must be that this big fund has to go on a whole raft of paid carers? Recruiting people, training them and then employing them? Of course, I remember when carers for older people were employed by Social Services. These carers had a career path with job security, continuous training and a pension at the end of their working lives. That’s long gone. All paid carers are now part of the private sector with large agencies employing them on an hourly basis and Social Services commissioning some agencies to be their provider of social care, which I think is the current jargon.
And don’t forget if you have any savings, or an actual house, you will be expected to pay for the lot, and usually organise this as well. Is it that some of the bed-blocking (ergh) is by some who can afford to pay for their care but haven’t organised it yet or don’t know how to? I don’t know. Someone out there, please tell me what proportion of older people stuck in hospital are self-funding? Or, are they all under the £23,000 mark? Btw, you might think it intrusive, to ask this question, but Social Services will investigate each and every person’s capacity to pay so mark this, you’ll have no financial privacy when you become frail.
But even so, whatever proportions of potential self-funders there are in the number of bed-blockers, is it not that the number of carers providing care is critical to solving this crisis? And not only the numbers but the type of person, the calibre, their training and their place in society because it must be, surely, that these people are pivotal to our old age. Who are they? And moreover, should they not be revered, admired and valued in our society? Should this not be a highly regarded profession? The articles in the press never seem to cover, let alone mention, this aspect of social care.
It is always about the money. And the money never quite does it. There’s always bed-blocking. And so it goes. And the idea is always, in the background, that there isn’t enough because as a society, we can’t afford this social care.
Is that the case?
Funny how Brexit is going to cost us billions, and that somehow these billions will be found. Similarly, we can always send a few jet fighters to drop bombs on 3rd world countries and have nuclear weapons, nuclear submarines and aircraft carriers along with large train projects, which also cost billions.
Yes, these are choices that we have made as a society in the polling booth and no doubt, in focus groups and polls and that referendum. We have chosen these policies, and somehow we choose, or our politicians that we have elected, choose to underfund social care.
Yes, I would argue, that it is a deliberate choice to have this crisis, which you might have noticed occurs every winter.
What I object to is the paucity of thought behind this current crisis. Yes, there is a ‘fund’ but it’s all about fire-fighting the ‘crisis’. There are no radical ideas within it whatsoever, apart that is from two very distinct and separate organisations, the NHS funded one way and Social Services funded another, aiming to work together. And that’s easily said and decided at the top level of management who all ‘want to work together’, but at the bed-side of someone who’s just had a stroke or the disabled person waiting to get out of bed, it’s less easy, and all dependent on that under-paid, harassed and often maligned care worker.
And why the focus on social care? Well, of course, everyone wants to stay in their own home for as long as possible (so they say) so if you become frail the usual answer is a paid carer coming in to your home. The alternatives are your relative or your neighbour (see below) looks after you. Or if that becomes too much for your relatives there is a care home if you are not too ill, or a nursing home if you are.
If this sounds a bit basic and bleak there are other more radical alternatives for housing as you age. For example, recently, co-housing has been in the media. This is a usually a cluster of homes and flats run by the owners with some communal spaces and activities. These co-housing projects can be small, maybe two or three people getting together, or much larger. One large project, for example, in High Barnet, North London, is just about ready for occupation. Mind you the article I read made my toes curl up as it’s for women only and they interview you as part of the process before you can buy into the flats – hmm, this may appal some readers but that’s not one for me, thanks!
Far more common are the ubiquitous retirement flats, which can be found all over the UK and are usually managed by a Housing Association, which me and Mr Frugalfashionshopper are going for.
But it seems to me (and correct me if I’m wrong) that neither of these options really get to grips with frailty. I’d like to know how these dynamic people project managing their co-housing will deal with incontinence and dementia; their own as well as others.
But it is good to think outside the box and go for these interesting and more radical ways of living as we age. Personally, I think there is far too much emphasis on bed-blocking and not enough on prevention.
I’ve said this before but I’d like to see government money going on one-to-one Personal Trainers for 6 weeks a year for every older person over a certain age to relearn skills and live as well as possibly before they ever get near a hospital bed. Why not? We can’t go on with these continuous crises. Or perhaps we will.
And additionally, I think this constant emphasis on older people as bed-blockers reduces older people to ‘that problem over there’, ‘that crisis in the months of the winter’, ‘those poor old things that can’t get out of that particular bed’.
Hey, you, yes, you, that journalist/civil servant/NHS manager, we can take some responsibility for ourselves, you know. We can make decisions. And if we don’t we should. We need to examine our own mortality, or at the very least make some practical decisions.
So, if you’re approaching 70, where are you going to be in 10-years-time? In your own home? Lovely for most of you. But:
- Is your house adapted? Can you turn that lovely bathroom with a roll-top bath into a shower room? Where should some hand-rails go? Can you manage the stairs? Does your house have steep steps up to the front door? What can you do now before anything happens?
- Who will help you get dressed? Yes, seriously, who?
- Who will help you around the house? Your husband? Your wife? Your daughter? All the time? Forever? Perhaps make arrangements before the crisis.
- How will you get food into your house? If I hear your answer is ‘oh, I have wonderful friends’, ‘oh, my neighbour will take me/get my shopping’, and worse, still, ‘oh, my daughter will do this and/or that’, that is just not good enough. What? You are going to be dependent for ever on your children? At the very least, get an online food shopping account on the go before it’s something you can’t cope with, please!
- Who will take you out to those essential appointments? Your son? Your daughter?
And finally, do you want a social life? I aim to document how the post-war baby-boomer older person ages. Because, will we be as lonely as the pre-war, non-social media older person who barely uses email (there are those, you know, really, there are, still, and some younger than me) let alone Facebook?
Will the connecting, iPhone older person lack contacts, networks, links? My iPhone is my newspaper and an intellectual gateway and link to exhibitions, the Arts, articles, politics, and above all, people. I can’t see it, unless of course I couldn’t see, but then I’d wire my radio into my head, and if I couldn’t hear or more importantly, understand my radio, then, dear reader, disconnect me from life. And that, I think, is a whole other debate!
But don’t read any more articles about crises in social care – unless that is, you see it as totally manufactured ideological nonsense designed for all of us to think of older people as a crisis, and for us to be grateful for any small solution that puts a plaster over society’s blind spot – which is, we are all going to be frail one day, in ever increasing numbers. The point should be how do we deal with this? Rather than, this forever throwing up of arms and declaiming, ‘oh calamity’ we can’t cope and haven’t got the money’ etc etc.
This is so boring. Instead, perhaps we have to be a bit more radical in our thinking about being old, both personally and politically.
Penny Kocher, 12th December 2016
P.S. I’ve been writing a piece on Brexit for ever it seems, but I’ve been very busy – excuses, excuses! However, I’ll be posting on Brexit by the end of the week. In the meantime, the above is a straightforward rant, apologies, but the phrase ‘there’s a crisis in social care’ makes me so cross! That’s not news!