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Care home survey
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What is to be done?
This survey has indicated the extreme dissatisfaction felt by many care home owners, particularly of smaller homes, with the level for funding provide by the local social services authority and the number of regulations and standards introduced by the Government.
Clearly, the balance between income and services provision has tilted against care homes, causing four-fifths of care homes in our area to consider refusing state funded placements and half the homes to close.
On a local level, social services have made some progress but recognise that they are not able to provide sufficient fees for care home owners. Somerset County Council Social Services currently has a target of being able to pay providers £400 per week nursing fees. However, the Department has said that the latest Social Services Standards Spending Assessment (the grant given by the central government to pay for social services locally) has made it very difficult to pay over £370 per person. However, Somerset has a good record of service and has invested to ensure there is adequate care for frail elderly people and those with mental health problems.
The local social services department works closely with care home providers to marry supply and demand. At the moment the social services department, NHS and care home managers, and other stakeholders are discussing a number of innovative ideas to cut costs in the medium term without compromising care standards. For instance, currently even small nursing homes must have a NHS nurse onsite. It may be more effective for a nurse to support three or four nursing homes in one area. Other ideas that can be explored are finding ways to allow more elderly people to stay in sheltered housing or their own home (as many would prefer) by having a care assistant allocated to a sheltered housing block.
In this way, the demand for nursing and care home places would be dampened, so allowing greater choice for those individuals who need to be housed in a care home. Although such ideas are useful, it is doubtful whether they will be enough to stem the loss of care home beds let alone raise them.
The bottom line though is that Somerset County Council can only realistically achieve their £400 per week target for its placements if there is a rise in the Social Services SSA. However, there is along way to go until this aim can be achieved. Indeed, the Local Government Association estimate that nationally there is a £1bn shortfall in the funding of care for vulnerable people. One-off payments such as the 300m the Government plans to allocate over 2001-03 to tackle bed-blocking are no substitute for a fairer funding system which takes into account the need each area has for care home beds and the costs local care homes are facing. The root causes of the malaise in the care home sector have to be tackled by making the funding system fairer and more generous.
The massive gap between cost increases and fees increases, and the real risk of a haemorrhaging of care home beds, therefore demands a strategic review of the whole system, taking into account staff shortages, care home capacity, local government funding and the NHS. This would include an urgent review of care home fees levels and their impact on the supply of places and an independent review of the compliance costs of the new care standards and the impact on the quality of care. We need to see an end to the postcode lottery on fees with the introduction of national standards for setting fee levels linked to demand for care home places and the cost of compliance with new standards.
The review of care homes in Somerset shows that the current situation is unsustainable and is likely to lead to a large number of care homes closing their doors to state funded residents. If the Government could measure the costs the care home sector has had to bear in each area, the level of demand for beds and the level of fees required then it would be in a position to provide fair funding for all. If the Government could then be persuaded to invest more in social services for the elderly, then local authorities be able to provide long term, sustained investment in social care, informed by a realistic assessment of what is needed to deliver real improvements. |
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