Do old people hold the key to the next election? The government’s Comprehensive Spending Review next year will map out spending priorities for the next three years: many interests will be battling it out for a chunk of the spend, likely to be smaller than in previous spending reviews, but one area which has been the poorer cousin for too long is social care, and older people’s care in particular.
The Wanless Review, published earlier this year, has given the debate about funding older people’s care a much needed kickstart. But the proof will be whether the CSR contains more than just a sop to those who want to see increased funding and support for older people’s services. Labour must make older people’s policy a high priority, not just because of the electoral maths, but because the interests of the older poor will be neglected by a future Tory administration in favour of the baby-boomer rich.
The partnership solution that Derek Wanless and his team favoured is unlikely to be the immediate option for government. An extra £1.7 billion would have to be found – and richer older people will receive more access to free care than they currently do. This means that the extra millions will not be channelled to the least well off, but the middle classes. There is a real need, however, for extra money to fund older people’s care as it is currently configured and the Wanless Review contributed a much-needed analysis of the problems with the system as it is.
Too many older people are not having their needs met. Many older people with low level needs, such as a meals service, are unable to access free services within their local authority because of stringent eligibility criteria, which only allow those people with critical or substantial needs to receive state funding for their care. This goes against advice by the Department of Health which asks local authorities to identify individuals with low level needs which may escalate. It also works counter to the philosophy of early intervention and prevention articulated in this year’s Health and Social Care white paper. Paradoxically, a strategy which most local authorities use to contain social care costs in the short term may increase their costs in the future. This is because many low level interventions, such as installing rails and safety features to older people’s homes, may prevent events such as falls which result in costly hospital care and accelerate admission to care homes.
Current state funding levels for care homes are also too low – by around £1bn according to research by the Joseph Rowntree Foundation. This means that many self-funders in care homes end up subsidising the care of local authority supported residents, causing anger and confusion. It also results in poorly paid staff which creates high turnover and low morale. While treating older people with a lack of dignity and respect is inexcusable, such an atmosphere hinders attempts to treat residents as individuals.
Finding the extra money will not be easy, but these problems can only escalate as demographic change increases the older population’s demand for care services. Solutions such as encouraging the take-up of preventative programmes such as telecare should be at the forefront of the CSR. Telecare is a combination of communications and sensing technologies installed in an older person’s home which can help them to retain their independence, and cut down on the need to go into residential care. West Lothian Council piloted telecare for all older people who needed it and saved 3,200 hospital days a year by getting people home quicker or preventing admissions. A telecare project in Northamptonshire County Council made cost-savings of £1.5 million. Spending now will save pounds later.
A commitment to a national roll-out of Sure Start for Older People following the Link-Age Plus pilots could also help to identify older people’s needs and direct them to services. The pilots, which are taking place in eight local authorities, could ensure that older people in the future have access in every community to a one-stop-shop providing everything from housing advice and financial support, to daily activities and volunteering opportunities. The highly successful and popular Sure Start for Children is a good model to extend to older people and their families.
As well as investing in more preventative services, the CSR should also give more support to carers. Currently around 3 million people of working age juggle paid employment with care. According to the Equal Opportunities Commission, one in five carers has given up work to care. Ensuring that carers remain in work will be important to maintain a healthy ratio between working people and those receiving state funded care. One way of encouraging this would be if tax-exempt employer-provided childcare vouchers were extended to all carers. Such vouchers could increase the amount of money going towards care by almost half a billion pounds per year. This would give an incentive to carers to encourage them to care for older people in the future without forsaking their employment.
There are a number of other things the government should be actively considering – such as whether a state supported equity release scheme would help people to pay for their care, or the need for independent care advisers to help older people and their families to choose appropriate care and use their finances wisely. Politicians need to face hard choices about the future of older people’s care, and how we are going to pay for it at a time when budgets are tightening. The Labour party should be at the forefront of leading this debate, particularly ensuring that poorer older people continue to benefit the most from public expenditure.
Read Jessica Asato’s recently published report for Counsel and Care, the older people’s charity