The provision of care to elderly people in the UK needs a new approach.
At present elderly care is mainly provided by local authorities and not by the NHS. Carers typically visit clients one or more times a day, providing a variety of services. It appears from press reports that these services are frequently rushed and clients and their families express much dissatisfaction (to say the least). Carers work under considerable pressure and receive low pay, often just minimum wage, for their work. There is a major disconnect between NHS services and local authority care services, resulting in many elderly people being kept in hospitals when they would be better off receiving regular visits from carers in their own homes, or in a care home. The cost of providing elderly care services is very high and likely to climb much higher in future years, as the UK’s population continues to age.
At the same time, much elderly care continues to be provided by spouses and family members, friends and neighbours, for no (official) charge.
At a time of great pressure on public funding, and a general unwillingness in the UK to pay increased taxes, we need a new approach to providing and funding elderly care. I consider such an approach should include the following elements:
Continued need for substantial government funding
– There will continue to be a need for government funded care for individuals who lack the private resources to pay for it.
Individuals must pay for their own care where possible
– Individuals who can afford to pay for their own care should do so, or at least make a substantial contribution to the cost. Pressure on funding will inevitably result in individuals having to pay for more of their own elderly care.
Assistance from family members should be encouraged and possibly required
– Family members should be encouraged to provide such elderly care as they reasonably can, having regard to their personal circumstances. Clearly if all family members live far away or are estranged, this will not be possible; however, in many cases there are family members living with an individual in need of care, or who live nearby. Family members who are unable to provide direct care could instead be asked, or even required, to make a financial contribution to the cost of providing care services to close relatives.
Facilitate the involvement of neighbours
– We should also do more to encourage neighbours to become involved in providing elderly care on a voluntary basis – this already happens on an ad hoc basis in a great many cases, but many neighbours who would in principle be willing to help out individuals requiring care are put off by bureaucratic obstacles and/or the fear of incurring liabilities to individuals they help. These are by no means minor concerns, but could we not do more to mobilise caring neighbours by setting up a system of local “care offices” that would match those in a locality who are willing to provide elderly care services on a voluntary basis with individuals who need such care. Alternatively, existing charities such as Age Concern could be asked to co-ordinate such services. Voluntary carers should also benefit from insurance cover to protect them from claims that might arise from the services they provide.
We need to take a broader view of what ‘care’ involves
– We need to encourage a broader view of what “care” actually involves. Depending on a person’s age and their state of health and disability, the nature of the care they require will vary enormously from one individual to another. Some individuals may simply need help with getting in groceries, keeping their home clean, and assistance in going to medical, dental and podiatry appointments. Others will need the full gamut of care services ranging from help in getting in and out of bed, taking a daily bath or shower, preparing meals and the use of the toilet. An individual’s needs are likely to vary considerably over time. Such a wide range of services could be provided by a wide range of individuals (whether employed carers, family members, friends or neighbours) possessing widely varying skills and experience. Not every carer needs to be capable of providing the full range of services an individual may require.
We need to be more flexible in funding care
– In the same way that we should take a broader view of what “care” involves, we should be more flexible when it comes to funding care. Government funding and individual resources will always be required. However, as noted above, could we not consider requiring family members to bear part of the cost of providing elderly care for close relatives if they cannot provide care themselves? Could we not also consider making payments to friends and neighbours who provide elderly care on a voluntary basis? Another possibility would be to keep records of voluntary care provided, which would entitle those who provide the care to receive care themselves at a future date free of charge?
The use of digital technology in coordinating care
– We should also do more to use digital technology to identify elderly care needs and co-ordinate how such needs are met. Every individual needing care should have a single “care profile” that would enable those with responsibility for their care to bring together the requisite carers and track the services that are provided. This would facilitate the involvement of different bodies such as the NHS, local authorities and “care offices” of the type I have described above in meeting the specific care needs of each individual requiring care. It could also help in identifying important changes in an individual’s care needs that could otherwise be missed.
The provision of elderly care is a key issue for our times and we cannot long continue the present system of providing it without major change.