This is my first blog about Covid, and was a letter for the Guardian. There is a lot of talk about how the reported cases of deaths among those in care have been excessive. The writers seem to think that it is a basic vulnerability among such a predominantly elderly population, but that is only part of the story.
They are missing the point when trying to explain why there is such a sudden surge in Covid 19 fatalities in care homes, and supported living in private homes. It’s mainly caused by the way those services are funded and managed.
Care homes used to be paid for by comprehensive grants from local authorities. They had permanent, full time staff who were not only reasonably paid, but provided continuity. They came to know and value elderly people, and those with mental or physical disability. Above all, they had consistent and knowledgeable relationships.
A similar situation existed with domiciliary care in people’s own homes. Such care is not cheap, and so a new policy was developed, whereby every recipient was given a care plan which specified, hour by hour, the nature and quantity of care, including everything, from eating to sleeping, and all other needs. These ‘hours’ are allocated throughout every day, but not every hour. Residents do a lot of sitting around!
In some cases, where an hour can be shared, a fraction is calculated. In others, a whole house is supervised, with staff sleeping on site. All these hours are totalled and paid for by local social services, and the money passed to the provider: usually a commercial company, but sometimes a charity at a rate of about £16 an hour. They then pay the carers less than £10 an hour and, in some cases, minimum wage.
Many carers are self-employed, and many visit a number of homes and ‘clients’ during a shift. In some cases, hours are divided up and a visit can be 15 minutes. Carers with multiple calls on a shift spend hours a week travelling.
So I want us to picture that army of carers, running around our towns and villages, permanently tired, in a hurry, and unable to provide more than the minimum on the clients care plan.
It is no wonder that the care homes and supported living clients have been hit the hardest in this crisis. Just imagine all the calls on close physical contact of necessity, and from perhaps five or six different carers in a day.
We who have been watching this from within for years as parents, and trustees, could have told anyone that running care on an industrial model, demanding ‘value for money’ is a very bad idea. In other countries, care homes and domiciliary care are fully staffed to ensure professionalism and continuity. Supported living is a normal provision.
Care should be a fully funded activity, which would retain consistent staff who gained in knowledge and skill. It would also mean far fewer people visiting a care home and, sometimes, only one person visiting a private house or flat from day to day, with the whole service properly paid, with the cash going to the care staff, and not a private care industry.
Care services must be delivered and paid for as a national priority. Not in order to answer the policy of saving taxpayers money. Maybe all those elderly deaths will be honoured by a serious reform. In the end everybody is going to need a bigger share for care accordingly.