Last refuge or no hiding place? The last scene of all.
By David Jolley
As young fit people, few of us have ambition to spend our last days with others in a Home shared with others who have become impaired, disabled and dependent on care from others. Older and nearer this reality we may find that it has its attractions. Albert Tatlock (Jack Howarth) famously spent his later years as a guest of the Midland Hotel in Manchester when playing in Coronation Street. At today’s prices that would cost him over £200 per day for bed and breakfast: well over £1,000 per week with little provided in terms of personal care or attention. Many fairly well off older people decide to enter a supported sheltered housing scheme or residential care home in advance of the greatest of infirmities and disability, preferring this to the uncertainties and loneliness of life elsewhere. Many thrive in their new setting and rediscover confidence and humour relieved from the strain of trying to be self sufficient and ensuring that their friends and relatives can visit secure in the knowledge that they are safe and being served with respect.
For people of lesser means this option is not available as the criteria for funding from the public purse, be it for care at home or in Homes, are raised ever higher. Only those with extreme needs are encouraged to move into care. The mantra is that people just do not want to live and die in a care home.
People who go into care, whether at their own expense or that of the authorities, make the decision because of their awareness of the loss of competencies consequent upon accumulating pathologies. Having given up their own home and established themselves in a place where they are content, where the staff begin to know them and their family, they do not wish to be required to move on.
Yet the care home sector in this country is now almost exclusively provided by independent agencies, most of them dedicated to making money for their owners or shareholders. New financial pressures on Local Authorities mean that where they have retained directly run care homes they must shed them. Where business find they cannot make a profit or can make more by using their facilities for other purposes, they close homes.
Rulings from the European Court make clear that when you enter a care home you do not have the right to stay there until you die.
The balance of evidence is that closure followed by relocation of elderly residents is certainly stressful to all concerned but need not be a threat to life so long as the process of relocation is handled according to best practices. Achieving best practice consistently is a high ambition and carries costs so may not always be attained. Thus the very frailest and most vulnerable, their families and friends and the professionals who work with them are at risk because of the vagaries and instability of the care system.
In the short term we must do our best for people despite the inbuilt hazards. Surely though we should be returning to a more generous, more stable model of care. Prices for full-time care of a patient judged to meet the harsh criteria for NHS continuing care? At roughly £500 per week, Albert Tatlock, Peter Townsend and William Shakespeare might feel that this is hardly enough when people require more than a clean bed and a generous breakfast. They need total care, skilful understanding, treatment and attention to perform the basics of life and hopefully to make best use of their remaining abilities throughout each 24 hour day. Tom Lockhart might deem the current situation a crime scene.
Dr David Jolley is Honorary Reader in Old Age Psychiatry in the School of Medicine, Manchester University. He is co-author (with Peter Jeffreys, Cornelius Katona, and Sean Lennon) of the paper ‘Enforced relocation of older people when Care Homes close: a question of life and death?’, which is to be published in Oxford’s Age and Aging journal. The paper can be read in full here.