Better At Home 2021

During the pandemic, Care and Nursing Homes are the unwilling victims of government strategy, having been asked by government to accept people coming out of hospital, without a test, and without adequate PPE, early in the crisis. Their carers and teams have provided the best possible care they could, often at risk to their lives. However, despite doing their best, the residents in their care have had the most challenging year. It has shown that the system is broken.

The 19th and 20th Centuries were the centuries of institutionalisation. The hordes of commuters, all having to get to work at the same time; the centralised, 

institutional solutions to problems; the creation of the concept of institutional care, arising from the workhouses of the 19th Century and evolving into the Care and Nursing Homes of the 20th.

This no longer works. We have seen the advantages of centralised, institutional life but there are also great disadvantages. New developments, from personalised medicine, to remote working, are going to make the way we live and work much more tailored to the needs of the individual, which will increase quality of life and happiness. The same is true with care.

Safety

Care and Nursing Homes are places which present a high risk of infection spreading quickly – however good their hygiene standards. The 2020-21 Covid crisis has shown this, with death rates of people in care homes at about 8,121 per 100,000¹. – three times the prevailing rate in the over-80s population of 2,376 per 100,000². 

These figures would have been even worse if it were not for the unselfish and caring efforts of staff, who often put their own lives at risk to help their residents.

The great news is that the roll-out of the vaccine means that care homes are less likely to be hit by the devastating death rate we saw in 2020-21. However, the epidemic shows that there is a high risk of individuals in a care or nursing home being at risk of an infection spreading., whether Covid or something else.

Dignity and happiness

In order to control the spread of Coronavirus, the residents of care homes have had to live under more draconian rules than the rest of society. 

All of us in the UK have had to endure months of lockdown but at least we have been able to go out for exercise, and at least we could see friends and relatives over the summer.

Residents of care homes have been (through nobody’s fault) denied even basic freedoms. A trip to the shops or taking advantage of the “eat out to help out” scheme was not on option for them, even in the summer.

They have not been able to see their families and friends for months at a time. It was only on the 8th of March 2021, after eleven months of isolation, that care home residents were able to hold a family member’s hand. Many people have faced a year of not being even able to hold hands with a husband or wife. The misery this has brought has been widely reported in the press and TV.

Basic freedoms

Even before Covid, those working in Care and Nursing Homes (by their nature) have not been able to give their residents the freedom and happiness that we all take for granted; which we all have at home.

The Live-in Care Hub worked with the Personal Social Services Research Unit (PSSRU London School of Economics/ University of Kent) and ran a large secret shopper survey of more than a thousand Care and Nursing Homes. It found that in many Care and Nursing Homes, freedom is significantly curtailed; for example:

• In a nation of animal lovers, in more than half of all the Care and Nursing Homes surveyed, pets are not allowed.

• And shockingly, in a quarter of the Care and Nursing Homes surveyed, residents were not allowed out of the grounds for a walk – a serious restriction of their basic right to liberty³.

Value for money

Most people are going to have to pay for at least a portion of their care. There is no way around this: local authorities’ budgets are very tight and the hurdles before they will contribute have got higher over the last two decades.

The economics of Care and Nursing Homes are similar to any institution, whether a hotel, a hospital or a school. The only way they can survive is by being as efficient as possible with their costs, in particular with the variable cost associated with labour. In just the same way as hotels have introduced buffets to reduce the number waiting staff, just as schools try to focus their efforts on the most needy people, so Care and Nursing Homes have to focus on being as efficient as possible with allocation of staff resources. Indeed, it’s important to note that majority of care home fees will go towards providing the accommodation and food, and proportionally less going towards actual hands-on care or time with caring staff to do the things that care home residents love to do. 

Even the most expensive care or nursing home carefully measures and rations staff time. The inevitable limit on staff time means that, by definition, residents can’t have the spontaneity and freedom that we all value in our day-to-day lives. If someone wants to go for a walk but needs help, this will have to be planned. If someone wants to cook a boiled egg with soldiers for him or herself, at three in the afternoon, this needs to be planned.

What does this mean in terms of the amount of actual one-to-one care you get for your money? It means that although the average price of a nursing home in 2019-20 in the South of England is over £1,000 a week⁴ homes will typically allocate around three hours of one-to-one care a day, much of which is ‘transactional’ rather than quality time spent doing what the individual would like. 

By their very design, Care and Nursing Homes can offer economies of scale. What is much harder for them, is to give their residents the one-to-one care, flexibility and freedom they deserve. Institutions can win on price but it is harder for them to win on a personalised approach to care.