On the 17th of February 2020 the Daily Telegraph led with a front page headline article, “Dementia patients dumped in hospitals“.
The article told of the closure of numerous day care centres and care services across the country, forcing an extra 100,000 Dementia patients to seek care in Accident and Emergency each year.
Sir Simon Stevens, Head of the NHS, warned that, “pressures in social care were now putting real strain on families, carers and hospitals”.
Social care is funded by the Local Authority and relates to the activities of daily living, such as assisting someone to maintain social interaction and their independence or preventing them from coming to harm in vulnerable situations. For example, getting help with washing, dressing, mobility, meal preparation, feeding and toileting etc. Social care activities are designed to provide service users and patients with interaction, company and stimulation and to help them lead a more independent life. Drop-in centres, lunch clubs and meals-on-wheels are just some of the typical services that some day centres may provide.
Chronic underfunding of social care has led to the closure of an increasing number of day care centres and related services throughout the country. According to the Daily Telegraph, this has resulted in Dementia sufferers attending A&E in increasing numbers, with some apparently remaining on hospital wards for many months (and in some cases even up to a year) – due to a lack of support and funding to help them maintain their social independence.
The lack of social care funding is inevitably putting a huge strain on the individual sufferers, their family, friends and carers. As families and the care system can’t cope, it is easier to refer their relative to A & E to seek immediate help. Time in hospital also provides some respite for families and carers alike. The buck then passes from the Local Authority (Social Services) to the NHS, exerting even more pressure on their already stretched resources.
We learn from the Daily Telegraph’s investigation that this situation is being fuelled by cuts to existing social services supposedly in place to help the elderly, frail and vulnerable in society to live in a safer environment with dignity.
Some cuts to social care services in different parts of the country are more drastic than others – with the worst cuts reported in the Southwest, where 7 centres offering social activities have reportedly closed in the past three years, compared to only one in the North-West.
It is well documented from all the recent media coverage, even preceding the recent General Election, that social care is grossly underfunded – particularly for Dementia sufferers. The Daily Mail ran an extensive campaign focussing on the lack of social care funding. Read our blog: Daily Mail’s Dementia Campaign – A missed opportunity.
The Government is committed to pumping vast sums of money into relieving the pressure on the social care system, care homes and homecare. The Prime Minister has pledged to “fix the social care crisis once and for all”. Sir Simon Stevens is reported to have said: “For the record – high number of people living with dementia and their families, health and social care are essentially two sides of the same coin. That’s why the Government welcome commitment to a long – term plan for social care – to ease the pressure on home – care and care homes, which is putting real strain on families, carers, and hospitals – is so important“.
As an aside, we don’t share the Minister’s view that social care and health care are flip sides of the same coin. They are different, both in how their respective services are carried out and how they are funded. Healthcare is provided by the NHS and is ‘free at the point of need’. Whereas social care is provided by the Local Authority and is means-tested, so you may end up paying for some or all of your social care. There is often a fine dividing line between social vs healthcare needs which causes confusion even amongst professionals. The importance of this distinction determines who pays for care.
We anticipate that the social care funding crisis is going to take many years to resolve, and it’s not going to be a quick fix nor simply a question of throwing money at the problem (although that would be a good start!). We believe that a root and branch review of the social care funding system is required. Better care facilities and improved living environments, together with better trained staff and higher quality standards will undoubtedly help. Dementia sufferers shouldn’t have to go to hospital to receive care or be housed in a safe environment. They and their families should be able to access care and social interaction within the community. Hospital admission may be a convenient outlet for those in desperate need, but surely this is a huge waste of valuable NHS resources and can only exacerbate ‘bed blocking’.
So, if the UK system is failing Dementia sufferers, where else can they turn?
Consider this alternative. Ever thought of providing your relative with care abroad?
There was an interesting article recently in The Guardian, “Families sending relatives with dementia to Thailand for care.”
The Guardian’s article suggests that there are an estimated 850,000 people living with Dementia in the UK, with local authority residential care costing up to £700 a week and private care costing around £1000 a week. Staffing levels in state and private care facilities are thought to be on the ratio of around 1:6 i.e. one carer for six patients/residents in a care facility. Some patients, may of course, have higher levels of need than others, and monopolise a carer’s time; meaning that five other residents who may be equally needy are not getting the same attention they deserve or require. Many care facilities are understaffed and will be forced to cut corners where they can to save funds and survive. After all, they are running a business. However, this could be to the detriment of your relative who may be left alone, isolated or unattended to for long periods of time. If family members or friends don’t visit their relative regularly, they can’t really be sure what is happening at the care home on a day-to-day basis. Look beyond the lovely grounds and surroundings, fittings, furniture, glossy brochures and attractive websites!
Substandard or unsuitable care in the UK is motivating a wave of ‘medical migration’ abroad.
There now seems to be a growing trend of families moving their relative abroad to get better care at a more affordable cost (referred to in the article as “medical tourism”).
The Guardian’s article focusses on care in Thailand, where “1:1 around -the-clock residential care in a care facility with fully qualified staff – in award – winning facilities that look like four star hotels – costs around £750 a week.” That is similar to the lower end of the scale cost of a care home in some parts of the country (and less than half the cost of some care homes in London and more affluent areas). But, the apparent advantage of a move to Thailand, is that your relative can get one-to-one personal 24-hour care. On the face of it, that seems highly attractive both financially and more importantly, from the comfort of knowing that your relative will be receiving excellent individual round-the-clock care for their needs. Unless radical reforms are made to increase social care funding, this new trend is likely to gather momentum over time and even be extended to other countries, perhaps nearer to home. ‘Medical migrants’ could become more common as families seek alternative more affordable (and better) options for their relative’s care needs.
The Guardian records Peter Brown’s story who moved to Thailand from the UK and founded care resort Chiang Mai, six years ago after becoming unhappy with the quality of care his mother was receiving in her British care home. He told The Guardian, “I don’t believe there are any relatives in the world who want to export their mother and father to a different country…What they want is care for their mother and father they are entitled to and unfortunately, the local city is incapable of giving them. They don’t want their mother and father locked away for 23 hours a day, sat in a corridor for one hour and put back into their room, so they start to look around for alternative options. There are plenty of options in a separate country, so how can you blame them for taking it.”
For many families, there will, of course, be a dilemma between seeking the best available care for their relative in the most comfortable and affordable surroundings on the one hand – versus the emotional upset caused by having a close relative living so far away, and not being in ‘control’ of their care, plus the distress to your relative of being exported to new and unfamiliar surroundings, with unfamiliar dietary options. Plus, families considering this move need to factor in the practicalities. You can’t simply pop in several times a day or on your way to or from work to check on your relative and to make sure that they are OK and receiving the standard of care you expect; that they’ve been washed, having proper nutritional intake and fluids, are fully clothed and not left sitting or lying in soiled clothes all day due to neglect.
In some cases, exporting your relative into care abroad may also mean families having to move abroad to be with them, or else spending longer periods of time abroad, say a month or two at a time, several times a year (which also incurs travelling and accommodation expenses).
Whilst some families may be absolutely delighted with the care and attention their relative is getting in their chosen care home in the UK, we suspect that there are many more families who are very unhappy. We believe that this is largely due to the fact that most care homes are grossly underfunded, which in turn means cutting corners and reduced staffing levels or compensating by recruiting low quality staff. We have read some damning Care Quality Commission (CQC) reports requiring immediate improvement. Some care facilities are not fit for purpose. Common complaints from families include poor hygiene standards, dirty rooms, urine stained floors, and being in need of urgent refurbishment – a distant cry from the outdated sales brochure or online glamorous pictures taken some years ago.
But, for families like Peter Brown, to even contemplate the upheaval of moving a relative to the other side of the world to find excellent care, illustrates how our social care system is failing families and the standards in care facilities need improvement and radical reform.
The move to Thailand, or indeed elsewhere abroad, may well suit some families and have its attractions if the reported care is such good value for money, but for the vast majority of British citizens, it will be ‘life as usual’ and daily complaints about the poor state of social care in the country.
However, over time more families may take the view that the emotional upset and overall financial investment of moving a relative abroad to get better care, is worth the risk for the sake of their relative’s wellbeing, and to enable them to enjoy a higher of standard of living and care, but at a more affordable price.
What is your experience of the care standards your relative is receiving?
In what circumstances would you consider moving your relative to a care home abroad?
We recommend these helpful articles for further reading around the subject: