The current crisis in provision in social care for older people is leaving millions across England and Wales facing a terrifying future.
A survey by Age Concern last month revealed that eight out of ten people in Britain are concerned about the quality of care they or their loved ones will get in later life.
Four out of ten are not confident that they will be treated with dignity or respect.
Even those whose pension days are far off are feeling insecure.
Seven out of ten 18-34 year olds are very worried about the quality of care that they or a loved one will receive.
There are three main forms of social care for older people who need help – homecare, residential care and “informal” care by friends and family. All three are reaching crisis point.
The state pays for around 25 percent of social care in England – though much of this is payments to private companies who deliver the care.
Around 10 percent is privately purchased and the remaining 65 percent is provided by unpaid carers, usually family and friends.
The government claims that an ageing population is to blame for the crisis.
Health secretary Alan Johnson launched a public consultation into social care funding earlier this year.
He argues that there will be a £6 billion funding gap over the next 20 years just to keep services at the same level – which is already far from adequate.
But, like the rest of the welfare state, care for older people is not “unaffordable” – it is down to the question of priorities.
For instance, the government allows corporations and rich individuals to avoid around £25 billion tax every year.
The Commission for Social Care Inspection (CSCI) reported in January that there are around 281,000 pensioners in England who need help with crucial tasks at home, but are getting no care from local authorities, charities or private care providers.
The proportion of older people receiving local government funded homecare has almost halved since 1994.
Most councils now ration and means test homecare services – so that only those categorised as in severe or critical need receive services.
Nearly two thirds of local authorities only offer homecare to those with “substantial” or “critical” needs. Some councils only offer care to those at serious risk of abuse or neglect, or whose life is in danger.
Thousands with “moderate” needs – which include problems getting out of bed, bathing and washing – are denied the help they need.
The decline of homecare services makes a joke of government rhetoric about shifting care away from residential homes towards helping people live in their own homes.
There are currently over 400,000 pensioners living in residential care homes in England – a fall of around 45,000 over the last eight years.
Most of those in homes are paid for at least in part by state funding. But over 91 percent are run by the private or voluntary sector.
The CSCI has found that 20 percent of standards for residential care are not met. Those in private homes are not protected by the Human Rights Act.
A Radio 4 questionnaire of CSCI inspectors last week found that, due to cuts, some homes might only be checked every three years. Care homes also now carry out self-assessments.
As residential care and homecare become unaffordable for many, the burden of care for older people is falling increasingly on families and friends.
Many carers have to give up work to look after a loved one. Benefits provided by the government are pitiful – the main carers’ allowance works out at around £50 a week for a minimum of 36 hours of care.
The government is failing older people and their families. Most have worked either in paid employment or as unpaid carers, or both, and paid taxes into a system that promised a welfare state free at point of need.
It is an unforgivable betrayal that people are not guaranteed some security when they are in need.
The fact that free personal care for over 65s has been available in Scotland since 2002 shows that such a policy is possible and popular.
There are urgent issues that need addressing. There must be an end to reliance on private and unpaid care, and to rationing and means testing.
There must be a massive injection of funding to raise standards of both home and residential care.
As Age Concern’s director Gordon Lishman points out, “Now is not the time for dithering about the unavoidable costs needed to care for our rapidly ageing society.
“Without sweeping changes, the system will limp on until it breaks completely, leaving millions of older people without the care they need to stay healthy and independent.”
Figure it out
- 300% – The average amount fees for homecare have risen since 1997. A coalition of 18 charities released a report last week showing that the fees mean that many are either giving up essential care, or cutting back on food or fuel to pay for it.
- £87bn – The amount worth of care that England’s 5.86 million unpaid carers, who are mostly women, provide. Three million of them are over 50.