'£35,000 cap' for care of elderly

1 July 2011 Last updated at 19:07 GMT Ministers are looking to revamp the social care system in England Bills faced by families in England for caring for the elderly should be capped at ?35,000 an official inquiry is set to tell ministers, the BBC understands.

The proposal could stop thousands of people having to sell their house or lose all their savings, says the BBC's political editor Nick Robinson.

The details will come in the report of the Commission on Funding of Care and Support in England on Monday.

Commission chairman Andrew Dilnot said a cap "would take away the fear".

He told the BBC: "If a cap were put in place we could take away the fear that people would lose everything that they had built up and in particular people seem reasonably anxious that people would lose everything that they had built up and in particular people seem reasonably anxious that they might lose all the value of their house.

"They still have to pay something but much less than if they end up with high care needs as it is at the moment."

Our political editor understands the report will say that the bill for caring for the elderly is soaring.

Cost of ?2bn-?3bn

A quarter of people aged over 65 can expect a bill of more than ?50,000. One in 10 pays more than ?100,000.

The cap could cost the Treasury between ?2bn and ?3bn - the same as the cuts to public sector pensions.

He says ministers will welcome the report but question where the money would come from to fund it.

At the moment, the support provided by councils is means-tested so that anyone with assets of more than ?23,250 has to pay for all the cost of their care.

It means thousands of people a year are forced to sell their homes when they go into a care home.

'Broken' system

Earlier Mr Dilnot said the system was "broken" after being left largely untouched for 70 years.

He said: "This is the only major risk people face where there is no sharing of risks.

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There is no doubt to make this system better we are going to have to pay more. It does need more resource, but at the moment the amount we spend on this is rather small”

End Quote Andrew Dilnot Commission on Funding of Care and Support "Our health care needs, the consequences of having a car crash, the consequences of having your house burn down - all of those are covered either by the state or private sector.

"Here the state doesn't cover you and the private sector won't cover you so people are exposed to a very large risk with nothing they can do about it."

"There is no doubt to make this system better we are going to have to pay more. It does need more resource, but at the moment the amount we spend on this is rather small," added Mr Dilnot.

Earlier this week care services minister Paul Burstow suggested the reaction to the recommendations could be "lukewarm" - the Treasury is thought to have some misgivings about more funding.

A spokeswoman for the Treasury said no decisions had been taken.

She added: "Once we have received the report, we will consider its findings and welcome continued constructive engagement from all stakeholders."

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Elderly 'facing social care cuts'

27 June 2011 Last updated at 00:21 GMT By Nick Triggle Health correspondent, BBC News Ministers are looking to revamp the social care system in England Social care budgets for the elderly in England will be cut this year - despite promises to invest more cash, according to an analysis of spending plans.

The Age UK research, based on freedom of information data, suggested spending on the over-65s would drop by over 8%.

The charity predicted the impact of such a cut could be "devastating" as the system was already at crisis point.

Care services minister Paul Burstow questioned the figures, suggesting the situation was not as bad as claimed.

He acknowledged budgets were "under pressure" but said that did not always lead to a deterioration in care.

"While some councils may simply be cutting care, others are working hard to get more for less with innovative ways of delivering better care, including using more telecare and cutting needless admissions to hospital and residential care," said Mr Burstow.

The findings come after extra money was promised in the 2010 spending review.

Ministers said ?2bn more would be invested in social care by 2015, with the first tranche coming this financial year.

This was earmarked for both elderly care and younger adults with disabilities.

Rationing

The promise came after the government had announced a review of the system amid evidence councils were having to ration care because of the increased demands being placed on services by an ageing population.

That review is due to publish its recommendations next Monday and pave the way for an overhaul of the means-tested system.

Social care has been struggling for funding in recent years with the overall budget only rising slightly above inflation.

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Funding for social care is already inadequate. The consequences of cutting expenditure further could be devastating”

End Quote Michelle Mitchell Age UK In recognition of the problems, the government said last year it would set aside some extra funds to help the system until any new arrangements were introduced.

But the Age UK research suggested that the money was not yet getting through to the frontline of elderly care.

It asked all 152 councils with responsibility for social care for data on their spending plans and service provision for the elderly for this financial year.

The charity received information on spending from 110 councils, which suggested the budget would be cut by 8.4% - equivalent to ?610m.

It also received evidence councils were coping by taking measures such as reducing the number of care home places and hours of home help.

Michelle Mitchell, from Age UK, said: "Funding for social care is already inadequate. The consequences of cutting expenditure further could be devastating.

"We are fearful that even more vulnerable older people will be left to struggle alone and in some cases will be put at risk."

Councillor David Rogers, of the Local Government Association (LGA), pointed out while extra money had been promised by ministers for social care, it was being cancelled out by the wider cuts to local government - its budget from central government is being reduced by a quarter over the next four years.

"As the LGA warned last year, and this report backs up, government funding cuts have left councils with huge gaps in their adult social care budgets. Savings have to be found and tough decisions will have to be made in some areas."

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Home care elderly 'not protected'

20 June 2011 Last updated at 08:22 GMT Anne Novis, says the level of care her elderly mother, who lives at home, gets is extremely poor

Care of older people in their homes is so poor their human rights are being overlooked, an inquiry by the Equality and Human Rights Commission has found.

The inquiry is investigating how well over-65s who receive homecare visits are looked after in England.

The commission says it has uncovered worrying cases of neglect and examples of lack of respect for older people's privacy and dignity.

Its full report will be published in November.

After looking at the evidence, it says there are "major problems" in the home care system.

It describes cases of people being left in bed for 17 hours, or more, between care visits and a failure to wash people regularly.

It received reports of people being left in filthy nightwear and bedding after a homecare visit, or without a wash or hair wash for several weeks.

Visits are sometimes so brief, the report says, that people have to choose between having a cooked meal or a wash.

The short visits also mean that staff have to rush tasks like washing and dressing, which frustrates both the elderly people and care staff.

No dignity

High staff turnover also has an impact on those being cared for, the commission finds.

The report said: "People have described the emotional impact of being washed and dressed by a large number of different people, and having to repeatedly disclose personal information every time a new care worker comes to the house."

Baroness Sally Greengross from the commission on what the inquiry found

Some older people describe feeling that their privacy and dignity were not respected when they were undressed by care staff in front of family members or in front of their bungalow window.

To gather evidence for the inquiry, the Equality and Human Rights Commission carried out surveys with NHS local authorities, primary care trusts and private home care providers.

Fifty-four per cent of local authorities completed the survey, as did 250 home care providers in England.

The commission also looked at over 500 written submissions from older people and their families, and 101 from home care staff.

One in five older people who responded to the commission's request for evidence said they would not normally complain because they did not know how to - or for fear of repercussions.

'Serious neglect'

The commission says it will explore what protection and support is in place for people who want to expose poor or abusive practices.

Peter Hay, from the Association of Directors of Adult Social Services, said "poor care is never acceptable whatever the system".

However, he pointed out that the interim report was looking at complaints, and so inevitably emphasized problems.

But he acknowledged that the problems were two-fold - "when organisations lose sight of the person they are caring for and it becomes about a task, and... how do we get older people in particular to be well-informed and powerful consumers.

"They are very passive about complaining."

He said people needed to more assertive in getting the right care they need, at the time they need it.

Michelle Mitchell, charity director at Age UK, said the findings showed "serious neglect".

"Despite government commitments made by both the previous and current government, basic rights to dignity, respect and autonomy are still being breached.

"The biggest threat to the human rights of older people receiving care at home is from cuts to adult social care budgets, and it is very unclear whether tightening eligibility criteria to care will allow local authorities to continue to meet their human rights obligations."

Care services minister Paul Burstow said: "There can be no place for poor quality care in care services, either in the home care system or in residential homes."

He added the inquiry would "help drive up standards of care and expose bad practice".

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Elderly drinking 'epidemic' row

25 May 2011 Last updated at 06:00 GMT The charity says bereavement and retirement can lead to heavy drinking among elder people An alcohol charity claims there a "silent epidemic" of heavy drinking among elderly people in Wales.

But Alcohol Concern Cymru's (AAC) report quotes statistics that have been challenged by drinks industry body The Portman Group.

The group argued overall trends showed "a positive and continuing decline in the rates of excessive drinking".

Andrew Misell of AAC said there was anecdotal evidence from elderly support workers to back their claim.

AAC's briefing paper, Hidden harm? Alcohol and older people in Wales claims that although drinking tends to decline with age, this pattern may conceal serious alcohol-related problems among some older people.

Mr Misell, the charity's manager in Wales, said: "With the number of people over retirement age increasing, some researchers have even talked about a silent epidemic of older people's alcohol issues."

The paper compares figures from Welsh Government-commissioned Health Surveys of 2003/4 and 2009 as "evidence that the proportion of older people drinking more than the recommended amount is rising".

AAC said the number of over 65s who said they had drunk more than the recommended maximum in the previous week rose from 22% (men) and 7% (women) in 2003/4 to 34% (men) and 17% (women) in 2009.

However, BBC Wales understands that as a result of changes in methodology adopted by the compilers of the Welsh Health Survey in 2006 the two sets of statistics are not comparable.

Continue reading the main story Age 16 and over: 52% of men and 38% of women said they had drunk more than the recommended maximum amount of alcohol in the previous weekAge 35-44: 61% of men and 49% of womenAge 65 and over: Men 34% Women 17%

Source: The 2009 Welsh Health Survey

Factors that changed included increases in size of wine glass, the increased alcoholic strength of wine and better estimates of the alcoholic strengths of beers, lagers and ciders.

When challenged on the paper's use of statistics Mr Misell said: "Those statistics were taken as an illustration. It's certainly the case that more work needs to be done in terms of finding out what exactly is the pattern of drinking among older people.

"The point of the paper is that it's a hidden problem. If you talk to people working with older people they will say there's quite a lot of anecdotal evidence to support the fact that alcohol is a problem."

Mr Misell said many who might benefit from support might not look like stereotypical drinkers. The fact that many older people drank at home contributed to the problem being hidden.

However, David Poley, chief executive of the Portman Group, said: "Just as we encourage people to drink responsibly, we would urge Alcohol Concern Cymru to use alcohol statistics responsibly.

"Overall trends shows a positive and continuing decline in the rates of excessive drinking. Trying to get people to adopt safer behaviour does not justify misrepresenting statistics in this way."

Alcohol Concern Cymru says a focus on the more visible issue of younger people drinking in city centres conceals the problem

The AAC's report said a number of factors linked to age, like bereavement or changes to lifestyle after retirement, could lead to heavier drinking.

It also claimed that many younger adults are now adopting patterns of heavy drinking that they may well carry on into later life.

Loneliness

The report said healthcare professionals did not always recognise when older people's health problems were alcohol-related, or might not know how to raise the issue, leaving the problems untreated.

And the charity called for research into whether current unit guidance and screening methods for alcohol misuse was relevant to older people.

The briefing paper was supported by Rhian Pearce of Age Cymru who said: "About a third of older people with drinking problems develop them in later life and they may struggle to access help for this issue."

Ms Pearce called for health professionals to be trained to identify drinking problems in older people.

Wynford Ellis Owen of the Wales Council on Alcohol and Other Drugs also rejected claims that the problem of alcohol abuse among older people was being overstated.

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Alarm over elderly patient care

26 May 2011 Last updated at 00:24 GMT By Dominic Hughes Health correspondent, BBC News The Care Quality Commission carried out 100 unannounced inspections Serious concerns have been raised by the NHS care regulator about the way some hospitals in England look after elderly patients.

The Care Quality Commission said three had failed to meet legal standards for giving patients enough food and drink and treating them in a dignified way.

They were Alexandra Hospital, Redditch, the Royal Free, in London, and Ipswich.

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, "with their care needs not assessed and their dignity not respected".

All six hospitals about which concerns were raised must now say how and when they will improve.

The worst three offenders will have to improve or face action from the regulator.

Continue reading the main story This is the first report of the Care Quality Commission's Dignity and Nutrition programmeIt covers 12 hospitals and by September the full picture of the rest for the country will be revealedOf the 12 that were looked at, three were found to be failing essential standardsAnother three had less serious failings, the regulator saidAll six have been told to come up with plans to rectify the situationThe programme was started following a request by Health Secretary Andrew Lansley following concerns raised by the Patients AssociationPrescribing water The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients' weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

One man told inspectors that staff "talk to me as if I'm daft".

Chief Executive John Rostill, Worcestershire Acute Hospitals: "This is a real wake up call"

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

"Many of these reports describe people being 'cared for' in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs - people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

"These are not difficult things to get right - and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual - not a nuisance to be ignored or a task that must be completed.

"This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them."

Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

"The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable.

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What the inspectors observed on that day was not acceptable and it has been something we have taken very seriously indeed”

End Quote Helen Blanchard Worcestershire Acute Hospitals NHS Trust "Where the inspections uncovered appalling levels of care, the CQC will be able to use its enforcement powers to ensure that real improvements are made."

One of the hospitals found to have problems was the Royal Free Hampstead NHS Trust.

In a statement the hospital said it was disappointed by the CQC report, but that it took the findings very seriously.

"Following the CQC's concerns, we immediately implemented an action plan to make sure we comply with both the letter and the spirit of the standards," it said.

"As part of the action plan, we are rolling out a programme of 'nurse rounding' which ensures that every patient is reviewed by a nurse at least once an hour to ensure their comfort and needs are met.

"We will continue to ensure that all measures are taken to respect patients' privacy, dignity and confidentiality and patients are put at the centre of communication about their care."

Siobhan Jordan, director of nursing at the Ipswich Hospital NHS Trust, said: "The trust was disappointed by, but responsive to, the findings of the review team. Much work is under way within the trust, particularly focusing on meeting the needs of the older person.

"The trust recognises the value of the regulator's unannounced visit and continues to focus on improving care at the hospital."

Worcestershire Acute Hospitals NHS Trust said it was "extremely disappointed" by the findings and had already shown "significant improvements".

Apology

Director of nursing and midwifery Helen Blanchard said: "I'd like to apologise to the patients and their families that were affected by the care that this report refers to.

"What the inspectors observed on that day was not acceptable and it has been something we have taken very seriously indeed."

She said the findings were an unpleasant surprise because service on the wards concerned had been traditionally "very good".

The trust would continue to carry out its own unannounced ward visits to monitor standards, she added.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.

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'Poor' NHS care for elderly falls

18 May 2011 Last updated at 00:56 GMT By Michelle Roberts Health reporter, BBC News Falls are the leading cause of accidental death in the over-65s NHS hospitals are failing to provide adequate care for elderly people who have suffered falls and fractures, an audit in England, Wales and Northern Ireland has found.

The Royal College of Physicians found "unacceptable variation" in the quality of services for treating and preventing broken bones caused by slips and trips.

Despite modest improvements on previous years, gaps in provision persist and deficiencies in care remain widespread.

Ministers say change is happening.

Paul Burstow, Minister for Care Services, said: "Every part of the NHS should be learning from this audit to make sure they are adopting best practice.

"The government is promoting prevention and investing in services to help people with their rehabilitation and NICE [the National Institute for Health and Clinical Excellence] is putting in place new quality standards."

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Once again it is starkly apparent that what organisations say they provide is not matched by what people receive”

End Quote Dr Jonathan Potter of the Royal College of Physicians Victims of falls and fractures, above the age of 65, occupy hospital beds for a total of more than four million days a year in England alone, at an estimated cost of ?2bn.

Every year in the UK, more than 500,000 older people attend hospital emergency departments following a fall, and 200,000 suffer fractures due to osteoporosis.

Information on nearly 10,000 patients from all NHS acute trusts, or equivalent, in England, Wales and Northern Ireland, as well as primary care organisations, mental health trusts and a sample of care homes, revealed only 37% provided any kind of fracture-liaison service to prevent future fractures.

Many of the patients had received inadequate acute assessment and care.

A third of those with hip fractures had not received pain relief within an hour of arriving in hospital.

A wrist fracture after a fall can be debilitating

And only 33% of non-hip-fracture and 60% of hip-fracture patients had received appropriate treatment for osteoporosis.

More than 90% of sites said they used a tool that assessed balance and mobility, but in reality only 34% of patients with fractures of the wrist, arm, pelvis or spine had received an assessment.

Dr Jonathan Potter, who was involved in the audit, said: "Once again it is starkly apparent that what organisations say they provide is not matched by what people receive.

"There is real urgency to ensure effective assessment and management for people who fall and in the very least to ensure evidence-based fracture-liaison services are established in all trusts."

Michelle Mitchell, of the charity Age UK, said: "Falling and breaking a bone can have serious, life changing consequences for older people - one of which is that they are much more likely to suffer falls in the future.

"It is extremely worrying then that in many areas of the country, people who have already broken bones are not receiving the treatment and support to avoid future injury including the lack of referral to comprehensive falls-prevention services."

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