Something of a theme on my caseload at the moment is one of ‘delayed discharges’. I have three people in hospital medically ready for discharge and am waiting for residential or nursing placements to ‘pop up’.
It’s a warped kind of waiting game with no beds being available locally and people increasingly being shipped further and further out of London or at least towards the suburbs as the hospitals become desperate for beds and the lack of resources becomes painful.
One of the three has been on the waiting list for a local residential home for months. Another has a devoted wife who has constantly cared for her husband for decades through his progressively deteriorating dementia and another – well – the hiccoughs are proving to be way too many to detail succinctly..
But the result is the same – people who have strong local attachments, families and spouses are having to be placed outside the local areas.
It’s a subject matter that I have personally brought up again and again – going directly to commissioners when necessary but there is no aspect of my work where I feel ‘less heard’. Of course, placements can’t spring up overnight although some people imagine they can – and the brutal truth is that a placement usually only becomes available when someone dies.
That’s why the dementia residential placements locally have been so sparse – often they are taken up by people who could be very well physically and this means that those who need the beds are waiting longer and longer.
A part of the problem is that there was a feeling that ‘Extra Care Sheltered Accommodation’ – namely sheltered accommodation with additional 24 hour support on site – would ‘divert’ some people from residential care. In fact, the extra care sheltered properties, which we were told when they were established would be an ‘alternative’ to residential care, are not – at least in the local area I work (and it really could change from borough to borough) – not geared to meeting the needs of those who have 24 hour support needs. This is a particular issue at the moment as they seem to be incredibly reluctant to take anyone who doesn’t fit in to the ‘kind of person they want and would be ‘easy’ to manage’ making it more of an alternative for sheltered housing than for residential care.
I would love for there to be a widespread rethink of residential and nursing care provisions in the context of meeting individual needs. Prior to my qualification, I worked for about 7 years in a small group home for adults with learning disabilities and there was a massive focus on individuals and meeting particular needs. Of course, the funding is massively different level and that will always be the ‘sticking point’. There are vast amounts of funding available for younger adults compared to over 65s – simply because there is not the money there to provide the same levels of funding. Local authorities are not able to pay high care fees and the cheapest fees often involve large care homes. That isn’t to say they can’t involve personal care but more often than not they don’t – and certainly not where they need to be.
For every problem I find though, money is the answer – unfortunately – and in these times of shrinking budgets, we are left to provide what constitutes poor outcomes. I’d love to imagine a world where some kind of charity or donor could set up some smaller group-home like care structure for older adults too but the costs are way too high.. maybe that’s a project for the future..
Working in central London probably exacerbates the problem in some sense that the housing prices and land costs in the area that I work are particularly high – definitely favouring residential redevelopments for bankers as opposed to more substantial community resources.
But there is something incredibly cruel about ‘shipping out’ the older and the frailer to outlying areas. I know there is a move towards less residential care services but that isn’t the answer as there will always be some need for the provision.