Esther Rantzen is my new girl crush. Somewhat surprising given her form as the figurehead of ruthless female ambition in the TV world of eternal youth, Esther has set up the first mental health hotline for old people, Silverline. Brilliant.
Despite our inevitable schedule with death, the mental health of old people has been thrown to the wolves of outsourcing and private contractors. With local authorities ducking their duty of care we appear to have a social care strategy where nobody in fact cares.
In policy terms we’ve recently had a sharp wake-up call courtesy of reports by the Resolution Foundation and the meticulous work of Shereen Hussein. Here’s what we now know about social care:
· 80% of domiciliary care workers working for private providers are employed on zero-hours contracts
· Ironically the most vulnerable carers are the domiciliary variety who go into people’s homes to provide care for the most vulnerable clients
· The highly credible professional body that stood up for carers and offered them professional training was put out of business a few years ago
· Social care job vacancies are higher than any other sector. Nobody wants the jobs
· 85% of Local Authorities restrict access to care and have cut the care budget by £1.89 billion over the last 2 years
There’s been a lot in the press trying to digest what it means for carers to have 15 minute appointment. Here’s what an anonymous carer had to say.
“It’s another 10 minute drive to my next client, Mrs. T. I assumed given the time (12.30 – 12.45pm) this was a lunch call but it is actually a medication prompt. It could have been a nice easy call, but it turns out the last carer was late so she didn’t take morning medication until 11am. I have to remove some of her meds and refuse to give them as the time frame is too short and could put her at risk of overdose. I again call the on-call team to inform them of the situation (a call I make from my mobile phone for which I pay the bill). Mrs. T’s was supposed to be a 15 minute call but what with reading the care plan and discussing with the on-call team it takes 25 minutes, 10 of which I won’t get paid for.”
Before you race sweaty-handed to the phone to call your aged parents to find out who exactly is caring for them, know that the situation is about to get worse:
Exhibit A: an ageing population and social care is boom time. We need more carers but because there is no training or progression in a job essentially being a domestic servant young people don’t want to do it. You don’t need to be literate or have a GCSE to work that one out.
Exhibit B: Most of the people who currently work as carers are the real deal. Women, middle aged, many of whom worked for the public sector and still remember what professional ethics and standards look like. Currently 50% of private providers come from the not-for-profit sector many of which were set up during privatization. Within the next decade most of them will retire replaced by profit making companies and with it our heritage of genuine social care.
Exhibit C: Under the 2013 Draft Care and Support Bill, people will be allowed to commission their own care. Hundreds of thousands of people suddenly become direct employers, and with it their responsibilities including national insurance. My head can’t compute how a carer could work out their tax returns with a different employer for every 15 minutes or handle the potential Tsunami of abuse on both sides when vulnerable old people also become the gaffers.
Rather than attempting to buy up Nepal to build a retirement village for people that you love, there are things that we can still do to close this care gap. Local authorities are still the primary commissioners of care and could decide to make grown up decisions about contractors. It could, for example, learn the lessons of public sector procurement since the 1980s and actually include quality into the cost of care.
Yup, that means costing out realistically what it means to ensure basic standards and avoid the scandals that are likely to dominate the Metro over the coming years.
This costing means working out how much those of us who work in health and social care pay the state to do their job properly. We are not exactly flush but when employers don’t pay the time it takes for a carer to travel to clients, or the phone they have to use to check medication schedules, the carer does. The state is in debt to some of the poorest workers in the UK. For local authorities to miscalculate the full costs of this is a failure of their duty of care to both carers and those being cared for and is likely to be an expensive mistake.
The biggest gap is an emotional one. Most of the people receiving social care are over the age of 85 years. This is hard to say, dear reader, but this means that the nature of care is of the most profound kind, preparing for a good death. Freud said that the reality of our own mortality is so hard to bear that it’s the only thing that our unconscious can’t dabble with. Our minds cannot know our own death. Even though we all die, the realisation of this is almost too hard to bear making the guardians of our final years crucial to whether we manage a good death or not. Currently, this job of emotional work is being outsourced to people on minimum wage where appeals to compassion and prayers for a workforce made of angels won’t work.
It doesn’t get more existential than that.
How we die affects all of us. It is the most important emotional project of any society, and one which we are currently making a right hash of. Unless we treat the guardians of our old age with dignity and a decent wage we split off the responsibility of living and ending a good life. This week we’ll mainly be tweeting quotes from carers and encouraging you to show some care for the carers, wherever you encounter them this week, whether it’s offering to cook a neighbour’s meal while they change the sheets or finding out the name of your mum’s carer and actually remembering it. All of us deserve enough time for people to know our names and listen to our stories, whether we’re the carer or the cared for.
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