Experts have warned that the current government figures for free care fail to take into account either an increase in demand with time, or the effect of people who previously chose to pay for private care switching to free care because they now qualify for it (a situation described by the Guardian as ‘redistributing to the rich’).  Whilst challenging the Personal Care at Home bill in the House of Lords, former health minister Lord Warner warned that when Scotland began offering free personal care in 2003, the costs doubled within four years and the number of claimants went up by 36%.  Although the bill survived the challenge, more and more organisations are now backing the view originally put forward in the Green Paper that individuals must share the cost of care with government funding.

Other concerns around the Personal Care at Home bill centre around how it will be decided which people have ‘critical’ care needs and will therefore receive funding.  How will needs be assessed as ‘critical’ and what help will be available for those whose needs are severe, but not ‘critical’?  This is made more complex by the fact that currently, local authorities all interpret care needs differently.  Some authorities currently classify ‘critical’ care needs together with the lower category of ‘substantial’.  With councils also offering different care services at different prices, there is a risk that many people will miss out on funding due to a ‘postcode lottery’ – as was the case when continuing care eligibility criteria were first introduced in 1995.

The Guardian has published an article warning of the problems that the UK faces due to its ageing population. Following on from their recent London conference on older people and ageing Britain, the article describes a raft of potential issues, including:

• By 2030 there will be over 2.9 million over-85s in Britain and by 2055 there will be only two working people per retired person, which is economically unsustainable.
• Over 1 million people will suffer from dementia by 2030 and it is unsure whether the Government’s white paper on social care, due for release in early 2010, will contain measures that are far-reaching enough to cope with the financial and caring burdens.
• A shortage both of housing that is suitable for the elderly and that is needed by younger families, because older people tend to remain in large family homes instead of downsizing.
• 7 million people feel that they lack social support in the UK, many of whom are lonely elderly people.

The Guardian calls on the Government to recognise the looming crisis of our ageing population and take immediate measures to tackle the forthcoming risks and problems.

posted by Cheselden Continuing Care at
08:13

On 5 August, the Guardian newspaper held a roundtable, sponsored by the Department of Health, to allow disabled people and the organisations that represent their rights to discuss the recently-published Green Paper on social care. Overall, the participants voiced their support for the introduction of a new social care service that is presented in the Paper, entitled ‘Shaping the future of care together.’ But they felt that the scope of the paper focused too much on caring for elderly people at the expense of younger disabled adults. Issues discussed at the roundtable included:

• The language used in the Green Paper, which some felt was patronising to disabled people and younger adults. Terms such as ‘national care service’ and being ‘looked after’ were seen as contrary to the outlook of most young disabled adults who want to be independent and included in society.
• A concern that the Paper implies through its tone that the cost of funding care for younger adults is a burden rather than an investment.
• The Government’s encouragement of people to participate in the Big Care Debate was seen as an opportunity to effect cultural change and to get the rights of disabled people to be reflected in mainstream Government policy.
• The roundtable liked the idea that, further to a single needs assessment, their care package would be ‘portable’ and they would be entitled to the same level of care funding wherever they lived in England. However, it was noted that the Paper did not refer to any specific services that an individual could expect to receive from the national care service. Participants also pointed out flaws in both of the proposed methods for setting funding levels – locally and nationally – and expressed concerns that adopting either method would not eradicate the current ‘postcode lottery’ of care funding and standards.
• Although the roundtable was told that the Government does not intend to abolish the Disability Living Allowance (DLA), some people were worried about the intention to re-allocate funds from Attendance Allowance (AA), a similar mobility benefit for those aged 65+. However, others considered that funds currently spent on AA might be better spent elsewhere.

To read the full article about the roundtable discussion, visit the Guardian’s website.

posted by Cheselden Continuing Care at
14:13

The Guardian has questioned why the option of ruling out funding social care through general taxation has been ruled out in the recent Green Paper on the future of social care in England. Their article points out that, during the research that preceded the Green Paper, many people were found to be in favour of this option. Despite this, the Green Paper states that ‘This is ruled out because it places a heavy burden on people of working age.’ This argument is described as ‘Orwellian’ by the Guardian, which comments that older people are tax payers too and are increasingly being expected to stay in employment for longer – and therefore pay more tax. At the launch of the Green Paper, the Guardian asked David Behan, the Department of Health’s director general for social care why this widely-supported option was dismissed whilst other funding options with ‘a limited evidence base’ were included instead. Mr Behan stated the need to maintain equality and fairness between the generations, but acknowledged that the issue of funding through general taxation would arise during the consultation process – implying that this option could be ruled in again. To read the article in full, visit the Guardian’s website or click here to read a full or abridged version of the Green Paper.

posted by Cheselden Continuing Care at
13:12

The Guardian reports that the current complex system of giving someone power of attorney over your financial affairs is being reformed – and people are being urged to put arrangements in place before it’s too late. Appointing a Lasting Power of Attorney (LPA) before health problems set in gives the peace of mind that someone else will have legal control over financial matters and health decisions when the time comes. Considered to be the second most important document after a will, the LPA was introduced to replace the Enduring Power of Attorney (EPA) in the hope of eliminating abuse of the power of attorney system. Unfortunately, the LPA form has proved to be extremely difficult, time-consuming and expensive to complete which has put off many people from going through the process. Now that it is due to be reformed, it is hoped that more people will take this opportunity to ensure that their future is in safe hands should ill health set in.

The cost of registering the LPA form has already been cut from £150 to £120 and amendments to the form itself are expected to take place from October 2009. The Office of the Public Guardian, which registers the LPAs, is also trying to simplify its procedures in order to reduce the mistakes and delays that have hampered the current system. Anyone appointing a LPA will still need to go through a solicitor, but the cost can be reduced by deciding in advance who will act as your attorney and what scope you want their authority to cover. To set up an LPA, your solicitor must be qualified to give advice on care planning; you can search for a qualified practitioner in your area at the Solicitors for the Elderly website.

posted by Cheselden Continuing Care at
12:22

As part of its Ageing Britain [link to http://www.guardian.co.uk/uk/series/ageing-britain] series, the Guardian has published an article on how to stay healthy and reduce the risk of contracting five age-related diseases: cancer, cardiovascular disease, dementia, osteoarthritis and diabetes. Tips include:

• Stop smoking
• Drink alcohol in moderation
• Eat a healthy and balanced diet
• Exercise regularly – but don’t overdo it
• Maintain a healthy weight
• Have your blood pressure and cholesterol checked regularly
• Keep active and maintain your social life.

Click hereto read the article in full.

posted by Cheselden Continuing Care at
12:19

Today’s (23 March) Guardian sees columnist Jackie Ashley recognising the crucial part that grandparents play in many families and that goes unrecognised by the Government’s welfare policies. Ms Ashley describes how countless families in the UK rely on grandparents to look after their children while they go out to work, 90% of which are unpaid, and many of whom still work themselves. Ms Ashley points out that if the grandparent were to look after a disabled adult for 20 hours per week, they would be entitled to National Insurance credits. But there is no financial help for caring for their grandchildren, a fact which the columnist describes as ‘…unfair, and mildly, barmy.’ The article then goes on to describe the financial challenges faced by older people who find themselves short of income, stating that 2 million older people receive means-tested benefits to top up low incomes, despite living in properties worth £50,000 or more. Faced with rising care costs and the need to buy disability aids such as stair lifts, the answer for many is an equity release loan. But many people are suspicious of these loans, and those who take them lose their entitlement to pension tax credits. Ms Ashley argues that the Government should take notice of Baroness Hollis, who will address these issues in the House of Lords this week, arguing that clearer advice is needed around equity release loans and those that choose them should be able to keep their pension tax credit.

posted by Cheselden Continuing Care at
14:04

Devon has introduced a new way of caring for patients with long-term health problems. Health and social care teams now work together to provide a comprehensive and personalized service to patients. This aims to reduce hospital admissions, reduce GP consultations and spending and increase patient satisfaction. After running two pilot schemes in 2008, the new care management system has now been introduced across the county. David Johnson, executive director of Devon’s adult and community services, explains: ‘…we decided to transform care management by making it simpler, user-led and more effective and less costly. We want to give people what they really want.’ Some of the changes made to the care pathway include:

• Introducing electronic records
• Provision of a telephone assessment service
• Creation of integrated complex care teams to enable patients with high risk, complex needs to receive quicker diagnosis and treatment and avoid unnecessary hospital admissions
• A new service that delivers 90% of disability aids within 5 working days, compared with previous lead times of up to 4 months.

The changes are already proving popular with patients such as Stephen MacDonald, who previously required regular admission to hospital to manage his condition of muscular dystrophy. Mr MacDonald condition has now stabilised and he no longer has to make emergency trips to hospital: ‘…my life has changed radically.’ Read more at the Guardian’s website.

posted by Cheselden Continuing Care at
10:44

The Guardian reports on the launch of Shop4Support, a new online resource for finding and purchasing care services. Aimed at helping people to manage the personal care budgets that are increasingly being allocated by social services, the site has been dubbed ‘the eBay of social care’. Users simply enter their postcode into the site to locate services in their area such as nursing care and personal and domestic support, rather than having to rely on their local authorities to provide information. Search results include customer ratings posted by other users as well as the option to sort by price or distance. Another feature of Shop4Support allows the user to keep track of their personal care budget online, so they can easily see how much they have spent and on which services whilst planning for future purchases. This can be managed by a relative if the user is unable to use the site themselves. An initial pilot scheme has proved successful, with positive feedback from participants, and it is hoped that the blend of choice and control that Shop4Support offers will prove popular with self-funders as well as those managing allocated budgets. The Shop4Support website has full details.

posted by Cheselden Continuing Care at
10:41

Gordon Brown has announced a number of reforms in public sector policy, including the introduction of ‘web-style feedback’ to enable the public to comment on their GP surgeries, local police forces and children’s centres.  People will be able to have their say on new Government-sponsored websites that are to be launched in summer 2009.  Mr Brown’s reform document also outlines a number of other changes to the healthcare system, including giving greater autonomy to nurses, longer opening hours for doctors’ surgeries and a free health check for 1 million people.  Read more on the Guardian’s website.

posted by Cheselden Continuing Care at
17:59

Gordon Brown has announced a number of reforms in public sector policy, including the introduction of ‘web-style feedback’ to enable the public to comment on their GP surgeries, local police forces and children’s centres. People will be able to have their say on new Government-sponsored websites that are to be launched in summer 2009. Mr Brown’s reform document also outlines a number of other changes to the healthcare system, including giving greater autonomy to nurses, longer opening hours for doctors’ surgeries and a free health check for 1 million people. Read more on the Guardian’s website.

posted by Cheselden Continuing Care at
10:31

Well-known presenter and broadcaster Fiona Philips has made a Dispatches programme for Channel 4 which tackles the subject of caring for Alzheimer’s sufferers in the UK. The programme tells the story of a number of dementia sufferers, including Fiona’s father, who are cared for at home by family members. These unpaid carers are reported to save the economy around £6 billion per year. However, the carers that Ms Philips interviews find caring for their relatives upsetting and stressful, especially as many of them are elderly and frail themselves. And where the dementia sufferer still lives alone, as is the case with Mr Philips, there are concerns about their welfare and safety. The programme also examines the problem of getting funding for care, with only 49% of carers surveyed in a recent YouGov poll receiving any help from social services. The funding problems extend to medication, with the drug Aricept often being with-held from patients in the early stages of Alzheimer’s as prescribing it is not seen as cost-effective.

The programme was aired on 12 January and can be viewed on-line at the Channel 4 website. You can also read about the programme on the Channel 4, Observer and Telegraph websites.

posted by Cheselden Continuing Care at
16:02

A three year study published in the January 2009 issue of The Lancet Neurology reveals that prescribing anti-psychotic drugs to dementia sufferers nearly doubles the risk of the patient’s early death. The study was funded by the Alzheimer’s Research Trust (ART) and was led by Professor Clive Ballard of Kings College, London. 165 Alzheimer’s patients in UK care homes who were already taking anti-psychotic medicines were involved in the study. 83 continued to take the drug while the remaining 82 were switched to a placebo. The results showed a significant increase in the number of deaths, which continued to rise over time, amongst the group taking anti-psychotic drugs. At the end of the three year study, just one third of the people on anti-psychotics were still alive, compared to two thirds of the placebo group.

Of the 700,000 dementia sufferers in the UK, it is thought that up to 100,000 are routinely prescribed anti-psychotic drugs to treat behavioural problems like aggressiveness and agitation. The drugs are considered to offer some benefit over a short period, e.g. 6-12 weeks. However, the average length of prescription is 1-2 years, even though a previous ART study showed no evidence that long-term treatment was beneficial.

The latest study has prompted some strong reactions, with Rebecca Wood of the ART describing the results as a ‘wake-up call’’ and the drugs themselves as a ‘potentially dangerous chemical cosh.’ Neil Hunt of the Alzheimer’s Society comments that the study ‘…highlights the desperate need to stop people with dementia being over-prescribed anti-psychotics…(which) do not have any effects on the underlying disease processes of Alzheimer’s disease.’ The Government has responded by pledging to review the use of anti-psychotic drugs as part of its National Dementia Strategy, which is due to be published this year.

Not everyone is wholly against the continued use of anti-psychotic medication. Jeremy Kuper, writing for the Guardian, offers an alternative viewpoint, examining the issue of quality of life for Alzheimer’s sufferers and whether it is worth prolonging it by avoiding the use of drugs. Kuper, whose mother has at times been prescribed tranquillisers for the disease, balances the issues of behaviour management against patient awareness. And the study’s director, Professor Ballard, admits that although the results show that alternatives to drugs must be found and unnecessary prescribing needs to stop: ‘…there is still a limited place for anti-psychotics in the treatment of Alzheimer’s.’

This issue has been widely reported across a range of media including newspapers, medical journals and mental health organisation websites. The below links offer a selection of articles for further reading.

• BBC website
• The Daily Telegraph
• Jeremy Kuper writing for The Guardian
• The Alzheimer’s Research Trust
• The Lancet Neurology

posted by Cheselden Continuing Care at
15:55

The Guardian has reported that the crash in housing prices is stopping many elderly people from releasing equity from their houses to help pay for care home bills. With care home fees rising to over £24,500 per year for some residents, the loss of tens of thousands of pounds from the value of their house means that the value of an ‘equity release’ loan is much less than before, resulting in a potential shortfall in care home fee payments. An equity release loan – using your home’s market value to take out a lifetime loan on the property – was an increasingly popular option for funding care home fees during the property boom, especially as a house is the only major asset owned by many elderly people. The Guardian website’s Money section has the full story, plus other articles and links to useful sources of information on funding long-term care.

In related news, Saga reports that an increasing number of older people are taking out secured loans on their homes as they are unable to sell them or to obtain equity release due to the property crisis. The secured loans are provided by the Local Council to enable payment for care home fees, on the understanding that when the property is finally sold, the loan will be repaid to the Council.

posted by Cheselden Continuing Care at
17:14