Care Home Closures
In the news these days there are many stories about families who are distraught about the closure of the care home where their relative lives. They write to me in the hope that I will provide evidence that being moved is bad for people with dementia and this harm should be prevented by forcing the home to stay open. I will talk about the evidence on that, but first have to talk about why the financial situation is overwhelming and can’t be argued against.
I am always sorry to hear what families are going through in respect of their mum or dad’s care home care. They have my deepest sympathy. But I have to explain the reality. Across the UK, care home closures are accelerating, not just council homes but in all three sectors i.e. charity, private and council. Homes cannot survive financially if the majority of residents are council funded. The council pays less per week for their residents than any home can charge privately funded residents. The amount they pay is often not enough to cover the cost of the care provided. This is caused by a perfect storm of difficulties. Rising costs of workforce and utilities and the increased demands for quality from the regulators crash up against reduced local authority budgets. If the home is over-exposed to local authority funded residents, it can’t pay its staffing and other bills.
For some older established homes, there may not be enough budget to adapt their buildings to modern requirements for ensuite shower rooms and other desirable or even essential design features. They don’t have enough money for new buildings. To be confident to break even a care home these days probably needs to be in a purpose-built modern building that meets the regulator’s standards, and also big enough to allow economy of scale - which means that many homes are much too small. It’s a nightmare. In addition, it needs to be in a catchment area where many people own their own houses. It’s the equity in those residences that will pay for the self-funded residents who keep the home viable.
Local authorities have hard decisions to make across a lot of services, especially if they can outsource them. Outsourcing care home care is a forced financial decision, along with using private contractors for care in the person’s own home. My own local councillor said to me recently that “being in power” in the local authority isn’t any more about choosing what to do, it’s about choosing what to cut. It is also showing in the closure of local authority care homes.
Some care homes don’t have as much expense on their buildings because they’ve inherited reasonable structures that have few costs. Others have had to make significant investments in buildings to bring them up to standard and have incurred debt as a result. Charities might have windfall donations and legacies that see them through the year, but that’s not sustainable. Some private and charity care homes manage to stay afloat by having a mix of private paying and council paid residents. On average the private paying people pay 40% more than the others for the same service, subsidising the council paid residents.
Unless we have a new government that is prepared to tax us more to pay for local authority care home care, this sort of thing will continue to increase across our country as the number of people needing care rises, and the cost of fixing it is beyond our wildest imagining. If the local authority provision is poor value for money compared with outsourcing care to other providers, local authority care homes will continue to shut.
So I can make some general points about the health consequences of moving people with dementia from one residential setting to another but they might be disappointing because they won’t support the case for keeping a care home open at all costs.
For people with dementia in care, consistency, routine and keeping things familiar are very important.
Change is always difficult for people with dementia and should be avoided where possible unless it is an improvement in the interest of the person for example for better accommodation, making family visiting easier, moving away from unsatisfactory care etc.
Emergency forced changes that happen without warning after a fire, flood, breakout of infection, financial collapse etc present a significant risk to the wellbeing of people with dementia and homes should have contingency plans in place for an emergency response in case it is ever necessary to manage that risk.
The negative effect of an emergency forced change can be mitigated if the staff who know the residents move with the resident, and if the families and friends, and volunteers are on board with the change and supporting the residents and staff, reinforcing positive messages, and maintaining as much consistency as possible.
Where a change is unavoidable it works best if it is planned in advance to have a positive outcome.
Where staff are anxious and upset about an unavoidable change, like the closure of a popular home, this is picked up on by those they are caring for and their families. If the staff are unable to be constantly positive in their own communication about it the bad feeling spreads. The research on this was not published, but it suggests that the staff anxiety about their own future and changes they’d have to make personally, made the families, and cared for people, anxious about their future circumstances.
I wish I could be of more help. If this tide can’t be stopped, it’s important to find out what is planned for damage limitation in every case and to put on a brave and positive face in the interest of the resident, even where staff and families are at their wits end worrying about what happens next for them.
