Scottish care crisis: Lower care home fees won't solve sector's problems

The amount that older people are expected to pay for residential care has come under the spotlight in a new report, which was commissioned by the government in direct response to Covid death toll in the country’s care homes.

It warns that the country’s social care sector is ‘fragile and creaking’. Organisationally and structurally and perhaps also under the weight of expectation about what the public expects it to deliver without paying more. 

Too few people in the public sector have a deep understanding of how the private sector works

The system continues to prioritise profits over wellbeing and working conditions, it says.

While it argues that profit plays an important role in market economy, it says significant sums are “leaking” out of the system, more of which should be used to drive up standards.

Donald Macaskill of Scottish Care, which represents independent care providers, says he does “not see any signs” that the public pay less in fees given that many charitable homes are going out of business while Professor June Andrews, an author and expert in the care of older people, said while praising the boldness of the report that it was “disappointing” that care homes are being accused of a lack of transparency.

READ MORE: Self-funding Scots care home residents to benefit from 'significantly' more financial support 

“It is as if every other private supplier of goods and services to health and social care is satisfactory in this respect” she says.

“Care home companies are often complicated, and too few people in the public sector have a deep understanding of how the private sector works, but that does not mean they should be regarded with suspicion.

“Blanket criticism on the basis of extrapolation from a small sector of the market, and some misrepresentation or misunderstanding of the market is not likely to encourage partnership.”

The report, which calls for a National Care Service on an equal footing with the NHS, involved more than 1,000 interviews with care workers, service users and experts, and recommends as a priority better pay and working conditions for those looking after our elderly – which should hopefully be one of the easier of the 50 recommendations to implement. 

Those who were interviewed during the pandemic said a lack of training ‘had put people at risk’ and frequently reported they could earn more money in a supermarket. 

READ MORE: SNP government urged to scrap unfair 'dementia tax' care home contributions system

Care homes are not hospitals, but better skilled workers would surely pay dividends elsewhere, in the NHS and economy.

The review does not deal with finance until the final chapter, a deliberate move by those leading the research because they wanted the experiences of adult social care support to be the focus. However it acknowledges that such radical changes come at a cost. 

Mandatory social insurance or local taxation are presented as two possible options and experts say we can’t avoid one or the other, going forward.

It has been suggested by some that the publication of the report, which was commissioned by the government, was timed to slot into the SNP’s forthcoming election manifesto. 

The idea of a National Care System is also backed by Labour and it will be interesting to see how either would plan to fund it.

The government announced earlier this month that it is to raise the allowance self-funding care home residents are given towards nursing and personal care costs by 7.5 per cent, which as welcomed by Alzheimer Scotland as an “important first step”.

The “free” care that was introduced under Henry McLeish’s Labour government in 2001 has not kept pace with the actual cost of paying for it, particularly for those with advanced dementia who require 24-hour nursing care. 

The report estimates that it would cost £116million annually to bring contributions up to the same rate as those who qualify for local authority funding, while the price tag for implementing all 50 recommendations is estimated at £660m per year.

READ MORE: Pandemic exposed Scotland's 'creaking' social care system as damning report estimates cost to fix it 

The daughter of one woman, who has dementia and lives in the central belt, pays almost £5,000 a month and said the private provider insists this does not include nursing and personal care costs. She says she was told the higher fees will guarantee her place when her savings and capital from her house run out.

“It’s the first question social work ask at an assessment – do you own your house? If you don’t, the chances of them saying you need a care home place are really low.”

Scottish Care say it has long argued that it unfair that care home residents do not have control over their budgets in the way others accessing community support do and the report advocates for change in this area.

The report is also clear that building more care homes is not the answer to future demographic trends, including the projected growth in diagnoses of dementia.

It suggests there should be wider use of models already being seen in areas including Moray, the Scottish Borders and South Lanarkshire.

The Shared Lives scheme involves an approved carer welcoming adults who need day support or longer term care into their own home and is most extensively used in Fife for people with learning disabilities. 

However, experts say this could be used more extensively, while the research also advocates for a home share model, where a younger person – subject to all the relevant checks – would provide companionship and practical help with tasks like shopping and cleaning in exchange for low-cost accommodation.

Former NHS Chief Executive Derek Feeley’s report has been widely praised and was fast tracked over a matter of months but it is likely to take far longer to solve the age-old problem of funding.