Home for longer

Better care at-home would have kept my family together for longer. Before mum went to live in residential care, she had two years of visits from carers at her home where she lived with my dad. Like thousands of other daughters and sons across the country acting as power of attorney for a parent, I agonised over the choice to move mum to a care home. This was four years ago.

A home-first approach is now a central pillar of Labour’s 10-year plan to reform social care: It is part of Labour’s ‘fundamental shift’ towards prevention and early intervention. In her April 2021 speech to the Association of Directors of Adult Social Services, Liz Kendall MP, shadow minister for social care, outlined how the party would keep people in their own homes for longer.

Labour’s vision for social care is transformative: It would elevate the whole sector to an equal footing with the NHS whilst also giving families far greater power over services and regulation.

In the December 2021 debate on the government’s social care white paper, Kendall reaffirmed Labour’s vision, with the overriding mission that all older people can live the life they choose, in the place they call home. This vision includes older and younger disabled people and people who are unwell – even those with dementia.

Back in 2018, if I had been able to find more specialist at-home dementia carers for the times I could not be with my parents, and if we’d had council advice and funding to make physical adaptations to their downstairs rooms, we would have been able to keep mum at home for longer. This would have made my dad happier. And though medically speaking she did not then have mental capacity to decide, mum’s agency would have been expressed by remaining in her own home for longer: in her own bed, surrounded by her things and close to her family.

Labour’s vision is a real alternative to the government’s at-home care provision set out in the white paper. Of the eight proposals in the white paper, only one speaks directly to people staying and being cared for in their own homes. This is also the vaguest and the only uncosted proposal, described as a “new practical support service … to help people remain independent and safe in their home.”  This proposal sits under the government’s principle that everyone should have the choice, control and support to live independent lives. But it simply pays lip service to those who advocate for care in the community:  a ‘practical support service’ of course covers anything and nothing. As a whole, the white paper is vague enough for the government to do the bare minimum and claim standards have been met.

One of Kendall’s central arguments is that by improving pay and conditions of the workforce, government could reverse the recent exodus of carers from the profession. Skills for Care records that 410,000 social care staff left their jobs over the course of 2020/2021 (many then found new jobs within the sector again), reflecting staff turnover rate of 28.1 per cent. The government’s white paper does not mention pay.  There is a costed-proposal for £500m in ‘training and qualifications’ for the social care workforce, and in what reads more like a wish than a proposal, a reference to social carers having their ‘wellbeing prioritised’.

A new national website, costed in the white paper at £5m, will apparently explain all these changes further. But as Kendall highlighted in the Commons debate, ‘some sort of website’ is not going to reverse the exodus, nor will it “pay a care worker’s bills or put food on the family table”.

Labour should not shy away from proposing a minimum social care wage, with pay increases linked to carers’ skills and experience.  This is particularly vital for keeping at-home carers in the community.

During the years that we had carers come to the house, we met some wonderful carers who made our lives much better for a few hours. But without additional dementia-care training, and without the physical adaptations to the house, there is no way those carers could have continued to care for mum at home as her condition progressed. Without spending significantly more to get skilled carers to travel in from a neighbouring city, several times a day, it became impossible to keep mum at home.

It is not only my family who want change. Staying at home with skilled carers coming in as needs increase is the long-term preference for 75 per cent of adults over the age of 65 according to an Age UK study in 2019. This is not to say that many residential care homes are not excellent at caring for those who cannot remain in their homes. But with such a high preference for staying at home, residential care should be a last resort.

There is also currently a shortage of supply of highly skilled at-home carers. And of the specialist at-home care providers that are out there – including dementia specialists – the standalone fees are beyond the vast majority of peoples’ budgets.

Keeping at-home carers in their jobs and attracting new people to train in the profession would not only improve social care standards in the community but would also go a long way towards alleviating the current NHS beds crisis. According to the Financial Times, 15 per cent of occupied NHS beds are filled with patients who are medically fit to leave but cannot be discharged because no social care is available – at home or in residential settings.

Labour’s home-first approach is exactly right. It demonstrates the party’s willingness to root a key policy area on the preferences and lived experience of thousands of families in the UK; families just like mine.

Image credit: Dominik Lange/Unsplash