Firstly, news that an an operator of three Lothian care homes is to take over 11 homes currently run by Southern Cross, which is being wound down due to financial difficulties.  Robert Kilgour, who built up Four Seasons Health Care before selling it, now runs three homes.  The owners of 11 Southern Cross homes, nine in Aberdeenshire, one in Edinburgh and one in Fife are forming a partnership with Mr Kilgour.  The handover is expected to take place within the next two months.

The full report from the BBC can be found here.

The second story concerns a care home in Hawick whose future may be in doubt.

A spokesman for the local Health Board said: “a study of NHS Borders’ services was being undertaken – the Health Board has a much higher proportion of beds than other regions of Scotland.”

One explanation for this, and one reason why this should continue, is the age demographics in places like the Borders.  Stories like this also show how much uncertainty surrounds the care home industry in Scotland just now.

The full story from the Southern Reporter can be found here.

Excellent report on the “cost of caring”, and how this can be reduced by preventitive measures, by Newsnight Scotland last night.  This was the first in a series of such programmes.  I am also looking at this issue in a series of articles: “Scotland’s care industry”.  The first two parts can be found in our “Publications” section above.

The programme outlined the many challenges we face.  The main issue being the increasing cost of caring for our ageing population.   That though is not the only issue.  Others include:  the quality of our health and social care services, standard of our care homes, who owns and runs these care homes, how we pay for these services and care homes, how do we divide the cost of these services between the individual and the state, how do we improve the health and well-being of our later years and do we need to restructure our health and care services.

There is also a question of perception.  This issue is not all all negative.  The fact that our population is living longer is a good thing.  As part of this debate the positive aspects of this issue need to be publicised.  This is also not just a question of money.

The programme is available on the BBC iPlayer.

Health Secretary Nicola Sturgeon said: 

“We are working on a strong presumption – supported by the landlords, and underpinned by our contingency arrangements – that older people will not be moved.  The welfare of all the residents will be maintained with minimum possible disruption. 

“The Scottish Government is working with COSLA and other partners such as ADSW [Association of Directors of Social Work] and SCSWIS [Social Care and Social Work Improvement Scotland] to ensure continuity of care for all residents in Southern Cross care homes in Scotland.

“This formal announcement signals the start of a process to break up the southern cross group on a consensual basis, it does not mean that the business has gone into administration, or that any care homes will close in the immediate future.”

The background to this statement is the announcement on Monday of this week that Southern Cross is to transfer all of its care homes to other operators.   

“The Report of the Commission on Funding of Care and Support” was published last week.  Although this report looks at the situation in England, and was commissioned by the UK coalition Government, the issues raised and the recommendations made are of direct relevance to us here in Scotland.

Extracts from the four key findings:

1. The current adult care funding system in England is not fit for purpose and needs urgent and lasting reform.
2. The current system is confusing, unfair and unsustainable.  People are unable to plan ahead to meet their future care needs.  Eligibility varies depending on where you live.
3. A major problem is that people are unable to protect themselves against very high care costs.   The current availability and choice of financial products to support people in meeting care costs is very limited.
4. Most people are realistic about the need for individuals to make some contribution to the costs of care in later life, but they want a fairer way of sharing costs and responsibility between the state and individuals.

Extracts from some of the main recommendations:

1. To protect people from extreme care costs we recommend capping the lifetime contribution to adult social care costs that any individual needs to make at between £25,000 and £35,000.   We think £35,000 is an appropriate and fair figure.
2. Not everyone will be able to afford to make their personal contribution, and those currently just outside the scope of eligibility for means-tested support are not currently protected.   To address this, means-tested support should continue for those of lower means, and the asset threshold for those in residential care beyond which no means-tested help is given should increase from £23,500 to £100,000.
3. Those who enter adulthood already having a care and support need should immediately be eligible for free state support to meet their care needs, rather than being subject to a means test.
4. Universal disability benefits for people of all ages should continue as now.
5. People should contribute a standard amount to cover their general living costs, such as food and accommodation, in residential care.   We believe a figure in the range of £7,000 to £10,000 a year is appropriate. [1] 
6. In reforming the funding of social care, the UK Government should review the scope for improving the integration of adult social care with other services in the wider care and support system.   In particular, we believe it is important that there is improved integration of health and social care.  [2]

Estimated cost

The estimated cost of these proposals is £1.7bn per year rising to £3.6bn by 2025.

Two examples from the Report may help explain how this would work in practice.  

Example 1:

Alice lived alone in her own home worth £180,000.  She had dementia and needed to go into a residential care home when she was 83 for the last 5 years of her life.

Under the current system

Alice’s daughter needed to arrange for Alice’s home to be sold in order to be able to use the money to pay for Alice’s care.   Alice had to pay for all her care and living costs in full until she died, spending £165,000 from her pension income and housing wealth.

Under Dilnot

Alice would initially need to contribute in full to her care and general living costs.  After two years she would have contributed £35,000 towards her care and reached the cap.   From then on, the state would pay Alice’s annual care costs of £18,500.  Alice’s general living costs would be paid out of her pension income.  Alice would be able to keep 80% of her wealth.

Example 2:

John has a stroke at the age of 85.  He could no longer manage at home and entered a care home costing £28,500 a year.   He lived in the care home for four years before he died.  Prior to this, he lived on his own, in a house which he owned outright and was worth £140,000.  He had £220 a week from his own pension and the state pension.

Under the current system

John had to contribute all his income except for £22.60 a week and use his housing assets to pay for his care.   He continued to pay for his care in full until he died, spending £74,000 from the value of his home.

Under Dilnot

John would pay the first £35,000 of his care costs and after two years he would reach the cap and then receive all his care without charge.  He would continue to contribute £10,000 a year towards his general living costs.  This would be done through his pension income.

John could choose to use his housing assets to pay for the £35,000 (taking out a deferred payment from the local authority), and still have £105,000 left, three-quarters of his wealth.

Reaction to this report in England

UK Government Ministers responded cautiously.  The health secretary, Andrew Lansley, described the Dilnot report as “an immensely valuable contribution” but warned that the UK Government needed to “consider carefully” the “significant costs” of reform.

Age UK welcomed the proposals. [3] Michelle Mitchell, Charity Director at Age UK, said: “Age UK welcomes the Dilnot Commission recommendations, which set out a clear blueprint for the long term sustainable reform of social care.

The Guardian said:  “Life is littered with potential financial catastrophes, from costly-to-treat illnesses to house fires, but in most cases the risks are pooled, whether through the state or the insurance market.    When it comes to care those with more than £23,500 are on their own, facing potentially unlimited liabilities.   The results are dire.  One in five retirees will clock up costs of more than £100,000.  Some 20,000 people are forced to sell their homes every year.  So Dilnot’s plan is very welcome as a way of staving off ruin for an unlucky minority.”

The Daily Mail took a different view: “The £35,000 doesn’t cover charges for bed and board; those could reach £10,000 per year.  And anyone wanting more than bog standard levels of care will pay extra.  So the middle classes will still face massive costs – while those on benefits will pay nothing.”

 Conclusion

This is a good and more importantly a timely report that points to the questions that we in Scotland also need to ask and answer.

In my next article I will look at latest thinking on this issue in Scotland and in particular what our main political parties said prior to the recent Scottish General Election.

James Aitken
Legal Knowledge Scotland

The article from the Scotsman can be found here.

A former Glasgow city councillor has been banned from making solo visits to his elderly mother in a care home run by Southern Cross after complaining about her treatment.

The report from the Scotsman can be found here.

Is there a crisis in how we care for the elderly and other at risk groups in Scotland?  The recent media coverage suggests yes but I suspect even as I start a series of articles on this subject that any conclusions I draw will be more complicated than a simple yes or no.

I am in my mid forties.   My Mum is in her early seventies as are my wife’s parents.   How we care for our parents is an issue that my generation cannot ignore.   It is not just how we care for the elderly that is making news headlines.  The scenes shown in the recent Panorama programme on Winterbourne View care home were sickening.

Southern Cross

Southern Cross has rarely been out of the news recently.  Southern Cross, which operates across the UK, announced it is reducing its rent payments and cannot afford to meet its annual rental costs of £230million.  The background to this is the reorganisation of the business a few years before the current economic difficulties.  The recession has caused Southern Cross, and others, real problems.   I will look at this issue in more detail when I look at how we fund elderly care.  I will also look at the charge levied at Southern Cross that “they are just like the bankers”, i.e. they award massive bonuses when things are going well but, when things go wrong, demand public funding.

Winterbourne View care home, near Bristol

The Winterbourne View care home, near Bristol, was featured in a BBCPanorama programme.  The scenes shown in the programme caused revulsion and outrage.   Police in Bristol have arrested a number of people after the secret filming by Panorama found a pattern of serious abuse at this residential hospital.  Winterbourne View treated people with learning disabilities and autism. The hospital’s owners, Castlebeck, have apologised unreservedly and suspended 13 employees.   The hospital has now been closed.  Even though this is an English care home the issues raised cannot be ignored here in Scotland.  How robust is our own inspection process?  Do we listen to whistle blowers?  Does the buck truly stop somewhere?

Elsie Inglis care home, Edinburgh  

The Elsie Inglis private nursing home in Edinburgh has been forced to close down. The owners of the Elsie Inglis Nursing Home volunteered to de-register the business after it became clear they would not meet a deadline for improvements ordered by Social Care and Social Work Improvement Scotland. SCSWIS said it had: “very serious concerns about the quality of care” at the home.  There is also a police investigation into the death of two residents of the care home.

Ninewells Hospital, Dundee

Ninewells hospital, Dundee, was severely criticised in a report by the Mental Welfare Commission over the care of an 80-year-old woman with dementia. Before her death, the woman was given dozens of sedative doses over 16 days in ways the Mental Welfare Commission deemed distressing and unnecessary.  Ninewells Hospital was not named in the report and its identity only became public when the media and politicians started asking questions about the report.

Erskine care home, Edinburgh

Erskine’s Edinburgh care home received a critical report from SCSWIS. It was also reported that the Chief Executive Officer of Erskine, Major Jim Panton has resigned.  A spokesman for the care home said that the resignation was not connected to the critical report.   The inspection report found that prescription drugs had not been administered properly and that fluid and food intakes had not been recorded.

The last three matters may in fact point to the fact that our system of inspection is robust.  I will though look further at this issue in a later article.

Some facts and figures

There are over 900 care homes in Scotland.  Approximately 170 are owned by our 32 Councils, 240 by charities and just over 500 by private operators.

Southern Cross has 98 homes in Scotland, Four Seasons has 49 and BUPA 30.

Approximately half of Scottish homes are run by sole traders.

Some 39,150 people reside in Scottish care homes.

77% of care home residents pay for their care.

Scottish Councils pay £550 per week to private providers to look after old people with estates worth less than £22,000.

Councils spend approximately £800 per week per resident in their own homes.

Someone occupying a non-specialist hospital bed costs the Health Board approximately £1,500 a week.  An acute bed costs approximately £2,800 per week.

Future articles

Over the next few weeks I will look at a number of the issues mentioned above in greater detail.  This will include how we fund elderly care, the quality of care given, inspection and whistle blowing issues, the role to be played by the private, public and third sectors, the debate on merging our health and care sectors and the options for taking control of some or all of a person’s affairs.

If you have any questions on this issue or simply want to make a comment please either contact me or use the “comment” option below.

James Aitken

Legal Knowledge Scotland

Plans to use a £420,000 bequest to convert a substandard care home into a healthy living centre, complete with spa and gym, for pensioners in the Galashiels area have been ditched following a three-month public consultation.

The report from the Southern Reporter can be found here.

A residential hospital for vulnerable adults near Bristol where alleged abuse was secretly filmed by the BBC Panorama programme is to close on Friday.

Castlebeck, which runs Winterbourne View, said the hospital would close on 24 June when the last patients would be transferred to alternative services.

The BBC news report can be found here.