Analysing The Political Economy

Social Care Crisis: "Am I Dead Yet?"

By Graham Vanbergen: The warnings about a looming social care crisis in elderly care have been ramping up for years. It was an inevitable demographic time bomb just waiting to blow up. More recently, those concerns have become the reality we are now experiencing.

Tory council leaders have warned the government time and time again as it faces this year’s record near on £4bn funding gap and a growing staffing shortage that has brought many local care providers to the brink of collapse.

To make matters worse, care costs have accelerated recently, fuelled by unbudgeted wage and energy inflation. And depending on what part of the country you live in, there won’t be any available bed space, no matter what the circumstances.

Since 2001, there has been a 35 per cent increase in those living over the age of 75. The consequence is a whole slew of new records. One in 5 people aged 50-64 are now carers to an elderly relative. One in three of the UK’s 6.5 million carers is over the age of 65. And another new record – one-quarter of all chargeable care cost users are in debt.

This hidden army of carers, now amounting to several million people, have more problems to deal with. Many have been forced out of the work they did making their own future prospects even worse. But even with this massive resource, things are getting worse.

Reports from seven years ago show quite clearly that ‘bed-blocking had reached a new record.’ It then reached a new record the following year. It kept going and did the same again in 2022 – but this time in the summer. Here we are, mid-winter, and bed-blocking is so bad that hundreds of people are now dying in ambulances each week.

Martin Tett, the Tory leader of Buckinghamshire council said last September, before the annual NHS winter crisis got into full swing – “We face the perfect storm of staffing shortages, fewer care beds, and higher costs – all of which will impact on individuals waiting for care and discharges from hospital.”  He wasn’t wrong. And it so happens that this is exactly what is occurring with my own father.

Just before Christmas, he collapsed. After waiting ten hours for an ambulance, he arrived at Milton Keynes University Hospital. A day later he is in a ward bed. It’s a depressing sight – being surrounded by elderly men who are unable to stand up, let alone look after themselves.

The nurses are attentive, kind and caring. Cleaning staff are permanently milling around. Technical equipment hanging around each bed to monitor vital signs makes you wonder how we afford it all.

My father looks weak and weary of life itself. Unshaven, he looks even older than his 93 years.

In this ward, one of many that make up a medical management system dedicated to the elderly in this hospital, there are another five beds. One patient looks even older than my father but is peacefully asleep. Another is awake but staring into space, and his nearest neighbour is attempting to escape but can’t move his legs.

“Am I dead yet?” shouts the man who was asleep a moment ago. He stares at the ceiling and asks again, this time much more quietly. I wondered what he was actually thinking at that fragment of time. Was he asking a question from a hallucinatory slumber or was he hoping he’d see something to confirm his tortuous ending and that his time in this world had finally arrived?

There is a huge debate in the so-called civilised world about how we should be able to end our time here. Right at this juncture, one has to dig deep to excavate the tension strings between morality and kindness. It seems impossible to answer without callous contemplation, the dark of the inevitable and of letting the burden of life itself slip through our fingers at the right moment.

After witnessing this dear old man’s questioning moment in his own life, my own father asks – “Is your Mum going to be OK after I leave?” I respond by asking, “leave what?” “You know – pass on to the great unknown” – as he likes to phrase it. I didn’t sidestep the question by smiling and reassuring him insincerely that somehow he has many years left – that would be disrespectful given this juncture. “Yes, she’s fine and always will be – you have nothing to worry about” – I say.

My father sighs and looks once again at his dinner menu. He knows he can’t return to his home of 43 years. He knows the comfort of his own armchair is lost forever. His mind hasn’t gone; his mobility has – and requires help in and out of a wheelchair or bed or one of many daily basic needs we all have.

In all of this, I was unable to find a care home room for my father that is local to my mother. The so-called care system isn’t creaking; it has now fully imploded. The hospital is desperate for the bed my father occupies. A doctor has declared he is fit to leave the hospital. The discharge team initially stated he requires nursing care, not a residential care home. The doctor almost agrees, but not quite. A week later, my fathers’ situation is downgraded to requiring a residential care home, not nursing care. He is moved to another ward in preparation for relocation via ambulance. Social services are charged with finding that room. The government announces a special fund to help – so social services block book all care home and nursing home beds. But still, nothing happens. There aren’t any care home beds available.

Weeks later and after many long-range car trips by the family to get mum to the hospital – there is nothing to report. My father waits patiently. My mother frets and cries – and asks when he will be moved.

We have no idea where or when a care room bed will become available. I keep looking. Nothing. The discharge team in the hospital (part of social services) has gone quiet.

Once in a care home, social services will pay for the first month (under the new government grant to unblock beds) – this is what the government fund is for. Then what? What unravels next is mind-bending and it’s impossible to explain. Briefly – it involves a needs assessment, a means-tested social care assessment, and then the job of working out how much is available to pay for all of this and what happens when he runs out of cash. Even the lower levels of a patient’s own money at £23,500 – the amount which cannot be used for care by the local authorities is ambiguous. The question about selling the house my mother lives in can’t be answered because different local authorities have different rules. And what happens if the status of a patient’s residential care home is changed by the care provider? Some care home providers will not accept those who cannot get out of wheelchairs unaided. Some will. There’s a big difference in what happens then.

The government has stated that all care costs will be capped at a lifetime limit of £86,000 from October this year. Cynically, they don’t like to state openly that this does not include the cost of accommodation, food, heat-light and so on – the vast majority of the cost of a care or nursing care room in the first place.

You can argue that the government is not there to look after you in your last years of life unless you genuinely can’t afford it, of course. Equally, you might want to ask how this nightmare situation has got to where it has – other than to point that question at cowardly politicians who have answered this simply by kicking the can down the road.

When you reach the point of being old and frail and stuck in this ‘bed-blocking’ situation – asking, “am I dead yet” is salient. You might think it an easy question to answer. But then again, the collapsing elderly social care crisis is hell on earth!

The government of the day has answered the question of kicking the bucket for the last thirty years or so by kicking the can. For the rest of us, the social care crisis, when it comes to a parent, is just that – a crisis.






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