Our elderly care system belongs in the stone age: it must change

In our supposedly civilised and wealthy country we confine large numbers of older people nearing the end of their lives to, at best, a mediocre and, at worst, an abusive existence. Too often the more vulnerable they are, the less adequate support they receive.

Back in the 1960s and 1970s, sheltered housing was hailed as the answer, a neat compromise between full independent living and the old people’s home. Yet while it has worked for some, many schemes have struggled to cope with more frail residents.

Neither has the predicted demise of the residential home come about. Instead, for a generation it has been the backstop of the care system – a relatively cheap stalwart that has enabled successive governments to cost shunt from a free health service to means-tested care. It’s a lack of proper progress that has been cynically disguised as a reform from unacceptable Nightingale ward accommodation to chintz-covered suburbia.

It is time to wake up to what this means for thousands of elderly people: the loss of their life savings in return for a poor quality of life. Politicians talk a great deal about choice, and doubtless will talk a great deal more about it as the election looms. But many elderly people, especially those with dementia, have no meaningful choices in their daily lives.

Of course there are excellent examples of good care, but too much in this field is mediocre and uninspired. To walk in the door of some institutions is to step back in time. Little or nothing has changed in the past 30 years. The television still shouts in the corner of the day room. The residents sit, seemingly oblivious, round the perimeter in those special chairs you never see anywhere else. There are few, if any, signs of individuality.

There is supposed to be a care market. But choice for these consumers and their relatives is often limited – and for those with dementia the shortage of specialist places means it’s practically non-existent. Older people cannot choose to stay in their own homes, nor about styles of residential accommodation; sometimes they’re not even able to determine where they live.

To walk through the door of some care institutions is to step back in time. The TV shouts in the corner of the day room; residents sit there, oblivious; there are no signs of individuality

And what of home care – the model most would prefer? For years now local authorities, pleading poverty and rising demand, have been raising the qualifying criteria to the point where, in some areas, only those most in need are offered help. People who would benefit from non-personal care – the home help given to individuals who are frail but coping – are often denied help.

And last but by no means least, there are worries about the future for sheltered housing. In the past, social landlords have used housing benefit to pay for the care element, but housing benefit is under review while the new Supporting People funding stream cannot be used for personal care.

All this is taking place within a care sector where there is a lack of consensus on the way forward; on both what is needed and who should pay for it. The government says there are enough residential and nursing home places and that the future lies in expanding home care and very sheltered housing; care home owners, unsurprisingly, disagree, at least about the number of residential places needed. Yet we need an agreed way forward.

Later this month the King’s Fund will publish an interim report from its inquiry into care services in London. The findings will resonate throughout the country, though some issues such as the massive increase in older people from ethnic communities may be more relevant in some places than others.

This document sets out the challenges that lie ahead if we are to raise our game and start protecting the rights and dignity of the most vulnerable elderly people. The government too is soon expected to set out its vision for the future of social care. It does seem we are at a crossroads: this may be a one-off opportunity to get a grip on an area of social policy that’s been neglected for too long.