The Crisis in Care For the Elderly

The dire situation really does pose the question of what sort of society we should and could be living in the 21st century.

Submitted by Internationali… on April 1, 2019

Another Sign of the Deeper Crisis of Capitalism

Elderly care is the fulfilment of the special needs and requirements that are unique to senior citizens. (Wikipedia)

Attitudes towards old people reveal a lot about a society. The UK is one of the richest countries in the world. But it is a world which is only managing to stave off economic collapse by piling up debt and turning just about every aspect of life into a commodity nexus for financial speculation. Of course capitalist commercialism which typically glorifies youth and plays on sex appeal to sell commodities predates the current crisis. By the swinging Sixties the post-war world was more and more in denial about the fact of ageing, never mind the process of death and dying. This cultural frame can help explain how nurses in a hospital ward for ‘the elderly’ can respond to someone in their death throes simply by putting up the bed rails and leaving him for the other patients (or should we say ‘bedblockers’?) to contemplate. Treating the last stages of life as an illness from which the patient ought to recover is part of a wider mindset that puts every infirmity of old age into the same bracket as a youngster with a broken limb: with a bit of time and some physiotherapy then the patient can get back to ‘independent living’.

Of course this is perfectly possible for some. Not every oldster is on their last legs. But when a local authority complains that the home care workers they employ to ‘speed up recovery’ and get people back on their feet within 6 weeks are not meeting their ‘targets’ we begin to smell a capitalist rat. Last July Birmingham council announced that ‘only 20 per cent of clients are independent after receiving the service’. So they set a new target of 80 per cent at the same time as proposing a ‘more flexible’ shift-system for the care workers that puts an end to full-time jobs! OK. Now it’s clear. We’re in the capitalist land of ‘targets’ and cost-cutting: As well as freeing up valuable and costly hospital beds "Council bosses claim the changes will make the service more productive and save £2 million a year." [Birmingham Live website] And since the main cost to the Council is the care workers’ wages then, logically, they have to be cut! No wonder there have been over 46 walkouts by care workers in Birmingham over the past year.

But this is not just a Birmingham scandal. All over the country job’s worth administrators in cash-strapped local authorities are trying to pretend that cutting care workers’ pay and making them work nigh on impossible hours will produce a ‘better service’ for a growing number of elderly citizens.

"… it has been observed globally, older people consume the most health expenditures out of any age group." (Wikipedia)

The first argument trotted out to ‘explain’ the dire state of care for the elderly is that there are simply too many old people. Last year the Local Government Association published a typical warning about the population over 85 growing three times faster than the rest of the adult population “and the number of older people needing publicly funded social care is forecast to increase by nearly 70% by 2035”. But these kind of projections are not new. Way back in the late 1950s and Sixties statisticians were predicting such an increase and the NHS began to plan for more Care Homes and long-term provision for the elderly. When the first state spending cuts kicked in, way back at the end of the post-war boom, funding for elderly care was one of the first sectors to be slashed. And so it has continued. In the 1980s much of what was now termed the ‘care industry’ was taken out of direct management by the NHS (i.e. the state) and handed over to private firms, most of them private equity companies. Now, since the financial crash over a decade ago and subsequent cuts in state spending (austerity) fewer than one in ten elderly people in long-term care are in local authority or NHS institutions. This has not resolved the impact of central government cuts on local authority budgets. So, despite all the off-loading, a recent report points out that 31 of 62 cities now spend the majority of their budget on ‘social care’ (not only elderly care) compared to 4 cities a decade ago.

Still, this is not the problem of the companies who have stepped in to see the elderly are well cared for — well, OK, with the aim of making quick financial gain. (We would say ‘profit’ but many of them are up to their ears in debt and on the brink of bankruptcy.)

“Increasingly, in modern societies care is now being provided by state or charitable institutions.” (Wikipedia)

Far from being charitable bodies, most care homes are in the hands of a complex web of finance capital, mainly private equity companies which “traditionally offer high returns” (Financial Times) for investors. According to the British Private Equity and Venture Capital Association the typical “private equity manager will work alongside the company management team to enhance the value in the business. ... from the top-line growth, efficiency savings, cash generation and procurement, to supply-chains, marketing and sales, improving reporting and human resources.” Then, after “a fixed life-span”, normally of 4-10 years, “they will have had to return the investors’ original money, plus any additional returns made”. In other words these are financial sharks out to make a quick kill.

As well as the fees that more and more families have to pay as the old NHS dictum of ‘free at the point of use’ dissolves into thin air, the ‘stakeholders’ are grabbing the revenue from local authorities (about 60% of care homes residents still get some funding from LAs). Naturally they are not too happy when this income stream is reduced. It makes it even more tricky to “increase returns” for investors. Apart from borrowing against the estimated market value of the ‘business’ the main way these sharks look to ‘increase their returns’ is by cutting the running costs of the homes. And, of course, the biggest ‘expense’ for them is the wage bill. For some the combined disasters of reduced income from the state, an increase in the minimum wage for care workers and a reduced supply of cheap wage doctors and nurses due to tighter immigration rules have all been too much. Care ‘businesses’ are going bust all the time. In November the Financial Times recorded:

"The FTSE 250 listed outsourcer Mitie sold its domiciliary care business for £2 last year after racking up large losses, while Mears, ... said last year that it was losing £3m a year on its home care business, and was handing back unprofitable local authority contracts."

These are the small fry. In 2011 the bankruptcy of Southern Cross, so far the biggest care home business to go bust, created a scandal and human disaster for many old people who found themselves being wrenched from familiar surroundings and friends and farmed out to other homes like a bunch of animals. There is danger of something like this happening again.

Last October the Care Quality Commission told local authorities to make contingency plans for the collapse of one of the biggest ‘home care’ providers, Allied Healthcare [owned by a German private equity firm Aurelius, after being bought up from Saga for £18m in 2015], which lacked “the ongoing funding or new investment necessary to ensure the business can operate beyond November 30, 2018”. In the event the company was sold on to another dodgy financial group for “an undisclosed amount” which promised to guarantee no disruption to people’s care. Well, that’s a relief. But the writing is on the wall, at some point another major ‘care provider’ collapse and a media outcry is in the offing.

All this translates into increasing misery in the real world. On the one hand ‘senior citizens’ are not being looked after as they should and could be, whether at home or in residential care. At home people with terminal illnesses can be left to a night of agony because a carer is not qualified to administer pain relievers. Fifteen minutes, or half an hour for someone―often a stranger―to provide ‘personal’ or ‘household’ care (depending on job description) is a joke and can leave the ‘client’ simply wishing to be left alone. Negative reports are increasing, including complaints of disturbing experiences in residential care ranging from neglect to callous treatment and sometimes outright cruelty. (Indirectly acknowledged by notices in some homes about how to file an official complaint against ‘bullying’.) Anxious relatives are resorting to trying to monitor what’s going on by installing their own video cameras.

"The majority of care givers are women." (Wikipedia)

On the other hand the people employed to administer ‘care’ are charged with doing the impossible on the lowest pay an employer can get away with. As one ex-care home worker explains,

"[in the] advertising you will see images of carers sitting with residents, reminiscing and having fun, [but] there just wasn’t the time ... Most days we were short-staffed; that’s four people for 50 [residents]. My time would be spent making sure people were dry and fed and hydrated, and that was it.”

Many find themselves going well beyond the bounds of duty, out of simple concern for other human beings. Home carers who have to supply their own car, visit up to 6 ‘clients’ in one hour and possibly fill in a worksheet for each visit are in an equally nonsensical position. And the situation is getting worse. More and more care workers are on zero hour, agency work which they dare not refuse. (Last year one of Britain’s care agencies, Newcross Health Care Solutions made the headlines for docking pay and fining workers who called in sick £50!) Many are getting stressed out and burnt out.

Some are seeing the need to resist. Unison has been having a field day enrolling new members from amongst care workers. And the more angry they are, the more the union has been pushed into staging some sort of action, as in Birmingham. But the unions are part of the problem, not the solution. It is obvious that a single group of service workers needs the active support of as many other workers as possible. It is equally obvious that ‘actions’ limited to one local authority or city are easy to contain and pick off one by one. Of course, this is not just a care workers or service sector dilemma.

The most pressing problem is that there really are no solutions within crisis-ridden, class-divided capitalism where a tiny minority at the top are getting richer as the living standards of everyone else are being ground down. The answer is not futile calls to ‘defend the NHS’. As we said, the NHS mess is as a result of the deeper capitalist crisis for which there is no civilised solution.

The dire situation really does pose the question of what sort of society we should and could be living in the 21st century. The material and human means exist for a completely different kind of world. A higher form of human community. A community where everyone’s needs are met directly without some set of moneybags making a profit whilst the people who do the work having to exist on a paltry wage; where those who care for others do so out of choice, and where all of us have a direct say in what is produced, built and decided for the future. The old world is crumbling. But a new world is possible. It’s up to those who can see this to organise, articulate and communicate the political way forward as we stick with our class in the troubles ahead.

The above article is taken from the current edition (No. 46) of Aurora, bulletin of the Communist Workers’ Organisation.