As Judi Dench urges people to take elderly relatives into their own homes, David Manion says it is a decision that requires a great deal of thought
Scotland’s system of residential care for older people is under stress. The viability of the business model for many private care homes is in doubt following last year’s collapse of providers Southern Cross and Argus. The effectiveness of the inspection regime is also under scrutiny after failings led to the closure of Edinburgh’s Elsie Inglis home less than a year after receiving a favourable report.
But let’s put this in proportion. Most care homes in Scotland offer residents a good quality of care.
And it’s not all sitting around in a circle watching TV all day, as participants in last June’s sports day at Edinburgh’s Marionville Court – complete with wheelchair egg and spoon race, space hopper relay and tug of war – will testify.
The kind of care home which Judi Dench so rightly castigates as “inhumane” remains the exception, not the rule.
However, no matter how good a care home is, it’s in their own home where older people would most like to stay – more than four in every five people aged 70 and older.
And continuing to expand care home provision in line with our ageing population will be unaffordable, both to families and the public purse.
That’s why Age Scotland wants a radical rethink of how we provide health and care services to older people.
If more of us can enjoy a healthy and fulfilling later life in our own home, then sustaining high-quality residential provision for those who need it becomes possible.
There are reasons to be optimistic.
Disconnection between the NHS and local authority services has left many older people in a residential or hospital care limbo awaiting a social care package to enable them to go home.
Now the Scottish Government has committed itself to legislation to join up health and social care and fix this problem. We’ll be watching carefully to make sure the job is done properly, and with older people fully consulted, but so far the signs are good.
Innovations in telecare, technologies that monitor the home and automatically call for help when it’s required, are increasing the options for older people to live independently in a safe and secure environment.
The Self-Directed Support Bill that’s progressing through the Scottish Parliament is also hugely important for ensuring that older people can take control of and direct their own home care packages to suit their needs.
Yet the impact of the current economic downturn cannot be ignored.
Across Scotland, local authorities are levying prohibitive charges for services that help older people to stay healthy, happy and independent in their communities, and in some instances closing them down altogether. While this might make short-term financial sense for cash-strapped councils, in the long run it will put more pressure on high-cost residential care providers.
Services such as day care, meals on wheels, lunch clubs and community transport are lifelines for many older people who would otherwise be socially isolated and, as a result, more likely to experience poor mental and physical health.
So where do families fit into all of this?
Where someone becomes unable to live independently, many relatives do choose to take on caring responsibilities, a contribution that would be worth around £10 billion in Scotland every year were it paid for.
These informal carers need to be valued and supported, with a recognition that carers of older people are often in later life themselves and may have needs of their own that make their responsibilities even more challenging.
Yet no-one should take on a caring role of this kind grudgingly or under duress. If they do, family relationships that have developed over many years can be put at risk to nobody’s benefit.
What all of us can do is to make sure that older family members who are living independently are not cut off from social contact, that when modern living leaves us pushed for time we can still find some to phone up, pop round and invite them over.
• David Manion is chief executive of Age Scotland
Conditions ‘distressing and inhumane’
Dame Judi Dench has hit out at what she described as “inhumane” care homes, and suggested families should instead take care of elderly relatives in their own homes.
In an interview with Saga magazine, the 77-year-old James Bond actress said seeing pensioners left in a place with noting to keep their minds busy was distressing.
“As anyone who’s visited one of these homes knows, you just cannot put people into a circle of chairs and have them watching television all day – it’s inhumane,” she said.
She added that for 12 years she and her actor husband Michael Williams shared their home with his parents and her widowed mother, Olave.
“After my father died and Michael and I got married, we bought a house in Warwickshire and we and my ma and Michael’s parents lived together. It’s the way they do things in the Mediterranean countries and, of course, in India, but by the very nature of what it is, it’s not easy.”