Social Care in Old Age

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Social Care in Old Age

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Tony Clack

Leader
June 4, 2017
Probably42 Discussion – Meeting 1 – 30/5/2017

The topic was Social Care in old age. Partly inspired by the furore around Social Care funding in the Conservative Election Manifesto.

The following is a summary of what we came up with as a first set of ideas. It is published here for wider discussion and development into eventual development into a set of proposals. Do you agree with any or all the ideas? Are there modifications or additions that you think would make them better, or alternatives or brand new ideas?

Root causes

We identified the following as the root causes of why Social Care is such a big issue:
- Increased longevity
- Expensive treatments
- Population Growth
- Sheer size of cost of care nationally
- National Insurance originally supposed to pay for health and social care and pensions throughout life but NI has gradually become a general tax. As a result most individuals have made no provision
- Care Homes going bust
Ideas

Provision for Social Care should be insurance based. The need for Social Care is not something any of us have control over (at the moment at least) i.e. some will get dementia others won’t. Therefore, it is a classic insurance situation, where rather than those unfortunate enough to need social care also having to pay all the costs themselves, it is better to pool the risk through insurance.

This leaves aside for a later decision who pays for the insurance premiums i.e. the state, the individual, part of each.

Although this may be a solution for the long term with people building up the insurance payments during their lives, the transition issue for those in later life, or part way through life, needs a solution.

If the solution is to be Insurance based, but not National Insurance, then there is a need to create an Insurance Market in Care protection, which does not appear to exist at the moment.

Assisted dying. We believe most people would like the option to have their life terminated if they have no quality of life. At the moment we believe living wills etc. enable instruction to doctors to at least not provide treatment. Although cost saving would be the wrong motive for introducing it, consideration should be given to changing the law to allow assisted dying, a side effect would be to reduce costs at end of life.

Application of Science and Technology

In the long-term there would seem to be an opportunity to both improve quality and reduce costs through application of science and technology. In particular through robotics. We are close to the point when this would be a viable option. Examples would be:
- Applying technology and robotics within Residential Care Homes and Nursing homes
o Use of robotics and remote monitoring technology in Care Homes to take as much mundane work as possible from staff e.g. toileting, washing, getting out of bed, dressing, giving tablets, other routine tasks, so staff numbers can be reduced and they can focus on interaction. Note many people would probably be happier to be toileted and bathed by a robot than an individual. Although the aim would be to reduce staff to some extent it would be important to ensure that it increased the time available for those remaining to have ‘human interaction’ with the residents. Over time robots could also possibly supplement the interaction role. Remote personal monitoring technology would also allow staff and remote doctors to monitor health without the need for so many visits.

o Reduce cost of care home infrastructure by Automated construction of modular Care Homes off site with standardised layout and equipment to simplify robotics and maintenance and periodic replacement. Technology designed in – plug in modules etc. Automated construction does figure in the housing white paper so there could be a dual benefit in accelerating take up for both Care Homes and General Housing.

o Incentivising acceleration of such technology applications for both Social Care and NHS would also drive cost-reduction and achievement of critical mass for manufacturers. It would also assist achievement of leadership in these fields with wider economic benefits.
- Extending the ability to stay in one’s home for much longer through use of technology
o voice control of all home functions from anywhere in the home e.g. Lighting and Heating, Appliances, Phone and Skype calls, Messaging, all Internet apps (Alexa), having a book read, turning on TV or radio, joining in online with others,

o extended use of remote monitoring capability as currently exists e.g. falls, floods, gas and alerting of relatives and/or call centres to give confidence and ensure action taken earlier if necessary

o personalised and remote health monitoring to give confidence and ensure action taken earlier if necessary

o priority given to drugs and research that can prevent or delay problems or make problems manageable e.g. dementia delaying drugs

o on the back of care home developments personal robotics to provide assistance e.g. bathing, toileting, but important not to lose the personal interaction benefits of home visits.

Promotion of Sheltered Housing and Retirement Villages. These potentially have even more benefits than staying in one’s own home. Firstly, quality of life can be much better because of the facilities, activities and interaction with others, especially if people enter when they are still fit and active. Also, you can get similar benefits to the application of care home technology and automated off-site construction as above. In this approach one also has the important attribute of one’s own home still and being able to stay in it longer because of availability of assistance on site. A valuable side-effect is probable down- sizing thus freeing up property and helping the housing market.

There is much greater use of Retirement Villages as a very positive life decision in the USA, so understanding and promotion of this, at a younger age, coupled with incentivising developers would both improve quality of life in later life and reduce costs of care when needed.

Reducing the need for care in the first place

Although not explored a great deal there should also be opportunities based on Preventative Health and Fitness initiatives, not just in later life but throughout life.

Similarly, with the rapid advances in medical science and drugs there should be continuous improvements in treatments or in delaying onset of debilitating illnesses i.e. ‘ill but active’ category.

Any such opportunities or initiatives would apply to reducing costs across both NHS and Social Care.

Foundations

A separate topic, but the idea of incentivising billionaires and companies to form Social Foundations (Community Interest Companies) and provide a heavier incentive for Foundations in the Social Care and other ‘big issue’ areas could also lead to deployment of additional imaginative solutions.

Questions

There was a suggestion that poorer people tend to die earlier, therefore don’t provide as big a caring cost as those in better health. To make good decisions we really need to understand if this is true. Similarly do those in good health actually live longer and end up costing more?

On the face of it weekly Care Home costs for the individual seem to be quite high in regard to the service provided, especially where staff are relatively low paid. An understanding of the balance of costs and why Care Homes do frequently go out of business is needed.

Other

It was mentioned but we didn’t conclude if National Insurance should be ring-fenced.

Operation of discussion meetings

We might consider inviting a ‘semi-expert’ in area to be discussed e.g. teacher for education.
[b]Probably42 Discussion – Meeting 1 – 30/5/2017[/b] The topic was Social Care in old age. Partly inspired by the furore around Social Care funding in the Conservative Election Manifesto. The following is a summary of what we came up with as a first set of ideas. It is published here for wider discussion and development into eventual development into a set of proposals. Do you agree with any or all the ideas? Are there modifications or additions that you think would make them better, or alternatives or brand new ideas? [b]Root causes[/b] We identified the following as the root causes of why Social Care is such a big issue:
- Increased longevity
- Expensive treatments
- Population Growth
- Sheer size of cost of care nationally
- National Insurance originally supposed to pay for health and social care and pensions throughout life but NI has gradually become a general tax. As a result most individuals have made no provision
- Care Homes going bust
[b]Ideas[/b] [b]Provision for Social Care should be insurance based.[/b] The need for Social Care is not something any of us have control over (at the moment at least) i.e. some will get dementia others won’t. Therefore, it is a classic insurance situation, where rather than those unfortunate enough to need social care also having to pay all the costs themselves, it is better to pool the risk through insurance. This leaves aside for a later decision who pays for the insurance premiums i.e. the state, the individual, part of each. Although this may be a solution for the long term with people building up the insurance payments during their lives, the transition issue for those in later life, or part way through life, needs a solution. If the solution is to be Insurance based, but not National Insurance, then there is a need to create an Insurance Market in Care protection, which does not appear to exist at the moment. [b]Assisted dying[/b]. We believe most people would like the option to have their life terminated if they have no quality of life. At the moment we believe living wills etc. enable instruction to doctors to at least not provide treatment. Although cost saving would be the wrong motive for introducing it, consideration should be given to changing the law to allow assisted dying, a side effect would be to reduce costs at end of life. [b]Application of Science and Technology[/b] In the long-term there would seem to be an opportunity to both improve quality and reduce costs through application of science and technology. In particular through robotics. We are close to the point when this would be a viable option. Examples would be:
- Applying technology and robotics within Residential Care Homes and Nursing homes
o Use of robotics and remote monitoring technology in Care Homes to take as much mundane work as possible from staff e.g. toileting, washing, getting out of bed, dressing, giving tablets, other routine tasks, so staff numbers can be reduced and they can focus on interaction. Note many people would probably be happier to be toileted and bathed by a robot than an individual. Although the aim would be to reduce staff to some extent it would be important to ensure that it increased the time available for those remaining to have ‘human interaction’ with the residents. Over time robots could also possibly supplement the interaction role. Remote personal monitoring technology would also allow staff and remote doctors to monitor health without the need for so many visits.
o Reduce cost of care home infrastructure by Automated construction of modular Care Homes off site with standardised layout and equipment to simplify robotics and maintenance and periodic replacement. Technology designed in – plug in modules etc. Automated construction does figure in the housing white paper so there could be a dual benefit in accelerating take up for both Care Homes and General Housing.
o Incentivising acceleration of such technology applications for both Social Care and NHS would also drive cost-reduction and achievement of critical mass for manufacturers. It would also assist achievement of leadership in these fields with wider economic benefits.
- Extending the ability to stay in one’s home for much longer through use of technology
o voice control of all home functions from anywhere in the home e.g. Lighting and Heating, Appliances, Phone and Skype calls, Messaging, all Internet apps (Alexa), having a book read, turning on TV or radio, joining in online with others,
o extended use of remote monitoring capability as currently exists e.g. falls, floods, gas and alerting of relatives and/or call centres to give confidence and ensure action taken earlier if necessary
o personalised and remote health monitoring to give confidence and ensure action taken earlier if necessary
o priority given to drugs and research that can prevent or delay problems or make problems manageable e.g. dementia delaying drugs
o on the back of care home developments personal robotics to provide assistance e.g. bathing, toileting, but important not to lose the personal interaction benefits of home visits. [b]Promotion of Sheltered Housing and Retirement Villages. [/b]These potentially have even more benefits than staying in one’s own home. Firstly, quality of life can be much better because of the facilities, activities and interaction with others, especially if people enter when they are still fit and active. Also, you can get similar benefits to the application of care home technology and automated off-site construction as above. In this approach one also has the important attribute of one’s own home still and being able to stay in it longer because of availability of assistance on site. A valuable side-effect is probable down- sizing thus freeing up property and helping the housing market. [b] [/b] There is much greater use of Retirement Villages as a very positive life decision in the USA, so understanding and promotion of this, at a younger age, coupled with incentivising developers would both improve quality of life in later life and reduce costs of care when needed. [b]Reducing the need for care in the first place[/b] Although not explored a great deal there should also be opportunities based on Preventative Health and Fitness initiatives, not just in later life but throughout life. Similarly, with the rapid advances in medical science and drugs there should be continuous improvements in treatments or in delaying onset of debilitating illnesses i.e. ‘ill but active’ category. Any such opportunities or initiatives would apply to reducing costs across both NHS and Social Care. [b]Foundations[/b] A separate topic, but the idea of incentivising billionaires and companies to form Social Foundations (Community Interest Companies) and provide a heavier incentive for Foundations in the Social Care and other ‘big issue’ areas could also lead to deployment of additional imaginative solutions. [b]Questions[/b] There was a suggestion that poorer people tend to die earlier, therefore don’t provide as big a caring cost as those in better health. To make good decisions we really need to understand if this is true. Similarly do those in good health actually live longer and end up costing more? On the face of it weekly Care Home costs for the individual seem to be quite high in regard to the service provided, especially where staff are relatively low paid. An understanding of the balance of costs and why Care Homes do frequently go out of business is needed. [b]Other[/b] It was mentioned but we didn’t conclude if National Insurance should be ring-fenced. [b]Operation of discussion meetings[/b] We might consider inviting a ‘semi-expert’ in area to be discussed e.g. teacher for education.