Mary Parkes was a fixture at her local church and bingo hall in South-East London, until dementia led to her being admitted to the Gallions View care home in Thamesmead. Over a four-year residence at Gallions View, her visiting relatives regularly found her with rancid, unchanged dressings on her ulcerated legs, filthy fingernails, and surrounded by vermin. She died of sepsis in 2017.
Gallions View scored “inadequate” in all but one category of its latest Care Quality Commission (CQC) review. Yet Mary’s family paid £1,000 a month for her room. There are thousands of cases like hers.
Across the country, 44 care homes with the same classification brought in pre-tax profits of £113m between 2017-8 for their management companies’ directors and executives. A combination of Tory-inflicted council cuts, profiteering by private care providers, and unreasonable working conditions for staff have contributed to a care industry crisis that subjects some of society’s most vulnerable people to (in the words of one care worker) “hell on earth”.
The cost of care
While healthcare is available for free from the NHS, most social care provision in Britain is either means tested or totally private. During the economic slowdown in the 1980s, the Thatcher government began gouging local authority budgets: a process that continued under Major and Blair.
Naturally, the most-defenceless layers of society suffered the most from this “quick blast of the market”. Thousands of care contracts were farmed out to the voluntary sector and private providers, many of whom have gone on to make healthy profits.
The 2008 financial crisis and subsequent decade of austerity has exacerbated the situation, with an additional £7.7bn taken out of social care budgets over the past decade, with total funding falling by 20 per cent in real-terms.
At the same time, there is a greater requirement for care than ever, with 376,000 older people living in 10,300 homes across the UK. And this figure will only go up, as the number of over-85s in Britain is expected to double in the next 20 years.
In any sensible society, medical advances and increased life spans would be celebrated and rationally accounted for. Under capitalism, old age creates suffering for the many, and riches for the few. And this is not to mention an ongoing mental health crisis affecting younger people, which places further demands on the care sector.
The cost of private care homes can be astronomical, while means-tested, live-in social care very limited. We interviewed a reader of Socialist Appeal, whose mother and mother-in-law both recently moved to nursing homes. Previously, they had received live-in care. This was capped at four, 30-minute calls a day, at a cost of £90 per week – but in reality, calls were often no more than 10-or-15 minutes.
While it is possible to apply for free social care for long-term, complex medical cases under NHS Continuing Healthcare (CHC) provision, the prevalence of dementia sufferers means it is usually denied to them (a situation Labour has pledged to rectify).
The shortfall in affordable social care has led 5m people to leave work to look after a relative or friend since 2017, representing a 12 per cent increase in four years, causing massive personal and economic harm. And despite their best efforts, it is often impossible for relatives to provide the assistance required by dementia sufferers.
In the end, the deterioration of her relatives’ condition made it impossible for our readers’ family to keep them at home. But moving them into a care facility was a difficult and dehumanising process:
“The decision was made in a time of crisis: after a fall and hospital admission… someone came for an assessment and gave us a list of homes to choose from. After that, it was literally a case of knocking on doors and asking if there was space.
“Then the homes sent someone else for another assessment about whether or not to accept us. They pick and choose the least-complex cases, not the ones that need the most help. We have both of them in good homes now, but it was really the luck of the draw.”
There are two main categories of care homes for dementia sufferers: Elderly and Mentally Infirm (EMI) nursing and residential homes. The former have medical staff on hand, paid for by the NHS, while the latter only have care workers. In both cases, the actual accommodation must be paid for by the individual.
The privatised care industry makes its money from the life savings and meagre assets that elderly people have worked hard to amass in their lifetimes, and from their relatives’ support. While the state carries some of the cost (pumping money into private hands), a large number of residents pay for their own care through selling their homes. What they worked their whole life to earn amounts, in the worst cases, to a final few months of neglect.
Our readers’ mother-in-law suffered multiple falls at her first home, and it was clear she needed additional supervision. But state-funded, one-to-one physical care is hard to get, and usually denied to dementia sufferers, meaning it was granted only after two seperate hip breaks – and even then because her family fought hard for it.
An impossible task for care workers
After all this bureaucratic wrangling and expense, you would imagine the quality of care at these private homes would be of a high standard. Of course, some institutions do a better job than others with their limited resources. However, CQC inspection reports from November 2018 reveal an absolutely dismal state of affairs in many homes.
Common findings included: residents soiling themselves; “inappropriate and disproportionate use of physical restraint” by staff; patients being left waiting for long periods after ringing their call bells; a lack of dignity and respect (with patients’ underwear being left exposed, for instance); the risk of abuse by other patients; and staff failing to safely manage medicines.
In order to cut costs and maximise profits, care homes hire as few staff as possible and on low wages, with as little training as possible. At one home we investigated, staff even had to pay £60 for their own DBS checks.
Socialist Appeal spoke to a care worker (also a reader and supporter), based in Norwich, who described the conditions on the ground:
“It’s not uncommon to be on night shifts in dementia units of elderly care homes with just three care workers and a nurse to 50 or more residents. Shifts are 12-hours long, and breaks come when they come. Or not at all.
“The rounds can be extremely difficult, as you rush around trying to clean and change residents who are distressed, in pain, upset, and often aggressive. There is no time allowed for the inevitable unforeseen events you have to deal with during and between each round: residents getting up, being sick, falling out of bed, even dying.”
Already unmanageable workloads aren’t helped by the fact that staff are always overburdened with paperwork, which due to the lack of state oversight, is not standardised across the sector and becomes an unwieldy drain on threadbare resources, and limits contact time with residents.
The pressure on staff comes with inevitable dangers, and not all of them medical. With only four workers to 50 residents, orderly evacuation during fires is nearly impossible. This was tragically demonstrated in 2017, when a blaze at Newgrange Care Home in Hertfordshire resulted in two fatalities. The company that ran the home, Chestnut Ltd, was fined £175,000 in February over this case.
Understandably, there is often a high staff turnover at care homes. Because homes close down all the time, either because they fail CQC assessments or simply aren’t profitable, many of these carers work through agencies rather than being regularly employed at one location.
The result (as the care worker we spoke to explained) is “no familiarity, no consistency. These itinerant care workers don’t know residents’ specific needs.” All of this is naturally demoralising for care staff, who often feel complicit in patients’ neglect.
“Every carer is absolutely exhausted, broke, and ‘this close’ to quitting. The whole system is designed for systematic neglect of the residents. While carers try their very best to ensure that everybody’s basic needs are met – that residents are clean, fed, and hydrated – there is little time or energy for anyone to go above and beyond that.”
Money from misery
While some homes do a good job despite all the difficulties, some of the worst-assessed are among the most profitable, precisely because they cut corners. Mulberry Manor in Rotherham, South Yorkshire, is owned by Minster Care Management, which made a pre-tax profit of £41.6m in 2017. CQC inspectors at the home described dehydration and malnutrition, improperly managed medication, and “faeces smeared on the bed rail cushion at the side of [residents’] beds”.
Chelmunds Court, in Birmingham, and Elizabeth House in Essex are both owned by Runwood Homes, whose highest-paid director nets £2.22m a year. Patients at the Chelmunds were found to regularly physically abuse one another. At Elizabeth, overworked staff were so late in answering call bells that residents often wet themselves.
There are many such examples. And the total profits of the sector (much of it stashed in tax havens) are unknown, due to a number of smaller providers who don’t need to make their figures public.
The results of this profiteering and systematic neglect are deadly. The Tory government promised a green paper on social care in March 2017. But the overwhelming focus on Brexit has continually shunted this paper down the priority list. Between the initial promised date and February 2019, 54,000 people (77 a day) died while waiting for the new social care package.
And in the last five years, over 1,500 residents in care homes across England and Wales have died of dehydration (400 cases), malnutrition (250 cases) and infected bedsores (850 cases). People are quite literally being left to rot by the callous Tory government and private sector providers.
And it doesn’t stop at the elderly. Working-age adults make up a third of people receiving social care, particularly via mental health services, which have also been savaged by Tory cuts.
Socialist Appeal spoke to a mental health nurse, based in London, who explained that a typical ward budget is between £1.2-1.3m a year, but his trust spends £500,000 a month on beds alone, with the overspill being handled by private companies.
Once they are turfed out of hospital to ease the strain on emergency services, mental health patients are often sent to squalid, dirty, unrefurbished housing, which they must pay for either with housing benefits or finance independently.
“We know their mental health will deteriorate in these disgusting conditions, but there’s nothing we can do about it because council budgets are limited and that’s all they’ll provide,” said our source. “And if our patients experience a crisis, we have to wait two to three weeks for an assessment before we can intervene. We take the blame when things go wrong.”
He went on to explain how the fragmentation and privatisation of big chunks of the NHS since the 1980s, under the “trusts system” and then PFI, have wreaked havoc on the provision of care.
“The situation right now increases wait times, creates more misery, and more profit for private companies. Every individual hospital is run like a business, according to the ‘rigours of the market’. We need to undo all that. Social care should be renationalised and integrated. We need full harmonisation between health and social care.”
A right to dignity in old age
The Labour Party has been committed to a National Care Service since 2015 - although this policy was greatly expanded in its radical 2017 manifesto, and fleshed out at the recent national conference in Brighton.
Labour is promising free personal care at the point of use, provided in people’s own homes – including for dementia sufferers – by eliminating the division between health and care needs. It has also pledged to raise standards of care and take the burden off workers by ending zero-hours contracts, paying carers a real living wage (including travel time) and improving training for staff.
In his speech at the party conference, shadow chancellor John McDonnell described Britain’s social care sector as a “national scandal” and slammed big, private care providers for “sucking money out of the system”, promising that these companies would be subject to “strict criteria on ethical standards” under a Labour government.
Labour’s proposals for free care, and better pay and support for staff, are clear steps forward that should be welcomed. However, why should vultures like Minster Care and Runwood Homes, who subject their residents to total misery, be allowed to continue operations? Especially when their income is nearly entirely derived from the savings, assets and taxes of ordinary people.
No amount of “ethical criteria” will eliminate the profit motive driving these private providers, nor address the lack of consistency and total fragmentation created by privatisation. Currently, even when homes are employing good practice, it isn’t replicated across the sector, because each institution is run like its own separate business. And the homes that try their best to provide good care are often the ones that go over budget and get closed down.
The millions stashed away by negligent care providers should be expropriated under a Labour government, and their resources taken over and managed by the state, to guarantee a high-quality, consistent and free service across the board. Experienced care workers from the best homes should then be employed by the government to implement and manage a total rejuvenation of the sector, based on their knowledge of best practice.
Under capitalism, millions toil to support themselves and their families. When our working lives are over, the system robs us of what little we’ve saved, bleeds our families dry, and condemns many of us to squalor and neglect.
The least any decent society owes its population is comfort and security in old age and ill health. But capitalism is in senile decay, and must be laid to rest so that humanity can live - and grow old - with dignity.