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Tuesday, 15 July, 2003, 14:41 GMT 15:41 UK
Care homes: You asked our expert
Maisie McCarthy with care worker
Maisie McCarthy, 92, found moving home traumatic
Age Concern's Stephen Lowe answered your questions on care homes in a live web chat at 2000 BST on Monday 8 July.
BBC Host: Hello, and welcome to tonight's chat with Stephen Lowe from Age Concern. Here's the first question:

Question-from Patrick, Preston: Is there any hard evidence of what happens to elderly people's health when they are moved from care homes?

Stephen Lowe: Not conclusive evidence in terms of research. The problem is that older people in care homes are often in a frail state, so their life expectancy may be short anyway. So it's difficult to prove that deaths following moves from care homes are actually a result of the move. But we're aware of numerous incidents where a large number of old people have died in the weeks and months following the move from their care home.

BBC Host: Stephen Lowe is Age Concern's expert on care homes, and he's online now to answer any questions that you may have on this subject.

Question-from jiperydoo: Is there anything that we can do to help on a voluntary basis, and if so how do we go about getting involved?

Stephen Lowe: I don't think there's anything to be honest. I think there's a need for care home residents involved in closures to have access to independent advocates, which might be volunteers from a local Age Concern.

Question-from Jenny, Surbiton: Are there any health factors which should be taken into consideration when moving an elderly person?

Stephen Lowe: There was a public inquiry in 1996, following the closure of long stay hospitals, following which a large number of old people died. That concluded that one of the main risk factors was respiratory illness, and one of the main causes of respiratory illness was stress so they recommended that care homes shouldn't be closed in winter.

Question-from Seifer: Real Story says every month 1100 beds are lost in the UK care sector. Have you got an estimate as to how many care homes are created each month?

Stephen Lowe: The number of care homes has been falling since about 1997. The rate of closure hasn't actually accelerated in recent years, but fewer homes have opened in the last two or three years. That seems to be very much because home owners feel that the fee rates from local authorities are inadequate.

BBC Host: Thanks for the questions. Stephen Lowe from Age Concern is doing his best to answer as many as possible.

Question-from John D: The issue of care homes closing is a very wide one. It's not about simply beating social services departments about the head when they are seemingly refusing to fund an increase in care home fees. Is Age Concern lobbying central government on the lack of funding for social care?

Stephen Lowe: Yes, we've joined together with the other major charities like Help the Aged, the Alzheimer's Society and various others. We were quite successful last year in getting the government to increase funding for social care for old people. We've produced statistics to show how care homes are currently underfunded and we've estimated that government funding to local authorities needs to be increased by about 10% overall.

Question-from Dorothy: My local council has argued that if they pay more for one home they will have to do it for them all. What's your stance on this?

Stephen Lowe: Local authorities usually have maximum rates they'll pay for care, but what the law requires them to do is to vary that rate if they need to do that to meet the needs of individuals. So if a home increases its fee to above the local authority rate, the local authority must then assess the needs of the individual older person, and if they need to go above their usual rate to meet the older person's needs, then they have to do it.

BBC Host: If you've already sent in a question - thank you very much. Stephen will do his best to answer as many questions as possible. If you have a question that you would like to ask please send it now.

Question-from Charl: How many care homes beds are needed to free up hospital beds?

Stephen Lowe: Difficult to say, because at the moment the shortages of care home beds are mainly local and regional, and there are shortages of particular kinds of homes, like for example homes for older people with mental illness. Nationally the most recent figure of the occupancy rate of care homes is about 91%. The main market analyst estimates that it's about optimum, because if it falls below that, care homes won't be able to break even.

BBC Host: Remember, if you can¿t stay for the duration of the chat you can come back later in the week and the transcript will be on the Real Story website at www.bbc.co.uk/realstory.

Question-from Caliandris: Could Age Concern set up a fund to help with top up fees for residents whose homes cost above the social services limit? At least that might prevent some elderly people being moved from homes where they have been long-term residents?

Stephen Lowe: It is a problem for a number of charities that they're being asked to top up social services fees and charities are concerned about the legality of doing that because it's a statutory obligation for the local authority to fund the entire fee. Charities are not permitted to carry out statutory duties. Local authorities should only ask for top-up fees where the person has chosen a home that is more expensive than the one the local authority has offered. We are very worried that local authorities are routinely asking relatives to top up fees, without giving them any choice.

BBC Host: Hi to Caliandris, Charl, crazylady24, drew, Geoff, Jerseyman, Johnd, LiveNow, RAM_UK69, Seifer, Steph and all you others online right now. Thanks for the questions, Stephen is doing his best to answer as many as possible ;-)

Question-from Peter, Huyton: I may have to look for a home for my elderly mother soon. What advice can you give on choosing the best one?

Stephen Lowe: Age Concern does a factsheet which is on our website, it's factsheet 29, called Choosing a Care Home. The URL is www.ageconcern.org.uk

Question-from Julie, Beeston: How do you envisage the future of residential care?

Stephen Lowe: It's likely that there will always be a need for residential care, particularly for people with dementia. But in the future there are likely to be more alternatives available, such as sheltered housing schemes that offer additional services such as home care and better services in people's homes, perhaps with the help of new technology. So it's very hard to predict whether the need for care homes will increase or decrease in the future.

Question-from Anon: I work in a care home and witness bad practice every day because of understaffing? Where do you think I should take my concerns?

Stephen Lowe: The obvious place to complain to would be the National Care Standards Commission, who are responsible for inspecting and regulating homes.

Question-from Ashif: I'm a GP. If an elderly person has a respiratory disease or other stress-related illness it's absolutely obvious they should not be moved.

Stephen Lowe: I agree. The local authority, before moving someone in that situation, should do a full assessment and be aware of the individual's needs.

BBC Host: Hi to Caliandris, drew, Geoff, Jerseyman, Johnd, LiveNow, Seifer, Steph, Steve and all you others online right now. Thanks for the questions, Stephen is doing his best to answer as many as possible ;-)

Question-from Duncan, Tenby: Are care home owners making huge profits - or is it true that local authorities aren't paying them enough?

Stephen Lowe: Nationally, local authorities aren't paying the full rate that it costs to run a care home. The situation is complicated by the fact that a care home business is in fact two businesses, because it's often also a property business, so care home owners may be making large profits through selling property for other uses, such as conversion flats.

Question-from Carolyn, Stourbridge: Why have we got such a shortage of care homes in the UK?

Stephen Lowe: It's not necessarily the case that we have a shortage of care homes, but that the care homes aren't necessarily where they're needed. The main problem at the moment is that the number of new care homes opening has declined. That is down to the fact that home owners see local authority care rates as inadequate. In fact, six or seven years ago we had too many care homes nationally, and homes were going out of business because they could only fill about 83% of their beds.

Question-from Jacqueline, Colchester: What's the effect on the quality of life of an elderly person if they are moved?

Stephen Lowe: Well, it can be very negative. An elderly person can be separated from people they know, friends and staff at the care home. It's particularly an issue for people with dementia, or in the early stages of dementia, because if people lose the things they're familiar with, it could lead to the progress of the dementia becoming more rapid. People may be separated from relatives as we saw in the report, and before moving people, local authorities should take account of these factors. Question-from John D: I think there needs to be a national debate on care homes and the care of older people etc. Whats is Age Concern's stance?

Stephen Lowe: We absolutely agree, and we're doing everything we can to raise the profile of the issue, and we've particularly focused on parliament and politicians. But we're pleased to take the opportunity to spread the debate wider, into the media.

BBC Host: Hi all, thanks for the questions on ths issue. Stephen Lowe from Age Concern is answering as many as possible for you...Remember, if you can¿t stay for the duration of the chat you can come back later in the week and the transcript will be on the website - www.bbc.co.uk/realstory.

Question-from Nick, Bristol: The Human Rights factor has been used quite successfully by people in local-authority owned homes to oppose closure, hasn't it?

Stephen Lowe: Yes, the problem is that courts have ruled that independent sector care homes, like the one we saw in the report, aren't subject to the Human Rights Act which applies only to public authority homes. Courts have said that local authorities ought to protect the human rights of residents through their contracts with homes, but it's not very clear how they would do this. We think the government needs to issue guidance and that the Human Rights Act should be amended to ensure that residents of independent sector homes have the same rights as residents of local authority homes.

BBC Host: Thanks for all the questions so far, we have time for a couple more ;-)

Question-from Giles, Sudbury: I want to complain about the treatment of my uncle when he was forced to move into another care home earlier this year. What can I do?

Stephen Lowe: It depends if you want to complain about the home or the actions of the local authority. If you're complaining about the authority, you should use their complaints procedure. If that doesn't work, go to the local government ombudsman.

BBC Host: Remember, you can come back later in the week and the transcript will be on the website - www.bbc.co.uk/realstory. Final question for Stephen from Charl.

Question-from Charl: Do you think we will have to pay for our own care in a couple of generations as the national average age goes up and up ?

Stephen Lowe: We have to pay for quite a lot of the care at the moment. Particularly in care homes, once people have more than a certain amount of capital they are responsible for funding their own care. That's been the case since 1948. People are usually charged for the services they get from the social services in their own home. It's difficult to tell whether the cost of social care for older people will increase in the future, because although there'll be more elderly people, they may be in better health.

BBC Host: Thanks to Stephen Lowe from Age Concern for taking the time to answer your questions on this issue. Here he is with a final word:

Stephen Lowe: We're delighted that this issue is getting the national attention it deserves, because it is a national scandal the way that older people in care homes are treated. It wouldn't be tolerated for any other group. The government needs to act to defend the rights of older people.

BBC Host: Thanks to you all for logging on tonight and for all your questions. Remember, you can come back later in the week and the transcript will be on the website - www.bbc.co.uk/realstory. Thanks to you all for logging on tonight and for all your questions ;-) The chat is now over. For further live chats and chatrooms, you can go to bbc.co.uk/communicate. Bye ;-)

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