Getting old ain’t for the faint hearted
In this article Chris Price looks at how the built environment affects all aspects of running a modern nursing home and in a follow-up article looks specifically at the benefits of a Planned Property Maintenance programme at care-homes
“getting old ain’t for the faint hearted”
This is not a phrase I was familiar with until I became a director at Horsfall House, a charity run 44-bedroom nursing home, at Minchinhampton in Gloucestershire. The home provides 44 beds, split evenly between General Nursing for the frail and Elderly and Specialist Nursing for those with Dementia and other memory disorders – The level of care provided is high with the home rated as good in the most recent CQC report.
What has become quickly apparent to me is the financial strain that is placed on the home, the guests and their relatives. When talking about the costs of care, generally, we only think about the front line care given to the resident’s, with little thought or conversation to the home’s responsibilities to the essential repairs and maintenance that is required and more recently the impact of the upgrading of fire regulations largely as a result of the Grenfell Tower inquest findings – My role, as property director at the home, has been a journey of discovery to understand how the built environment affects all aspects of the running of a modern nursing home.
In 2011, The Dilmot Commission recommended to Government that the maximum cost of care to an individual should be capped at £35,000. In theory this would have meant that when an individual reached the cap the Government would take over their care payments. In 2016, having reviewed the reports findings, the Government introduced a cap on care costs but set the level significantly higher at £72,000 and this will rise, over time, with inflation. The cap only covers what is defined as ‘care costs’ and was to have been introduced in 2016 however this has been deferred to 2020.
So, what does the mean in practice? – Residents will still be responsible for paying general living costs even after the cap has been reached. Also, under current proposals, any money that residents pay out on care will only count towards the cap if it is spent on substantial or critical care needs that would be considered eligible by the relevant local council. So if you pay for care to meet low or moderate needs the amount you spend will not count towards the £72,000 cap.
Is it right that in a rich modern western country that the lottery of nursing and end of life care costs is dealt with in such a manner? – Councils are struggling with their obligations and, in truth, can only meet the basic costs; my experience being that the amounts paid by the councils do not cover the actual cost of a proper caring service or meet the additional needs of patients with greater needs such as dementia. The squeeze on council funding puts pressure on homes who face difficult choices. Such choices include having to close, as many have, or cut corners such as property maintenance.
WHAT I BELIEVE is needed is a system of insurance to cover nursing and end of life costs which could be along the lines of National Insurance but tapered so it increases with age. In addition, if a total cap was put in place I am sure insurance companies would come up with policies to provide additional cover. What is clear to me is that as medical advances increase life expectancy the need for care of the elderly will continue to increase with the care of patients becoming ever more complex. Dementia is a terrible illness and a caring society must look after those with the greatest needs – With the additional funding provided by such a system not only can appropriate care be provided but the built environment in which care is provided be looked after properly.
Chris Price is lead director at PACT Property & Assets Ltd
with more than 30 years experience in the property sector
T: 0117 456 8775
M: 07979 541215
CHRIS PRICE MRICS, NARA