Realities of social care for older people in Wales

The IWA’s Adding Life To Years report, published earlier this year is a focused consideration of the main issues connected to policy on ageing in Wales. I read it because for the last nine years I have been a carer for my mother and parents-in-law and I wanted to lift my head, as it were, from the daily business of dealing with elderly people to understand better the context in which I have been trying to help them to enjoy life.

The report, authored by IWA Director John Osmond at the request of the Older People’s Commissioner for Wales, has certainly given me a useful overview of how Welsh policy on ageing has evolved and the direction in which it is heading.  Wales can rightly be proud that in some respects we are leading the way in this field, notably with the appointment of the Commissioner for Older People Ruth Marks herself, probably the first in Europe. This is definitely a stage in life which needs all the advocacy it can get.

The paper, informed by interviews with a range of experts in the field, is organised efficiently in seven sections which take one through attitudes to and experience of old age into some ‘headline concerns’ of older people. It considers how policy affects the delivery of care both in residential and domestic settings, concluding with a brief, optimistic, summary of the likelihood of successful policy development.

In my experience, there is a gap between the policy level and how things feel for my relatives and for me as a carer. This is to be expected and the aim of exercises like this paper is to work out how to narrow the gap. To give an example engages with the issue of Direct Payments (page 23):

“Wales has taken its own approach to people managing their own care. Direct payments for care have to be offered by local authorities in Wales but in practice have been taken up by a relatively small number of older people. A direct payment is available to people who have been assessed as needing community care and who qualify for help with the cost. It enables people to arrange care for themselves.”

No social worker has ever mentioned Direct Payments to me – ever. This is despite:

• One of my relatives being 95-years-old, another a stroke victim, and a third, dependent on a 23-year-old quadruple heart by-pass, until his recent death.
• I was a busy professional caring for a chronically ill child and coping myself with a physical disability.
• Even though it became clear that the forms of care that the Social Care Services could offer was not meeting my relatives’ needs or that there were problems within some of the care agencies themselves.

We had a care worker stealing money. Another turned up and admitted that she didn’t know if she would be coming again because, well, she’d only been interviewed an hour before and, no, they hadn’t checked her out in any way at all. In another instance the supervisor from a care agency was so racist that we made a formal complaint to the council social services with all the stress that involved.

It’s one thing to be offered care and another to find that some of the care, or the circumstances in which it is delivered (for instance over-worked staff, too-short time-slots) mean that the recipients become so stressed that it’s simply not worth accepting. Councils themselves, contracting out to care agencies, have to balance a desire for high standards with the maintenance of continuity of service.

As soon as I read about Direct Payments for Care in Adding Life To Years I followed up on them and, yes, they are mentioned on the last page of Cardiff Council’s booklet, Charging for Non-Residential Social Care Services (available here, at the bottom of the page). Direct Payments allow money that would otherwise go to a care agency to be used for the beneficiary to arrange care as they choose to themselves, providing they meet certain criteria. When I asked about Direct Payments the social worker’s response was that yes, of course, they were available but usually they are offered to young people and most clients don’t want the responsibility of managing them.

Not to be offered an option can mean in practice that one has been (however unintentionally) denied that option. If I had known about this earlier I would certainly have pursued it as my relatives have been arranging some care (with my assistance) using their own money for some time. Direct Payments were never mentioned by anyone dealing directly with my interests as a carer either. A social worker will be calling this week to do an assessment of my relatives to see if Direct Payments are appropriate and available in their cases.

It might be said that it is the carer’s responsibility to keep abreast of everything. True. But in practice carers need to be met half way. And so often the efficacy of a beautifully designed ‘help’ depends on the individual filling the position. One Carers’ Champion whose catchment area I had the misfortune to be in for a while was brilliant at smiling and seemed to think that was ‘Job Done’! Another kept telling me he was new to the job and didn’t intend to stick around for long. He was very pleasant, though, as he said it.

Of course, such inadequacies are not confined to the care sector. However, ‘quality-control’ is no less important in this area that other parts of the public sector. Arguably, it is more important even though it is productive of nothing more profitable than happiness and contentment.

Another area where the ideal and the reality don’t always meet is that of respite care. Care homes may be tending to move away from keeping rooms available for short-term respite care towards the more lucrative long-term lets.

There is a great deal of good will for the elderly in ‘the system’ and genuine warmth too. That sense of humane interest is the thing to cultivate when it comes to policy development. No one wants to live long and live lonely. Adding Life To Years claims that, “as a society Wales is culturally attuned to the social solidarity and community empathy that will be needed to put together policies and programmes designed for the less well off and those in need of a public sector safety net.” Let’s hope that’s true because we might all be needing that empathy sooner than we think.