Friday, 11 September 2015

Growing Old Gracefully: Valuing Personal Care

By Peter Adams
Director, Avida Care

Most of us want to grow old gracefully, don’t we? However, despite our best efforts, this is by no means a certainty; in fact it is something of a lottery. Being careful and responsible in our own life is unfortunately no guarantee of a long life, let alone a graceful old age. Whilst there are many personal choices and actions we can take to help stave off what used to be called "decrepitude", sadly most of us will, sooner or later, become frailer and more dependent on others to perform functions we previously took for granted.

I should clarify that all I mean here by growing old gracefully is merely how we can grow old while maintaining a reasonable quality of life and standard of living for as long as possible. I suggest that for most of us this means being of sound enough mind and body, with enough money to be able to lead a largely self-determined, happy life, and leave something to our children.
But how can we continue to remain "graceful" in our older years, particularly when we need help coping and caring for ourselves? How can our hard-pressed care system help make this happen? This is surely one of the greatest challenges our society faces, because it will face each one of us sooner or later. We are living longer; can we live happily longer? This begs some very important questions of the care system, our funding of it, and indeed our very attitude to caring.

The current care system does indeed face massive pressures. It has been geared mostly to doing the basics to keep older people out of crisis, and less to promoting happiness and wellbeing, so there is a transformative expectation that the system needs to satisfy – extremely challenging in its own right. Moreover, the available funding for care has not kept up with both the fact that we are living longer and that the population is ageing. So budgets have been stretched thin; like a pastry chef with one lump of pastry left to roll a pastry lid to cover an ever growing pie, the lid is rolled ever thinner to the point of falling apart. Of course, factor in the austerity cuts to council budgets and the funding outlook becomes dramatically worse. To cap it all, to use a very inappropriate phrase, the prospects for hard-pressed families have hardly been helped by the Government’s recent decision to renege on bringing in the long-awaited cap on care fees.
So the system is at breaking point, with serious danger of collapse in the near future. So what can be done, now, to properly address this funding crisis? Well, one of the answers is certainly more money. Nice one Einstein you might reply, but hear me out, because making more money available, though vital, needs to be done in a totally new way. So whilst there is a good argument for re-prioritising current government expenditure budgets, such a solution, involving as it does robbing Peter to pay Paul, cannot be the long-term answer, even though there may be obvious, less-deserving candidates right now to "rob" from.
Moreover, making more money available is actually not the starting point, but an ending point, once the proper worth to society of care funding has been calculated. This requires a deeper, more fundamental approach based on values – specifically how we value care and caring, and our notion of real value, which is more than just monetary worth. Ultimately this approach forces us to reflect what real value society places on older people. This is important not just morally, but economically too, because any economist will tell you that investors search out value – or to put it another way – money follows the value. So, we have no hope of funding care properly as a social good if we do not first appreciate its true value.

So how do we put a true value on care and caring? Well we need to look at both economic value and social value. Let’s look at some figures.
For many of us the first steps along "reliance road" will be to receive support or care from immediate family or friends – and this army of "informal" (ie unpaid) carers actually delivers a huge amount of care. ONS data show that, between 1995 and 2010, the total amount of informal care delivered to adults increased by nearly 50% to over 7.5 billion hours per year! Around half of these care hours were for people aged 70 years or older. In 2011 the Valuing Carers report estimated that unpaid carers contributed the equivalent of well over £100 billion per year to the economy, and much of this "value" concerned personal care for older people. Yet this is not properly reflected in budgetary planning for the funding of care, which assumes this free service will continue ad infinitum – an unlikely scenario given that many carers are elderly and indeed frail themselves. Also does even this stupendous figure begin to adequately reflect the real value of these carers’ love, commitment and sacrifice to those they care for, let alone to society at large? So this social added value needs to be measured properly too.

Of course, informal care is just part of the picture – there is another army of professional care workers out there. As we become frailer, these paid care workers supplement, and sometimes replace altogether, our unpaid carers. Does the funding for paid care (or indeed the amount of money these care workers are paid) really reflect the true value of their contribution to those they care for, on behalf of the rest of us? Once again we need to recognise and measure the true social value of what they do, and add this into the funding mix. Only then can we hope to make, as a society, a properly informed decision as to how much money we should, and are willing to, put into care funding.
This more holistic, values-based approach to funding our care system for older people is urgently needed. Progress is starting to be made in the right direction. Organisations such as Carers UK and In-Control – with the latter’s conception of a transformed "public offer" based on the "real wealth" of individuals and communities – are making valuable contributions to this new values-based thinking. But there is much more to be done, and quickly. Far more emphasis must be placed on ground-up values measurement, combined with more focused, top-down values-based policy making.
Only when we recognise and measure the true value – both economic and social – of our older people and of caring properly for them, can we possibly hope to invest the right amount of money in funding a care system that is fit for an enlightened, 21st Century society; one in which more of us can grow old gracefully; one where we really can live happily for longer.