Falling Down Charges

I’ve just seen Charging old people for falling down in the Grauniad, by Jack Monroe.

I’m kind of surprised by it. Most councils, if not all,  provide some sort of telecare service. They differ by supplier, but they’re much of a muchness. The vulnerable person has an alarm pendant, bracelet or button-clipped-onto-their-waistband, and if they fall or have an emergency, they press the button to summon help through a radio-controlled unit linked into their phone line and connected to the control centre. The control centre might be part of council services, or it might be run by a private operator. Additional services can be added, such as falls detectors which trigger if the person falls without them having to press anything, heat/smoke/unburnt gas detectors, flood detectors, inactivity detectors (if the person hasn’t got out of bed by a set time, the alarm is triggered), or bed occupancy detectors (if the person gets out of bed in the night and doesn’t get back in within a set time, the alarm is triggered). There are also seizure detectors, intruder detectors, door sensors which trigger if the person goes out, and lots of other things, collectively known as telecare.

My own employer charges a basic charge for the unit and a bit more for every additional add-on. If all the control centre has to do is ring round the person’s nominated responders and notify them, the monthly charge is less. If the control centre has to send its own staff out to respond, the monthly charge is more. People on income support don’t pay.

Councils have charged for social care services for decades. Care in your own home, care home places, telecare – if you need it, you’re financially assessed and you make a contribution. I’m not sure why charging for an alarm & response service is so much morally worse than charging for help to get someone out of bed, or feed them, or change their stoma bag. If, as a society, we accept that it’s ok to charge for social care, then why would alarm services be exempt? If the people of Essex have had that service for free until now, they’ve been a lucky minority.

If you’re going to get angry about this, then get angry about the charges for all social care services. They’re not any better, or any more justifiable. And if you’re in Scotland, get angry about the free personal care for over 65s, which means that millionaires aged 65+ don’t pay, but ordinary people under 65 do pay.

And Jack, I think you’re great, but “Elderly people, save your pennies and buy a £10 mobile phone. Stick it in your pocket, and if you should find yourself needing to be picked up and nobody else can get into your home, 999 is – and will always be – free to call” is naive. If the emergency services get called out to pick the same person up over and over again, they eventually phone the social work office to request an assessment for an alarm service. And if the vulnerable person says they don’t want the alarm service, and continues to phone 999, the emergency services will continue to pressure social work, and depending how bolshie they’re feeling, they will even talk to the person about wasting emergency services’ time. Believe me, I’ve seen it.

ETA: of course, what we should be encouraging is more use of exercise and falls prevention classes. Edinburgh has seen great results with the Steady Steps programme.

http://www.edinburghleisure.co.uk/activities/older-adult-activities/older-adult-sportexercise-activities/steady-steps

http://evaluationsupportscotland.org.uk/media/uploads/resources/edinburgh_leisure_-_model.pdf

http://www.theguardian.com/public-leaders-network/2014/jul/12/steady-steps-exercise-class-older-people

When I  worked in Edinburgh, I referred many many people to Steady Steps. One woman was registered blind, diabetic and had serious mental health problems. She had gained a lot of weight and needed gall bladder surgery, but the surgeons didn’t want to operate because she was a poor anaesthetic risk. Within a few weeks of attending Steady Steps, she had regained so much confidence that she was walking up and down the stairs in her house several times a day, and going out and walking up and down the street. She lost so much weight and was so much healthier that she no longer required the gall bladder surgery, and because she was more confident in moving around the house, she was less dependent on her husband, who was coping much better as a result.

The first person I referred to Steady Steps had contacted us because she wanted a stairlift. She had been very independent, managing everything for herself and line-dancing a few times a week, but had a bad fall on ice one winter and completely lost her confidence. Rather than go straight to putting in a stairlift, she agreed to a Steady Steps referral. Within a few weeks she was completely confident and safe on the stairs, and by the end of the programme she was going out independently, was line-dancing again and had joined the gym.

My most recent Steady Steps success was an 84 year old lady who has a lifelong history of depression. She had recently moved to Edinburgh after being widowed, in order to be near her family, and the upheaval of the move had reduced her confidence. She and her family were worried that if she remained lacking in confidence, she would stop going out, become more isolated, develop depression and possibly attempt suicide again. She’s now attending Steady Steps, getting there independently, enjoying it very much, and at the age of 84, is now learning to swim.

Preventative and health promotion/maintenance services are incredibly important, but when money is tight they’re often the first to go. They generally pay for themselves many times over in terms of reduced dependency on other services.

So yes, complain that councils charge for important services. But don’t forget to complain that there aren’t enough preventative services too.

 

 

Another Private Care Agency Lets Us Down (And By Us I Mean the Tax-paying Public)

I refer you to my previous post on this subject.

For the last few years I have been working with a man who has a degenerative neurological condition. He now requires, and has received, a large care package including 2 workers 3x daily for hoisting and personal care, and one worker once a day for meal preparation. This has been provided to him for several years by one private agency. We’ve tweaked the package over the years but it’s stayed relatively stable. The man’s wife died a few weeks ago, after a long illness, and I had arranged to meet the agency at the house next week to see if we needed to make any further changes.

Yesterday morning the agency phoned me to say they had some concerns about their ability to provide the service and that they were planning on withdrawing from it, but said they would maintain the service until we found a replacement agency. We agreed they would visit the client the same day to tell him. at 1630 yesterday, they rang me to say they had decided to give us 12 hours notice that they were terminating their involvement, and that the man’s last visit would be this morning. When I pointed out that contractually they can’t do that, they said they only have to give 12 hours notice if their workers are at risk in the house. I asked what the risks were and the care manager couldn’t answer me – her response was “I’m the care manager and it’s my decision.”

Even worse, when I phoned the client to say “we will do our best to find another agency by tomorrow but it might be impossible”, he told me that they had told him (and his sister, who was present) that they were giving 28 days notice and would hand over once we had a replacement care provider. When he realised I was telling him that wasn’t the case, he was in tears. So I rang his son and asked him to go round, and the son said they had phoned him that afternoon and told him 28 days too.

Lying liars who lie.

Bad enough that they’ve left the man in the shit (literally), but to lie about it to him, to his family, and to me?

So today I phoned 21 different care agencies to see if any of them could take the package on, only to completely and utterly fail. The poor man has gone into a care home tonight, three weeks after losing his wife, and with absolutely no idea when we will be able to get a new care package and get him home.

This is the reality of private agencies providing public services.