High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
Andrew kerslake future of care for older people
1. All Change - New Horizons for Local
Government
The Future of Care for Older People
December 2011
2. National demographics
Numbers of people aged 80 and over will
increase from 2.3 million to 4.4 million by
twenty years time.
Nationally, big differences between rural
and urban populations, eg, by 2030 the
population aged 75 and over will have
increased on average by 47% in urban
areas and by 90% in rural areas.
Already 60% of all hospital beds are
occupied by people aged 65 and over, 40%
of whom have a dementia.
The rate of admissions of older people to
hospital in the last ten years has grown at
nearly double the rate for the whole
population. 2
3. National wealth
Average pensioner incomes have risen
faster than average earnings since the mid-
1990s, increasing by 44 per cent in real
terms between 1994/95 and 2008/09.
Occupational pensions are increasingly
significant, accounting for over a fifth of
average gross income for single pensioners
and over a quarter of average gross income
for pensioner couples.
Nearly 50% of all housing equity is held by
people aged 65 and over some £3 trillion
worth of property assets.
3
4. Regional demographics
In the West Midlands the population aged
80 and over will grow from just over a
quarter of a million to just under half a
million, in the next 20 years.
By 2030 over a 100,000 older people it is
estimated will have a dementia with some
30,000 people per annum being admitted to
hospital after a fall.
In Shropshire and Herefordshire by 2030
nearly a third of the population will be aged
65 and over.
However, 76% of the older peoples
population across the region are home
owners.
4
5. Government policy
To increase the personalisation of care
through giving care users the funding to
purchase in the care market.
To shift LAs from being providers and
purchasers of care to being ensurers of
care supply for all.
To reduce regulation through reducing the
inspection regime and promoting the
growth of personal assistants.
To increase diversity in the market place
through encouraging different forms of
enterprise.
To resolve the future funding of care.
5
6. The care market
Residential care – Private, fragmented and
diminishing.
Home care – Private, fragmented and
growing.
Specialist housing – Public, still
represented by sheltered housing, extra
care still small.
6
7. Care market questions
Who is residential care for?
DO we need to tackle perverse incentives in
home care?
Will personalisation increase costs?
How do we make sure voluntary
organisations deliver independence rather
than provide a step up onto the care
pathway.
If there is less regulation who determines
and measures quality.
How do we fund and support capital
investment?
7
8. Potential impact of government policy
Could bring more people into some element
of state funding depending on the threshold
levels.
In the short term we could see more care
organisations fail.
In the longer term could increase the use of
residential care.
Does little to reduce demand or promote
efficiencies.
8
9. What needs to happen – seven pillars
of wisdom?
1. Understand demand for high intensity
care.
2. Target interventions.
3. LA funding to support individual and
community endeavour rather than replace
it.
4. See older age as an issue for the whole
local authority not just social care.
5. Integrate at the point of delivery not just
strategic management.
6. Stop seeing providers of care as the
enemy.
7. Stimulate private housing with care for
older people. 9
10. 1. Demand for care
Failure to deal with or plan for
bereavement.
Extreme old age.
Social isolation / living alone.
Poor health service performance.
− dementia,
− falls,
− stroke,
− continence
Ageism
10
11. 2. Target interventions – falls as an
example
Patients with first fractures are not flagged
up for secondary prevention. Only around
half of A&E and MIU routinely screen
people who have had a fall for risk of future
falls.
Many of the exercise programmes being
provided are not evidence based.
Less than half of falls admissions are
screened for osteoporosis risk.
Care homes were the usual place of
residence in 10% of non-hip fractures and
22% of hip fractures. Although they only
make up 4.5% of the population.
11
12. 3. Using funding like gold dust
Need to move population from seeing care
as an acquisition to a service available as
and when needed.
Testing the value added benefits the
voluntary sector brings.
Focussing funding for carers.
12
13. 4. A holistic LA approach
Is strategic planning old age focussed and
tested?
What does business support offer the care
sector?
Start focussing on outcomes rather than
cost and volume.
Make sure Public Health delivers VFM.
Recognise that better health in the
community means hospital closures.
13
14. 5. Integration
Start to integrate services at the front end.
Persuade clinical commissioning groups of
the financial gain.
Stop signposting.
14
15. 6. Work with providers
Framework agreements often not worth the
effort.
Set standard terms and conditions for
contracting.
Be clear about price v quality.
Better understand business and recognise
vulnerability not always good for
consumers.
Incentivise good performance that reduces
demand.
Incentivise diversity, recognise the kinds of
choice people really want.
15
16. 7. Stimulate private sector specialist
housing development
Health and care will not sustain people in
the community on their own.
Using housing equity to fund housing that
reduces demand is better than using
housing equity to fund care.
Understand local market issues and how
the LA can help to overcome them.
Help to support housing that offers ‘Wow’
rather than ‘has it come to this’ design and
development.
16
17. Delivering the future
“"We can't solve
problems by using the
same kind of thinking
we used when we
created them." Albert
Einstein
Hinweis der Redaktion
In 1908 Lloyd George introduced state pensions. If you were aged 70 or over and you had means of less than 12s per week and you had not been convicted of an offence you could claim a pension of between 1s and 5s (at the current equivalent this would equal around £4.50 to £22 per week). Average life expectancy was around 50 years of age and the pension was set deliberately low so as to encourage people to save for their old age.
Res care - There are around 18,000 registered care homes, with a total of 460,000 registered places.Around 20% of those places were provided by just four providers.There has been a 19% reduction in supported placements in residential care since 2003 – between 2-3% each year. Most of this has been influenced by the closure of Council run homes – very small reduction in independent market.68% of care homes and 88% of care homes with nursing are in the private sector.Home care - The number of home care agencies has risen each year since 2004. 73% of home care agencies are in the private sector.The largest home care provider only has a 6% market share.Housing 560,000 specialist independent living dwellings for older people which represents around 9% of all 65+ households. Sheltered housing units account for around 85% of this total. Extra care
Out of town shopping centres, capital gain on housing v shops. Dont just test retirement housing on land use.