Issue 172 of SOCIALIST REVIEW Published February 1994 Copyright © Socialist Review
They couldn't care less
The white paper on community care published in November 1989 said:
'The government believes that for most people community care offers the best form of care available--certainly with better quality and choice than they might have expected in the past.'
It outlines ways the community care proposals would be beneficial: they would enable people to live as normal a life as possible in their own homes, the right amount of care would be provided to ensure maximum independence, people would get a greater say in how they live their lives.
Everyone, apart from those of us with some political insight into what the Tories really meant by community care, became excited. Of course people wanted to stay at home, and why not? The Labour Party applauded the government's proposals and indeed got quite umpty when they were postponed until 1993!
And here we are nearly a year into 'Community Caring'. What is the result?
Area offices are responsible for the budgets. Each area can choose, within the government guidelines (80 percent of the funding has to be spent in the private sector), how they wish to allocate their resources, and no area is the same. For the moment at least we have teams of carers who go into people's homes to try to support the old, the disabled and the mentally frail.
I am a Home Care organiser, with responsibility of assessing need and prioritising those who actually get support from our limited resources. The percentage of people who get help becomes smaller and smaller. As hospital beds are at a premium, doctors are forcing people to leave prematurely in very frail conditions at a moment's notice. The idealistic notion of 'packages of care' being drawn up is a fantasy. Programmed discharges are a thing of the past. Daily we get frantic calls from social workers, relatives and friends with pleas of help on behalf of disabled folk, to cover emergencies.
In such conditions all we can offer is half an hour in the morning to get people out of bed and dressed. Maybe, if they are lucky, another visit at lunch time (but more than likely the carer will prepare some sandwiches and a flask of tea) and another fleeting visit in the evening to put them to bed. In between visits these vulnerable people may not see another soul. Occasionally there may be a place at a day centre, but these are few and far between, and usually only once a week. More and more people are coming out of hospitals with pressure sores and often weaker than when they went in, due to the shortage of nurses and consequential lack of time to give patients adequate nursing care.
Last week one of the main hospitals in my area was on red alert. This means that only emergency cases were allowed to stay. There was a guy in there, 86 years old with a brain tumour, the prognosis is a few months. His wife knew he was ill but had not been told the diagnosis. Their home was rented. It was damp, with steep stairs to the bedroom and few facilities. She could not visualise being able to cope and searched for new accommodation, which she was lucky enough to find. She had two weeks to wait before she was able to organise the move. She went into the hospital to tell her husband. She was greeted by the doctor (at 4pm) and he broke the news of the tumour. At the same time she was told that her husband had to leave the next day, that it was no longer a medical problem and therefore he could not take up a bed any longer.
So much for choice, so much for adequate help being provided. So much for individual packages of care.
Because of the changes in the home care responsibilities from domestic support to personal care, cleaning is no longer done. If you are able to dress yourself, hard luck--nothing else gets done. It doesn't matter that you stagger around with a zimmer, take half an hour to get to the toilet or are prone to falls, there is a lifeline to stick round your neck to call someone if you do...but you won't get your cleaning done. And, of course, there is your daughter-in-law four miles away, she can do your shopping, hoover up once a week and do the laundry. Oh yes, she does have that full time job... but what about the weekends, she can do it then.
The Home Carers, we used to call them Home Helps, have had their job descriptions changed. They are expected to deal with incontinence, catheter bags, grapple with hoists for the most disabled and change stomach bags, among their other duties. They care for the dying, cope with bereavement, deal with the mentally frail. They see their clients struggling with loneliness and counsel those families frantic with guilt if they are unable to help due to other commitments, work or because they live a long distance away. Many of the carers lie awake worrying about what they will find on their next visit, whether their clients will fall in the dark getting to the commode, or if they will find them dead in the morning. For this they are paid £4.10 an hour! To be accepted in the job they are expected to work split shifts, weekends and bank holidays (it's known as being flexible).
My patch is a rural area with dark country roads and lonely cottages. The carers are still out at 10pm. They are expected to provide their own cars and now the mileage allowances are being threatened. They are not provided with car phones, the budget will not allow them to go in pairs, the conditions of service leave much to be desired and yet they are the backbone of this so-called community care.
Many of them do hours of unpaid work in the afternoon on a voluntary basis to make their clients' lives more bearable: taking them out, doing shopping, making curtains or simply visiting for a chat. All this goes unacknowledged by the authorities. Community care Tory style is a cheap option. For it to work adequately millions of pounds would need to be poured into day care facilities, good regular respite care, provision of food, transport, domiciliary services and comfortable homely accommodation, which not only respects people's privacy but ensures that people who need it get care in the proper sense of the word, when and if they need it. The Tories are not about to provide this. Their philosophy is 'self reliance' and support either from the family or the voluntary sector. Of course if you have the money you can afford to buy help. Even this is fraught. The private sector employs untrained staff, pays a pittance and working conditions are abysmal.
Meanwhile each day I dread going into the office to make those phone calls. 'Good morning, this is the home care service, sorry we have no "care" for you today, shortage of staff, can you manage... I am so sorry.'
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