The capitalist free market means luxury for those with sharp elbows — and being trampled underfoot for those whose elbows have become frail with age.
Thirty thousand old and frail people in care homes face disruption, and probably, some of them, being shunted to different places, as the country’s biggest private care homes operator, Southern Cross, goes bust.
Disruption and forced moves often kill old and frail people. If they don’t kill, they leave the elderly people frailer and more confused.
The plight of those 30,000 is only the top foliage of a forest in which market mechanisms grind harshly into the fragile fabric of elderly lives.
All of us, unless we die young through war, accident, or quick-killing disease, will grow old and fragile one day. For all of us, life will end “badly”. It doesn’t have to end in slow, painful horror. For many it does, under the current system; and the government’s cuts are making that worse.
The drastic cuts to public sector pension provision - which, if successfully, will have a ratcheting-down effect on the remaining occupational pension schemes for private sector workers - are set to deprive many of us of the protection that a passable pension can give.
In the 1990s the law was changed to make the National Health Service no longer responsible for long-term care of the frail elderly. The responsibility was shifted to local authorities, which provide or organise care at means-tested rates, with the detailed means-testing varying from local authority to local authority.
By the Blair and Brown governments as much as by the Tories, local authorities were pressured to contract out services to private-profit firms.
Now 70% of old people in care are in private care-homes, and 70% of care provided to frail old people in their homes is from private-profit firms.
The numbers are large. One half of all people over 85 are in care homes, and another 25% get commercial care in their homes.
There is sense in trying to move frail elderly people where possible out of hospitals — where the geriatric wards can be death-traps — into quieter, smaller-scale accommodation. Trouble is, it has been done according to the priorities of public-sector cost-cutting and private-sector profit-maximisation.
For the care-home profiteers, that was the opposite of trouble. The Blair government had helped them by setting the required standards low (only 50% of the staff need to have any relevant qualification; no minimum staff ratios; building standards to apply only to new starts, not to existing operations).
For a time, as one industry boss told the Financial Times (30 May), “it was a bit like the internet bubble”. Care home companies were as favoured by rich investors keen for quick profits as Silicon Valley firms. Or more so. The supply of old people couldn’t fail, and as long as you had a place with four walls and a roof, and a few minimum-wage workers to run it, your fortune was made. In this industry, you could just pocket the profits. You didn’t have to spend on new equipment and premises, or on training your staff. One finance director told a lawyer: “There is absolutely no room for anything to go wrong” (FT, 30 May).
He meant, for anything to go wrong for the owners. For the old people it was different. But where they were wealthy, articulate, or had articulate younger relatives with the money, energy, and house-space, the old people would be being looked after at home, often by relatives; or (as happens with a quarter of old people in care homes), their relatives would pay extra to get them into a slightly better care home.
In the “mass market” of elderly people ill-equipped to make complaints, and with support only from harassed younger relatives with too many problems of their own, the profiteers had fairly free rein. The occasional scandal about mistreatment was an affordable business expense.
The Financial Times has recently revealed that the official Care and Quality Commission ranks one in seven private care homes as “poor” or barely “adequate”, a much worse report than not-for-profit homes and the few remaining local authority homes (themselves far from ideal) get. But the FT had to dig that out of obscure reports.
Now some things are going wrong for the profiteers; and the old people are paying the heaviest price.
The care-home companies gained from owning lots of property, whose prices were soaring. Now the property prices have fallen (while rents, for companies like Southern Cross which rent their premises, have not).
For good reasons as well as cost-cutting ones, local authorities have pushed to have a bigger proportion of old and frail people cared for in their own houses rather than in institutions. Care homes now have a bigger proportion of much more fragile and sickly old people, often with a short time to live.
As the government has squeezed council budgets, so the councils have squeezed the amounts they will pay to care-home owners.
The top bosses of Southern Cross saw this coming. Four of them sold their shares in the company in late 2007, at a profit of £35 million, and over the next year or so quit to go to other jobs. They won’t suffer. The old people will.
Three answers:
• Support the strikes on 30 June, and spread into a struggle for a decent pension for everyone.
• Fight for shorter working hours, good work conditions, and decent affordable housing for everyone, so that younger people can afford to take elderly relatives into their homes and look after them without unmanageable strain.
• Expropriate Southern Cross and all the private care-home chains, with no compensation for the profiteers. Reorganise care homes, and professional care provided to elderly people in their own houses, as a public service, free at the point of use, and staffed by qualified workers paid at trade-union rates.
