Simon Spiller is co-owner and Registered Provider of The Croft Residential Home in Newton Abbot, Devon, as well as owning other small businesses.  He is a Fellow of the Royal Society of Arts. Here he gives his devastating assessment of the state of the funding of our social care system:

Families in England’s poorest areas will be forced to give up work to care for elderly loved ones with dementia

The poor will be hit hardest by the Government’s ongoing failure to tackle adult social care funding reform

The Guardian newspaper recently highlighted the significant social care funding hole that affects elderly people whose care home fees are paid by Councils.  

Unfortunately, the problem has been understated, especially for those in need of permanent residential dementia care in less affluent areas of England.  

The funding shortfall highlighted in the recent fair-cost-of-care exercise is particularly hitting specialist homes caring for people with severe dementia.  The shortfall is partially responsible for the decline in care standards across dementia homes in England, as well as a nationwide shrinkage of residential dementia care provision. It is happening at a time when the ageing population is causing an increased demand for residential dementia care.  And it begs the question of what will happen to those unable to find Local Authority funded residential placements?  

Most commentators attribute this winter’s hospital bed-blocking, A&E waiting times and poor ambulance response times to capacity constraints in home care agencies and residential homes.  Estimates suggest up to 14,000 ‘medically fit’ people have been unable to leave hospital because a home care package, or residential placement, cannot be found.  But, for dementia sufferers not in medical crisis, the burden is falling on families to provide round-the-clock care for their loved ones when a residential placement is not available.  This situation is not yet being sufficiently highlighted, but will only worsen as care standards and capacity in residential dementia care continue to fall.

This week, parents in England are decrying the average £15,000 annual cost of child care and that it simply doesn’t pay to work.  

Alarmingly, it won’t be long before similar claims are made by working families faced with sacrificing working income to care for parents suffering with dementia. Those in affluent areas are less likely to be affected as they will utilise their assets to pay the £50,000-£150,000 per year required to fund private residential dementia care.  

The fair-cost-of-care exercise describes how care homes with a high percentage of private, or self-funding residents, rely on those higher fees to subside their local authority-funded residents.  

Such homes tend to be situated in more affluent areas, which is why most new care homes are located in well-off towns and retirement communities. It also explains some of the profiteering in the care home sector, which regularly grabs headlines.

As the owner of a dementia-specialist home in Newton Abbot, I can attest to the financial challenges of a business relying almost entirely on Local Authority-funded residents. 

In 2022, my business partner and I were forced to subsidise our care home as it buckled under the cost-of-living crisis and spiralling wage costs.  

We each contributed a hefty five figure sum to keep the home open. We did this out of necessity, and in the firm belief that our new Registered Manager would achieve a CQC ‘Good’ rating, after two difficult years of reduced occupancy following the pandemic and a rating of ‘Requires Improvement’.  

Thankfully, and against the sector trend, we returned to ‘Good’ in January 2023 and our occupancy has started to improve, although cost pressures continue to spiral upwards.  

Other Providers in our area have been unable to subsidise their care homes, or haven’t believed that the council’s funding shortfalls will be addressed, and so have closed.  

We are aware of three care homes within close proximity of us who have closed in the last year.  With increased borrowing costs for the care sector since the pandemic, many owners have finally opted for a change-of-use, and developed their homes into flats or multiple houses, for rental or sale. 

 Without our financial sacrifice last year, our care home would have closed too.  Perhaps stubbornness, or a naive belief in our ability to improve our financial position (David and I have been care home owners for just four years) has given us the determination to keep going.  

Our decision has been influenced by our Local Authority, Devon County Council, paying some of the highest fees of the 48 councils responsible for funding adult social care in England.  

We also understand we are now the only remaining dementia-specialist home in our area.  So we expect future demand for our service to be high.

But, if we have struggled, other dementia care providers across England will have experienced a harder time than us.  

Those in the most deprived areas are relying on council fees up to 40% less than those provided by Devon County Council. Based on our experience, we cannot see how they are making ends meet.  By its nature, residential dementia care is very expensive.  

Specialist equipment such as profiling beds, hoists, mobility aids and monitoring equipment are all needed to keep residents safe. Staffing ratios are also much higher than other types of residential care, as people with advanced dementia need around-the-clock support.  

The Care Quality Commission recognises that dementia care standards have been declining as a result of these funding shortfalls.  In my view, it won’t be long before a tipping point is reached and swathes of dementia care homes will close across the country, especially in economically deprived areas.  

We are already receiving enquiries from families who say they are ‘desperate’ because we are the only provider in the local area suitable for their loved one with dementia.

Some commentators and politicians believe the best place for the elderly to receive care is at home.  At face value, few would disagree with that assertion.  But the situation is much more complex than this crass assertion suggests.  Of the roughly 400,000 people living in care homes in England, the highest percentage are suffering from severe dementia and this number with severe dementia is set to double over the next 20 years. 

I am well aware that there are few family members with the skill, patience, or time, to care safely for these highly vulnerable adults, even if they were able to secure a home-care package of three visits a day. Sadly, most of the families who will be required to look after their loved ones live in the less affluent areas of England. They are unlikely to be able to afford to give up work to look after their loved ones, putting them in a Catch-22 situation, like some parents of children requiring child care.

With carers leaving the profession for better paid, lower stress roles in the NHS or other sectors, this could be the catalyst which brings down the ‘house of cards’ which is Local Authority-funded residential dementia care provision.  Service providers will be unable to keep pace with the pay demands of their staff and, like the other homes near us, will opt for a change-of-use.  I see this trend accelerating further when house prices do eventually bounce back, making change-of-use redevelopment financially attractive again.

Politicians of different persuasions over the last two decades have failed to demonstrate the political will to address much needed social care funding reform.  The current Chancellor, Jeremy Hunt, knows from his previous role leading the Health and Social Care Select Committee that at least £7 Billion of extra funding is needed each year for social care to keep up with the demands of an aging population.  This Government claims it has delivered an extra £2.8 Billion for adult social care over the next year.  But as the dust settled on that announcement, it is apparent that much of that increase relies on Local Authorities raising Council Taxes, which many are loathe to do during a cost-of-living crisis.  

I think it is likely we’ve passed the ‘point of no return’ for Local Authority-funded residential dementia care in England, meaning many working families will be hit by a double whammy, having to look after their children and their vulnerable parents.  Thus, taking them out of the workforce for protracted periods and further reinforcing their poverty trap.  The scenario for those vulnerable elderly without families to rely on is almost unthinkable.  I’m ashamed to live in a country where this is allowed to happen in plain sight of those who are accountable for our welfare state, health & care system and economy.