Planning to care

Reports of a social care funding crisis, variable standards of care and a growth in unmet needs are, sadly, increasingly familiar. Whilst they shine a light on the challenges facing our elderly and most vulnerable citizens, too few address how we can better plan for the future[i].

New research published by Kingston and colleagues[ii] which endeavours to predict the future care needs of those aged 65 and over is, therefore, timely. Comparing cohorts from 1991 and 2011, the authors explored changes in the composition of need amongst older populations living in Cambridge, Newcastle and Nottingham to model national trends:

More people with care needs are living in the community rather than in care homes

Irrespective of age and the extent of a person’s need, the proportion of people aged 65 and over living in the community rather than in a care home increased substantially between 1991 and 2011. For example, of those classed as having a high level of dependency aged 65-74, only 4.4% lived in a care home in 2011 – compared with 24% in 1991.

We need to understand the implications of such trends if we are to plan for the future. Care provided in community settings can help people to remain in their own homes and connected to their communities. But, increasing levels of unmet need have been reported amongst the older population – for example, Age UK have suggested that 1.2 million older people in England aren’t receiving the care that they need.[iii] And, as the responsibility of meeting such needs is transferred to unpaid carers, which a growing body of evidence suggests is the case[iv], there will be knock-on effects for individuals but also the wider economy.[v]

850,000 more older people requiring medium or high levels of care predicted by 2035

Based on calculations that assume the proportion of older people in each state of dependency remain the same as in 2011, the authors project striking increases in future need. The number of older people with medium dependency (requiring daily care) is, for example, projected to increase by 190,000 by 2025, and a further 272,000 by 2035. The number of people with high dependency (requiring 24-hour care) is predicted to increase by 163,000 by 2025 and a further 237,000 by 2035. In order to meet these needs (assuming current numbers stay constant), the authors suggest we will need over 70,000 additional care home places by 2025 – rising to 189,000 by 2035.

Whilst people are living longer as a result of improvements in health, it brings with it associated challenges regarding an older population with increasing care needs. The numbers are striking, yet it is worth noting that the number of years that individuals need these high levels of care is usually limited – Kingston et al. report that the average years spent with substantial needs is 3 for women and 2.4 for men; as Andrew Dilnot has recently said in The Lancet[vi] – it is only a small minority for whom this period will last longer yet “the fear of that is a powerful one”.

How can policymakers respond?

The report authors highlight a range of mechanisms that could help meet changing patterns of need, but emphasise that the greatest chance of slowing decline in individuals is at the stage of low dependency or even prior to this – rehabilitation, adaption and assistive technology can contribute to this as well as a focus on prevention.

Success will depend upon our being better able to model needs and plan ahead, if we are to avoid a situation where we remain in perpetual crisis mode.

Modelling and planning for formal care is vital given the scale of the impending challenge we face, and the report authored by Kingston and colleagues adds to the growing body of evidence that indicates this is now urgently required. If an additional 70,000+ social care beds will be needed by 2025, where will they be needed, and how will they be resourced?

There also needs to be comprehensive planning to better support those providing unpaid care – which is currently said to equate to a contribution of £132bn per annum to the UK economy, although almost three-quarters of unpaid carers report that they do not feel their contribution is understood or valued by the Government.[vii] There are serious consequences for the physical and mental health of carers, for their finances and their overall quality of life. The majority are of working age and, according to Carers UK, more than 2 million people have already given up work to care. If the number of people reliant upon unpaid carers grows as predicted, how will this impact the quality of care provided but, also, the wider UK economy – and, in particular, the growing number of women with caring responsibilities aged 50+ who will themselves be disadvantaged from planning ahead to meet their own care needs?

The time for action is now where today’s social care crisis is concerned. But, it needs to be accompanied by an era of planning on the part of Government and individuals alike if the crisis is ever to abate.