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High-quality care for the elderly comes at a price

An unwillingness to properly fund care for elderly people has a direct impact on their quality of life.

It is time to acknowledge that the sector is underfunded and staff are underpaid. That is a necessary prerequisite to considering the new figures we reveal today about the sub-standard service received by some older people dependent upon care-at-home services in Scotland. Approximately one in 10 services are rated only adequate or below, according to the care watchdog, which assesses such services on a number of themes including staffing, management and quality of care.

Industry body Scottish Care is right to point out that while one in 10 services are barely sufficient, this means the rest are rated higher. It is a dubious boast. Meanwhile, the Care Inspectorate says one in 20 failing services are graded unsatisfactory or weak for every theme. With more than 62,000 people receiving some form of care at home, even if a small percentage receive poor care it affects thousands of our vulnerable older people.

Why is this happening? And why do the providers that are told to improve do so, but then fail to sustain the shift? The answer can only be to do with resources. Inspectors say common problems include staff taking on jobs for which they are not trained, too few workers being sent to a home to meet an individual's needs, and visits cut short to allow staff to travel to the next appointment. Those receiving care commonly complain about staff changes, with new faces turning up all the time and workers not appearing on time. The administration of medicines also often gave cause for alarm.

The cause of this could be profiteering. There has been concern in England about private equity firms taking over care services and slashing the wages of workers. In some cases bad management is to blame. But it is plain that an unwillingness to acknowledge the true cost of care is the deeper problem. Care firms say councils expect care to be delivered at an unrealistic price, with the result that training budgets are trimmed and pay is squeezed.

This risks a negative spiral, as good care staff leave for better-paid work in other sectors. What training is possible becomes an unrewarding option for employers when staff turnover is so high. The notorious 15-minute care visits may be all some people need. But those people are very much in the minority.

The Government cannot heap all the responsibility on to councils, or rely solely on the Care Inspectorate to deliver improvements. Ministers should look again at whether local authorities are properly funded for what they have to deliver. The public, too, needs to be more realistic about costs and expectations. Most of us would not entrust the care of our children to underpaid and undertrained workers, and we should not be willing to take that risk with our parents and grandparents. So we need a national debate about what we pay for care and the quality we expect. The push to deliver more care in the community means care at home must be high-quality, not a bargain basement option.

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