The Centre for Health Solutions report Better Care for Frail Older People highlighted the challenge of caring for an increasingly frail and ageing population, including the need to improve access to care in all places of care. This week’s blog is a personal take from one of our senior consultants who spent seven years of his career working for a major aged care provider in the UK, where he saw first-hand the pressures that the sector is facing in dealing with an ever-ageing population and increasing numbers of people suffering from dementia. An experience that led him to question whether there will still be a care home sector in 2030?

It seems an almost daily occurrence that the elderly care sector will be the subject of negative news articles, be it failings by care homes to adequately provide end of life care for dementia patients1, crimes committed in care homes2, or the industry facing an inability to finance itself3. Every week appears to bring a new set of lurid headlines.

Over the past seven years I travelled around the country visiting care homes of all varieties, from small local authority-managed operations in Teesside, to large multi-sites in central Birmingham, to beautiful retirement communities in leafy Wimbledon. I found a number of common issues existed, regardless of size, demographics or affluence:

  • The difficulty in running a profitable care home
    The oft-heard answer to all the ills of a care home that is struggling financially, is to attract more self-funded residents. Local authorities appear to pass on cuts in social care budgets by limiting increases in fees paid for publicly funded care home places as a first port of call. Certainly any increases that have been made have failed to match the increased cost of providing care to elderly residents. At the same time, attracting self-funders is becoming more difficult as more people of retirement age choose to, or are supported to, live in their own homes for longer and only look to move into a care home as their needs become acute, by which time they may have less available funds to pay for their care, and their needs are more complex, often requiring a more expensive care, or indeed nursing, home.

  • An ageing workforce
    You may be surprised to hear that I often found that those working in care homes were nearly as old as some of the residents. One activities coordinator, who came into the home once a week to run a yoga class for the residents with dementia, was approaching 80 herself.  New analysis has shown that half of all registered managers in the adult social care sector are aged over 50, which could see 10,000 retire within the next 15 years. It is clear that fewer young people see nursing for the elderly as a viable career option, despite the potentially rewarding nature of the work.

  • Lack of innovation
    The baby boomer generation are now approaching the age where they are beginning to require professional care. Using my parents as an example, they are (largely) tech-savvy, live highly social lives and have a certain expectation for their lifestyle. However, I would argue that the care sector is not prepared for this type of resident. With some notable exceptions, the approach to care homes I saw was still to sit residents in front of the television for hours, with a daily activity and the occasional trip out. In future, if care homes are to remain relevant and be attractive to self-funders, care home providers are going to need to think about the environment in the home, including the availability and access to technology and connectivity, creative activities and more personalised care.

While this appears to paint a somewhat bleak picture that is the last impression I want to give as I greatly enjoyed my time working in the sector and am still passionate about the subject of aged care. Rather what we need to do is focus on solutions to the above problems, beginning with raising awareness of the industry.

There are huge numbers of dedicated staff in all types of care homes doing amazing jobs every day, and I think there is a real need to sing the praises of these people and work hard to make care work and nursing an attractive career to enter.

A recent development is the growth of retirement villages. Popular in the US and Australasia, they are becoming an increasing option for ageing baby boomer couples where one, or both, of the couple are beginning to become infirm but want to continue to lead an active lifestyle.

These villages offer an integrated care pathway, usually in three stages:

  1. retirement apartments which still provide independent living
  2. assisted living apartments, where there is a care team if needed and daily chores (cleaning, gardening etc)
  3. a traditional care home providing 24-hour nursing care

Some of these sites are impressive, with gardens, spas and even onsite restaurants. Personal testimony from people who have visited them has convinced me it is the way to spend your retirement!

So, to bring me back to my original (admittedly sensationalist) question, will there be a working care sector in fourteen years’ time? My opinion is that there will always be a need for decent care homes providing a compassionate approach to caring. Furthermore, that the problems that are facing the industry can be solved, but there needs to first be an acknowledgement that the system as it stands is not working and that creative thinking is required to find a solution.

Finally, I would urge you to visit a local care home to see for yourselves. The 4th annual National Care Home Open Day is on 17th June and is a great opportunity to see what life is like in your community and what great care can and should look like.4


Karen Taylor - Director, UK Centre for Health Solutions

Karen is the Research Director of the Centre for Health Solutions. She supports the Healthcare and Life Sciences practice by driving independent and objective business research and analysis into key industry challenges and associated solutions; generating evidence based insights and points of view on issues from pharmaceuticals and technology innovation to healthcare management and reform.

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Richard McFarlane - Senior Consultant, Risk Advisory

Richard is a qualified accountant and Senior Consultant working in Financial Operations & Support (FO&S), a team within Risk Advisory. Richard focusses on finance transformation projects, in particular statutory reporting, business case development and MI improvement. Prior to joining Deloitte, Richard worked in the healthcare industry for 8 years including 7 years in a variety of roles within a global, private sector elderly care provider.

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