Not Good

"Castlebeck is 80pc owned by former Kerry Group chief executive Denis Brosnan's Swiss-based Lydian Capital Partnership ...

"Castlebeck charges around €4,000 a week to care for each resident. The investment fund, backed by two of Ireland's richest businessmen, JP McManus and John Magnier, has overseen an 80 per cent rise in the annual turnover since buying the company in 2006."
 
An 80% rise in annual turnover's easily enough attained when you hire untrained staff and force them to do 12-hour stints. I'd not be surprised at all to find a lot of them coming as trainees from India and neighbouring poor countries, the Philippines, and any number of eastern European countries, as I found when removing my own mother from the shithole recommended to me by Social Services.

Those charges are scandalous - I thought it was enough that we were paying the care home over £2,000 a month.

It all sounds drearily familiar, though, doesn't it? Incredibly rich people who know nothing about the way their riches are obtained for them. Or say they don't.
 
Wealth used to be accompanied by a duty of responsibility ... well, way back and just the civilised ones ... hmm a bit circular that. But you get my drift.

I'd best not say what I think here about the 'names' ... even tho "Soary Stars" remains uncracked :)
 
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Before I start this, I'll just make it clear that whilst I'm about to explain a bit about fee levels for people in care, none of it excuses Castlebeck, or what happened at Winterbourne View - which was horrifying. The issue of cost, however, is a different matter altogether.

First things first - as far as Castlebeck's fees are concerned, the Independent's report is only partially true. You can access the old (up to 2010) CQC inspection reports through the CQC website - anyone can do it - and looking at the one for Rose Villa, which is one of the Castlebeck homes in Bristol, the fees for their residents vary from £2,000 per week to £4,000.

You may feel that is scandalous but Castlebeck provides specialist services for people with very challenging behaviour. Such individuals often need at least 1:1 support during the day, some need dedicated 1:1 waking night support, some need more than 1:1 support. For every individual who needs 1:1 support during waking hours, you have to employ 3 members of staff. If someone needs 2:1 support, you have to employ 6 people, and so on. Add on to this night staff, management, specialist staff, high repairs bills (because people who challenge can be highly destructive of property) and general accommodation/food costs and it doesn't take long for the fees to rack up. You would also expect a provider like Castlebeck to be spending a lot of money on training.

On top of all of this, Winterbourne View was supposed to be more than a care home, it was supposed to be an assessment and treatment centre. People were supposed to go there for behavioural analysis, psychology treatment and so on, supposedly with the aim of reducing behaviours so that the individuals could return to the mainline care system. Such a place would have had additional staff, nurses, psychologists, etc., adding more cost to the fees.

Now to the subject of care workers. Kri is right in that there is a high proportion of foreign nationals in the care industry. There are two reasons for this, the first is pay levels - the annual wage for a support worker is around £13-14,000 - and the second is that basic care is another of those things (like cleaning and waiting at table) that many British people don't want to do (and reality is that they can earn more stacking shelves in ASDA).

Finally - elderly care. Kri, to be honest, whilst £2,000 a month may seem a lot (particularly if the standard of care is poost) but in actual fact, there will be very little "meat" in that. One rather unpalatable fact about elderly care is that it is not uncommon for people paying their own fees to be more or less subsidising Local Authority placements.
 
Oh, I know about local authority placements, Muttley - my mother was one of two people in a 32-room home paying her own fees. The rest were there courtesy of the State. I think the pit into which she first went (and where I pulled her out after a month) was probably all local authority, bar her, and it certainly showed and smelled like it. She left with what the other home's senior nurse called "the mother of all urinary tract infections" and was sent there with drugs (which I'd previously dispensed for her) which, the nurse told me with some horror, would have killed her if administered. She had sores on her heels and the lazy bastards left her lying in bed with a catheter inserted (not sent like that from the hospital). The catheter bag was actually lying in the bed alongside her, full up with what looked like Jim Beam, it was so old. The last time I complained, they emptied it into her loo and left it there without flushing. People were just literally rotting to death in the place - yet when I was first shown it (albeit not the back rooms, where she was placed), it was displayed as having all kinds of nice amenities. Yeah, but they were never used. The staff was virtually all foreign bar the joke of a manager and a couple of senior 'care' assistants, who, my mother said, never spoke to her and were very brusque.

I'm not impressed that £2,350 pcm buys a lingering death in distress because local councils have to cough up, Muttley. The care home Mother was in had 30 out of 32 residents with dementia of some sort or another, incontinence pretty much at 95%, and while many were too frail to cause physical havoc, there were many who had to be hand-fed all their meals and drinks throughout the day and evening. Okay, not on a par with one-to-one care 24 hours a day, although the night staff went round checking nappies and ensuring no-one had fallen out of bed or was roaming around causing too much interference to others (although there were a couple of Midnight Ramblers who did!). So I do understand that care goes on round the clock and that disruptive environments like Castlebeck would cost more in providing more staff.

However, that's it for extra, isn't it? More staff, but not more food or drink or drugs, heat/light/water provided. I honestly don't see how it could cost £2,000 per month for a mildly disruptive, incontinent Alzheimer's resident versus £2,000-£4,000 a WEEK for someone with a few more problems. One costs at least four times the amount of another to keep?

I would love to see the costing-out per resident on this and know where the money's apportioned. If the staff are poorly or even untrained, them shame on the business.
 
Kri, I'm not going to go into any more detail about the costs of keeping someone in 24-hour 1:1 care but I can categorically say that £2,000 is not unreasonable BUT for that money one WOULD expect high standards of care, high levels of training, committed staff and the individuals being cared for being able to live an active life. It is NOT to pay for individuals to be stuck in bed (or in padded cells, or whatever) and left to rot. And fees should only be as high as £4,000 if you have an individual who is so challenging that they need multiple staffing and/or high levels of specialist input. It costs a fortune to care for people PROPERLY, especially people with challenging behaviour or complex needs.

I'm not providing excuses for poor care - there is absolutely NO excuse for the dreadful care your mother received, or what happened at Winterbourne View - that is about poor management, poor training, poor monitoring and governance and about people simply not caring. In some cases, I've no doubt it's also about the money going into shareholders'/proprietors' pockets rather than into the care itself. One thing I DO know for sure, though, is how much it costs to deliver GOOD care for complex people - it's my job to know it, and to know it from the perspective of a non-profit making organisation.
 
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It doesn't seem appropriate for such places to be run by commercial companies. And yet the description of the local authority run places sounds awful.

What's the solution?
 
Many local authority homes have been closed - local authorities contract a high proportion of care, both residential and community-based, from the private and not-for-profit sectors. I don't think the home Kri was referring to was local authority, it was just that most of the places were bought by the local authority. The problem is then (from the money perspective) that in many homes, such as the one Kri is talking about, the majority of the placements are purchased by the LAs, who then refuse to pay above a certain fee level. This fee level is often inadequate and so the charge for private placements in the same home is inflated to cover the shortfall.

For Learning Disabilities, most care is contracted by the Local Authorities or Health - again, many LA run homes/hospitals have been closed and clients moved out either to private/NFP sector run homes or into the community, where they receive community-based care. LA homes have been closed for a variety of reasons - poor buildings stocks, cost (salary packages were expensive), in some cases, quality. Whilst I find it unpalatable that people should make a great deal of money from the care industry (and to be honest I'm not sure that many do - look at the state Southern Cross got itself into), the private sector is now essential because the not-for-profit organisations and the remaining LA homes cannot meet demand.

The first thing is that people need to recognise how much decent care does cost. Theroetically, the UK doesn't shove people into institutions and leave them, drugged to the eyeballs, to rot any more - thank God. Looking after people properly costs money, however - as I've said above, care staff are poorly paid and there are only so many people who are prepared to do the job, and do the job well, for the love of it.

The second thing is that we need a proper regulation system - the Care Quality Commission has been pared to the bone to cut costs and it just does not work. Inspectors need to visit homes regularly, not rely on paper audits prepared by the homes themselves.
 
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Of course, the trend at the moment is to close the care homes and care for as many people in the community as possible. This is done under the guise of personalisation - i.e. getting everyone to live as fulfilled and independent a life as possible in the way that they want to live. Some great things have come out of this, in terms of enablement, but the true motivator for the change is cost, which in turn leads to issues around quality.
 
Ha! I worked for Headway at the time it was all go to close homes for the people you describe, Muttley. I lived in Staffordshire at the time and we had a vast complex called Stallington - huge gardens where the - what are we allowed to call them now, mentally 'challenged'? - residents were free to roam at will, to take part in gardening and to grow their own veggies. They had a fabulous spa which helped those with added mobility problems, you name it, the place had it. They had regular escorted outings and they may have not been in the community but were considered very much a part of it.

What happened? The decision was taken to close this place down and bung the residents, some of whom had been in it for decades, into small houses throughout local towns. Mencap (now SANE) lobbied very hard against this, having a good idea of what would come next. Which it did - people formed small bands and protested outside the individual homes with placards saying things like NO PSYCHOS NEXT TO MY KIDS, etc. The poor ex-home residents were shouted at and there were attempts to vandalise the houses they lived in. They weren't welcome in the communities at all. So long as they remained in their purpose-built estate, part of the community but not living right alongside non "challenging" residents, all was well.

The other issue was cost: there had to be a 24/7 assistant living in each house, meaning that there had to be two (one on days, one coming in for nights), and sometimes there'd only be two, three or four people to care for. The costs went through the roof in farming out some 300 people into a variety of small houses, many now far away from Stallington and with tiny or inadequate gardens and certainly the special amenities (previously in full employment, in-house) would only now visit - chiropodist, hairdresser, physio, etc., all charging more because of the wider geography they had to travel to service the same clientele.

They weren't living a more independent life at all - they all still had to be supervised 24/7 and there was far more of a problem with them getting out and roaming into towns where they got picked up by the police or set upon by pea-brained youths. Mencap was certain that "independence" was a dangerous myth promoted by well-meaning do-gooders who had little idea of the reality of dealing with people who needed a strong structure of friendships around them (these were often summarily broken up in the fragmentation of housing), routine, and should not be given the illusion that they could function "in the way they want to live".

It cost, at the time these actions were taken, about three times as much to house these often very difficult people in communities, due to the need to hire more staff than was previously necessary and to pay for services to be performed contractually, where once they were done in-house. Pleasures lost to the residents were the large gardens, the spa facility, the swimming pool, and the contact with staff such as the nurses, physio, etc. And obviously, instead of one large structure to maintain, there were now dozens of different houses to maintain through contracts, leading to the appointment of administrators to handle these (and thus more cost in salaries).

It seemed to be a cruel exercise. Why not have let those already in places like Stallington live out their days there, but gradually introduce open living to newbies who'd know no different? I'm sure everyone thinks that living in an open community is the best thing for all of society, but sometimes, as the murders of members of the public by people off their meds (their decision, to live as they want to live, etc.) or away from supervision and secure living places have shown, this is not a one-size-fits-all solution.
 
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Krizon and Muttley, thank you for your very interesting insights into the care of the elderly and more "challenging" members of our society.

I recall that when Care in the Community was mooted, I asked the GP for whom I was working at the time: "What Community and who cares?" to which she replied that what concerned her most was that her husband (who had very high-level connections) had heard that a secret dossier had been opened by the Government to keep track of how many cases of assault and murder would follow the introduction of this policy.

Furthermore, there is a frightening attitude now prevalent amongst many people under 45 in the so-called "caring professions" - who do not actually care about the people entrusted to them at all. I have seen it myself on the wards in the hospital where I work and last year the head of the Nurses' professional body expressed his worries when he said: "The problem is that so many nurses now do NOT care about their patients."

It is very sad and more than a bit scary.
 
I totally agree, Kri, that it's not a case of one size fits all - living in the community can work for some and not for others - and, yes, it can cost a great deal more. Some authorities, having originally taken the line that they were going to get everyone out of registered homes into supported living houses in the community, are now back-pedalling furiously because, oh, what a surprise, they've found that their overall costs have increased dramatically.

On the other hand, we have a large number of people in supported living houses in the community and it works very well for them. They have good, solid support plans, with comprehensive risk assessment and if the LA or Health won't pay for the support we believe the individual needs, we won't offer support - there's no point in setting people up to fail from the beginning, it does more harm than good.

The attitudes from the communities can, indeed, be dreadful and people with a disability can be appallingly vulnerable. That's partly because for decades (centuries?) we've been shutting people with disabilities away and excluding them. There are many, many people in care who can make their own positive contribution to communities but so far, as a society, we've failed in our attempts to get the right balance.

Redhead - I absolutely agree about the under-45s. Recruitment is becoming more and more difficult - firstly, fewer and fewerr people want to enter the care industry and secondly, the quality of those who do is significantly reduced.
 
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Thanks, Muttley, for some good insights and a more up-to-date picture of what's occurred and occuring since the inception of Care in the Community. I certainly do want to see a much more integrated society, where people with a range of difficulties, physical and mental, are not treated as something so different they have to be feared, shunned, or tormented in a hunchback of Notre Dame manner. There's an awful long way to go in trying to get through to a range of society, not just the usual numb-nuts, that with decent support, most can manage a far better range of abilities than was once perceived.

However, there should still be institutionalisation (imvvho) for those who are seriously a risk to their communities if they opt out of their meds. I don't care about their human right to say no to being medicated, frankly, if that means they're likely to go round stabbing everyone wearing a red sweater that day, because red is the colour of Satan, blah, blah. If I end up being someone garrotted by a schizoid who's decided I'm his wicked grandmother and deserve to die, I shall not be best pleased. I will be sure to come back and haunt him, meds or no meds!
 
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