Not enough beds

There is an old Jewish saying: "Who's buying and who's selling." This applies to residential care. There are more old people requiring residential care than there are beds available. So the power rests with the providers of care.

There is no real market. People have too little choice

All of which makes something of a mockery of brave words about "standards" – the funders are unlikely to close homes, or withdraw funding from even the bad places. If we close homes, then the inhabitants might be tipped out into the street – there might be nowhere else to go! Mind you, bad places will not get a stamp of approval, and they might be asked to fix particular details – but that is all. They too often know when inspections are coming, so they can prepare and look good.

And because we are ageing (a third in the last century or so) there are more people alone, more dependent old people and more dementia. – and there are going to be lots more of each group.

This is not a party political matter. We are going to be in trouble no matter which Party is in power.

We are going to need more residential places.

Anyhow, many of the facilities existing now were not custom built for their present job. Many are older big family homes that have been adapted as residential homes for old people. Some of the corridors are too narrow for movement of beds and trolleys and personnel and food; some have small and hot and dark rooms; some have inadequate plumbing; some have steps, some are unsuitable for people with dementia, and so on. More purpose built facilities are appearing, often (but not always) for the "healthy old" and are often built by developers anxious to make money, with little regard for the public good. They are comfortable places, but they are often expensive and isolated from shops and community services. Few of the newer homes cater for the poor. Only some of them cater for people as they become increasingly frail and dependent.

If one has to use a retirement home, the best kind offers a continuum of care so that one can go progressively into more intensive facilities as one becomes increasingly dependent and frail. The best facilities have these staged facilities – one starts in the relatively independent area but ends in the nursing home. But some retirement places might accept little responsibility as dependency increases. In fact some very upmarket facilities more or less force people to leave if they develop significant disability and infirmity. They just do not cater for significant disability and do not want disabled people in that facility. Added to that, in many residential facilities staffing levels are as low as the law allows, staff shortages are common, the food is poor, and the places are often unpleasant. One widow recalled recently that her late husband referred to his nursing home as a "hell hole".

The truth of the above statements can be attested to by many people and

hidden cameras have revealed just how poor the care may be.

And, by the way, those institutions usually run to financial and budgetary agendas, not to the needs of residents, nor to personal agendas that might be inconvenient for the institution. And some of the bad institutions operate cruelly for profit – often at the expense of the residents. Minimum staff, the minimum number of qualified helpers; poor meals, poor skin and foot care, restrictions on numbers of incontinence pads, custodial rather than personal care, chemical restraint, poorly trained staff. It might seem hard to believe that people are sometimes transferred to hospitals from nursing homes suffering from bedsores – pressure ulcers on the skin - which indicate that nursing care has been poor.

Nursing homes often have a nasty smell of urine related to incontinence – interestingly, a smell not noticed in nurseries full of incontinent babies nor in spinal injury units full of doubly incontinent people with paraplegia or quadriplegia. If those units do not smell, then why do nursing homes? What emerged on television is that some facilities restrict the numbers of incontinence pads that can be used (and which some old people need) – again, commercial considerations trumping medical need.

So there are not enough places now; some of them are of poor quality, some were not even built for residential care, and there will be many more needing places in the future as the population ages and dementia increases.

We are in deep trouble.