"Awful" care homes are worse than prison because "some people aren't getting the assistance they need", according to a care worker in Liverpool.
The care worker of 16 years, who we're calling Jane because she asked not to be named, works in a care home with roughly 40 residents. Some are incontinent, immobile or need help feeding themselves and going to the toilet.
But understaffing across the social care sector means they aren't getting this support, according to Jane, 54. She said: "How long do you think it's reasonable to wait to go to the toilet? They'd like to go to the toilet, but there's not enough staff to take them."
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She said this is worse than prison where prisoners must have 24-hour access to a toilet - roughly 91% of prisoners have one in-cell. Jane said: "Yet an elderly person can go into a room and pay £600 or £800 and still doesn't get a toilet. They get a commode. No one seems to be shouting about that. We're not looking after our elderly in this country."
Social care has come under renewed scrutiny as public attention turned to the ambulances queuing outside A&E and the patients being treated in hospital corridors. Doctors in Liverpool described A&E as a "warzone" where "it's a lottery whether you will survive". Top doctors at the Royal wrote a letter to the hospital trust's board saying they were "ashamed" of the "overcrowded, chaotic and unpleasant" emergency department in the hospital's new facility.
While the NHS suffers from staff shortages, burnout and underfunding highlighted by the nurses' and ambulance workers' strikes, the backlog is further downstream, in the handover from hospitals to social care.
Latifa Patel, a junior doctor who trained in Liverpool, is a chief officer at the British Medical Association. She said: "A&E is not the problem, A&E can see the patients. There is nowhere for the patients to go because they're stuck. There's nowhere for them to go because we don't invest in beds."
On January 5 this year, 220 patients across Liverpool's main hospitals - including the Royal, Aintree and Broadgreen - remained in hospital beds for more than 21 days despite being ready for discharge. Just five were discharged by midnight that day.
The figures are similar throughout December and early January, with the rate of those being discharged as low as 2% on Sunday 8 January. Patients are waiting weeks for social care packages to be arranged, but "social care is on its knees and can't take the backlog of the hospitals", Jane said.
She described care homes as "understaffed" and "underfacilitied", with care workers working for minimum wage with no sick pay or paid breaks. She told the ECHO: "They're not going out to a nice, lovely little, social care home. They're coming into somewhere that's probably as bad as where they were sitting in the NHS."
England's social care system is "not fit for purpose", according to The King's Fund, a charity working to improve health and social care in England. It said: "The social care system remains under intense pressure with an unstable provider market, a workforce crisis, and high levels of unmet need. Unless these problems are addressed, it will continue to fail the people who rely on it."
That pressure is only growing as the country's population ages and the number of people needing help in older age rises. Like the NHS, care providers are struggling to recruit people to work in the sector. Turnover rates are high at 29%, with 400,000 people leaving their jobs last year. More than a third of those left the sector entirely.
Last year, the number of vacant posts jumped 55,000 to a total of 165,000 across England, an increase of 55% from the previous year, according to Skills for Change, the strategic workforce development and planning body for adult social care.
Some of the factors behind this shortage are affecting other sectors. There's been a lack of long-term workforce planning by the government and the NHS, Brexit means fewer people come from the EU to work, the pay is low, and the pressures of the job grow as the staffing crisis worsens, according to the House of Lords Library.
Unlike the NHS, most people pay for social care usually provided by private companies. People with assets worth more than £23,250 have to pay for social care, like home help and care homes. From October this year, this minimum will be increased to £100,000 and people will only pay for care up to the value of £86,000.
King's Fund describes this set-up as "unfair" because costs of £86,000 could be "catastrophic" for someone forced to sell their house to pay for care. Care England, which represents the largest private care home providers, wants the government to double their usual fees and pay them £1,500 a week per person in order to increase care worker pay and hire more staff.
Care providers already make bumper profits, and Jane sees that as a problem if it leads to a lack of investment in staff and buildings for the sake of cutting costs. One of the country's biggest care companies, Runwood Homes, reported pre-tax profits of £25.4m in 2020, widening its underlying profit margin by 37%, The Observer reports.
But such profits aren't passed down to employees in the sector, who on average earn £22,000. Directors of some of the biggest care companies in the UK saw their pay rise on average from £146,100 to £296,600 between 2015 and 2020. That's almost double the rate of their employees pay since 2020, according to a report by the Centre for the Understanding of Sustainable Prosperity at the University of Sussex.
The report also highlighs something that may fuel Jane's fears about the future of social care. It found care workers felt care companies taken over by investment firms exploited care staff, cut corners on service delivery, covered up mismanagement, failed to communicate, and prioritised profit over care.
It suggested a national care service with sufficient government funding could help solve the social care crisis. Jane wants to see social care "stripped back to the bone" with more regulation to ensure standards are maintained.
She hopes by speaking out she can affect change, but she feels "sad" about the conditions she gives care under. Jane said: "People say, 'Why do you go?'. Well what if we don't go? What happens to them then?
"While there's people like us willing to voice what's going on, maybe there might be change, because let me tell you, every person in this country has only got two options. They'll either grow old, or they'll die, so let's hope we can make change because we're making it for ourselves, because it's not good enough."
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