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people37, said a doctor or nurse had never discussed with them how to keep

the condition from worsening.38 As more than two-thirds of hospital patients are

over the retirement age the failure to adequately treat and care for older people

in hospital has a significant impact on the public purse, as well as on patients'

quality of life.

The quality of rehabilitation and dementia care is also dramatically below what

it should be. People with dementia on average stay in hospital seven days longer

than those without39 and are at higher risk of developing major complications

including pressure sores, falls and incontinence while there.40 The Alzheimer's

Society also claims that statistics show that half of those with moderate dementia

who are admitted to hospital with an acute illness, such as hip fracture or

pneumonia, will die within six months.41

The Care Quality Commission's 'Hospital Intelligent Monitoring: 2013' survey

found that 44 out of 161 trusts fell into the two highest risk categories; a rise on

previous figures.42 However, the issue of poor care is not resigned to a single

area, cutting across care in hospitals. After carrying out spot checks at 100

geriatric wards, The Care Quality Commission found that 35 hospitals needed

to make improvements.43 An ITV News Index carried out by ComRes revealed

that 34 per cent of the people polled said that they, or someone they knew, had

experienced poor standards of care in the past two years.44

2.3 Cases of poor care outside a clinical setting

While much social care is excellent, the media has highlighted a number of

high profile scandals. For example, the BBC Panorama documentary exposed

mistreatment at Winterbourne View hospital, with police arresting four people.

Such scandals have encouraged negative public perceptions of social care. There

are various forms of social care. In this report we use the phrase 'housing with

care' as defined in a recent report by Demos as care homes, residential care,

extra care and supported living.45 A survey commissioned by Demos found that

only one in four people would consider moving into a care home if necessary

in old age, while 43 per cent said that they would definitely not move.46 It is

also possible that the almost solely negative coverage of the care industry has

contributed to people's reluctance to save for their future care (see below).

However, such perceptions do not reflect the norm of social care as experienced

by many hundreds of thousands of vulnerable people. In other words there is a

significant gap between perception and reality. This perception gap is boosted

by the rare but shocking recent failures in care allied to the lack of media interest

in the vast majority of those who receive excellent care. For example, while fear

of abuse was one of the most commonly cited reasons against wanting to move

into housing with care (54 percent of members of the public cited this47) a 2013

survey of 20,000 care home residents from 1,000 care homes found that 92

per cent of care home residents said they were happy living in their care home,

97 per cent of residents agreed that staff treated them with kindness, dignity and

respect and 95 per cent were happy with the care and support they received.48

2.4 An unaffordable system

The financial pressures on councils seem set to continue. The NHS is projected to

have a £20bn funding gap by 2020/21.49 And despite the fact that the Association

of Directors of Adult Social Services (ADASS) survey recently reported that more than

£3.5 billion has been saved from Adult Social Care budgets during the past four

years,50 councils are still facing a £12.4bn funding gap by 2020.51 This is largely as

37 National Institute on Health,

What is Osteoarthritis?

(Accessed December 2014)

38 Royal College of Nursing, Safe

staffing for older people's wards

(2012)

39 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

40 Alzheimer's Society, The journal

of quality research in dementia

issue 8 (accessed December

2014)

41 Alzheimer's Society, The journal

of quality research in dementia

issue 8 (accessed December

2014)

42 Triggle, N "Quarter of hospitals

'at raised risk of poor care', BBC

News (24 October 2013)

43 Beckford, M "Elderly suffer poor

care in half of NHS hospitals"

The Telegraph (13 October

2011)

44 ITV News, "1/3 'experienced

poor NHS care'" (14 May

2013)

45 Demos, Commission on

residential care (2014) define:

Care home is a housing

with care setting usually with

communal living and dining

areas, separate bedrooms, and

care staff on site. People living

in care homes might be older

or disabled people. The CQC

defines care homes as offering

accommodation and personal

care for people who may not

be able to live independently.

Some homes also offer care from

qualified nurses or specialise in

caring for particular groups such

as younger adults with learning

disabilities.' Unless stated, this

report will use 'care home' to

refer to both residential care

home and nursing homes.

Residential care is all

care delivered in specialist

accommodation. Residential

care therefore includes not only

residential care and nursing

homes, but also extra care and

care village settings, as well as

supported living.

Extra care describes a range

of settings where people have

their own apartments, set around

communal living and dining

areas and other on-site leisure or

health facilities. These are often

in 'village'-style layouts but can

also be more widely dispersed

within neighbourhoods.

Supported living describes

apartments lived in individually

or by small groups of people

where care is provided on site

- this might be round-the-clock

support, or for part of the day.

46 Demos, Commission on

residential care (2014)

47 Demos, Commission on

residential care (2014)

48 Ipsos Mori, Your care rating

2013 survey (February 2014)

49 NHS England, The NHS

belongs to the people - a call to

action (June 2013)

50 ADASS, "Social care services

'unsustainable'" (2 July 2014)

51 LGA, Future funding outlook

2014 (July 2014)

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