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Post by Big Blue on Sept 13, 2021 13:31:12 GMT
….. but wouldn’t you prefer your parents enjoyed as much of their money as possible be that living life or paying for the best care they can have? I’ve been in care homes, know people that work in them and know people that own them. My father was quite clear that if he were to make it out of hospital and require care in any form I was to buy him a bottle of scotch and several hundred painkillers. Look back at the post I wrote when he died. W2.0 has also advised me that if she is required to care for me as a drooling, shitting old man I will be taken for a walk into the forest: she with one of her father’s rifles. I tell my mother to spend her money as I told my father to but the idea of handing it over to a care home is not my idea of what they, I, or my own children envisage as useful or desirable. “Care” is a loosely defined word where care homes are concerned and comfort is better served being looked after in your own home even if the risk is higher that you’ll gas yourself or get in the bath with an electric fire.
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Post by michael on Sept 13, 2021 13:35:42 GMT
….. but wouldn’t you prefer your parents enjoyed as much of their money as possible be that living life or paying for the best care they can have? I’ve been in care homes, know people that work in them and know people that own them. My father was quite clear that if he were to make it out of hospital and require care in any form I was to buy him a bottle of scotch and several hundred painkillers. Look back at the post I wrote when he died. W2.0 has also advised me that if she is required to care for me as a drooling, shitting old man I will be taken for a walk into the forest: she with one of her father’s rifles. I tell my mother to spend her money as I told my father to but the idea of handing it over to a care home is not my idea of what they, I, or my own children envisage as useful or desirable. “Care” is a loosely defined word where care homes are concerned and comfort is better served being looked after in your own home even if the risk is higher that you’ll gas yourself or get in the bath with an electric fire. In all seriousness euthanasia needs to be a part of this broader conversation.
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Post by Big Blue on Sept 13, 2021 13:40:02 GMT
I agree: I’ve known my mother all my life and the thought of her in a home being cared for by a stranger leads me know that euthanasia is the best option - otherwise there will be other deaths among the staff!
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Post by Tim on Sept 13, 2021 13:40:13 GMT
Thre should also be a question about why care homes are so damn expensive when they pay their main asset - the staff - so little.
I don't know what its like now but 20 years ago I did accounts for a couple of privately owned carehomes, in each case 1 home not a group, and it was alomost a licence to print money. I know the current model appears to be geared more to large groups of homes, often owned offshore, but don't know what sort of margin they work at.
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Post by Deleted on Sept 13, 2021 13:44:20 GMT
I am considered by my mother with a certain kind of hated because I told her to get the money out of the house and use the proceeds to live comfortably, go on holiday and all the top class care she needs. She WOULD have been comfortably off but no. She insists she has to leave it @for her kids/grand kids/cousins/nephews/aunties etc. She has very OLD idea's of what money can do. I did point out that the then values of the house could look after her for the rest of her days but no, she prefers to give half to the gov'mint and spread the rest so thin it is an afterthought. I will not be taking any of it so that is sorted but she is wasting her biggest asset. She tells us she does not want to move because her friends are the4re. They all moved out years or decades ago. Oh well, you can only tell people so many times before it becomes pointless. Next topic?
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Post by michael on Sept 13, 2021 13:46:24 GMT
Thre should also be a question about why care homes are so damn expensive when they pay their main asset - the staff - so little. I don't know what its like now but 20 years ago I did accounts for a couple of privately owned carehomes, in each case 1 home not a group, and it was alomost a licence to print money. I know the current model appears to be geared more to large groups of homes, often owned offshore, but don't know what sort of margin they work at. No idea on the costs but the ‘pile them high’ approach is one of the reasons our care system did so badly with COVID and other diseases. Unlike a lot of European and particularly Scandinavian homes, ours have many, many residents so when COVID got into one home it affected a far larger number of people.
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Post by racingteatray on Sept 13, 2021 13:47:03 GMT
I’ve been in care homes, know people that work in them and know people that own them. My father was quite clear that if he were to make it out of hospital and require care in any form I was to buy him a bottle of scotch and several hundred painkillers. Look back at the post I wrote when he died. W2.0 has also advised me that if she is required to care for me as a drooling, shitting old man I will be taken for a walk into the forest: she with one of her father’s rifles. I tell my mother to spend her money as I told my father to but the idea of handing it over to a care home is not my idea of what they, I, or my own children envisage as useful or desirable. “Care” is a loosely defined word where care homes are concerned and comfort is better served being looked after in your own home even if the risk is higher that you’ll gas yourself or get in the bath with an electric fire. In all seriousness euthanasia needs to be a part of this broader conversation. There's a whole other minefield to be sidestepped! I've always told my mother that her money is her money and if there is nothing left when she dies then so be it. All three of her children have well-paid careers and the two of us who are married have spouses with well-paid careers, so any inheritance from her would fall firmly in the "nice to have but not essential" category.
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Post by michael on Sept 13, 2021 13:56:55 GMT
Sometimes minefields need to be cleared. I don’t think we should be bumping people off to save on overheads but instead on compassionate grounds. We treat dogs with more respect in this regard. That said Logan’s Run was a classic for a reason.
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Post by johnc on Sept 13, 2021 15:53:09 GMT
Nursing homes don't operate on huge margins (apart from some of the private only ones at £1,500 a week). Most have a break even of around 85% occupancy so the benefits of getting as close to 100% occupancy are very big. Effectively everything over c 85% is pure profit but running at about 90% occupancy is normal, 95% is doing very well and 100% is very rare for more than a few weeks at a time.
Most privately owned nursing homes are somewhere between 40 and 60 beds. The problems come when there are 4 or 5 deaths in quick succession and it takes several months to get replacement residents. The Care Commission keep moving the goal posts and are always looking for a higher staff to resident ratio together with property improvements, some of which are very expensive. The regulations also change with regard to room sizes etc which can create big issues with older homes in particular where it simply isn't possible to make a room bigger so they lose a room or two or have to convert offices into bedrooms and ineligible bedrooms into offices.
Nursing homes aren't the gravy trains they were 20 to 30 years ago but a well run home with 50 or 60 beds can do very well if the owners are organised.
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Post by Deleted on Sept 13, 2021 16:28:34 GMT
What is the market for respite care in those homes at less than 85% occupancy? IO would have thought that would get a fair degrtee of take up.
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Post by michael on Sept 13, 2021 16:33:19 GMT
What is the market for respite care in those homes at less than 85% occupancy? IO would have thought that would get a fair degrtee of take up. The problem with respite care as an offer is they struggle to know sufficiently in advance if they’ll have availability so they can’t really make provision as they’d prefer a permanent resident.
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Post by PG on Sept 13, 2021 18:47:52 GMT
Nursing homes don't operate on huge margins (apart from some of the private only ones at £1,500 a week). Most have a break even of around 85% occupancy so the benefits of getting as close to 100% occupancy are very big. Effectively everything over c 85% is pure profit but running at about 90% occupancy is normal, 95% is doing very well and 100% is very rare for more than a few weeks at a time. Which brings up also one of the issues I've seen friends have with nursing homes. It pays them to keep high paying private clients alive. So whilst mum or dad would die in "normal" circumstances, the home keeps getting doctors in to prolong the agony. An ex work colleague's late eighties mum had a serious stroke in her care home. They saved her life. She was left bed bound and unable to feed herself. They got another 24 months of fees from her at even higher rates as she had to have extra care. Yes, I'm sure homes don't actually think like that (well I hope not) but the quality of life argument seems to have little sway in any of the decisions taken about people. As michael said, we treat dogs better and with more dignity.
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Post by Deleted on Sept 13, 2021 22:34:11 GMT
Care homes have improved leaps and bounds from the late 70's and early 80's where people were literally left in their own shit for days. I had two teeth knocked out by one victim and will never forget another brought in for an emergency hernia. Not pretty. The problem is that you need motivated staff and paying peanuts gets you monkey's. Having worked in various parts of the health care sector I came to the conclusion that student nurses and trainee technical staff should do a stint in this area to get a thorough grounding in what health care really means rather than paying lip service. Maybe would be doctors too.
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Post by alf on Sept 15, 2021 8:31:13 GMT
Such a big issue this. I feel no negativity about the NI increase, on the basis that social care is a huge issue and needs paying for. It is very difficult in politics to make wholesale changes, leaving things as they are is politically safer, but somehow we had got to a system where the NHS has a huge budget and if I need a million pound operation, I'm getting it, even if I got myself into that position through abusing my body. But if I get dementia, then for some reason I'm supposed to pay for all of my care, and will get batted about between the council, the NHS, the police (who should not be involved, but often are) and so on like a hot potato.
The NHS has an unassailable position in the national psyche and while the budget increases in the New Labour era were not matched by better results, woe betide anyone trying to make wholesale cuts or changes there. So unfortunately more money was needed to fix a big issue - for poorer people the care was often lacking, for the better-off, expecting them to pay potentially their entire life savings including house equity for an illness seems grossly unfair. As does the council paying for it all for the genuinely rich - so again its a fine balance.
At the end of the day there will always be tonnes of unhappy people however you fund it. Some are asset rich, some have high earnings but less assets, some make money on capital gains, and so on. No tax increase will be universally popular. I find it incredible Labour opposed the whole thing, their funding "method" always seems to be "taxes on the rich" that in practice will not work, the rich are mobile and have good accountants.... Sadly things like VAT rises are the safest way to get the money, including from people swindling the income tax system, and yes its a shame that poorer people suffer unduly there. But the money is needed, and also they will gain most from it.... So overall I'm happy that someone finally did something about it rather than just decided it was in the "too hard" box along with public sector pensions and many other big issues (the house of Lords??)...
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Post by Big Blue on Sept 15, 2021 9:20:30 GMT
The NHS has an unassailable position in the national psyche and while the budget increases in the New Labour era were not matched by better results, woe betide anyone trying to make wholesale cuts or changes there. Time for me to repeat the fact that the NHS was started at a time when very sick people were often sent home with a load of painkillers to die on their own beds, deformed babies were "stillborn", severely injured limbs were amputated and very severely injured people were accelerated towards the afterlife. We now have the medical capability to effectively keep a head alive in a jar, like Nixon in Futurama, but that doesn't mean it needs to be used in every single instance. One of the last things I did with my dad was feed him as he was incapable. At the time I was thinking "this is my fucking DAD. The man that raised me and my sister to be self reliant with little assistance. The man that would be dancing on tables at the end of the night in his late 60s. The man that travelled the world with the navy and the Crown Agents. He's not to spend any longer being cared for in this manner than is absolutely necessary as he himself advised." My mother is similarly brutal in her own outlook, having cared for my step-father with Alzheimer's until the doctors told her she was to stop for her own health. Life is for living, especially for we fortunate ones in the west. It is not for simply being kept alive. The original NHS came from a period when that was understood and when medical science supported it with its capabilities. Very clever people have improved many things, notably cancer care in younger aged folk and neurological care but one of the fathers at our school left St Barts to become a teacher after getting disillusioned with the spending and arguing over some critical care infants that were never going to live any kind of life from birth but were being afforded care at a cost that would support several severely ill children on their journey to living a life.
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Post by Alex on Sept 15, 2021 10:25:32 GMT
The sad thing about dementia is that it's the exact opposite of the head in a jar. The head has gone but is stuck in a body that modern medicine has allowed to outlive its design. We did not evolve as a species to live much beyond 50 so with life expectancy being somewhere in the 70s and many many people getting into their 80s and 90s its no wonder so many end up needing such high cost care. Couple that to a funding model that was based on people living for a max 10yrs after retirement and there was always going to come a point where the money pot was no longer overflowing but was in fact almost empty.
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Post by PG on Sept 15, 2021 12:51:17 GMT
The sad thing about dementia is that it's the exact opposite of the head in a jar. The head has gone but is stuck in a body that modern medicine has allowed to outlive its design. We did not evolve as a species to live much beyond 50 so with life expectancy being somewhere in the 70s and many many people getting into their 80s and 90s its no wonder so many end up needing such high cost care. Couple that to a funding model that was based on people living for a max 10yrs after retirement and there was always going to come a point where the money pot was no longer overflowing but was in fact almost empty. A model based on well less than 10 years on average. In 1950, average life expectancy in the UK was 67.66 years. And whilst that was better than at the start of the century, a lot of that improvement was more sue to reductions in child mortality than adults living longer. It is only really since the 1960's onwards that adult life expectancy has inexorably risen through better diet, housing and healthcare, plus a decline in heavy manual labour for men and domestic drudgery for women. www.statista.com/statistics/1040159/life-expectancy-united-kingdom-all-time/In fact I remember reading that when the NHS was set up, there was a general belief that the cost as a% GDP would actually go down over time rather then rise. As health increased, there would be a two fold benefit - better growth in GDP and less call for healthcare. A "slightly" naive view as it turned out. As alex said, we're basically attempting to fudge and live with a funding model that was barely fit for 1950, let alone 21st century expectations that are all based on that 1950 funding model still working - "I paid NI all my working life so I deserve free treatment for anything for ever".
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Post by johnc on Sept 15, 2021 14:05:38 GMT
Does anyone know how the health systems in France, Germany, Spain etc work and who pays for it and how much? Is it inclusive for those who can't pay for it?
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Post by michael on Sept 15, 2021 14:36:07 GMT
Does anyone know how the health systems in France, Germany, Spain etc work and who pays for it and how much? Is it inclusive for those who can't pay for it? Compulsory insurance model with a far greater private sector involvement in services and optional private insurance to improve the patient experience. As an example, in Germany you have to pay for your meals if you are an in-patient. Your private health provider may cover that but the basic version does not.
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Post by Big Blue on Sept 15, 2021 14:46:02 GMT
Also if you have periods of unemployment your state payment is reduced in line with a contribution to the healthcare system. There are homes and facilities in much the same way there are here however there is also a far larger culture of family assistance, with one offspring almost tagged for parental care responsibilities by their own situation making it more manageable.
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