Why care of our elderly is best delivered at home

Given the easy access to health professionals and round-the-clock support, a care home has many advantages for some elderly people. 

But there are clear downsides, too. 

One of those is price, both for local authorities and individuals. Residential and nursing homes are significantly more expensive than at-home care, and the recipients themselves increasingly have to cover large portions of the cost. Anyone with assets of more than £22k has to sell their property or use their savings to pay for care.

Added to that, it can’t be ignored that most people feel more comfortable in their own homes. Care at home also provides a unique opportunity to rewrite the current societal narrative in which elderly people are often portrayed as a burden to be placed out of sight. 

Let’s take a look at the advantages of at-home care.

1. Lower costs for individuals and local authorities

The latest figures show that average costs per week for a residential care home in England range from GBP 536 in the northeast to GBP 702 in the southeast. For nursing care, which is designed for people who also have ongoing medical requirements, costs are GBP 666 and GBP 1,041 respectively. 

With funding cuts reducing how much local authorities can spend on individuals each year, an increasing number of recipients now have to pay a significant proportion of their care bills. At the same time many nursing homes have simply had to close, victims of a situation where funding fails to cover running costs.

At the same time many nursing homes have simply had to close, victims of a situation where funding fails to cover running costs.

The squeeze on funding also results in local authorities cutting care that would previously have been seen as essential. With no spare cash, and budgets actually being cut, the situation is not set to improve in the immediate future.

Sadly, this creates a polarised system in which wealthy people can access the best available care, while those on lower incomes are often left with poor-quality care and little or no choice about where they receive that care.  

How at-home care reduces costs

Delivering at-home care can help to reduce the cost burden for both local authorities and those receiving care. 

It means people don’t need to pay for round-the-clock care they may not need. Instead, the associated cost relates to the direct care received. When nursing care is delivered at home, people no longer have to shoulder the burden of paying for transport to get them to and from clinics and specialist centres.

Of course, for home care to become the norm, local authorities will need to develop a system that allows people to receive and pay for only the care they need. The UK’s Secretary of State has argued that this can be achieved by paying for home care visits on an hourly basis, but such a system will need to be carefully developed to prevent elderly people from rationing the care they receive to keep costs low. 

2. Fosters community spirit

According to data from the University of Oxford, there are 10 million people in the UK aged over 65 and three million over 80, with figures expected to double over the next 20 years. Despite this trend, elderly people are still positioned as a societal burden rather than celebrated.

One of the biggest proliferators of this elderly burden narrative is the practice of moving elderly people out of their homes and into residential or nursing homes. This can remove older adults’ sense of independence and autonomy, seriously impacting their emotional health, wellbeing and confidence.

One of the biggest proliferators of this elderly burden narrative is the practice of moving elderly people out of their homes and into residential or nursing homes.

With this in mind, it’s important to help elderly people feel that staying in their homes is both safe and realistic. We need to implement befriending or practical support schemes, and encourage retired people to take second careers as carers or companions – paid or unpaid, depending on personal means.

Investing in community initiatives to roll out such schemes nationally would boost intergenerational contact, help address loneliness, and improve the health and wellbeing of elderly people. 

How to boost community spirit

Research published in a 2019 World Health Organization report has shown that social contact is strongly connected to good physical and emotional health, and should be supported at all life stages. 

The impact of this finding is huge for social care. Not only could delivering at-home care help elderly people feel like valued members of the community, it could also help keep medical costs in check by improving their health and wellbeing. Facilitating links between age groups will benefit all groups, enabling younger generations to learn from more experienced older people.

3. Happier at home

Helping older people to stay in their homes prevents the confusion and upset often associated with moving into a residential or nursing home. 

There’s no denying the fact that most people feel more comfortable in the familiar surroundings of their own home. However, for elderly people, the importance of maintaining familiarity extends beyond comfort. 

There’s no denying the fact that most people feel more comfortable in the familiar surroundings of their own home.

A sudden change in environment can trigger the condition of delirium in those who are unwell, especially those with dementia. It can prolong existing illnesses and is associated with an increased risk of chronic disability and even death. This makes it all the more important to deliver care to elderly people in their own homes rather than in nursing homes or unfamiliar specialist centres.

Furthermore, moving patients into care homes can exacerbate the loneliness many elderly people feel. Unless a person pays privately to go to a care home of their choice, there’s no guarantee that the home they move to will be in the same town or city as their family and friends. The distance created can make regular visits challenging and lead to further isolation.

How to prevent distress from moving

As a condition that carries a large burden of care, preventing delirium in elderly people is of key importance, not just to the individuals themselves but their families, the NHS and the social care system. 

In the short term, delirium can lengthen hospital stays and introduce the need for extra medication and equipment. In the long term, it can lead to deterioration in mental and physical health, increasing the level of care required. The consequences are higher costs for the NHS and social care system, and more distress for the person and their family. 

Providing care in the familiar surroundings of someone’s home can reduce these risks. 

Challenging the ‘out-of-sight’ status quo

It’s easy to assume that placing older people in care homes that have been specifically created for elderly care is best, but this isn’t always true. Many care homes are struggling with both lack of funding, and lack of people prepared to work for the minimum wage in a tightly regulated, emotionally challenging and complex role.

But can all vulnerable older people currently get the best care possible in their homes? No – the current social care system is not yet optimised to do this. The quality of care delivered at home needs to be monitored and controlled on a par with care homes if it is to be part of a joined-up care system, and not just a sidestep out of it.

Also, many frail elderly people can end up living at home with no visitors – unless they are considered sufficiently ill or vulnerable, local authorities won’t pay for supervision or support. 

However, in spite of these obstacles the goal of quality home-based care is achievable. Taking new measures, such as reformatting the approach to payment and investing in national initiatives to widen community support have great potential for helping truly transform elder care in the UK.

Community Integrated Care is a national social care charity which provides care and support to thousands of people across England and Scotland. To learn more, please visit www.c-i-c.co.uk.