Money is no object, or at least it is for the ‘silent generation’

Louise Ahrens, an industry-expert, explains our older generation have witnessed great horrors. From war to a global pandemic they deserve a break, however the current costs of care homes will provide them with anything but.

I have always considered working with the older generation as a privilege. Our current ‘silent generation’ or ‘the first defined generational group’, are made up of those born between 1926 to 1942. These inspiring individuals have lived through The Great Depression and a global pandemic and working in frailty/adult social care today, means that a large number of these ‘traditionalists’ make up our patient base. 

As a result of living through great pressures, our older generation have become some of the most economically resilient people in our country. Although back in 1952 a property was just £1,500, against an average weekly income of £7.08, which made buying a property a much more financially viable prospect than it currently is for Gen Y’ers, a multitude of elderly people have been saving for a ‘rainy day’ with little insight to the fact that current costs of being able to afford care homes/home-based care are what they will all be spent on. 

I reside in a large seaside town on the South Coast, a lot of the ‘silent generation’ have retired here, and been lucky enough to purchase properties with a whiff of sea air and the sound of distant gulls wafting in through their windows.

These same people are now living with a lot of age-related issues which require regular support to ensure that they are safely able to carry out their ‘activities of daily living’. Gone are the days where if you were 75+ with chronic and degenerative conditions that you were placed in a ‘home’. A lot of the silent generation still live in fear of being “carted off to a home”, when it has actually become increasingly difficult to secure a residential/nursing home placement if you are looking for council funding.

Being in a residential placement is often not the ‘least restrictive’ option, and with spiralling fees it has become the norm in my area for a placement for someone with ‘low needs’ to be in excess of £1,000 per week.

I have worked in health and social care for many years, yet it still makes me take a sharp intake of breath to know that a bog-standard residential placement is costing circa £4000 a month. Add in a ‘hotel-like’ reception area, a cappuccino machine and a sea view and you would be lucky to see change from £6,500 a month.

Terms such as ‘brokerage search’ and ‘personal budget’ hang in the air like the sword of Damocles. Families are waiting weeks to hear a loved one is off to a placement 20 miles away to balance the public purse.

We know it’s necessary. We all appreciate it makes sense to seek care at the lowest price. But this doesn’t mean that we would be elated to hear our relative is off to a home ‘requiring improvement’ which is three bus rides away and 90-minute journey to get to.

A Guardian investigation in March 2023 discovered English councils spent £480m on ‘Inadequate care homes’ in four years, and a third of those UK places are being funded by the taxpayer. Eye watering figures. So surely life is far easier for those with money who can fund their own care, choose their own residential homes and domiciliary care providers? You would be forgiven for thinking this – but it is unfortunately not the case.

A question we have to ask, a lot – and usually during the first meeting is the dreaded: ‘Are you able to advise me if you have over £23,250 in savings?’ Cue the tumble weed, and the bell tolling ominously in the background. I always consider this question to be a fork in the road. The answer will decide the route of their future fate. Time stands still for a few seconds and one of the couple finally replies: ‘Oh yes dear, we have a lot more than that in savings, but we are keeping it for a rainy day, and we want to leave something to our children and grandchildren’.

My heart sinks. Every time. Here is a couple from the silent generation who have been married for 65 years, they have been thrifty, resilient, loyal, worked hard, saved well. They have lived by a ‘make do and mend’ ethos their whole life. As a result of ‘being careful’ financially, they now have a decent amount in the bank, a couple of savings accounts, an ISA or two, and premium bonds. On top of this, they own their bungalow which is ‘in need of modernisation’ but in an expensive area where there are a queue of developers waiting to raise properties like this to the ground and build a block of flats.

The hypothetical couple are Mr and Mrs M. Mrs M is a 92-year-old living with Alzheimer’s, diabetes and mobility issues. Mr M is 94, he has recovered from cancer three times in the last 25 years, lives with COPD, macular degeneration and is utterly exhausted from being a carer for his wife and not considering his own needs. His family live miles away and don’t visit regularly. There is no lasting power of attorney in place.

You sit and do a quick care act assessment in your head against ‘eligible outcomes’, and surmise that a twice daily package of care for them both, seven times a week, is the minimum really to ensure their safety and wellbeing.

You open up a sensitive conversation about care needs, contingency plans ‘safety netting’. You give scenarios, not to scare them, but to highlight the ‘what could go wrong’ crisis situations.

They are both vehement that they don’t want or need care coming in at the moment, a care line isn’t necessary they feel, they have a fixed line telephone and ‘nice neighbours’. You offer assistance with sourcing care, you offer a care act assessment and a carers assessment, you offer for an occupational therapist to visit. The answer is a polite but firm no, or lip service of ‘we’ll give it a little think’.

They don’t want you to contact any family, and you feel that they have the decision specific capacity to make this (unwise) decision.

It never sits well, you diarise to call or visit again in two week’s time. You have the same conversation with the same outcomes. You discuss at virtual wards/MDT’s/ in supervision, but you know your hands are tied. The situation deteriorates, you raise a safeguarding, you continue to try to get the couple to see their rainy day is well and truly here, and they are drowning while you stand there watching, helpless on a lifeboat, begging them to get in.

The inevitable day comes, within your predicted six month timeline, and you open an email to say Mr M has had a nasty fall and a 10+ hour long lie and is very unwell in hospital. Mrs M has had to be taken into hospital as well as a ‘social admission’ pending a respite placement. She is upset and confused and crying for her husband.

Mr M sadly passes away, Mrs M never returns to her home, and sees out her days in the same home she was placed in for respite.

The end could have been so different, daily care going in, hot meals delivered, assistance with activities of daily living, medications all administered, care line in place, ‘eyes on the situation’ every day, twice a day, to pick up any signs of UTI’S, cognitive decline or sudden deterioration. A bit of company each day, a brief chat, the occasional sticky bun on a Friday.

Yes, the same outcome could have occurred even with all of the above in place, but risk would have been vastly reduced, quality of life would have been better/easier for them. In all probability, they could have stayed at home for the rest of their lives.

Often it is this group of people who will accept help when it is free, such as interim care put in place after a hospital discharge, or hospital admission avoidance programmes, but they remain stoic, and once the free care ends and becomes a chargeable service, it is considered superfluous, a luxury that isn’t needed. ‘We’ll manage’ rings like constant tinnitus in your ears, as experience tells you they won’t manage, and you know that the situation will result in a crisis.

Crisis prevention relies on willing participants, and the silent generation are often not willing to access their rainy day fund. Sadly it is not uncommon to see this generation struggle in dire circumstances whilst their healthy bank accounts and savings gather interest.

There are small wins, some self funders are extremely insightful about their care needs. I have heard the terms ‘There are no pockets in a shroud’ and ‘You can’t take it with you’. There are also instances where a fall, or a short spell in hospital has meant that the silent generation have seen the merit of funding a package of care or a residential placement, but these cases are few and far between.

In my role, I continue to encourage self funders to use their rainy day fund when the light shower turns torrential. I’m often relegated to the sidelines, where I’ll continue to stand with my first aid kit in the hope of being able to patch up crisis situations and encouraging the silent generation to use the money they have worked a lifetime for, for their own benefit.

Images: Towfiqu barbhuiya, Gus Moretta, Stephen Phillips and Louise Ahrens

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