The care home sector is near meltdown, according to owners, care experts and financial analysts. They warn that thousands of homes will be forced to close because they are not financially sustainable.
The prospect of such large scale home closure should be sending shockwaves through government.
Many of the most vulnerable older people in our country may face losing their home in the next year.
Will the government intervene? And if so, what will it do to avert this crisis?
As this blog has highlighted repeatedly, the crisis in care is predictable. Growing numbers of older people are fuelling demand for care while public funding for care has been severely cut.
For care homes, the problem is particularly intense. The needs of older people admitted into residential care are greater than ever, either with dementia or requiring substantial nursing care. Higher levels of staffing are needed. But at the same time local authorities have squeezed the fees they pay for residential placements over several years.
Providing quality residential care is becoming unsustainable, especially if a care home relies on local authority income. That challenge will become even tougher next year with the much heralded increase in the national minimum wage.
It's no surprise that care home providers and their national umbrella bodies are warning that the crisis will be worse than that currently devastating the steel industry. The consequences are far-reaching - for older people and their families, and for the NHS with added pressures on hospital beds if residential care fails.
So what could be done, starting with the government's spending review on 25 November? Here are some steps forward:
1) The government should commission an independent review to establish 'fair care funding' and ensure that local authorities pay at least the minimum rate required for both care home places and home care services. Alongside this review the government must fund councils properly to ensure that care providers are paid at or above the agreed minimum rate.
2) Care providers for their part must also commit to greater transparency, for example, of the wages they pay, staffing levels, profit margins and shareholder dividends. As private companies funded by public money, they should be accountable not just for the quality of care they provide but also for the way they run their businesses.
3) The investment in integration of care and health must be stepped up several gears, with one integrated budget at local level. Local authorities and CCGs must be required to demonstrate how effectively they are using this funding, for example to keep people out of hospital and residential care,
4) Following what is in essence the scrapping of the cap on care costs, the government should look at better ways to protect families from catastrophic care bills. One such measure would be to raise the threshold for paying for care from £23,250 to £250,000 (the average cost of a home in the UK). It is estimated that such a move would cost the same as the postponed cap and it would be a lot easier to administer.
All the above should be seen as steps on the way to the long term sustainability of care funding. That will also require a new way of paying for care that is fair and effective.
In the meantime the government must ensure that care, in whatever setting, is available when older people need it. Averting the crisis in care homes must be the first step. But only a first step, given the parallel crisis in home care. Above all, we mustn't lose sight of the vulnerable people stuck in the middle of the care crisis.