If families are to make good financial decisions for their loved one and their wider family, they need accurate data with which to base their judgements on. They will find data sadly lacking, out of date and sometimes misleading. But let us try and make sense of what is at our disposal.
Number of People in Care Homes (Dementia)
In 2020, more than 490,000 people were living in UK care homes. Over half (53%) were occupying beds in homes without nursing, usually referred to as residential homes, with the bulk of provision (83%) designed to provide care for older people with frailty. Unfortunately, data does not accurately detail how many of these people were living with dementia.
Kings College report (2014) stated there were 311,730 people living with dementia in UK care homes (either residential care or nursing homes). This was approximately 80% of the total number of people living in care homes. Therefore, if we have our best guess, we can safely assume there are around 390,000 (80%) people with dementia currently living in care homes.
Anecdotal evidence backs this assumption and the fact that, over the past 10 years, more and more care homes have stated they provide ‘specialist’ dementia care. What most of them really mean is that they cannot fill empty beds with frail elderly people because they are more likely to stay at home, more now than ever before. The ‘specialist’ care is the fact that their staff have attended a basic dementia awareness course.
Length of Stay
Information about the expected length of stay for people admitted to a care home, is important for predicting lifetime costs that families will be committing to.
In BUPAs study, they investigated the length of stay of care home residents by drawing on information about all 11,565 residents that died in Bupa care homes in the period November 2008 to May 2010. Residents of the 305 Bupa homes are largely representative of the England average in relation to age and sex. In the Bupa sample, the average length of stay was 801 days, but half of residents had died by 462 days. People had a 55% chance of living for the first year after admission. The BUPA report does not separate deaths attributed in part, or whole, to dementia.
Most of these care home residents had an average life expectancy of less than 2.2 years but it is safe to state that people admit.ed with dementia certainly had a shorter life expectancy as a sample group, probably closer to one and a half years.
Hale Place has had one of the most impressive life expectancy rates in England since 1988, averaging 4 years 3 months over the previous 25 years. Even more impressive, when you think, all residents were admitted with dementia and most were at mid-stage. This is certainly not the case in most care homes where people with dementia are mixed with other people who are frail or are living with other health conditions.
Longevity over the last 10 years has been reduced to under 4 years, partly attributed to people entering care homes when their dementia is at a much more advanced stage. COVID-19 has screwed data for obvious reasons.
Advances in medication is slowing the advancement of Alzheimer’s, people are living twice as long from diagnosis than they were 20 years ago, but this has little bearing on mortality within care homes because the individual is usually admitted when the dementia has advanced, and it is no longer safe to live at home. The medication at this stage has little impact on extending life.
End of Life
This means, of course, that caring for people approaching the end of their lives is a critical area of what care homes, with or without specialist nursing care, must provide.
In 2016, the government’s response to the Review of Choice in End-of-Life Care declared a commitment to improving end of life care in all settings. The Review found that people want to make choices about their own care even at the end of life and they want these choices to be real – based on available, varied, high-quality services.
Hale Place has always ‘specialised’ in supporting people to die with dignity, whilst embodying love and support. However, following the publication of the government’s review we went further and ensured that our senior people had advance training in this critical area of our work. We are also currently awaiting the outcome of our Gold Standards award for support to people at the end of life.
Costs of Long-Term Care
If we assume that all care homes can provide excellent end of life care, with support from the health community support team, and the average life expectancy is 18 months, we can begin to plan for the person’s care.
The average weekly fee charged by care homes, in our location, is approximately £1,350, the highest fees I know of is £2,200 per week. Most of these care providers also charge for ‘extras’ which may include hairdressing, toiletries, outings, pub lunches and even laundry. Hale Place fees cover all costs and entertainment.
Therefore:
£1,350 x 78 Weeks (1 ½ years) = £105,300 Total Care Fees
£1,350 x 104 weeks (2 years) = £140,400
£1,350 x 130 weeks (2 ½ years) = £175,500
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Average Fees £1,350 x 3 years = £210,600 (Plus expenses)
Hale Place Fees £1,445 x 3 years = £225,420 TOTAL
Conclusions
There is an urgent need for updated and accurate information concerning the number of people living in UK care homes who have dementia and what their average mortality rates are expected to be.
Our best guess from the data available is there are around 390,000 people living with dementia in UK care homes, and this group is expected to live, on average, for one and a half years, in the average care home.
However, Hale Place has proved over 35 years that, good quality care which stimulates people and gives meaning to lives, does have a positive impact upon life expectancy.
On average, people can expect their care costs to exceed £100,000, with some paying over £150,000 over the same period.
People who are living in a stimulating environment can expect to pay over £250,000 for their care.