The last five years has seen an expansion of the private sector in terms of health care of the elderly that few would have predicted. The main reason for this rapid growth had been the government led inducements for elderly people to enter private homes, the government paying a substantial proportion of the bill via DSS board and lodging benefit. As soon as this means of payment was established by the government the huge increase in places began, with many private homes opening almost overnight. It is now big business with large companies becoming involved, as is already the case in the United States. The total cost escalated to astronomical sums (literally billions of pounds). The government’s answer was the 1990 legislation, the NHS Care in the Community Act, which moved the funding decisions from the DSS (which was effectively limitless) to social services – given a yearly sum, 85 per cent of which must be spent in the independent sector. Private homes are in the same two broad groupings as the state sector, that is residential homes (similar to the local authority old people’s homes) and nursing homes; some health districts have state run nursing homes or the nearest equivalent would be long-stay/ continuing care wards in the local geriatric/psychogeriatric hospital.
Private residential homes are often called rest homes and some have gone back to the concept of the old people’s home that was around many years ago. They like to cater for the elderly frail but genteel type of person. Many there are not even frail; they have chosen this type of care for the company and the lessening of worries about house repairs, etc. Standards will vary as will the fees, but as this type of home caters for the more articulate and well-off type of person, the standards and costs are usually high. Any form of mental illness, especially confusion, is likely to be an absolute bar to entry, as are any problems with incontinence.
The number of people wanting the type of home described above is relatively small compared to the total market for care and hence many homes have relaxed their unwritten rules to widen their potential client group. Many work on almost the same rules as State-run old people’s homes, with confusion not being a bar to entry if it is not accompanied by difficult behaviour or wandering. Residents must be fully mobile (a Zimmer frame is acceptable) and continent, and must be able to care for themselves in a minimum way such as dressing and feeding without help.
Problems begin if the resident fulfils the criteria on admission but runs into difficulties later. In the State sector a great deal of effort will be expended to keep the person in the home while at the same time trying to reverse the problem that has arisen. This may involve the help of numerous people, from both health and social services. As we have seen before living in residential accommodation is not easy. In the private sector there is no in-built requirement to try and make a go of it. Some homes will be excellent and use the resources that are available, but some will simply ask the relatives to remove the person as soon as possible. The latter are the homes led by the profit motive who know they will fill the vacancy almost immediately.
Few private homes cater for the elderly mentally infirm exclusively. They too will vary from the superb to the awful. This type of home also tends to be more expensive because of higher staff to resident ratios.

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