The tale of Miss R

I don't really know Miss R; in fact I couldn't really pick her out of a police line-up. Still, as Miss R couldn't really pick Miss R out of a police line-up I don't suppose it matters. What matters is Miss R is 81 years old, has severe memory problems and dementia, no family, no money, and as of now nowhere to live.

I have the privilege of serving on the management committee of a residential care home for the elderly. It's not a nursing home - it doesn't (or shouldn't) provide medical care. It's a charity set up after the War to look after the old who had lost everything and everyone in the Blitz. 70 years later and the old are much older than they were, and their attendant health problems have certainly not gone away. Dementia care and palliative care are very much the order of the day even for non-medical care settings.

The care home is in Wandsworth (a part of south west London). Because in Britain healthcare is free but social care is means tested the care home charges the princely sum of £640 per week per resident funded partly by the county the resident is/was from and partly from their own money as determined by some fiendishly incomprehensible formula derived by a bureaucrat who was Not Having A Good Day that day.

Miss R has a happy enough life with the care home. She has her friends, and a wonderful care worker who has been by her side for five years and despite the dementia has built a real bond with her. Miss R has even made friends with one of the innumerable cats who hang around too.

The problem is Miss R isn't from Wandsworth. she is from Westminster. And Westminster won't pay. Can pay - one of the wealthiest parts of London. Just won't.

After five years with us they have built up a deficit of several thousand pounds, and not unreasonably the care home is seeking to avoid the situation worsening by getting Westminster to pay the home's full fees. It's really tough for us to stick to our guns on this because we deeply care for the person, far more than any other part of the system. However, as a charity there is a real risk we won't be able to afford the care and accommodation the residents deserve if we can't get organisations that fund us to pay up.

So, in theory Westminster has to pay up or she goes. Problem is we're very likely to blink first as we are mindful of the person not the paperwork.

Westminster itself is quite insistent that the care home must do more to 'control its costs' but I find that argument a problem for two and a half reasons. Firstly, I do feel we provide incredible value for money - it is about the quality that we provide and the continuity of care that is in Miss R's best interests. Secondly, partly in response to serious and significant cuts to local authorities' funding to help manage the Government's yawning budget deficit, costs have been pushed down hill. Miss R has complex and intractable care needs that are not best met outside a nursing-care environment. Yet increasingly the threshold for more intensive (cf. expensive) care seems much higher than it ought to be. Finally, though, in the back of my mind is the thought that if Westminster were exercising appropriate control then Miss R would have been given care in the place she came from, and they would not have needed to rely on our good offices in the first place.

Well, I've often written that no good deed goes unpunished. Doesn't means we shouldn't do it, however, so we'll write our letters and argue back but overall it's pretty good to write that Miss R is safe and will be so for the rest of her life. We know what the real victory here is - and it is such a pity the powers that be don't.