Care homes are already in crisis. Up to 50% of them could close due to the shortfall between what councils can pay and what the care costs, according to reports in The Observer. But when you look into the future, I’m afraid the news gets considerably worse.
Old age might seem a long way off to many. But when a recent YouGov survey asked us which should be the NHS’s priority areas over the next five years, care for the elderly came top, on 57%. And the reality is that the population of over 85s – the main users of UK care homes – is forecast to more than double over the next 20 years.
The big question is, what will we need to build exactly? This is not as straightforward as it might first appear. By the 2030s, new technologies that make it easier to look after people remotely should have become standard. For example the worldwide market for mHealth – healthcare via mobile phone – is expected to have increased 54% between 2013 and 2018, to US$22 billion (£14 billion). These changes are likely to mean that a lower proportion of tomorrow’s over-85s will need to be in care homes than today’s.
But if this saves money on care homes to some extent, someone will still have to pay for the technology. And remote care won’t always be enough on its own. Suitably equipped houses will be required. So we need to think about the future requirement for homes fit for everything from “independent living” through to very sheltered housing. According to estimates made in 2013 the future will look like this:
Time for a national plan
In total, our estimate at the Institute for Sustainable Construction is that the UK will need to build more than 15,500 residential “care” developments by 2035, each of which would accommodate 40 to 70 people. That is 780 a year, and a huge rise on the 18,000 plus that we have in the country at present. At say £5m per care home, we are talking about an investment of around £4 billion a year. To that we may add the cost of designing homes for a new class of older people who would currently need to live in care homes/sheltered housing – assuming it wouldn’t be cheaper for this to continue rather than taking advantage of new technology.
The government is pursuing new building regulations to make it easier for people to stay in their homes for longer, while the pan-UK Technology Strategy Board has been focusing on remote-care technologies. But to a large extent, those at local level are being left to fend for themselves, and we are in danger of over-focusing on technology that will never help everyone. Instead we need a national infrastructure plan to support councils and care providers to make the necessary changes.
Normally infrastructure is associated with major transport systems and utilities, but it should also be relevant to major changes in where we need to live – and how we navigate around these places.
This is not just about funding but also strategy: we will need to identify gap sites in cities, towns and villages to enable as many elderly people to stay in their local communities. For those that can’t stay at home, this is essential for enabling them to see family and friends, and reduce feelings of loneliness and isolation.
We need to start responding to this immediately, over and above the current funding difficulties. With the right foresight, any rich country should be able to care for those who helped build it. History will look very unkindly on those who failed to take the necessary decisions at the appropriate time.