Another post in the Care Combine series:
Recap
Last time, I told you how the idea of the Care Combine first came to me. After Lena’s dementia diagnosis I was struggling with my new role as her 24 x 7 carer. Dementia had isolated us from most of our old friends and we spent almost all our time alone with each other.
Suddenly it occurred to me that if I teamed up with other carers I’d met, we could share our responsibilities, giving one another a much-needed break from care. And Lena would certainly enjoy getting back together with other people again.
+ + + + +
But that’s not the way our care system is set up. Let me illustrate … with a little thought experiment, a leap of imagination.
In this game, let’s forget for a moment dementia and people in their later years, and talk about children. Your children. They’re 7 and 10 years old, and you and your spouse are busy parents, both in full-time jobs so that you can pay the bills. You get this letter from the children’s school. As you read it, I want you to think about the implications for you, your children, and the state of education in the country:
The Headmaster’s Letter
Dear Parent
As you will be aware, the recently passed School Reform Act ushers in an entirely new approach to the education of our children. We are writing to inform you that Willowbank, like all other schools in the area, will not be re-opening for classes after the summer holiday.
It goes without saying that we will continue to have the best interests of your child / children at heart. The Government’s decision to close the schools was not made easily, but research has clearly proven that by investing in teachers rather than premises, the quality of education in this country will rise. We plan to double our staff numbers by September.
What will this mean in practice? Each child will receive at least one hour of private tuition per day from Monday to Friday. The teacher will come to your home twice a day, once in the morning and then again in the afternoon for a period of approximately 30 minutes each time. We will notify you in due course of the weekly timetable of visits scheduled for your child / children during the Autumn term.
We believe that our children will quickly benefit from this one-on-one coaching. In the crowded classrooms of the past, teachers were obliged to teach in lockstep, at a pace that was too fast for some, too slow for others. Now each child will be able to learn at the pace that suits them best.
Inevitably, the role of parents will change. After work has been set by the teacher, we encourage parents to work closely with their children, assisting them with their home assignments. We know that many Willowbank parents will welcome this opportunity to be more involved in their children’s education, and we know we can count on you to provide this vital support.
To clarify your role and to answer any other questions you may have, we are hosting a Parents’ Meeting at the school on Wednesday 15th August at 2:30 pm – to which you are warmly invited.
Yours sincerely
F H Taylor
Headmaster
You’re Going To Do WHAT!!??
I hope you’ll agree with me that this letter is full of terrible ideas. OK, so maybe we can agree with the headmaster’s argument in paragraph 4 — that our kids should ‘learn at the pace that suits them best’ — but to do it like this!!??
If the children are going to be at home all day, then who’s going to take care of them? Do you have to give up your job? And how are you supposed to assist with the homework assignments? You’re not a trained teacher … and you haven’t got the first idea how they teach maths these days. How are you going to keep the kids happy and entertained all day long? Especially when they’re not with all their friends, now there’s no school. How are they even going to make friends when they’re stuck at home all day, waiting for the teacher?
Then more questions. The changes are a consequence of the Government’s new education policy. Save on the cost of buildings; invest in the teachers. But if every teaching establishment (we can’t call them schools any more!) in the country is planning to double staff numbers like Willowbank, then where are all these new teachers going to come from? Wasn’t there a report recently about teacher shortages in this country? So what’s the plan? To lower the qualification standards for teachers? Maybe to recruit from overseas? And is doubling the number of teachers even enough? Let’s do the maths – using the methods you learnt at school. A typical class-size of 30 – each visited for half an hour twice a day. So that’s:
30 x 1/2 x 2 = 30 hours per day
Typical working hours in a teacher’s day. Let’s say 8 hours.
Number of teachers required for 30 students in the new plan:
30 / 8 = 3.75
Ah, but wait — that’s still not enough! We’ve missed something. There’s travelling time between each of the ‘lessons’ too. So how many teachers will we need? Lots.
Of course this scenario is completely ridiculous. No government in its right mind would ever contemplate introducing a School Reform Act like this, would it? Not even by rolling out the time-honoured and slightly weary argument … it’ll save taxpayers’ money. Kids would hate being forced to stay at home. Parents would revolt — I could imagine some trying to give their children away … to grandparents perhaps, or failing that, anyone else who would take them. The birth-rate would tumble. It’d be a disaster.
Dementia Care – The Same Terrible Ideas
And yet, dear reader, the way we deal with dementia care is exactly what I’ve just described. And just like the School Reform Act, it’s full of terrible ideas. Ideas, unfortunately, that we’ve just become accustomed to — we accept them without question.
Nearly one million families in the UK care for someone with dementia, according to the charity Dementia Carers Count. And typically these unpaid family carers are supported by professional domiciliary care workers, who visit the dementia patient at home a couple of times a day for 30 – 45 minutes. The domiciliary carers assist with morning and evening routines, such as washing, dressing, food preparation, light housework, making sure that medications have been administered.
So the family carers get 1 – 2 hours of support, and then for the rest of the day, they’re in charge, keeping the vulnerable person they’re caring for out of trouble. That’s easy enough: making sure, for example, that they don’t have accidents in the kitchen, or wander off out of the house and get lost. But to do this, a family carer may need to sacrifice a career.
The tougher challenge is how to keep a dementia patient occupied and entertained for all the remaining hours in the day. With dementia, interests and abilities begin to wane, you see friends less often, maybe not at all. You always said you were looking forward to spending more time together — but you didn’t mean all the time, every day, every week, every month, every year. Family dementia carers get worn out. No wonder so many of them end up with poor health themselves (as shown in the Dementia Carers Count findings).
Never miss a thing
And then there are the logistical issues of our domiciliary care system. As we saw with teachers, home visits require high staffing levels. In 2025 the Quality Care Group reports that there are 150,000 unfilled job vacancies in the UK’s adult social care sector — 10% of the workforce. The annual staff turnover of 30% shows that morale is low — the effect of long hours and low pay. And what are the consequences of this state of affairs for the family carer? You can never be quite sure who’s going to turn up, when, and sometimes even whether they’ll come. Just adding to all the pressure.
With all this to contend with, it’s hardly surprising that so many carers and their families end up making that agonising decision: to let someone else take care of the person they love. Full-time. They make arrangements for a care-home. Which, if the dementia patient has any self-awareness at all, was probably always their greatest fear. The final loss of freedom.
So How Do We Fix Dementia Care?
The politicians and their expert advisors seem to think it’s all about money. Let’s add a few more hundred million pounds to the budget, use it to raise salaries and improve training, they say. But in these times, as governments begin to prioritise warfare over welfare, we have to face up to reality — there will be no more money, not in the foreseeable future.
And even if our pockets were stuffed with cash, what would be the point of investing it into a dementia care system that simply doesn’t work for the people it’s supposed to serve? The way we do domiciliary care leaves dementia patients isolated and lonely, their carers exhausted, their families aghast as they contemplate the potential cost of years of residential care.
So, I hear you saying, you’ve made your point. But if the current system isn’t working, then what do you propose? If money won’t fix it, what will?
Imagination. With a healthy dash of creative thinking.
We might start by looking at sending people with dementia back to school.
In fact, that’s where I will start next time.
