During a recent visit to Millvina House, a residential care facility in Anfield, Liverpool, Louise Casey, who leads the commission on social care in England, witnessed firsthand the challenges faced by people living with advanced dementia and the pressures on the social care system. The visit highlighted both the difficult conditions experienced by some residents and the demanding nature of the work undertaken by care providers.
At Millvina House, Casey observed residents affected by severe dementia exhibiting symptoms such as aggression and confusion. She recounted an incident involving a man who suddenly became agitated, striking out and shouting, while a young care assistant attempted to soothe him. Casey emphasized the inevitability of aging and illness, noting dementia as one of the leading causes of death and a central concern for social care services.
The commissioner’s recent experiences extend beyond residential facilities. During an overnight visit accompanying home care workers, Casey encountered several troubling situations that underscored the inadequacies in current social care provision. She described an elderly man with diabetes and stroke-related disabilities who struggled with basic tasks such as opening a bottle of water. With no family nearby and insufficient funds for additional care, he had reduced his aides’ visits by half. Casey also noted the conditions of a woman with early-stage dementia whose infected stoma bag appeared untreated and causing significant discomfort.
Casey expressed deep concern over what she described as a “hidden misery” faced by many vulnerable individuals receiving minimal support. Despite the difficulties, she also praised the dedication of home care workers, many of whom are young women paid about £6.50 for a 30-minute visit. She pointed out that their earnings are roughly £4,000 less annually than those of healthcare assistants employed by the National Health Service (NHS). Casey highlighted the importance of attracting and retaining care workers to improve service standards.
The commission’s findings suggest that expanding quality home-based care could be a more cost-effective alternative to residential care homes like Millvina House. Casey emphasized that most people prefer to remain in their own homes and that providing several daily visits can offer better outcomes at a lower cost compared to institutional care.
As the commission continues its work, it faces the complex task of addressing who will bear the financial responsibility for sustainable, quality social care in England, amid growing demand and constrained resources.