I can't imagine ending up in a care home. Maybe the exigencies of life, the absence of family, incapacity, memory and exhaustion might lead me there.
My life condensed into a single room, a tiny bed, three or four shelves, a few pictures in silver frames and a dozen hangers in a wardrobe... takes me to a place in my mind I don't want to go.
Name tags sewn into my socks and underpants; institutional lip service to dignity.
A life hollowed out. An existence fuelled on reminiscence. A life full of strangers; hoping they will be kind, not smell of cigarettes and speak my language enough to know that when I want to 'spend a penny', I don't want to go to the shops.
Meals on a tray or under the glare of lights bright enough not to be a health and safety trip hazard. Learning the menu through repetition and boredom. I can't bear the thought of it.
Acuity slipping though my fingers. Joie-de-vivre draining away; watching television, nodding off and Tuesday, the man with his electric piano... we sing songs.
For thousands, that is their life. The door opens, they look up; will it be a familiar face to smile at, a new face to be cautious of or a loved one who has found the time... 'I can't stay long, but I was passing and thought I'd pop-in...'
I might die there. In the last ten years deaths in care homes have gone from 33k to 100k. Why is that?
Because more people live in care homes? Maybe. Could it be that the concept of care homes, where people need a bit of help to jog along, has been overtaken by unforeseen reality? A reality that has delivered a real problem.
People move to care homes when they need some help with the day to day. It is not long before they transition from help, into needing assistance, aids, adaptations then support and later... everything.
At what stage do they tip the fulcrum point to needing proper care, nursing care and our full attention? At what point do the best intentions of care assistants become eclipsed.
Even if a pivot point could be identified, how do we deal with a resident drifting into nursing care that will require a reappraisal of the care package and costs shifted from social services to health? How willingly is the transition made, how often is the transition not made?
People stay put, without the level of care they really need being expanded to match their needs.
Care homes should be the last place A&E attendances originate from. Care homes should be equipped, staffed and prepared for frailty and guard against its consequences. The safest places on earth.
Are residents in care homes at greater risk of dying? Do we know? How do deaths in care homes compare with similar cohorts in the wider population? Are some care home providers better than others? Do some have a greater percentage of deaths than others? What are the deaths per provider?
I can't answer these questions. I should be able to click my way to the answers on a screen.
I believe the CQC knows the answer. I believe the CQC could tell us easily. I believe they have the data, done the analysis and are too worried about litigation and backlash to publish.
If I'm wrong, let them say so.
The care home industry, 90% privately owned, has been squeezed by 6% real reductions in council fees. Most hardly break-even. Many trade at a loss. Forecasts predict 1 in 10 care homes will disappear because of this financial crisis. There are currently 425,000 people in 18,000 care homes across the UK. Do the maths.
More than 1,500 beds were lost in 2015; capacity falling despite the surge in demand. Do the thinking.
It's time to take the lid off the care home sector before it becomes the NHS' equivalent of the banking crisis. If it collapses, who bails them out?
Who has Plan B?
