In America, the agencies involved in paying for nursing home costs of those not privately funded are the the federal Centers for Medicare and Medicaid Services (CMS), and, as any ‘piper’ are able to ‘call the tune’ – they can exert considerable influence over quality of care at nursing homes.

The British equivalent are local councils and their contracts compliance departments. Overall, care is monitored by the Care Quality Commission (CQC).

Because of the huge costs that arise from poor and negligent care – such as the hospitalisation of residents – the CMS is going to work with ‘partner organisations’in states that have signed up to this initiative. Each of these organisations will have staff unducted into 145 participating nursing homes, who will “provide preventatives services as well as improve assessments and management of medical conditions”. (That is, why the hell is that patient not getting enough to drink, or is developing pressure sores?, what the hell are you going to do about it?). Care will be monitored, with the central aim being to identify problems early-on – preventative care is far cheaper than emergency services.

Outcomes will be monitored using external evaluators.

This initiative follows on research showing that 45% of all hospitalizations among the most chronically ill elderly are avoidable. This represents a huge expenditure, as according to CMS estimates, avoidable hospitalizations cost between $7 and $8 billion a year.

In an age of budget constraint, such savings are significant.

Not allowing the elderly to reach a stage that requires emergency treatment is also humane.

Could such an initiative be copied in Britain?

After all, all recent changes in care have been modelled on the American ‘care for profit system’, with some doners to the Conservative Party doing very well out of such ‘marketisation’ of care.

If a system is copied, is it not logical that initiatives to prevent system failure are also copied?


Can you imagine any of the large companies feeding off the care industry willingly allowing care monitoring staff into their facilities. (The banks’ facilities, really, as they lent the acquisition money to the companies).

It would be like a thief inviting a detective for supper.

Would they be made to comply? Not likely.

For the large companies involved in all aspect of care in Britain are the ‘pipers’ that call the government tune. All political parties in modern times have danced to it, and have accepted money for their performance.

Jeremy Corbyn may talk about making energy prices and rail fares cheaper through nationalisation, which will appeal to many people; he may talk about curtailing the economic assault on the most vulnerable; but in this category is it not morally right to include the vulnerable who have been committed to the penny-pinching mercies of nursing home operators?

I challenge Jeremy Corbyn and Heidi Alexander to say why all government funded care of the elderly should not be nationalised, and heavily monitored, as in the CMS system.

This would make economic as well as moral sense.

But to whose tune will they dance?

lenin nightingale 2015