The charity running one of Britain's largest care homes is complaining that welfare organisations are being pulled in "too many directions" over government quality targets at a time of slashed public spending.
Karen Phillips, chief executive of Manchester's Federation of Jewish Services, has called on the community to support it through a £12 million strategic shake-up and capital investment programme being devised to cope with "enormous and very worrying demands.
"Gone are the days when someone can hand over care of their family member and expect the state and a care home to take over. The state is not going to fund us to do that anymore," she said.
FJS administers Heathlands Care Village, which sits on a five-acre site and has more than 200 residents. As the primary Jewish welfare organisation in Manchester, its 300 staff and 600 volunteers help 1,200 people a month through adult and child social work, mental health provision, carer support and home visiting services. The charity has offices in north and south Manchester.
In recent weeks, the government has frozen the threshold of assets people are allowed to keep before councils will fund social care. And FJS treasurer Bernie Yaffe noted that families were getting wise to the situation, signing over assets to children before they needed to go into care.
This was putting greater pressure on local authorities to shoulder the cost and increasing the pressure on FJS, particularly with a fall in bequests and a five per cent drop in donations last year.
It has to find £250 a week for every Heathlands resident to make up the shortfall in care costs as local authorities only part-fund residential places. Relatives are often unable or unwilling to meet the difference, adding to an operating deficit currently standing at £1.5 million annually.
FJS director of community services Mark Cunningham highlights a further challenge the charity faces in meeting the needs of the elderly living at home, with public funding slashed for carer services. One council has capped the maximum supported living grant it gives FJS by nearly 70 per cent, from £160,000 to £50,000 a year. Yet the Communities and Local Government Department says it is policy to ensure more people remain in their homes for longer.
"The rhetoric out of local authorities is that their contribution is going to decrease while the Care Quality Commission [England's social care regulator] is looking to see demonstrable improvements in quality of life for people. Their goals are not going hand in hand and are pulling so many differing factors in different directions," Mr Cunningham pointed out.
Laws introduced in October and overseen by the commission demand an unprecedented level of basic care. Organisations are now graded on tailored care for individuals, making cost-efficient care more difficult.
Ms Phillips hopes a major fundraising dinner at the end of the month will heighten awareness of the charity's need to raise £12 million over three years to secure its operations.
These include a £7.5 million transformation of the Heathlands site from a care home into a community welfare hub for all ages, which is rapidly taking shape. Teams of workmen in blue uniforms have already converted a former storage area into a children's centre catering for 100 youngsters with disabilities. A social lounge for adults with mental health issues is up and running.
Another £300,000 has gone on revamping kitchens capable of preparing 1,000 meals a day and heating, lighting and laundry facilities have also been overhauled - a move which will save thousands in energy costs. Twenty-nine refurbished supported living apartments have required £240,000 expenditure on contemporary kitchens, bathrooms and a jacuzzi spa facility. The investment is already paying dividends with a waiting list for properties that have sat half occupied for some years.
"Educating the public about this is a huge challenge," Ms Phillips said. "It's not a case of £20 donations for our Pesach appeal - we need major backing."
In May, the charity will run public awareness courses for its next major focus - dementia care. FJS has hired a clinical services expert and staff training supervisor to assist planning and improvements.
It also recently spent £5,000 for a consultation on cutting-edge care with the renowned dementia department at Bradford University, which has been working with the Nightingale care home in south London. It could lead to a partnership which would see a full-time expert from the department working at Heathlands and Bradford students using the home for training studies.
FJS clinical services manager Karen Johnson reported a rise from 50 to 75 per cent of Heathlands residents with some form of dementia over the last decade or so. This is in line with statistics projecting dementia rates in Greater Manchester increasing by 23 per cent in 10 years.
Research by the Alzheimer's Society indicates that areas in south Manchester, including wealthy Jewish communities in Altrincham, suffer the worst rates of dementia diagnosis in the north-west. People avoid medical consultation for fear of losing independence and lifestyle.
"Change has to happen," Ms Johnson said. "There is an exponential trend in dementia and the challenge is getting people to have the right care." Heathlands was also investing in colour co-ordinated carpet, toilet seats and bedroom doors on its 32-bed dementia wing, as well as in other areas. It is one of a number of techniques which help reduce dementia symptoms. The major cost implications will result from increased staff-to-resident ratios as person-centred dementia care becomes the standard.
Ms Phillips cited a recent instance where staff investigated a repetitive motion performed by a dementia sufferer. Discovering that she had been a seamstress, they provided her with a sewing machine.
"We have constant pressure to make these improvements because we are dealing with frail, elderly and needy people," Ms Phillips said. "What we try to do is understand what would make people happy."