Residents with advanced dementia lined the day room, glazed stares or sleeping mouths agape, with that terrible human vacancy everyone most fears for their own end days.

This was Millvina House in Anfield, Liverpool, which I visited with Louise Casey, who is heading the commission on social care in England, last week. Here is a snippet of what she saw: an angry man jolting into life, shooting out his arm at her and bellowing: “Out! Get out! Get out!” A young care assistant went to stroke his back and calm him down. It’s a hard job, and part of it is watching for warning signs of aggression, one of dementia’s dreadful symptoms. “People don’t want to know,” Casey said, “but if you are born, you will die. Chances are you will need care, and dementia is the biggest killer.”

In her travels she has been appalled by the standards of social care she has found in some places, with so many people getting far too little help. The evening before this visit, she had been out with care workers attending to people at home. She said she had come away “profoundly, deeply shocked”. She had photographed an elderly man with diabetes, swollen legs and a stroke affecting his left side, who was unable to open a bottle of water. He had no relatives nearby. “He couldn’t afford more care, so he’d just cut their visits by half.” Then there was a woman with early dementia and an untreated, infected stoma bag, which she said had looked “so sore”.

Casey’s shock at this “hidden misery” was matched by her admiration for care workers: “Only young girls, going into unknown homes, paid just £6.50 for a half-hour visit; it’s grim. But they are so patient.” She noted they were being paid about £4,000 a year less than if they had become healthcare assistants in the NHS. With better care, Casey thinks many more people should stay in their own homes – indeed, most would........

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