The Scandal of Older People’s “Homecare”

The EHRC has published a shocking report highlighting yet another area of neglect and cuts in levels of service. This time it’s homecare, and reliable reports of people being left in wet and soiled beds for hours on end, waiting for a care worker to arrive and help them – often with just 15 minutes allocated for the work.

The temptation is to blame the care worker, who is surely recruited, trained and paid to “care” . I have commented, raised concerns, blogged and generally got on my soap box about these issues many times. There are several pertinent points to make:

1. Homecare is a complex logistics exercise – getting the right person to the right place, at the right time, with the right skills and training, the right support and supervision, and the right information hour after hour and day after day, 24/7.

2. Homecare is not cheap but those responsible providers who try to provide good services are deemed too expensive and therefore do not win contracts. People with personal budgets to buy their own care are told they can only have the standard hourly rate, which is not enough to buy from a quality provider.

3. Homecare workers, in the main, are human beings trying to do a good job on limited resources. They are generally on “zero hours contracts” (i.e. no guarantee of work, fluctuating hours etc), zero travel time and expenses paid, on or close to minimum wage for the hands on hours only, many are not paid for attending compulsory training,  supervision and meeting time. Many work excessive hours in order to make ends meet. They are lone workers, out at night, alone, on our estates and in all weathers. (GPs on call get a car and driver / security guard provided. Homecare workers with cars do not generally even get a free parking permit as many local authorities refuse to provide them)

4. Cash-strapped local authorities are now engaging in cutting back on the time allocated to visits. Imagine a routine 30-minute visit where the person is frail. and work out how to fit in all the essential tasks required for any kind of safety and dignity (open the door, say good morning, either assist the person out of bed and into the bathroom or clean and change them in bed, either way assist them to the toilet or commode, prepare breakfast, make the bed changing the sheets as necessary and putting them into the washing machine, help the person to wash (no chance of a shower or bath), help them to dress, assist them to walk if possible into the living room and settle them in a chair, give them the breakfast, make a sandwich and flask of tea to leave for the day, make sure the TV remote and any personal alarm is nearby, check and give medication, record the medication, clear away the breakfast things,  say goodbye. Then remember you also have to write a short report before you leave to run to the next person who needs you. Oh and by the way, under the principles of person-centred care (the right ideal) you must also discuss with the person what they would like you to do today too.

Why am I so upset at this report and its findings? Because these are exactly the things we have been saying for years are happening and would get worse as the cuts begin to bite. And guess what? Responsible providers, campaigners, concerned relatives and carers were right. It’s still happening and it’s getting worse. After all the wonderful work being done on personalising service planning,  design and provision the cuts are setting us back again.

The announcement by the CQC promising to look  into 250 home care providers from next April by unannounced visits to care provider’s offices, planned visits to client’s homes and asking questions of people who are receiving care, is to be welcomed. However, there is nothing new about this!

When the Commission for Social Care Inspection, (CSCI) which was replaced by the CQC, was in place, these proposed checks were in place and were a normal part of the home care provider inspection process. There were great variations in the inspections – ours used to last 4 days and was extremely thorough and we got a “good” rating. A neighbouring organisation’s inspector spent less than a day, no files were examined, few questions asked and the agency got an “excellent” rating! This company has since gone bust – they were actually providing a very good service but it wasn’t affordable on the rates paid by their local council.

Homecare is the cornerstone of personalisation, keeping people in their own homes and maintaining quality of life. Let’s examine the whole system and change it. There are examples of really good practice in the EHRC report so it can be done – we need to make such a fuss that excellence is achieved everywhere, in every person’s home. Anything less is unacceptable.

Brenda Bond

Hi, I'm Brenda, previously Chief Executive of Age Concern Lewisham and Southwark (ACLS) and now carrying out a 6 month research and development project for the organisation. I have a childcare and nursing background plus too many years to mention in Age Concerns in the North East and in London. I'm a trustee of Age UK London and represent ACLS and the voluntary sector on various local fora. I'm interested in health and social care issues, human rights and social justice.

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