Homecare, also known as domiciliary care, is the first choice for people who need help with their personal care to lead independent lives. Many people use a homecare service as an alternative to moving into a care home.
In the UK there are several people who really do care about the fragile in our community. The majority of homecare is funded by the state (usually by local council social services departments, Primary Care Trusts (PCTs) or Health and Social Care Trusts in Northern Ireland). However, homecare services are largely delivered by independent and voluntary sector providers working under contracts with the statutory sector.
Often the home carers are independent, voluntary, working in the not-for-profit and statutory sectors with more than 1,900 domiciliary care providers in Great Britain and Northern Ireland, associated in United Kingdom Homecare Association Ltd (UKHCA). They would love to promote high standards of care and provide representation with national and regional policy-makers and regulators at the best conditions. But they have to face the problems of the financial crisis today and not finding people interested enough in the elderly.
The Commission’s inquiry into the home care system in England reveals disturbing evidence that the poor treatment of many older people is breaching their human rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want.
‘Close to home: older people and human rights in home care’, says hundreds of thousands of older people lack protection under the Human Rights Act and calls for this legal loophole to be closed. It questions commissioning practices that focus on a rigid list of tasks, rather than what older people actually want, and that give more weight to cost than to an acceptable quality of care.
An estimated one in five (20 per cent) of older people living at home receive care services. In 2009-10 about 453,000 people received home care through their local authority, excluding those in receipt of direct payments.
The inquiry found age discrimination was a significant barrier to older people getting home care. It found that people over the age of 65 are getting less money towards their care than younger people with similar care needs, and are offered a more limited range of services in comparison. It also found that local authority phone contact lines can screen out older people needing home care without passing them on for a full assessment – which is unlawful.
Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. They most valued having a small number of familiar and reliable staff who took the time to talk to them and complied with their requests to do specific tasks. Home care workers said their job satisfaction came from improving the quality of older people’s lives.
Care home staff feel “under pressure” and “not trusted” because of the number of adult safeguarding alerts providers feel they have to make, sometimes for trivial issues.
“Staff feel they are not allowed to make mistakes or to learn from them; they are often suspended,” Bailey said in a response from the floor. “Staff are saying, ‘are we going to have soem more common sense?; is it safeguarding if someone throws a piece of toast and it hits an elderly person?’.”
She emphasised that the Social Care Association wanted to improve practice, but added: “Ninety-five per cent of people who deliver care in care homes get up in the morning to do a good job and they don’t feel trusted.”
Bailey said providers felt that they were not “partners” in adult safeguarding with councils and other statutory agencies and that they felt “done to”.
But for care workers it becomes more and more difficult to give the elderly the time they really need. The home to home visitors are only paid for 15 minutes (yes you read right: only 1/5 of an hour) per patient to be able to undress him or her, wash him or her and bring the patient to an other room, down or upstairs. Taking into account that those elderly do not move as fast as younger people more time should be needed to walk around in the house. To be able to refresh the patient, and sometimes providing clean textile the health carers do not have much time to do a prober job.
In the payment of the 15 minutes per patient no time travel is provided. Exclusive their travel you can imagine that a carer does need a lot more time per person than he or she is paid for. And there is no full travel allowance provided by the tax office. This means they work underpaid and cannot do what they want to do.
So it is understandable that they want to reduce the pressure and would like to have serious talks with the authorities.
The inquiry reveals the pervasive social isolation and loneliness experienced by many older people confined to their homes who lack support to get out and take part in community life. Yet evidence from the home care industry indicates that social activities are some of the first support services to be withdrawn when local authorities cut back their spending on care services.
Alarmingly, one in three local authorities had already cut back on home care spending and a further one in five planned to do so within the next year.
- 82% of councils were reducing the amount of time they allowed for personal care for at least some people;
- 76% of councils were reducing the number of visits to some service users’ homes;
- 58% of councils appeared to have cut the fees they pay independent and voluntary sector providers.
Service users’ safety and dignity are being put at risk due to council home care cuts.
The low rates that some local authorities pay for home care raises serious concerns about the pay and conditions of workers, including payment of the minimum wage. The low pay and status of care workers does not match the level of responsibility or the skills they need to provide quality home care. A high turnover of staff as a result of these factors has a negative impact on the quality of care given to older people.
UKHCA‘s Chief Executive, Bridget Warr, said: “Older people must receive safe, dignified and effective homecare which protects and promotes their human rights. Examples of poor practice in the EHRC report are troubling. However, the Commission has rightly concluded that many of the problems are largely caused by inadequate commissioning of homecare by local councils in England, who fund and arrange the majority of social care. This report must act as a wake-up call. Aggressive public cost-cutting is damaging the very homecare services essential to support people in their communities.”
Diane Lawson, Chief Executive of the National Skills Academy finds the recent published report from the Patients’ Association, on the poor quality of care of older people, damning.
“This report is extremely shocking. Older people and their families put their trust in the people that are charged with providing their care, and it is clear from the examples provided in the report there is great inconsistency in the experiences of people across the NHS in relation to care. We believe this strongly relates to the leadership capacity of the sector.
“With a drive towards more integration of health and social care in future, to ensure a seamless experience for patients it is vital that we develop the leadership and management ability of the workforce to enable care with a capital ‘C’ to become the norm. We must strive harder to build confidence in the community that social care and health services will deliver safe outcomes that are responsive to their individual needs.
“We urge NHS leaders to take action demonstrating the vision and the capacity that is required. We are working closely with our NHS Leadership Academy partners in order to develop the avenues for leaders to be the best that they can be, and to help them to become more outcome focused for the people using their services.”
With partners including the Social Care Association and the National Care Forum, the Skills Academy has called for managers of care homes and domiciliary care services to be recognised as the lead professional in their own care environment to help raise care standards.
The group has written to Paul Burstow, the Care Services Minister, looking for backing for a three-pronged approach to overcoming the government’s rejection of mandatory registration for social care staff in England. This involves setting up a support body for registered managers, building on best practice, networking and learning, as well as looking to key national bodies such as the Skills Academy to ensure that a national approach is adopted. A positive response has been received and a meeting with the Minister is being arranged. According to Debbie Sorkin, Head of Membership and Engagement: “Leadership is needed at all levels in social care, particularly in the person of the care home manager.”
A model for monitoring the supply and demand of social workers in England was been made public at the National Children and Adult Services Conference (NCAS) in October : Find stories on the NCAS conference 2011
- Service users at risk as home care cuts shorten visits (communitycare.co)
The average visit fell from 48 minutes to 38 as a result of cuts this year, while visits of 15 minutes to undertake personal care were “increasing rapidly” despite being widely discredited as poor practice.
+A Department of Health spokesperson said: “While some councils may simply be cutting care, others are working hard to get more for less with innovative ways of delivering better care, including using more telecare and cutting needless admissions to hospital and residential care.”
Cuts damaging viability of domiciliary care in rural areas
Home care staff face worsening pay and conditions
“We pay barely above the minimum wage. We managed to give staff an increase of about 1% and that was by cutting [profit shares and bonuses] for directors.” A Cornwall Council spokesperson said: “The adult care and support budget has been frozen this financial year, with a commitment for it increase in 2012-13. …
- Home care firms face inspections (bbc.co.uk)
CQC chief executive Cynthia Bower said: “The operation of home care is not as transparent as care in hospitals and other sectors because the interactions happen behind closed doors.”That is why we want to focus on this sector of social care in this way.”
- Evidence uncovered by the EHRC home care inquiry is shameful (ageukblog.org.uk)
The news that older people are being stolen from, left hungry and dirty by local authority funded care workers responsible for looking after them is truly shocking and a sad indictment of how our supposedly humane society allows older people to be treated.The findings in the Equality and Human Rights Commission’s report into home care show that in too many cases support provided to many older people in their own homes fails to uphold the basic rights enshrined in law that most of us would expect as a moral obligation.
- ‘Systematic failure’ of OAP care (mirror.co.uk)
Key findings included carers neglecting tasks because of time constraints, carers refusing to warm up and serve food because of “unfounded” food, health and safety concerns, money being stolen over a period of time, chronic disregard for older people’s privacy and a disregard for clients’ dignity when carrying out intimate tasks.”The cumulative impact on older people can be profoundly depressing and stressful: tears, frustration, expressions of a desire to die and feelings of being stripped of self-worth and dignity – much of which was avoidable,” the report said.
- Revealed: elderly home care failures breach human rights (guardian.co.uk)
There was also reporting of sporadic violence against the elderly and the infirm. “The cumulative impact on older people can be profoundly depressing and
stressful: tears, frustration, expressions of a desire to die and feelings of being stripped of self-worth and dignity – much of which was avoidable,” the report said. It also recommended greater legal protection for older people after discovering the Human Rights Act does not cover all home care situations. The commission said councils were reducing carers’ hours, causing them to cut corners. Sometimes they were paid to spend as little as 15 minutes with individuals.
- Letters: Dignity, care and the plight of older people (guardian.co.uk)
The government’s response to the commission report is what has become standard practice. It says it will ensure that the elderly are cared for. In reality it will continue to deny local councils the funds necessary to deliver a proper service, obliging them to outsource the provision to the lowest bidder. The inevitable result is that those caring for the sick and elderly will continue to be underfunded and ill-equipped and will not have the necessary time to attend to the needs of those they are meant to be caring for. Rather than shed crocodile tears, the government should acknowledge its responsibility to provide an appropriate level of funding.
- Home care ‘breaches human rights’ (bbc.co.uk)
Basic care for the elderly in their own homes in England is so bad it breaches human rights at times, an inquiry says.
- Doubling in number of care home firms collapsing into administration(guardian.co.uk)The crisis in social carefunding has led to a doubling in the number of care homes going bust, according to a new report.
- Scandalous treatment of old people cared for at home revealed in report (mirror.co.uk)
The Commission says that many older people – particularly those with dementia – do not even get proper meals or drinks.It heard of one woman who was left stuck on the toilet because a care worker was “too busy” to help her, and of dementia sufferers going hungry because their food was “hidden” in the fridge. It also found a “chronic disregard” for people’s dignity when it came to washing or helping them use the toilet.
And it uncovered evidence of staff talking over people on phones or failing to cover them when doing intimate tasks.
There were also numerous instances of older people having money and valuables stolen from their homes, and of physical abuse such as “rough handling or using unnecessary physical force”.
The Commission’s Close to Home inquiry found: “Many of these incidents amount to human rights breaches. The cumulative impact on older people can be profoundly depressing and stressful – tears, frustration, expressions of a desire to die and feelings of being stripped of self-worth and dignity, much of which was avoidable.”
The report added that many elderly were lonely and “treated as invisible” by staff. And it warned the problem could get worse with one in three local councils slashing their spending on social care.
- Scandal of elderly facing abuse and neglect in own homes (independent.co.uk)
Almost 500,000 elderly people are looked after in their own homes by carers partly or wholly funded by their local authority. The EHRC found cases of people who were put to bed in mid-afternoon and left in soiled nightwear until morning. They were strip washed with no respect for their dignity and food was left out of reach so they went hungry. Some were systematically robbed of their money.In one example, a care worker refused to help a women who was stuck on the toilet in her bathroom. The woman shouted for help but the carer replied: “Can’t do that but I’ve made you a butty and I am going now.” The woman was left to free herself.
In another, a young female carer watched as a 76-year-old woman with terminal cancer struggled from her lounge to the kitchen to microwave a meal after the carer said she could not do it for “health and safety” reasons. The report says the carer might have misinterpreted rules that applied to restaurants. The Health and Safety executive confirmed that there was no reason why a carer should not microwave a pre-prepared meal for a client.
- Commentary: Basics of dignity not being addressed(telegraph.co.uk)
Not enough is done to provide older people using social care services with a voice to challenge any poor care they experience.
We think local authorities should include in their contracts clearer requirements for providers to monitor and check the services they provide, and local authorities should reverse the trend to base commissioning on cost rather than quality.
Instances of abuse could be dealt with under existing government guidance on safeguarding, but that requires more vigorous leadership and monitoring of social care.
Simon Bottery is Director of Policy at charity Independent Age
- ‘Systematic Failures’ In Care For Elderly (news.sky.com)
It also discovered instances of carers refusing to heat and serve food because of health and safety concerns which the report describes as “unfounded”.”The cumulative impact on older people can be profoundly depressing and stressful: tears, frustration, expressions of a desire to die and feelings of being stripped of self-worth and dignity – much of which was avoidable,” the report says.
- Vulnerable elderly abused by their carers, says inquiry(telegraph.co.uk)
A year-long inquiry into standards of care for the elderly at home has uncovered “appalling” evidence of pensioners being deprived of food and drink, handled roughly, humiliated and even robbed.
Many incidents amounted to “abuses of human rights”, which left elderly people feeling profoundly depressed, in tears and even expressing “a desire to die”, the report said.
- Vulnerable elderly abused: what they don’t need are more ‘human rights’ (blogs.telegraph.co.uk)
In one case, an elderly blind man said two council carers were talking to each other over his head, leaving him feeling like “a lump of meat”. In another, a 76-year-old woman with advanced cancer was told her care worker could not prepare her a microwave meal because of “health and safety” rules.
Strangely, the logical conclusion of the creed of positive human rights, which comes from the utopian Left (but based on older Christian notions) is that its adherents end up accepting a deeply conservative notion that man is inherently evil. By the logic of the EHRC, without sufficient diversity training everyone in England would start walking around in white hoods, burning crosses on their neighbours’ lawns.And funnily enough the only people who can redeem this fallen nature are the professionals, that new priesthood preaching the doctrines of equality, diversity, inclusivity and human rights. Well, when put like that, the £80 million annual cost of the EHRC looks almost like a bargain.
- Fine words butter no parsnips in residential care (careintheuk.wordpress.com)
Andrew Lansley has come up with the revolutionary concept that there will be a code of conduct and minimum training standards for all care workers operating in the field of adult social care. Or is it perhaps a slow evolution of care?
- Shortage of caregivers ‘a major cause of concern’: report (canada.com)
Canadian parents assume their kids will look after them when they’re older. Those without kids assume they can pay for care with all the money they’re saving.But a new study on the aging population suggests both groups could be setting themselves up for disappointment.
While the number of elderly Canadians requiring assistance is expected to double in the next 30 years, researchers say a shortage of adult children and health-care workers could mean the baby boomers won’t get the care they need.
The Institute for Research on Public Policy (IRPP) describes the outlook as “a major cause of concern,” noting a critical need for policy-makers to reconsider their approach to voluntary, for-profit and public homecare.
“Caregivers are essential. Without them, we, as a society, will go bankrupt,” says Janice Keefe, author of the IRPP report released this week. “We need to figure out a range of supports to help them do what they need to do.”