I saw Panorama last night. It was an undercover report into the poor state of home care services provided to elderly people in their own homes by a few private companies.
I wish I could say some of the findings surprised me, but they didn’t. Some of the extremes presented perhaps, did – but cutting short visits because of overloaded rotas, lack of basic training and cost cutting above everything else – it all rings a bell with me having worked closely with home care agencies for a good few years.
It never fails to anger me either. These companies are paid to provide a service and a service of care at that and sometimes, particularly when the user of the service is particularly vulnerable, take advantage of the situations they are in to promote abusive environments in just those situations in which they should be empowering and promoting.
In the world of the local authority, home care for the elderly seems to be something of a burden. The process of tendering by councils was explored in the programme and the competition to drive costs lower and lower by the councils. This hit particularly close to home as I have a lot of anger at the moment towards my own local authority as a result of their tendering processes and a contracts department that sees little beyond figures.
Of course local authorities, being funded on taxation, need to have some kind of accountability regarding contracts but there has to be a better trade-off between cost and quality.
I have to say that I have come across more than a few exceptional home carers and home care agencies. I have particularly strong ties with one of the agencies we use because I’ve worked very closely with the area manager. I know when I ask for something or for someone with a particular sensitivity – for example a carer with experience of working with someone with dementia, or sensory impairment – she will locate such a person and if she can’t, will ensure that the carer is fully briefed before attending. As for me, I’ll tinker around with timings to make sure that I can be realistic about how long things take and try to not rush people through tasks. Her agency recently lost the contract in our local authority. That annoys me too. She told me, off the record, they just couldn’t make their bid low enough to make money or keep their experienced carers.
I hope more people become aware of what is happening in the home care sector. It is such an easy area to cut costs in because while spot checks do happen, they are not as frequent as they should be and a user who doesn’t remember or cannot report back on poor treatment, is almost too ripe to be picked off by unscrupulous, hurried or inexperienced carers.
Part of the problem is also the poor pay and poor status of those who are employed in home care jobs. They are seen as ‘entry level’ jobs for those who have little experience – perhaps straight from school. Obviously there is a place for entry level positions but how much more of a role for experienced, quality, respected home carers to be mentoring newer starters. There is little scope though for higher pay rates when the margins are cut so tightly in order to win the local authority contracts.
I have a rather old-fashioned solution that has made me the mockery of colleagues in the past, but I honestly believe the local authority should employ carers directly. Even with lower than deserved pay, they would at least have the benefit of a secure contract, good training which could be followed up, a clear appraisal and management structure and good benefits such as holiday pay and pension.
In my experience, some of the most effective and competent care managers have got to where they are at from being hands-on carers (er.. myself included.. ok, I didn’t say I wasn’t biased!). My experience of working as a carer (I was in residential care rather the domiciliary care) has informed so much of my judgement and perception through my work as a qualified social worker that I know I would have been infinitely less able and competent if I hadn’t had that experience and likewise for some of my colleagues who have worked in domiciliary care. You see and know the pressures of time, the type of work that is expected and most importantly, the corners that can be cut – and can then spend more time pursuing them.
The career structure though, from home (or residential) carer, to senior home care manager to a care manager post including sponsored training through the social work degree seems almost to have disappeared in the local authority where I work – and possibly others too. In-house care is all too rare, although I don’t think there is any doubt that better quality could be provided due to better conditions and prospects being established. But the tide seems to have good out too far now – in the tide of privatisations and tenderings.
The NHS and Community Care Act 1990 is too firmly entrenched in our system now and private enterprise is pushed as the solution. I just have an issue about profit-making companies ‘selling’ care and cutting corners in order to amass greater profit.
Direct Payments were seen as a possible solution save that the people who are most dependent and vulnerable and have no other family are not in any place to make arrangements to hire and employ carers or personal assistants directly. Personalisation agenda? I don’t want to be overly sceptical but I can’t see any solutions to the problems thrown up by Direct Payments which have had a particularly poor take up by those who are over 65 and those who are mentally ill.
For me, one of less obvious but equally horrific failings highlighted in the programme was that of the regulators, CSCI (Commission for Social Care Inspection) – which ceased to exist last week and became a part of the amalgamated CQC (Care Quality Commission). How ineffectual is this body? It has moved to desk-based inspections of care homes – has it done the same with domiciliary agencies? Is there any way that inspections and regulators can actually provide a service which is better than a mere star rating and mealy-mouthed platitudes even in the ‘one star’ organisations. The language of the inspection reports is rarely cutting and usually couched in comforting language except in the most exceptional examples – possibly due to fears of legal action by the companies involved.
As it’s probably clear by now, I have a lot of difficulties with home care, the way the system is tilted towards an almost industrial-style turnover of short impersonal visits by staff that are constantly changing and perhaps poorly trained, regulated and paid.
It is not the staff on the ground who bear the responsibility for this, some of whom are desperate to do a good job, but they are pushed to work to timetables that are impossible – to do more work than is physically possible in the time that is available – by companies who are desperate to make increased profits and local authorities pushed to reduce costs at all levels.
And what do the home care agencies and managers do? They blame the care workers they are sending out on minimum wage and with little guidance.
I think this might have turned from a review of a programme into a more general rant but it is an issue I feel exceptionally strongly about.
It truly is scandalous. Older people are not other people. They are all of us eventually. They are and will be our grandparents, our parents, our siblings, spouses and children. We might want to forget. But some day we won’t be able to.