Most older people want to remain independent at home for as long as possible, but the care that some receive is very poor. A recent Unison report showed that most councils still commission homecare visits lasting just 15 minutes.
This is something the government has in the past criticised, saying brief visits risk “stripping people of their dignity”. It is hard to see how this approach can promote a person’s overall wellbeing.
As a matter of urgency, we need to identify ways to improve the homecare system and I believe the answer lies in the three Ps: procurement, personalisation and prevention.
This was highlighted in the Equality and Human Rights Commission’s report, released in 2011, as a major reason for the failures of homecare. The report found some councils base their commissioning decision overwhelmingly on cost rather than quality.
When we surveyed homecare providers, only around a third said they thought the rates paid by local authorities support them to promote and protect the human rights of older people.
We sympathise with councils working with reduced budgets, however, the trend to base commissioning on cost over quality is having a devastating effect on the vulnerable people who use the service, and also on the care workers who provide it. The practice of “reverse e-auctions” – where potential suppliers compete to provide the lowest possible priced service – is nothing other than a race to the bottom and cannot possibly produce quality care.
The personalisation of care services is critical because it enables people to take charge of their own care budget and commission their own services if they choose to. Though there are some issues around how elderly people can take full advantage of this system, at its best it provides choice and flexibility and empowers the client.
Good quality, accessible advice and information about what services are out there – and what good services are out there – is essential to making it work.
Many councils provide advice and information for those who qualify for their services, but not for those who don’t. This means that someone who is assessed and has substantial care needs but is found to have too much income to qualify for local authority care could be left completely in the dark about where to go for help. Under the guidelines of the new care bill, councils will have a duty to provide advice and information for everyone – the challenge for overstretched councils will be to make it of an effective standard.
The holy grail for care services, and homecare should surely play a part in this. Older people who qualify for local authority homecare typically have substantial needs, so the challenge for the care worker should be to maintain their health as much as possible in order to delay their needs from increasing and further support being required.
It makes sense, then, that the function of homecare should be broader, focusing not only on the basic care of washing, dressing and feeding, but also taking the responsibility – and the time – to identify other ways to support the client’s health. Are they isolated? Are they prone to falls?
Ensuring that support addresses all their issues and includes, perhaps, providing a befriender or installing grab rails and extra lights, can make a huge difference to an older person’s health and should be far more cost effective in the long run.
Action in these three areas must be taken if we are to fundamentally change the current homecare system which, as Norman Lamb has rightly pointed out, “can incentivise poor care, low wages and neglect, often acting with little regard for the people it is supposed to be looking after”.
Janet Morrison is chief executive of Independent Age