22 Nov 2011

Revealed: growing crisis in UK home care sector

Health and Social Care Editor

Nearly half a million older people receive care in their own homes paid for by the local authority. But Channel 4 News has seen evidence the system is struggling to cope.

We are sadly familiar with stories of poor care or neglect that emerge from residential homes or hospitals, but there is one part of the adult social care sector we don’t hear so much about – care delivered in people’s own homes.

And yet the size of the industry is huge – nearly half a million older people receive care in their own homes paid for by their local authority.

Now Channel 4 News has seen new evidence that the system is struggling to cope. Figures from the industry regulator, the Care Quality Commission, show that more than a quarter of home care companies are not meeting standards on care and welfare. And 27 per cent of agencies are not meeting standards on the management of medicines.

In a month of research, Channel 4 News has been speaking to those closely involved in this business: care workers, the agencies that employ them, and of course the clients themselves.

More than a quarter of home care companies are not meeting standards on care and welfare.

Very few people felt able to talk openly about their experiences and concerns. Elderly people spoke of their fears about complaining, and workers told us how they have not been listened to – or have even had action taken against them – when they have tried to raise concerns. Many described home care to us as a sector that operates “behind closed doors”.

“Kerry”, a care worker with a regional agency who spoke to us on condition of anonymity, described how carers “go in with stopwatches. We’re watching the clock all the time we’re giving the personal care, or doing responsible jobs like giving medication.”

She fears that guidelines to merely “prompt” medication can mean some clients, forgetful of what they have already taken, are in danger of overdosing. And she says that with lunchtime visits now regarded by councils as a “luxury”, she regularly has to prepare sandwiches for clients with dementia – who will forget they are there and go hungry all day.

People like Kerry are not alone.

The numbers on care at home
Councils buy about 180 million contact hours of home care each year from private providers.

The Alzheimer’s Society estimates that 50 per cent of people with dementia who live at home – a quarter of a million people – aren’t getting the care and support they need. Their recent report “Support, Stay, Save” found that only 10 per cent of home care workers think the care and support people with dementia receive in their own homes meets all their needs.

Of the calls about care made to the helpline of whistle-blowing charity Public Concern at Work, 36 per cent are about abuse and 22 per cent are about client safety.

Channel 4 News was given exclusive figures by Public Concern at Work, the whistle-blowing charity that offers confidential advice to workers wanting to speak up, revealing that its helpline has seen a 60 per cent jump in cases from the care sector in the last six months.

And new data shared with Channel 4 News by the industry regulator, the Care Quality Commission, shows that hundreds of people have contacted them to report concerns about home care in recent months.

Another worker prepared to risk her job to speak to Channel 4 News was “Jill”. She explained how care visits are so rushed, essential tasks are not done.

“It could be that you haven’t washed the client properly, that could be a cause of infection. You could leave them not safely in their own home. They may not be dressed properly; toileted properly.”

Carers don’t want to behave like that. They want to be given the time to do things properly. ‘Jill’, care worker

Jill is outraged that cutbacks in the length of time carers have with clients mean these risks are taken.

“Carers don’t want to behave like that. They want to be given the time to do things properly,” she said.

And we spoke to the clients – people like Sheila, who is 87 years old and was once a carer herself. She’s been left struggling to get to bed herself, and in pain, when care workers haven’t turned up.

“It’s in and out,” she said of the care she receives at home. And she feels that care workers today are not properly trained, which is “not fair on them, quite frankly, and it’s certainly not fair on the patient.”

Our investigation revealed a complex – and failing – system. Workers describe acute time pressures that force them to cut corners. Care agencies report that councils demand ever-shorter visits and cheaper services. Councils themselves are feeling the squeeze of cuts – and many of their duties towards older people are discretionary, not a legal duty, making older people’s services an obvious target for cost-cutting.

The ones who suffer most, of course, are our elderly.

Public Concern at Work helpline: 0207 404 6609 
Contact the Care Quality Commission online here