Imagine that every morning when you wake up, you are unable to get out of bed without the help of a carer. You might wake up quite early, needing the toilet or wanting a hot drink, but you live alone and rely on people who are paid to come and look after you.
You may wait many hours for help to arrive. It may never come if the home care agency don’t have enough carers on duty, or it may be much later than you expect because your carer has been delayed helping other people. In that time you may soil yourself, become dehydrated, or attempt to move around and end up falling, potentially breaking a bone and ending up in hospital, the shock of which, in someone who is elderly, could bring about premature death.
This is the reality that many single, vulnerable, elderly people with physical or mental health problems face every day. When care does arrive it can often be rushed, with the carer unable to give all of the help that is required. Imagine if you had to choose between being washed and dressed, helped to the toilet, fed or given your medication? You need assistance with all of those tasks, but your carer only has time to help with some of them, leaving you hungry or dirty as a result.
For many people who live alone, the carer that comes in to help them may be the only person that they see or speak to all day, and yet there is no opportunity for meaningful interaction. This is a system that is almost de-humanised, where the people who need care are effectively on a conveyor belt, and carers are operatives in a factory environment where output, rather than quality, is king.
Over the course of just a few weeks of home care you may see many different faces, each time having to try and explain (if you are able to) what you need and want. The turnover of staff is high because this is low-paid, often poorly trained work, where staff are put under immense pressure to meet deadlines, rush care, make stark and extremely unpleasant choices about what they realistically have time to do for someone, and where every shift leaves them feeling physically and mentally exhausted. Many carers often end up completing tasks in their own time, such are the time constraints enforced by their employers.
Morale is low, carers feel undervalued, and those who chose this type of work precisely because they genuinely wanted to care for vulnerable people feel utterly let down by a system that is run around two defining factors – the time on the clock and the money being paid to the home care provider.
Don’t run away with the idea that having home care is a cheap option for the most vulnerable, elderly citizens in our communities, because it isn’t. Universally however, most people would rather remain in their own home than move into alternative more supported accommodation or indeed into a care home. I would argue that everyone has the right to do that, whenever practically possible, and therefore in a compassionate society this should be supported, not just financially for those who need assistance paying for it, but from a cultural point of view as well.
The culture that defines how we care for older people in the UK is still one where we don’t value the person enough. As a society we don’t make provision for elderly people to exercise choice and be supported to do that, we cut corners because we think it doesn’t matter, we try to rush those who are naturally slower than they once were, we are incapable of seeing beyond ‘doing the basics’ and we ignore the need every human being has to feel cherished, loved, cared for, appreciated and listened to.
It can be very easy to blame the carers on the front line who have the day-to-day contact with our vulnerable elderly people, and there are certainly those within this line of work who should never be caring for anyone, least of all those in greatest need. But I believe that so much of what is wrong within the care system, and home care in particular, is about what happens within the companies that provide care and the authorities who commission it.
Many home care providers will say that they don’t get paid enough by councils (whose budgets have been squeezed in this area) to provide the care that people need. Councils will say that for the money they are paying, they expect far better for the people they are responsible for supporting. The real truth probably lies somewhere between these two viewpoints, but what I always find staggering in these debates is how the needs and the voices of the people who are on the receiving end of this care are generally never heard, and even more worryingly, those who are making the decisions often have no real appreciation of the situation that these people are in.
Of course we know of the cases, all too common, where home care has gone so catastrophically wrong that someone has died as a result of neglect. Yet all over the country, every day, neglect is happening, often not with immediately tragic consequences but with the slow-burn, saddening effect of reducing the lives of people who were once vibrant, hard-working, energetic and valued, into something that is a daily struggle to exist, a struggle that for many may not feel like one that they want to keep fighting for.
I couldn’t be a home care worker, simply because I could not cope with leaving people who needed me, at the same time knowing that if I stayed longer I let someone else down. It is an impossible situation. Home care is a vital resource that a compassionate society should value. Carers should be well trained, well paid and with enough colleagues to give our cherished elderly the help that they need in a time frame that they can cope with.
This is a job where you care for people with very high dependency and often multiple problems – it should be a profession with a far greater standing than it currently has. Ultimately care should be about helping people to flourish, live their lives well and feel happy and fulfilled. It should never be about losing dignity, being lonely, frightened, misunderstood, neglected and potentially an early death. If you offered anyone the ‘services’ in that last sentence, they would never sign up for them.
Until next time…
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9 thoughts on “Home alone”
That is an incredibly sobering read but sadly one that is far from unique.
UNISON are campaigning to improve homecare services. For more info about it please have a look at http://www.unison.org.uk/localgov/timetocare.asp
As part of the campaign we helped to generate a debate in Parliament where MPs talked about the problems with homecare similar to those recounted above – you can find out more here http://www.unison.org.uk/localgov/pages_view.asp?did=15424
It is clear that things need to change and change quickly to restore dignity to the system for both people receiving care and for the workers.
Amongst other things homecare services urgently needs to be properly funded
I was ‘laid off' after 6yrs in retail at the end of January and decided it was time to return to care work, something I enjoyed for many years. I was interviewed by a local company, offered the job the next day, and agreed to start work for them the day after that as they were 'deserate'!!! The last 11 days have been an absolute nightmare except for the clients and some very dedicated staff. I went to see my line manager 1 week after my employment commenced and said I was unhappy to have learnt that I was not going to be paid for travel time (though I do get a whopping 20p/m fuel allowance) & that I thought it was outrageous that I could work two split shifts, amounting to a 14 or 15hr/day, starting at 6, 6.30 or 7am, and not finishing until 10.30, 11 or later with sometimes only an hour between the shifts & end up being paid for less than 10hrs. In those shifts there are no breaks, not to use a bathroom or get snacks/drinks. I told her I was exhausted getting less than 6hrs sleep a night only to do the same again the next day, and that I felt I was a danger driving on the roads. (of the hours I am allowed to claim the 20p/mile allowance, I logged 307 last week) I was told it was the norm and to ‘take it up with Government’. 4 days later, after a horrendous weekend, and some internet research, I went in again today with a letter of formal grievance. It stated that it was against the law to not pay travel time, against the law not to pay minimum wage, against the law not to have a break after 4hrs work, and against the law not to get 11hrs uninterrupted rest over 24hrs between shifts. I was told I was wrong. It was not against the law to refuse to pay travel time. They didn’t read the letter while I was there but offered me a senior position (ha!!!) with half my hours office based and only half of them caring. They said they took the decision to increase hourly rates from £7/hr to £7.50/hr after a year of trading and realising the business was simply not viable if they continued to pay travel time. I said ‘this job isn’t viable if you don’t pay me travel time. I cannot make a living earning less than £5/hr’. They said they would pay me in full for last weeks wage as it was due to organisational errors and isn’t how their service is normally run, and to leave it with them for a week and after this week they would try and restrict my rota to shorter runs in a more local area. The run they are talking about is my favourite but it still takes me 5hrs and I am only paid for 3.5! In the letter I said I had sent a copy to my local M.P (Julian Smith, Skipton & Ripon) & was willing to take it to an employment tribunal. I also stated that I’d been told I would be ‘shadowing’ for the 1st 2wks while my CRB check came back, so that by the time
it did I would know the routes and the clients and their needs. I was working within 24hrs of accepting the job after 3hrs shadowing and on the runs I’ve been given often I am alone delivering care to clients I have never met. I have not received the 6 week induction the company handbook states, no training and I doubt they could have had my CRB check back yet, certainly I have not received a copy. I do have an NVQ2 but I have not worked in a role delivering care of this type for 10yrs+. In actual fact I do have a provisional job offer, pending CRB checks, references and other pre employment checks that should take 2 – 4 weeks. I cannot afford to walk away from this job in the meantime. I am worried because the new job will seek a reference from my current employers, & I’m wondering if it is a good or bad idea to inform them of my current situation. I have just joined Unison. Employed by these people or not, I want to take this further. It is outrageous. The only way to make the job financially viable for the carer is to skim the time spent with the clients to make up for their lost travel time. Most (but by no means all) carers are not willing to do this. I am disgusted that this work is not paid a fair and honest wage. I am disgusted that it is common practice and ‘accepted’. The result is that workers look for other jobs and continually move on, meaning clients are receiving care from someone different every week, and often carers that are exhausted, feel exploited and undervalued. In this job it is essential that you get to know your clients, so that you recognise when their needs are changing or there is cause for concern. I was so happy to return to this field of work and I am so disappointed in the experience over the last 11 days whilst in this employment. I feel a real sense of pride when I know I have delivered care that counts, my standards are high & I strive to really make a difference. By contrast, when I have rushed a cleint, when I don't know them, when I am trying to do the maximum in the minimum time possible I know I am guilty of not working ethically and it is demoralising and hard to reason. I often choose to work over the allocated time knowing I won't get paid but then I'm aware that other clients further down my list are suffering as I am late & yet again, rushing! I reached a clients remote home (previously unknown to me) for a morning call at 1.15pm this weekend! He was uncomplaining as he sat in his pyjamas with a soiled pad eating a microwave dinner he had proudly prepared himself! He said he thought there was a problem with his toilet and I found his bathroom flooded with water and faeces. There was no phone signal + I cleaned up as best I could & fashioned a make
shift commode but I was already running over 3hrs behind schedule, with a later teatime/evening shift to set off for at 3.20pm!! I felt absolutely terrible leaving him, but I still had 2 more calls to do to finish that 1st run. I made 18 calls in total that day, varying between 15 minutes and 1hr, I started at 6.45am and finished at 10.30pm. I had 45 minutes at home between shifts, no breaks in either, drove 93 miles, & got paid £67.50 (for 13.75 hrs work) and £18.60 for petrol. THIS is the root problem. Adequate care cannot be delivered within these constraints. If anyone could offer any advice or wants to join forces with me in trying to get some sort of regulatory body willing to investigate this industry, please get in touch, my email is firstname.lastname@example.org
I would like to think that the majority of people who want to do this type of work really do genuinely care and want to deliver a service that is truly supporting a client to stay in their own home. But with employers blaming local authorities for low wages and poor working conditions, and local authorities favouring low cost providers this system is doomed to failure and ultimately, it is the client who is paying the price. Our aged and vulnerable are being systematically neglected in their own homes & it isn't at all to do with what's best for them, it's about minimum investment maximum profit, behind closed doors we've managed to dehumanise home care to a 15 minute slot that's invariably skimmed to 10 & delivered by an exhausted harassed stranger. That's 'care in the community'.
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Thank you Beth. To be fair to the care providers, my mother's situation was probably one where truthfully home care was not going to be the answer. We had not had a definitive diagnosis and felt we were dealing with the after effects of strokewhile all the while seeing that she needed guidance with everything that would previously have been second nature. The idea from Social Services point of view was to rehabilitate Mum even though it quickly became evident it was not going to work. We stayed with Mum in her home for 10 days while she got used to strange people coming in but it fell apart quickly when we left. Yes, I'm sure resources and finances are a driving force and will continue to be so. It is a big dilemma when the country is struggling to control its finances.
I hope that 2013 will be the year that sees public pressure applied and new quality and standards of care put in place. The elderly have too long been "out of sight, out of mind".
This is a very powerful and eloquent description of how the service can look, and the pressures care staff work with. It’s always humbling to get insight into lives of people receiving home care. A service which could often provide much more worthwhile support if given the chance.
I have held a number of managerial posts within community care services and recognise most of the assertions you have made about care within the home. The view of a ‘poor’ service is very frightening indeed.
I would like to add to this from a service provider’s perspective, which I feel would be representative for most people working within them, including managers and the majority of owners. Many of whom are attracted into the sector to ‘make a difference’.
There is a chronic issue with the funding and commissioning of services, which will remain beyond implementation of Dillnot. It emanates from the theme that comes out from your blog, which is about a lack of appreciation of the value home care services.
As things stand, the majority of home care commissioning is concerned with reducing price. Reductions in price can either be achieved through efficiencies in the way it is produced or a reduction in quality. I would argue that significant efficiencies continue to be made by most providers of services; however this is clearly not the case in all instances.
It is difficult to know how many ‘poor’ services exist, however CQC recently provided a benchmark in their home care report that stated around a quarter of providers were not meeting all of the national standards. This is an appalling enough statistic, before you think about the fact that almost all of these failing organisations will continue to be commissioned by our Local Authorities.
In the majority of cases, these providers will be reliant on the services commissioned by Local Authorities. When you consider the ‘market dynamics’ of these arrangements, councils have enormous influence. When coupled with the fact that there are thousands of organisations in the sector, the most effective means for driving improvement is by working with Local Authorities.
In my own mind, successful organisations provide services that people and purchasers want. In the case of home care, the overwhelming majority of people are represented by Local Authority commissioners, who are being forced to put price reductions ahead of quality and value of the service.
My mother fell foul of home care pretty much in the way you have described here, multiple carers, late arrivals, lack of time and understanding of mum's needs all aggravated by her own confusion. I had no quarrel with the carers themselves but the system didn't allow for a confused woman who couldn't do anything for herself and who needed more support than could be offered in the few minutes that the carers were allocated. We were encouraged to leave my mother in her own home with this system in place to see if it could work. We very quickly found out it couldn't (which I really already knew) and my mother ended up in hospital in a shocking state not knowing me when I rushed to be with her. The speed of her decline was terrifying. While it is ideal for a person with dementia to be in their own familiar environment I knew that mum could only be safe with 24 hour care. Her situation came on very quickly following what had appeared to be a minor stroke so we were all on a rapid learning curve. Home care is all very well with carers calling in during the day but what about the night time hours? Can the person with dementia be relied upon to stay safely in bed until the carer arrives? What if the carer is unavoidably delayed? I lived 140 miles away from Mum and trying to calm her over the phone at such time was hopeless and scary for both of us. Her home care lasted less than 10 days and we were lucky she stayed safe in that time.
So much of the care question comes back to funding. Home carers do have caring natures and care about their job and the service they provide but they are frustrated too by the constraints that they work under, the radio control that continually interrupts them checking how far they have got through their schedule. You have described the situation eloquently. Sadly I think the money and the changes in cultural outlook towards the elderly will both be a long time in arriving. On a personal level I fear my old age which is rapidly approaching (age 60) especailly if old age means sick age.
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