Care at home:where the system is falling down

It is now nearly a year since my mother died, so there has been some time to reflect. I believe that the system of care companies which look after older people in their own homes is at breaking point, and reforms to it are urgently needed.

The need to bring some support first occurred four years ago, when Mum felt she wanted help with getting up and washed. She had too much in savings (that is, more than £23,000) to qualify for Local Authority carers, but social services provide families with information about the various companies that are available. We went for a small family-run operation. This worked well for the next two-and-a-half years, Mum having an excellent rapport with her carer, Marie.

As her requirements grew, however, she was in and out of hospital, and needed more frequent visits. Eventually, there was only one company that could provide the level of cover required: the element of choice had gone. The idea that the client can mix and match from a range of options is a long way from reality. And this was in a part of the south coast of England where there is a large concentration of elderly people.

I met one of Mum’s former carers, Sue (not her real name) recently. She looked exhausted. Working for the care company for the past 14 months, on a zero-hours contract, had taken its toll.

She could have a day packed with back-to-back calls, or the office manager might give her a couple of hours of work in the morning, then a gap of four hours, and later on, calls stacked up into the evening. Often, she said, she wanted to stay longer to get the job done properly, but there was pressure to get in and out as quickly as possible.

Most companies have a system whereby the carers ring their office on arrival at the client’s house, and again before they leave. This gives an accurate record of the time spent with each client. It has to come from the client’s phone, to confirm that the carer is there, and not elsewhere with a mobile phone.

There has been much talk recently about 15-minute calls as not being sufficient for care needs. This can, of course, be the case, but sometimes, 15 minutes could be more than is needed. If you are paying for the call, you want the visit to last as little time as necessary. It is one of the more distressing elements of private care that you have to judge whether genuine compassion is being shown, or whether it is really about the care company’s getting paid.

The company needs to be monitored by the client’s family or a friend. In our case, Mum was loath to lose Marie, with whom she had struck up a friendship. In the case of a company that we used later, however, I was constantly seeking to have one person lead the operation, to ensure that the routine was done the same way; that things were put away when the carer left; and that the team dealing with Mum should consist of a small, stable number of faces. This was not always the case, which caused great distress.

A number of lessons can be drawn from our family’s experiences. The first is the need for the vulnerable person to have someone acting as an advocate, to stand up for him or her when dealing with the care company, and with social and medical services.

A distinction needs to be drawn between people who fund themselves, and those for whom the local authority picks up the bill. The amounts can be horrendous. The final four-visits-a-day bill was £800 per week. Recent recommendations suggesting a cap on care spending by individuals would be welcomed by many.

There should also be more concern for the carers. Relatives often say that they feel unsupported, and overwhelmed by the pressure of looking after a member of their family, particularly, if they are trying to keep a job going at the same time — often, such people have to give up their jobs. Research conducted by YouGov for Carers UK in February 2013 found that 2.3 million people had given up work to care for elderly parent, or a disabled or ill family member. This is said to have cost the exchequer £5.3 billion in lost tax revenues, on top of the additional benefit costs.

One of the problems is that the ability of families to provide voluntary support is taken for granted. The Generation Strain, a report published by the Institute for Public Policy Research in April, argued that soon (by 2017 was the estimate), there will not be enough family members to deal with all those who require support.

Professional care workers do vital, skilled work, which should be valued by society. They should not be on the minimum wage and casual contracts: they should be salaried, with decent pay and conditions of employment, such as holidays and sick pay. This would change the care sector overnight. The present system of bringing in people, giving them a little training, and exploiting them to the point pf burn-out is no way to run a system.

A wider question must be whether care can ever properly be conducted by private-sector companies, whose concern at the end of the day is profit and return to shareholders. The ethos of caring does not sit easily with their bottom-line economics. A state-run system is unlikely to prove popular with the current Government, however, especially against the background of continuing cuts in public spending. More non-profit organisations and charities operating in the sector would help.

As a whole, there needs to be a more accurate assessment of what the care requirements of an ageing population are, and what systems could be put in place to cope with this.

What is certain is that the present system is not working.

 

*Church Times - 27/6/2014