Medication left out of reach – home care must change

As an owner of a small family run care agency, it is devstating hearing the level of unprofessional support being provided. we are in the very early stages of development but find it extremly hard to become recognised due to bigger (not always better) agencies being given the ‘ok’ by social services and smaller agencies having to work twice three time even more harder just to be given the ok to become a approved provider we have excellent level of one to one support for our sevice users and famlies, but feel we come up against barriers because we are small. Not all care agencies are bad.
the reasons why we desided to run set up our own care agecny was because we had identied that people/families wernt being given the support they not only deserved but required to live a fulfilled life at possible.

Many Thanks

Sarah Hill

The appalling findings in today’s report highlight the urgent need to address what are clearly critical issues in the country’s home care system.

Last November the Equality and Human Rights Commission concluded that older people’s human rights were being breached as a result of poor treatment in the system and this report only supports those disturbing findings.

There are obviously serious problems around capacity, funding and communications. It was very telling that less than half of the people surveyed for the report were given the procedure for making complains so where there were problems there was very little hope of them being adequately resolved. In some cases there is also a clear lack of compassion and respect for older people’s dignity, which should always be at the heart of care.

The Which? report on homecare confirms what families have been telling Good Care Guide since we launched: much care is good and appreciated by older people and their families, but there are still many examples where older people have been badly let down. Common complaints are around the length of visits, lack of companionship, too many different carers, rudeness by some staff and poor communication by the agency when things go wrong.

Rather than passing the buck from the regulator to homecare providers to local government, everyone needs to work together for better care for our ageing population.

After this latest report, there can be no doubt that the care system is severely underfunded and in crisis. Families can’t wait any longer for the government to create a sustainable and fair way to fund better care. Action is needed urgently to tackle the care crisis and address families’ fears.

My experiences pre-date July 2006. Cut backs have nothing to do with it. Although not one visit was missed, the timing of a visit varied by 4 hours. One carer did call if she needed to change the time. I suggested that if this always happened it would help me to make decisions about my wife’s care. I was told that it was against the rules. Travelling time between clients was taken out of the allocated time in those days too – unfortunately for my wife as the previous client lived 20 -25 minutes walk away and most of the carers did not have cars and did not use bikes.
The problem now, as it was then, is that once care is handed over to private companies, after a few weeks of being done by council employees (as it was in my wife’s case) nobody is responsible for making checks. When a child is not protected properly by social services someone loses their job. How often does that happen when an adult is involved is neglected? Carers are often asked to do the impossible. A contract (not just a care plan) must be drawn up stating exactly what is to be done and the time allocated for each actual task. Failure to attend, lateness, failure to carry out a task correctly or to spend the allocated time on it should lead to a refund plus an additional amount paid to the client as compensation. Frequent, UNANNOUNCED checks should be made by social workers, very frequent (weekly at least0 on the most vulnerable. This should be enshrined in law with prison the penalty for senior social service staff who have failed to ensure the contract has been carried out correctly. It is only when punishment for failure is sufficiently severe that those with the power will make sure that proper care is given and be brave enough to rock the boat making themselves unpopular instead of making do so they get promotion or keep their jobs.

Care companies

When we complained in person to the care company we were using the, the owner,made us feel unwelcome and the director shouted at us. They then called the police on us and sent bailiff’s letter to my 84 yr old mother in law. We have since put her in a rest home for her own safety.
We have video and written evidence which has been passed onto our solicitor but do have copies if needed. It has been traumatic for all our family.

I have been involved in the care sector for over 30 years and in that time it has gone from bad to worse, I have worked for both small and large organisatins the same theme runs through both, the council demand times to be cut insisting a mirowave meal can be cooked and served in 15mins if you dare to sugest this is not care then you are told if you dont do it then there are plenty out there that will. The demands on care agencies to deliver quality care on a a shoe string budget is causing mistakes to be made and no contnuity as staff get frustrated with the system and find other job out of the cre sector.As with all busnesses there are good and bad but those of us that want to be the best get very little encoragement from the people that should be supporting us.Most of us do this job because we care and want to make a diffrence and it is definatly not for the pay, can you say the same?

I agree wholeheartedly with the findings in your report and the comments.
My wife was taken ill in November 2010 and after returning home from respite she was unable to stand or walk and needed the help of home service care. We were allocated a nationally known care company by Social Services to provide two carers three times each day.
She was bed bound and suffering severe bed sores and I was being pressed by the Doctor and District Nurses to have her moved into a chair during the day. I refused owing to the unsatisfactory service I was receiving from the care company. To move her from bed to chair and back by hoist required two carers and at times only one arrived or there was often a delay in the arrival of the second carer. For example, on Christmas morning 2010 a carer knocked on my door at 0740 hours, somewhat earlier than the agreed time of 0830 hours. It was also difficult at times to communicate with the care company and on one occasion I rang three times and twice left a message without receiving any reply.
This situation gave me reason to find a new care company and we contracted with a small local company for two carers to attend my wife morning, noon and night. The company is owned and run by two ladies, each with 35 years experience as carers. They operate single and double care rounds and from time to time they personally conduct a round together or one will accompany one of the usual carers. They can be contacted by phone 24 hours a day and when absent from the office the call is automatically transferred to one of their mobile phone. Since moving to this company on January 15th 2011, without fail, every time I have answered the door there has been two carers who have arrived together and are within 1/4 hour either side of the agreed time. The company consult with me should it be necessary for there to be a permanent or temporary arrangement to our agreed times and I will be notified by phone should there be a possible delay in their attendance owing to traffic problems or a difficulty with the previous call.
As any person in a similar position to me will know, it is vitally important to be able to have 100% confidence in those who provide such a vital service. For my part, I suggest it is important to look for the services from a company whose owners or managers are experienced, completely familiar and knowledgeable with what is required for providing excellent home care services.

My mother in law who has Alzheimers was awarded 2 hours of care per week for carers to come in and prepare her meal and give her medication four times a week to give my husband and I, both of whom work full time hours albeit that I work compressed hours (5 days over 4) in order to be available to take her to appointments etc. a break. Although there was supposed to be one or at most 2 carers to come at 6 p.m. there was a different person each day who turned up at anywhere between 4 and 9 p.m. Hardly surprising that my mother in law didn’t want food at such varying times and although already a very petite woman lost over a stone through not eating properly. Eventually and I have to say , without the help from the Mental Health Team to whom we are affiliated, we insisted on Direct Payments, employed a different company who are not in the Social Service network and now we have 2 carers a week who have got to know my mother in law, ensure she eats healthy food, liaise with us whenever necessary and are both flexible and caring. Perhaps Local Authorities ought to be asking Service users more regularly about the care they receive as in 2 years no-one asked and no-one seemed to listen to complaints.

Carers are routinely expected to take on a great deal of responsibility (last week I had to call 999 and perform resuscitation on an elderly lady who had sadly died) in return for pay rates only just above the national minimum wage. These wages are often paid only for the time spent at a client’s house, rather than at an hourly rate, so travel time is unpaid. In addition, some agencies don’t in any case allow any travel time between calls, which means that the carer has the choice of giving the full amount of time to clients and running increasingly late, or using some of the care time for travelling. The Which investigation report did not touch on the important issue that, partly because of the poor pay structure, many carers are recruited from outside the UK. This is not a criticism of those carers but inevitably there are differences in culture and difficulties in communication to be overcome. Finally, let’s not lose sight of the fact that not all clients (a better term than the horribly anonymous “service users”) are elderly, and that carers need different skills to look after younger people.

I think your which care survey, campaign is brilliant, and would like to have my 2 penneth worth.

The situation we find ourselves is of our own making. Years and years of doing things for cheaper and cheaper.

Lets be factual 100% of the blame lies with successive governments. Fact is the client does not matter. Care does not matter. Employees (care staff do not matter). WHAT DOES MATTER IS COST. THAT IS THE ONLY THING THAT MATTERS. More for less is this countries ethos.

I am a father of a 24 year old daughter who provides care to the vulnerable in the community. She works for Echoes Care Agency in Basingstoke Hampshire. As such I hear first hand how bad it is. Whilst she does not get minimum wage £8-9 per hour she is paid by the minute. I can confirm the following.

She regularly has to do 14 hour days from start to finish of her day.

She does not get travelling time between clients and is therefore unpaid.

In her day she can have a 2-3 hour gap from one client to the next for which she does not get paid mileage or time. This effectively means she has to sit in her car and wait for the next clients time or travel home at her own expense, to then travel back roughly to where she has just come from to do the later calls.

She is paid by the minute, has to log in at the start of the call, and log out at the end.

If she gets there early she does not get paid.

If she leaves early she does not get paid.

If she runs late because of the client needing extra care, she does not get paid. She has to wait justify the extra time, this then has to be applied for retrospectively by the care agency to the council. Maybe she will get paid maybe not, but definitely not when she is due to be paid.

She has to use her own mobile for all calls, to book in and out, for every call. Also to ring the office if she has concerns about a patient, or if she has to ring a relative, as she is not allowed to use the clients phone. She is not reimbursed for this.

She only gets 20p per mile fuel allowance, (this has been the same since petrol was £1 a litre).
Whilst I acknowledge she can get a further 25p per mile through the tax system, she was owed 14 000 miles, but because of maternity, inland revenue said they could not give her a cheque for the money owed, she would have to wait to get it back when she returned to work through her tax coding.

She does not get paid for the first and last journey. To save money they usually give her the furthest calls as first and last.

She is often late having to play catch up because of traffic, a double up is late, or a client has kept them longer, which can mean she finishes gone 11, again because of this her pay is cut but she works longer.

The order of clients is not sensible, going backwards and forwards to the same area rather than doing all calls in A before moving to B.

She has had to leave clients who are lonely and crying because she has to get to her next call.
She advises me she does not get her mileage money for up to 6 weeks after she has incurred the fuel costs, again she is effectively paying to do her job. She spends on average £40-50 per week in fuel to get back in the order of £20-30 at 20p per mile.

They are further looking to make further savings by merging other areas of the business into one and merging several care areas into one. Reducing back room staff. The examples quoted include, pay being centralised. But more importantly one person/office planning all calls for a vast geographical area. Which ultimately trying to manage hundreds of staff to thousands of clients, will lead to things being done at stupid times, bed at 18:00 etc, so little regard for the client on no regard for the care giver.

The continual drive/process of getting more for less can only result in the long term to two things, poorer service for the client, and poorer pay/conditions of service for the staff. This will inevitably result in poor staff motivation leading to poorer care, high turnover rates, inconsistency in training and level of service, inconsistency/poorer care for the client.

Let’s be honest the people needing care are not human beings, officially they are entitled clients, but all they are is numbers, to the agency and to the respective local authorities and government who administer this process. Working cheap, making people pay to effectively work for you, is only going to lead to poor and inconsistent standards. Nothing will improve all the time cost is the sole motivator

My daughter is currently looking at other alternatives having skills experience in child care and retail.

Andrew Brown