Time to Care? An overview of home care services for older people in England, 2006
A report by the Commission for Social Care Inspection (CSCI), “Time to Care?”, published in October 2006, highlights some of the current and future problems concerning the provision of home care services for older people in England.
The report draws upon a range of evidence collected by CSCI over the last two years, including evidence from contact with care service users, CSCI’s regulatory and inspection work, as well as its performance assessment of councils.
The report aims to make a contribution to the debate about what kinds of changes are needed, by setting out some of the evidence that will help national and local policy makers and commissioners make decisions about what home care services should be offered to whom, and what form they should take.
Key Findings
80% of registered home care is purchased by councils on behalf of people assessed as needing it, which gives councils considerable leverage over home care providers. Only around 7,000 older people were using direct payments to purchase their own care by the end of 2004-05, compared with more than 300,000 receiving state-funded home care though numbers are increasing.
Most councils are targeting their services to those whose needs are defined as ‘substantial’ or ‘critical’ and who need more intensive support. The actual number of households supported fell from 528,500 in 1992 to 354,500 in 2005, and the proportion is now low by international standards. This tight targeting of services in most areas means that some people with significant needs are not receiving home care.
Since the 1990s, councils have steadily increased the proportion of home care purchased from independent sector providers. The percentage of home care hours delivered by the independent sector increased from 2% in 1992 to more than 73% in 2005.
With regard to the quality of care provided there were concerns about the care worker’s handling of medication, where there is a need to improve both procedures and training and the level of supervision, support and training offered to care workers more generally.
Surveys of older people usually demonstrate high levels of overall satisfaction with home care but this is often tempered by concerns, usually associated with a perception that care workers are ‘rushed’. CSCI found widespread problems in relation to shortness of visits, the timing of visits, and reliability (associated with care workers rushing between visits and turning up late).
Most councils restrict the help they will offer to a list of prescribed activities. Care managers draw up individual care plans that tightly specify both the tasks to be undertaken and the time to be devoted to these tasks. People using services, their families and their care workers say that it is often difficult to carry out the required tasks in the time available. The system is also inflexible and there are often problems in getting plans reviewed as circumstances change.
At least 163,000 people are employed as care workers. There are significant problems recruiting and retaining care workers due to both the low pay in this sector and the terms and conditions of this type of work. Where there are staff shortages there is evidence that care agencies ‘cut corners’ in their selection and recruitment practices. Thirty nine per cent of inspected agencies are not complying with the national minimum standard in this area, often because they cannot demonstrate to inspectors that they have carried out the necessary checks before the person starts work.
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Time to Care? An overview of home care services for older people in England, 2006
