Does the country care enough to pay a proper price for care?

EHRC Report on Home Care of Older PeopleAt Beechtree Totalcare we are saddened but not surprised by the Equality and Human Rights Commission’s (EHRC) report "Close to home: older people and human rights in home care" that was launched this week. Having worked in the care sector for many years we have experienced at first hand the escalating demands and the ever-diminishing resources available to meet those demands. And we feel moved to respond to some of the issues raised by this report.

There is clearly no excuse or justification for some of the terrible incidents that the report uncovered and that are being widely reported in the press. And the fact that only half the people who gave evidence to the enquiry were able to say they were really satisfied with their homecare is shameful. However increased regulation and legislation is not the answer – as homecare providers we are already subjected to some 378 pages of 'Essential Outcomes' for Health and Social Care, as well as the standard employment law rights.

What we need is more time for caring – but time costs money. One of the conclusions of the EHRC was that "some commissioning practices (by the local authority) make the negative experiences that some older people described more likely to happen" and the Commission "strongly endorses the recommendation of the Low Pay Commission that commissioning policies of local authorities should reflect the actual costs of care ...".

The root problem is that, as a nation, we have not valued the elderly. Thus they have received a poor service from the National Health Service and now they are receiving a poor service from Social Services. The real question that needs answering is “Does the country value the elderly enough to pay a proper price for care?"

Despite these pressures Beechtree Totalcare, along with most homecare agencies, are working hard every day to continue to offer a very good service to very many people. Sometimes a complaint is made and we pride ourselves on responding quickly and sensitively to put problems right. The heart of homecare has to be the carers themselves and recruitment and training are a major focus for us.

Caring is not well paid but can provide real job satisfaction. At Beechtree we aim to recruit people with caring attitudes and give them a thorough training programme, letting them spend a couple of weeks shadowing other experienced carers before they are allowed to work on their own. Some potentially good carers find that, although they thought they could, in fact, they can’t tolerate the less pleasant aspects of the work and leave quickly. At Beechtree we work hard to nurture the best carers and can proudly boast that many of them have been here for more than 10 years.

The issue of cost is never far away however. It is well known that when local councils deliver homecare themselves the cost is in excess of £30/hour. For years other organisations (homecare agencies such as ourselves) have been able to provide a similar service for less than half that. Unfortunately the price that the councils have been willing to pay has not kept up with inflation and, in an environment where Kent County Council have to save £94m over 4 years, there is little prospect of the pressure to cut costs changing to a debate about investment in quality homecare.

Not only have KCC not given inflationary increases but they have restricted the visits for many service users. For instance a person suffering with dementia may not be allowed a lunchtime visit so that any lunchtime meal has to be prepared during the morning visit and left for the dementia sufferer to remember to eat. Even though we find this unsatisfactory we have to find a way round it and Beechtree carers are instructed to leave food which will not deteriorate (e.g. biscuits, crisps, a cold drink) in a place where it will be seen. Some dementia sufferers are always hungry so the above strategy may well work for them, but others never feel hungry so may not eat what has been left out. The only real solution we can see is a lunchtime visit and a meal consumed whilst the carer is there. Fine if it is a private client who can afford the extra visits but what happens if they cannot pay themselves and the council will not fund it?

Faced with all these challenges, and the accompanying bad publicity, you might be forgiven for asking why do homecare providers continue at all? We certainly don’t do it for the money, but the answer is not that hard to find. We do it because every day we are reminded that we make a real difference to people’s lives. At the end of the day we do it because we do care.

Mary Becket & Sam West
Beechtree Totalcare
November 2011