Ceretas News
Home care often fails to meet older people's basic rights
The Equality and Human Rights Commission?s inquiry into the home care system in England published this week has been widely covered in the media. It reveals disturbing evidence that the poor treatment of many older people is breaching their human rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want. The press release for the final report of the Commission?s inquiry, Close to home: older people and human rights in home care, says hundreds of thousands of older people lack protection under the Human Rights Act and calls for this legal loophole to be closed. It questions commissioning practices that focus on a rigid list of tasks, rather than what older people actually want, and that give more weight to cost than to an acceptable quality of care.
What has not been so widely reported is that around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. They most valued having a small number of familiar and reliable staff who took the time to talk to them and complied with their requests to do specific tasks. Home care workers said their job satisfaction came from improving the quality of older people?s lives.
The inquiry also revealed many examples of older people?s human rights being breached, including physical or financial abuse, disregarding their privacy and dignity, failing to support them with eating or drinking, treating them as if they were invisible, and paying little attention to what they want. Some were surprised that they had any choice at all as they thought they had little say in how their care was arranged. Ways for older people to complain about their home care are either insufficient or not working effectively. Reasons for their reluctance to make a complaint about their treatment included not wanting to get their care workers into trouble, fearing repercussions such as a worse standard of care or no care at all and preferring to make do rather than make a fuss.
The inquiry reveals the pervasive social isolation and loneliness experienced by many older people confined to their homes who lack support to get out and take part in community life. Yet evidence from the home care industry indicates that social activities are some of the first support services to be withdrawn when local authorities cut back their spending on care services. Alarmingly, one in three local authorities had already cut back on home care spending and a further one in five planned to do so within the next year.
The low rates that some local authorities pay for home care raises serious concerns about the pay and conditions of workers, including payment of the minimum wage. The low pay and status of care workers does not match the level of responsibility or the skills they need to provide quality home care. A high turnover of staff as a result of these factors has a negative impact on the quality of care given to older people.
Very few local authority contracts for home care specify that the provider must comply with the Human Rights Act. This undermines the quality of care that older people are getting. The evidence given to the inquiry indicates that where human rights are embedded into the way home care is provided - from commissioning to service delivery - high quality care is delivered without necessarily increasing costs.
In response to the findings of its inquiry, the Commission says that legislation and regulation needs to be updated to reflect huge shifts in how care is provided. Its recommendations from the inquiry fall under three broad categories:
- Proper protection: Closing the loophole in the Human Rights Act which would give protection to the growing number of older people receiving home care from private and voluntary sector agencies. The law was changed in this way in 2004 to protect residents of care homes who are funded by the state.
- Effective monitoring: The government, Care Quality Commission and local authorities need to work together better to build human rights into home care and make sure that abuses are detected faster and dealt with more effectively.
- Clear guidance: Clear and robust guidance on human rights is needed for councils so they can use the opportunities they have to promote and protect older people's human rights in commissioning; older people also need guidance to help them make choices about care and to explain how their human rights should be protected.