• Assessing the quality of services provided in people’s own homes can often be difficult for care bosses.
• New research compiles views of almost 3,500 people on what it’s like to receive help at home including support preparing meals, getting dressed and using the bathroom.
• Most experience reported is positive, in particular the dedication of staff, but key concerns identified include medicines management and staff training.
Across England there are more than 5,500 home care providers, collectively helping an estimated 673,000 people to continue living independently within their communities.
Over the last year, the number of local Healthwatch citing home care as a priority has doubled. Home care, also known as domiciliary care, can include regular visits from a carer to help with personal care, getting dressed, using the toilet, shopping and preparing meals.
Healthwatch England analysed the experiences of 3,415 home care users, their families and front line staff across 52 local areas between August 2015 and June 2017. These findings came from local Healthwatch events, surveys and site visits to health and care services and included the feedback gathered from almost 700 people in Dorset.
Most people had positive things to say about their home care. These services are invaluable to many people, both for the quality of care provided and the support and company of care workers. A relative told Healthwatch Dorset: “My sister has
severe learning disabilities and I am very happy with all her regular carers. She is very happy in her own flat.”
Older people in particular said that one of the most positive things about home care is that it enables them to remain in their own home and to maintain as much independence as possible.
However, Healthwatch also discovered four themes across our research that will be of interest to those who commission, provide and regulate social care services:
• Care planning – People frequently reported that staff were unfamiliar with their clients’ care plans. In cases where it was a staff member’s first visit to a client, insufficient time was often allowed to enable them to read the care plan. A care user speaking with Healthwatch Dorset said, “Most staff never read the care plan if new to me. I then have to try to explain it all again (I have dementia).”
• Skills and qualifications – Many of those who spoke about their experiences said they valued the dedication and experience of those sent to care for them. However, others lacked experience and basic skills, such as being able to wash someone or make them breakfast. A resident told Healthwatch Dorset that one of her carers was unable to boil an egg or make porridge, while another person said care workers needed to be taught “home care common sense.”
• Consistency and continuity – All local Healthwatch found problems with staff coming at different times and even missing appointments. Healthwatch Dorset found a number of people reporting that it felt like care packages were designed to meet the needs of the service provider rather than the service user. A care user they spoke to had been promised no more than 4 different carers, but in the space of one year there were 44!
• Communication and feedback – Providers need to look to make greater and more regular use of feedback to address problems early and prevent minor issues turning into complaints. Many people who spoke with Healthwatch Dorset highlighted the lack of communication they had with the organisations providing their care.
Healthwatch driving improvements
Although this national report highlights a number of concerns in home care, it is encouraging that many local Healthwatch have already had their evidence used by local commissioners to inform the development of new service specifications and contracts. Healthwatch Dorset’s report “Where The Heart Is” (available to read on their website: www.healthwatchdorset.co.uk ) gathered feedback from almost 700 local people and their findings have been used to develop new strategies for home care services across Bournemouth, Poole & Dorset.
Joyce Guest, Healthwatch Dorset chairperson, told us: “Over 80% of the people who took part in our survey told us they were happy with the home care service they received. But we also heard disturbing stories from some relatives and friends about poor care and instances where people had not had a medicines review for 3 years. People told us that they would like better continuity of care workers, to have care provided at the times that suit them, to be listened to more and to have more choice.
“This national Healthwatch report will really help to highlight the issues we’ve raised locally and work towards creating better services for local people.”
The Healthwatch network will share the findings of this briefing across the health and social care sector, as part of a wider programme to encourage greater use of user feedback.
Neil Tester, Deputy Director of Healthwatch England, said:
“It’s often incredibly important to people to be able to stay in the familiar surroundings of their own home. One of the most positive aspects of home care is that it enables people to hold on to as much independence as possible.
“We listened to people using home support services and those delivering care and they have given us a clearer picture of how the system works for them. We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards.
“Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard. So if anyone has a story they want to share or an idea they think might help, I urge them to get involved and speak to their local Healthwatch.”
To find out more about the report and/or to share your feedback about home care please go to: www.healthwatchdorset.co.uk or call 0300 111 0102.