Secret homecare investigation uncovers missed visits and food left out of reach

An undercover investigation into home care has uncovered missed visits, forgotten medication and food left out of reach.

A Which? investigation has exposed numerous examples of poor home care of vulnerable people, and has asked whether care agencies are stretched to their limits.

Which? asked 30 older people to keep diaries during one week in January.

These diaries showed a distressed older lady left in the dark, unable to see her food or drink, a man's vital diabetic medication forgotten and rushing careworkers.

Which? executive director Richard Lloyd said: ‘The Government can no longer claim to be shocked as report after report highlights the pitiful state of care for older people.’

‘If they are serious about ensuring vulnerable people are treated with dignity, then we must see real action because every day they delay is another day older people risk being neglected.'

The investigators also spoke to home care managers who reported ‘tightening margins and the struggle to maintain a quality service’ and care workers who talked about ‘bearing the brunt of increased responsibilities and low pay’.

One manager said ‘victims are caught in a ‘conspiracy of silence’ and unable to challenge the council that pays them’.

Commissioning managers said there is a huge pressure to make savings and spoke about the difficulty in not compromising on service delivery. Which? experts analysed the diaries alongside a survey of 926 Which? Connect Panel members.

They were concerned that, as people are living at home with increasingly complex care needs, safety is being jeopardised by poorly managed care.

However, they did also see some excellent care, where diarists reported carers going the extra mile to give excellent service, especially those with regular careworkers.

However the diaries showed, that in many cases, a good service was only received after making complaints.

One daughter said improvement came after ‘continuous phone calls’ and a ‘constant battle’ with the agency.

But many receiving care were afraid to complain with one saying: 'My mother wouldn't hear of me complaining because she was frightened.’

One daughter told how the agency had ‘missed a day just after Christmas.

They incorrectly entered into the database the days we didn't need care. I covered, but Mum didn't contact me until early evening by which time she needed a lot of cleaning up.’

The survey showed 47 per cent had reported a missed visit in the past six months, and 62 per cent of these were not warned in advance. In a previous Which? survey, poor communication was a big issue, with agencies failing to let people know that their careworker couldn’t make a visit.

Mike Padgham, chair of the homecare sector’s professional body, United Kingdom Homecare Association (UKHCA), said the report from Which? ‘supports our growing concern over state-funded homecare.’

He added: ‘People and their families must be confident that they will receive dignified and effective care. They must look to Government and local councils to place the needs of elderly and disabled people at the forefront in the current economic climate, to avoid the concerning picture described in today’s report.’

The Which? report also highlights the consequences of the commissioning of homecare by local councils, who fund three-quarters of all homecare delivered in the UK.

To meet the current stringent public sector spending cuts, councils are reducing the price they pay for care.

This is supported by Mr Padgam’s findings as ‘homecare agencies repeatedly tell us that councils also allow less time for care to increasingly frail and elderly people.’

UKHCA is currently undertaking a major study into the impact of public spending cuts by councils. Initial responses show over three-quarters of agencies (77 per cent) believe councils now place lowest price before quality of care.

Chief executive of the Care Quality Commission (CQC), Cynthia Bower, called homecare ‘one of the most difficult areas of care to monitor because it is delivered behind closed doors’ and added this ‘is why, starting next month, CQC will be carrying out a themed inspection programme of 250 providers of domiciliary care services’.

Tom Hadley, director of policy & professional services at the Recruitment & Employment Confederation (REC) - the representative body for recruitment agencies, agreed that the report flags some worrying examples of poor practice but said: ‘We must avoid further stigmatising individual care workers - the vast majority of whom do a great job in increasingly difficult circumstances and on very low pay rates.’

He added: ‘Which? themselves acknowledge that a major problem lies with the overall care system and insufficient staff numbers but we need to get to the real heart of this issue if we are to make real, sustainable changes to care provision.’

‘Specialised recruitment agencies have a key role to play by ensuring that all front-line workers are suitably skilled, fully vetted, and that the need for extra staff can be met at short notice on a 24/7 basis.’

‘However, increasing pressure on costs and margins means that this risks becoming an almost impossible task. It is vital though that in the rush to cut costs, we don’t put recruiters in a position where they are no longer able to carry out necessary checks on care workers. We need more emphasis on quality and control, not on cutting corners.’