Who cares about home care?

The Con-Dems don't

Sue Powell

Two recent reports highlight the plight of the elderly in England and Wales. Firstly, the Office for National Statistics reported 25,700 deaths due to cold weather in 2010/11.

Secondly, the Equality and Human Rights Commission (EHRC) studied the care of older people in their own homes and produced a report Close to Home: older people and human rights in homecare. As a result of this, Tory ministers were quick to lay the blame for poor care on local councils. The Tories promote privatisation, which is part of the problem and have cut local government spending by 7.1% from April.

Councils are responsible for commissioning and monitoring the home care of 500,000 people in England and Wales. This includes meals, domestic help and personal care. According to the EHRC: "For too many, the care delivered behind closed doors is not supporting the dignity, autonomy and family life which their human rights should guarantee".

Home care may be provided by social services, but is increasingly contracted out to private care agencies and voluntary bodies. Often it complements care provided by relatives.

There's no automatic entitlement - needs are assessed according to eligibility criteria set by local councils. For some, this process is intimidating and it can take months for claims to be processed. Many don't bother to claim their full entitlement - and in any case, help is limited.

The system does not take account of people's needs. During the six years I cared for my mum, neither of us saw a social worker and no advice was offered on how to deal with her personal care. We got on really well, but how many carers are unable to cope? How much suffering (patients and carers?) goes unmonitored?

My mum's care was only monitored when she came on the "dying patient pathway" - a checklist covering the last six to eight weeks of life to ensure continuity of care. We joked: "Suddenly they need to know about dental hygiene." But it's not funny, before that there was no care plan.

Council budget cuts and privatisation take their toll. Often people must pay towards the services they receive. Bizarrely, as with people cared for by family members, this means they are not protected by the Human Rights Act.

The EHRC wants this loophole closed, but even they explain that, where legal safeguards apply, councils often fail to observe the law, despite their 'positive obligation' to promote and protect human rights. The Act pertains to residential care homes, but hasn't proved effective - look at Southern Cross!

There are several reasons why elderly people prefer home care - familiar surroundings, independence, the bad reputation of residential care and frequently - costs. How sad is it that some are abused by those from whom they expect support?

Cuts in NHS beds and the failure of private care homes will see more people being cared for at home. Not without reason, this is seldom called "care in the community" like that Tory cost-saving disaster in mental health.

Price decides

The EHRC identified many "quality-driven" services, but said price was often the deciding factor. Services are axed and less time allocated to tasks. It is this rather than the callousness of helpers that leads to most complaints, like people not being washed or helped to take food or drink (especially dementia patients) or care workers not being allowed to prepare hot meals.

The report links failure to provide agreed measures to lack of time (as little as 15 minutes for each home visit). Large numbers of staff quit because they feel the system makes it impossible to deliver proper care.

This contrasts sharply with the shocking tales of theft, neglect or abuse beloved by the media, but the EHRC explains: "the underlying causes of these practices are largely due to systemic problems rather than the fault of individual care workers."

Condemning this breach of human rights, they point out that care work is accorded low esteem, and despite the responsibility and skills required, is invariably low paid. The report criticises poor training and monitoring of services. Staff morale is low and staff turnover high, which the EHRC believes poses a major risk to the personal security of the elderly.

Cuts and privatisation will erode the quality of service even further. Staff demoralisation affects the patients too. One disabled women cancelled her home help because she got fed up with the constant moaning about the work, hours and pay.

People desperate to find work may be forced into low-paid care jobs for which they are neither trained nor suited. Not everyone can cope with the demands of the job. Abuse cannot be excused, but as with most cases of bullying, there is a correlation between the low self-esteem of the perpetrator and the "low status" of the victim.

Politicians kiss babies and wring their hands over reports like that from the EHRC. But German Tory Gottfried Ludewig, a budding leader of Germany's government party CDU, let the cat out of the bag. He is demanding curtailed voting rights for pensioners and the unemployed. "Those who finance the welfare state should finally have more influence", he pompously states. And in Westminster a member's bill to reverse cuts to the heating allowance for pensioners was defeated. Why upset the shareholders over 25,700 lost lives?

Capitalism values people entirely on the basis of how much they contribute to the profit margin. Carers, like the people they look after, are undervalued. Good care is a right not a privilege, but it will not be delivered through recourse to law or human rights training - not as long as market values dominate.

Have you got experience as a care worker, do you receive home care? Write to the Socialist with your experiences: editors@socialistparty.org.uk or the Socialist, PO Box 24697, London E11 1YD

Stop the intimidation of "whistle-blowers"!
Proper staff training, decent pay and improved working conditions for care workers
A fully-funded publicly owned, democratically controlled service, run by care receivers and providers, families, the unions and medical/care professions
For the trade unions to campaign for decent pay and conditions for all care workers

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In The Socialist 30 November 2011:

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