'Shoddy and not fit for purpose' — report slams standard of homecare as vulnerable users left with wet clothes and soiled sheets

The Home Care Report by Healthwatch Bolton details instances of vulnerable people being left in wet clothes, refused showers, and having to cope with soiled bedsheets.

One service user described being upset at being unable to attend a Remembrance Sunday service because a carer was delayed — receiving a response that care would be provided “when the carer could get there”.

Another user detailed how a carer was doing her own shopping and on the phone during the time she was meant to be helping her client.

While the report includes some accounts of good care, Healthwatch has concluded that no one it spoke to during its six-month study — including clients, family members, carers and commissioners — believes the current business and contracting model for home care in the borough is fit for purpose.

In fact, the group — which speaks up for health and social care users in Bolton — is calling for a total overhaul of the way home-based care is organised in the town.

Bolton Council currently commissions a wide range of home care services from private companies, while other services can be provided directly by companies to clients.

The authority is currently in the final stages of re-tendering home care provision and Healthwatch said it wanted to highlight the experience of service users to inform this process.

In carrying out its research, the team spoke to individuals from groups in sheltered housing, at a stroke support group, at an older person’s luncheon club and at its own volunteer forums.

They asked users for any comments on care services, be it positive, negative or neutral.

The most frequent complaints focussed on inadequate visit lengths, poor monitoring of time spent providing care and a ‘slapdash’ approach to specific tasks.

While these problems are sometimes caused by the organisation of the service and not the individual carers — it is felt there is too much variation between carers and poor quality monitoring so users feel like they are in a lottery and hoping for the ‘good ones’ on any given day.

One user commented: “They don’t dry me properly and I end up sitting in wet clothing.”

Another stated: “If on occasion, bed sheets are soiled there have been instances where carers, having provided personal care, will not remove the soiled sheets.”

As well as people feeling that carers are not always staying for the full amounts of time — there were also issues around the scheduling of visits.

The report states: “This is particularly evident in relation to morning and evening visits when some agencies seem to schedule work to suit their own staff rotas rather than respond to the needs described in the clients care plans.”

Some clients felt organisations were unwilling to accommodate specific requests and even ‘made an issue’ out of users asking for flexibility.

One comment stated: “On the morning of Remembrance Sunday, despite particularly asking for a visit which would enable them to attend services locally, X’s visit was delayed and he missed the service. A senior carer’s response was I would have the care when she could get there.”

Continuity of staff was another issue, with users reporting seeing numerous different faces and sometimes struggling with language barriers.

Healthwatch suggest that the provision of effective care is “seriously affected” by care staff employment factors — such as the age and experience of carers.

The report states: “Agencies difficulties in recruiting and retaining committed staff who are able to build a relationship based on trust with the cared for person directly impacts on the perception (and reality) of the quality of care.

“The client can be left with the feeling that carers are inexperienced, do not receive sufficient training or supervision and are not empowered to do a good job.”

It goes on to state that clients and frontline staff recognise that the current business model does not lend itself to attracting and retaining people in the long term.

Major issues arise in terms of the payment for care services, with Healthwatch suggesting that there is a “complete lack of transparency” surrounding the pay arrangements for home care in Bolton.

One family member is quoted as saying: “Carers needed to come at night to see my husband. Up until then I had cared for him. He died a few weeks ago, they didn’t wash him but just put him in his pyjamas — we paid over £11 per hour and they only stopped for 15 minutes.”

Another user, a sheltered housing residents reported being billed £140 per month by the council for visits intended to last one hour each morning and half an hour each night.

The report states: “These are actually 10-minute visits and the first thing they do is use the residents land line to phone and book in — they don’t do that when they leave and she feels they are not being open about their leaving times with the service provider.”

It adds that the user’s requests for an extra shower are billed at £15 a time.

The report also focuses on the families who are providing care for loved ones and cites a lack of respite care as a major issue.

While families felt that respite care was essential for their wellbeing, they said that accessing it was a “Tortuous and disappointing process”, with many unable to access appropriate respite even when they were told they were entitled to it.

Concluding that home care services are “not working well for many people,” Healthwatch suggests that home care provision should take a more holistic view of the client and require a much better appreciation of client’s preferences, interests and most importantly needs.

The report is heavily critical of the current contracting model — stating that it works directly against the idea of personalising care.

The author states: “Clients are recipients of ‘pre-designed’ care packages, they are not adequately supported to manage or even influence the terms of their own support.”

Turning to the frontline carers, the report concludes that they are “ill informed, badly connected and disempowered.”

As far as the care providers are concerned, Healthwatch believes major improvements are needed in rota planning of staff as well as a “radical re-evaluation” of human resources, stating that the council should help with this process.

The commissioners of home care are also in the firing line, the report states: “When an individual’s personal care requirement is enumerated as a list of how many showers a week they can take, how many times they can be dressed or have a hot drink, it is hardly surprising that the care does not feel that personal.”

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This can be combated by re-inventing the terms of the commissioned service so it is based on the best outcome for the client and not the ability to deliver ‘units of care.’

Other major recommendations include a need to urgently address the “undersupply of respite provision” for family members as well as a move to invest in informing and educating families about care options and financing.

Speaking about the report that her team has created, Healthwatch Bolton’s chief officer, Alice Tligui said: “This is a huge part of the market and it is important that these people can say what they think about it.

“A lot of these people are housebound and we were very interested to hear their views.”

She said that while a lot of the users spoken to were grateful for the care they receive, she described the general feedback as “disappointing.”

She added: “The whole commissioning structure is based on tasks rather than personal relationships — it is a sort of care by numbers and we think this needs a big re-think.”

“It was a hard report for us to put together because these people could be any of us or our loved ones and while there were lots of good things, it appears that the vital care element is missing.”

Healthwatch said it hopes its report will now be used to help quality control any future contracts that are commissioned in the borough.