Home Care in Crisis

Two reports recently highlighted the plight of the elderly in England & Wales. One, from the Office for National Statistics, reported 25,700 excess deaths due to cold weather in 2010/11: The other, from the Equality and Human Rights Commission (EHRC), criticises the provision of care to 500,000 older people in their own homes. Tory ministers responded by warning local councils to sort out the mess, but have said little about energy price hikes. Attacking council services fits the Tories privatisation agenda – but it’s misleading.
Councils are responsible for commissioning and monitoring home care services (which include meals, domestic help, personal care, e.g. getting up/getting dressed, washing, bathing). 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, charities and voluntary organisations. There is no automatic entitlement – needs are identified on the basis of eligibility criteria set by local councils. Some find this process too intimidating. Staff shortages mean it often takes months before claims are processed. Thus countless people will not even claim their full entitlement – and services are paltry.
Many people receiving care in their own homes must pay towards these services. Scandalously, this means they are not protected by the Human Rights Act. The EHRC wants this loophole closed, although it points out that even where legal safeguards apply, councils frequently fail to use the law properly. Public authorities have a ‘positive obligation’ to promote and protect human rights. But where the Human Rights Act pertains, as in residential care homes like Southern Cross, it cannot prevent neglect.  Although the EHRC found plenty of “quality-driven” services, it reports that price was often a dominant factor. Complaints included people not being helped to take food or drink (especially dementia patients), health and safety law being falsely cited to stop care workers from preparing hot meals and failure to provide agreed measures – often due to lack of time. Shocking cases of theft, neglect or abuse are likely to be flagged up by the media but, the EHRC explains: “the underlying causes of these (bad) practices are largely due to systemic problems rather than the fault of individual care workers.” They argue treatment is often a breach of human rights and reinforces the view of the RCN and other professional bodies that training standards are woeful. Despite the responsibility involved, care work is low paid and accorded low esteem, yet demands special skills. Staff turnover is therefore high – which the report identifies as posing a major risk to the personal security of the elderly.
People desperate to find work may accept low paid care jobs whether they are trained or even suited to the work. 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. The question is, why is it allowed to happen and how can it be stopped? There has been some obligatory wringing of hands over what the EHRC calls “chronic disregard for older people’s privacy and dignity”. Mainstream parties pay lip service to family values and human rights, but privatisation and council budget cuts make the provision of decent care almost impossible, thus their laments are sheer hypocrisy.
Care and health are “markets”, dictated by the profit margins of private companies. The report may lead to changes in training but given further cuts, it is unlikely that time and budget constraints will be relaxed. Staff morale is already low. Carers, like the people they look after, are undervalued.
Capitalist society does not value people who cannot contribute economically. With leaders like Miliband saying council homes should go to “worthy cases” and the poor being blamed for being poor, it is understandable that older people, who can’t cope like the‎y used, to worry about being a “burden” on the state or their families. Especially as: “we are living too long”. The report says they tend not to complain about ill-treatment, don’t want to make a fuss or “get their carers into trouble.”
But good care is a right not a privilege. Legislation is not enough – so intimidation of “whistle-blowers” must stop! Staff should receive proper training, decent pay and improved working conditions – including more time for individual tasks. We need well-funded publicly-owned, democratically controlled services run by care receivers and providers, families, the unions and medical and care professions.
What will we get? Gottfried Ludewig a Conservative student leader in Germany, clumsily revealed the bosses’ view, calling for voting rights of pensioners and the jobless to be curtailed: “Those who finance the welfare state should finally have more influence…” And in Westminster the government voted down a bill to reverse cuts to the heating allowance for pensioners. Why upset the shareholders over 25,700 lost lives?

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