EHRC Report

Report highlights home care failures

by http://www.nhs.uk

Wednesday November 23 2011

Lapses in home care 'may breach human rights'

A number of elderly people are being let down by home care services, an inquiry by the Equality and Human Rights Commission has found. The commission reported that around half of the older people and relatives interviewed were highly satisfied with their standard of care. However, in a minority of cases there were significant lapses in the care some received.

Among the problems reported were older people being left unwashed, denied assistance with eating and without a say in the way they were treated. In a few isolated cases, elderly patients reported physical abuse and having money systematically stolen.

The report is one of a series of damning examinations into elderly care to be published in recent months. Investigations by the Patients’ Association and Care Quality Commission (CQC) both found major lapses in medical care for the elderly.

It is important to stress that this report, like other recent investigations, found that the overall standard of care was good and that these types of incidents are not necessarily widespread. However, the CQC has said people have a right to expect a certain standard of care and that it wants to ensure that all elderly people are being treated with dignity and respect. Earlier this week the regulator launched a major inspection programme to monitor home care services for the elderly.

Why was the inquiry performed?

The Equality and Human Rights (EHRC) says that a great deal of attention has been paid to the human rights of older people in institutional settings such as hospitals, and residential and nursing care, but that there is a significant risk that older people could have their human rights infringed while receiving care at home.

To assess the situation the EHRC examined a broad evidence base gathered from 1,254 individuals, local authorities, care providers and other organisations across England. As is the case with all surveys of this type and size, there is the potential that the results do not accurately reflect what is happening across the wider population.

 What experiences does the report highlight?

The EHRC says many older people reported being highly satisfied with their home care and that good quality home care has undoubtedly had a hugely positive impact on their lives.

The report noted though that while they may not be typical of the standard of care on offer, several people reported concerning lapses in home care, including those that may breach their human rights. Below is a selection of these comments and experiences.

Support with food and drink

In one particularly bad example a 76-year-old woman with advanced cancer had to struggle across the room to heat her own food, as her care worker said she could not use the microwave due to ‘health and safety reasons’. The EHRC contacted the Health and Safety Executive, which said that it could see no reason why workers could not heat meals in a microwave.

There were also a number of reports where older people had experienced severe weight loss and dehydration because they did not get the support needed for them to eat.

Physical abuse

A small number of people surveyed highlighted instances of intentional physical abuse, most often rough handling or unnecessary physical force.

One 78-year-old woman said: “Rather than say ‘sit in the chair’, they’d push me back into the chair, that sort of thing, and I didn’t like that… It was only on one occasion – I recognised it as a push. She wasn’t nice at all… I couldn’t do anything about it. I can’t even walk and I think they know this you see; they know you’re vulnerable.”

Neglect of personal care

In a number of instances care workers did not perform the tasks set out in people’s care plans, which often feature just the basic tasks needed to ensure physical wellbeing.

The daughter of a woman in her 80s said: "One time carers decided not to do any of her washing any more, even though [it was included] on [her] care plan, leading to my mum being left in filthy nightwear and clothes and bedding.”

Another woman described how care workers often rush their work or leave early, leaving her mother “in distress, dirty and without water and food”.

Patronising or ignoring older people

At times, the way care workers addressed people was condescending, patronising or ignorant of elderly people as individuals: “Some staff ‘talk down or shout’ at my mother thinking they will ‘get through’ to her by doing so. She is an intelligent woman and isn’t hard of hearing.”

Financial abuse and theft

Groups assisting with the report, such as Action on Elder Abuse, said they had seen a number of examples where care workers had systematically stolen from elderly people, particularly those with dementia.

However, on a positive note there were instances where care workers had protected vulnerable people from being financially exploited, such as a case where an older man was having two friends take money from his pension while pretending to assist him with banking and shopping.

Lack of control and flexibility

At times people receiving care said they felt they were treated like a task rather than as a person, or not given assistance with tasks of true priority. For example, some reported being put to bed in the afternoon due to a lack of evening care slots, and in one case, a woman was refused help getting off the toilet by a worker who had instead used her appointment time to prepare the woman a sandwich.

Lack of personal sensitivity and privacy

At times people found care workers lacked awareness of people’s cultural or personal backgrounds. For example, one older gay man with dementia said he decided to stop receiving care “because of the homophobic reaction of care staff”, and many Muslim people felt they could not be sure that the prepared meals they received were genuinely Halal.

What solutions have been recommended?

The EHRC’s extensive report looks at a range of measures that could ensure better care for the elderly. Among the suggestions made by the CQC:

The introduction of improved legal protection for older people, particularly the closure of a loophole that means that home care is not subject to the Human Rights Act in the same way residential care is.

Greater consideration of the impact services will have on people’s human rights when they are being designed and commissioned. The EHRC points out that even though budgets are shrinking, many local authorities have already redesigned the way home care is delivered to make the most of the money they have and ultimately improve the standard of care elderly patients receive.

Better guidance for older people and their families to ensure they know their rights and how these should be protected.

Having recently examined standards of hospital care for the elderly the CQC announced a major programme of inspections to assess the standard of home care for the elderly. In its role as an independent regulator of health and social care, it will start its inspections in April next year, and will scrutinise the support administered by around 250 care agencies across England.

What can I do if I am unhappy with my care?

Make sure you know your rights. The EHRC says that most older people have little or no understanding of how home care works or what their options are. If you are a carer you can find more about home care on Carers Direct or by calling Carers Direct on 0808 802 0202.

Make an informed choice. Many older people feel that they have had no choice over their home care provider, especially if it has been changed. Not only can older people make choices of who their home care is provided by, they can also choose to take local authority funding to hire their own home help (for example, through a direct payment). For more information, see Choosing your own support on Carers Direct.

Make sure you know who to complain to and how. The EHRC says that older people commonly endure distressing treatment that in some cases breaches human rights legislation. Complaints about care can be made directly to the home care provider or to the local authority. These can then be taken on to the Local Government Ombudsman. People who pay for their own care (self-funders) can complain directly to the ombudsman. You can find out more about local authority complaints on Carers Direct.

Home Care Inspections by CQC

Home care services in England are to be subject to a fresh inspection by the Care Quality Commission from April.

BBC News Health 22 November 

The CQC has announced it will report on 250 companies who help people in their own homes with tasks such as eating, washing, dressing or taking medication.

Its reports will be produced before the health watchdog publishes its verdict on the state of home care nationally.

An Equality and Human Rights Commission report due out on Wednesday is expected to be critical of home care services.

An EHRC spokesman said the care watchdog’s pledge could be an “important first step” in addressing concerns raised by its own inquiry.

CQC inspectors will carry out the reviews alongside professionals and those who have personal experience of using home care services.

‘Behind closed doors’

CQC chief executive Cynthia Bower said: “The operation of home care is not as transparent as care in hospitals and other sectors because the interactions happen behind closed doors.

“That is why we want to focus on this sector of social care in this way.”

The CQC already runs routine spot checks, but this will be an extra inspection.

An advisory group is to be set up to assist the inspection process, with members from organisations including the EHRC, Age UK and the United Kingdom Homecare Association.

Ms Bower said it would focus on areas such as dignity and respect, safeguarding of people in vulnerable circumstances, and inspections would also look at how well supported and trained staff were.

Checks will include speaking to those who receive home care, as well as to their families, and home visits, she said.

The inspections follow a pilot scheme run by the CQC in which 30 home care services were reviewed.

Protecting the Elderly from their Carers

Stephanie Rose reviews the recent Government statistics concerning risks to the elderly, and details how risks can be reduced.

Tim Ross, Political Correspondent of the Telegraph, in his spine-chilling article this week, draws our attention to the first-time-publishe


d government figures concerning abuse of the elderly.

Of 96,000 adults who had suffered alleged abuse between April 2010 and March 2011, more than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded. Almost one in four cases, some 23,000, involved ‘financial abuse’, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly. Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

The figures make frightening and depressing reading. An occasional case of abuse is a case too many, but these figures suggest that failures in care are not occasional. Of course, they do not reveal the huge numbers of vulnerable adults who receive high levels of care and attention from their carers, nor contrast with those whose carers go beyond expectation in the way that they provide for their relatives, patients and clients.

What as a society can we do to protect the vulnerable and the elderly?

A first observation is that care should not be left as the sole responsibility of one carer. Initially, care may be excellent, but as time progresses (or a relative, patient or client becomes more challenging) care can deteriorate. Without the support and oversight of others – extended family, relatives, visiting nurses, supervisors – the risks increase. Every vulnerable person should have the support of both a carer and 'a confidant' –someone who they can confide in, and who has the capacity to take responsibility and alert other services where necessary.

Secondly, we as a society should focus greater care and support on the care providers.   There are thousands of home carers who go unassisted and unmonitored, battling daily against difficult conditions and behaviours, and no doubt succumbing to the short-cut, the drop of standards or the reaction backlash. Frequently, the sheer stress of providing care without respite may give rise to risk.

Managing risks to clients is one of ‘Stephanie’s Bespoke Care Services’ top priorities. It was for this reason that we originally introduced the relative’s video log. Clearly, over time, it has developed a plethora of uses over and above risk management, but this still remains a core purpose of the video recording. We also ensure, whilst providing continuity of care, that each client is cared for by more than one carer; and each client is seen and cared for on a regular basis by supervision. This way, the corners are identified and reinforced. Poor practices are picked up at an early stage. Carers who are not coping are supported. Most importantly, the little tell-tale signs of concern are spotted.

No system can be perfect, and any care is going to be only as good as the carer can manage; but with the right level of experienced observation and scrutiny, risks can be reduced.


The ideas here are the personal ideas of the author and may not be reproduced without permission and attribution to Stephanie's Bespoke Care Services.

Abuse of the Elderly

100,000 elderly and disabled victims of suspected abuse

Almost 100,000 elderly and disabled people were feared to have suffered abuse at the hands of their carers last year in what ministers described as “an absolute scandal”.

By Tim Ross, Political Correspondent

4:02PM GMT 03 Nov 2011

A landmark inquiry into the scale of mistreatment disclosed that a quarter of cases involved relatives or carers putting alleged victims under pressure to change their wills, stealing property, or fraud.

More than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded.

Ministers and elderly rights campaigners condemned the picture of care home staff and relatives who exploit society’s most vulnerable citizens.

It is the first time that comprehensive government figures have been published showing the number of cases of alleged abuse in care homes and in the private residences of vulnerable adults in England.

The figures follow warnings from the Care Quality Commission over the “alarming” failure of hospitals to care for elderly patients.

The watchdog has also severely criticised the company that owned the now closed Winterbourne View care home for disabled adults in Bristol, where alleged abuse, including slapping and taunting of residents, was uncovered in a BBC documentary earlier this year.

Details from 151 councils showed 96,000 adults had suffered alleged abuse between April 2010 and March this year.

Almost 14,000 victims were suspected of having been abused or neglected repeatedly during the year, according to the report from the NHS Information Centre.

Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

Almost one in four cases, some 23,000, involved “financial abuse”, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly.

Paul Burstow, the health minister, said the figures were “an absolute scandal” and promised more snap inspections of care services to stamp out abuse.

“No-one should have to put up with abuse,” he said. “This is the first publication of mandatory data of this kind. It demonstrates our total commitment to shining a light on poor care.

“Hundreds more unannounced inspections of adult care will be taking place, and we will also be making it mandatory to have local boards, involving police and other professionals, in place to tackle abuse.”

Social or healthcare workers were the alleged perpetrators in 29% of cases while family members, including the victim’s partner, were suspected of being the abusers in 25% of cases.

There were more than 18,000 cases of alleged emotional or psychological abuse, and almost 7,000 cases of sexual abuse.

Four in 10 investigations that were completed during the year were found to have been fully or partly substantiated, while 30% were not, and more than a quarter were inconclusive.

Michelle Mitchell, Charity Director of Age UK, said: "These figures show shocking mistreatment of the most vulnerable in our society.

"It is extremely worrying to see such high levels of neglect and abuse in residential home settings. The figures also raise further concerns about the quality of domiciliary care, which is delivered in a person's home behind closed doors and so problems are likely to be under reported.

"Safeguarding measures are clearly still failing far too frequently and urgent attention needs to be paid as to why 96,000 cases of abuse were allowed to happen last year."

Adrian McAllister, chief executive of the Independent Safeguarding Authority, which is responsible for banning abusers from working with vulnerable people, said the figures were "appalling".

"Behind these statistics are stories of real pain, lives that have been damaged and trust that has been broken by those who job was to improve the lives of vulnerable adults, not abuse them," he said.