IT IS nearly a year now since my mother died; so there has been
some time to reflect. I believe that the system of care companies
that look after older people in their own homes is at
breaking-point, and reforms are urgently needed.
The need to bring some support first occurred four years ago,
when Mum felt that she wanted help with getting up and washed. She
hadtoo much in savings (that is, more than £23,000) to qualify for
local-authority carers, but social services provide families with
information about the various companies that are available. We went
for a small family-run operation. This worked well for the next
two-and-a-half years. Mum had an excellent rapport with her carer,
As her requirements grew, however, she was in and out of
hospital, and needed more frequent visits. Eventually, there was
only one company that could provide the level of cover required:
the element of choice had gone. The idea that the client can mix
and match from a range of options is a long way from reality. And
this was in a part of the south coast of England where there is a
large concentration of elderly people.
I MET one of Mum's former carers, Sue (not her real name),
recently. She looked exhausted. Working for the care company for
the past 14 months, on a zero-hours contract, had taken its
She could have a day packed with back-to-back calls, or the
office manager might give her a couple of hours of work in the
morning, then a gap of four hours, and, later on, calls stacked up
into the evening. Often, she said, she wanted to stay longer to get
the job done properly, but there was pressure to get in and out as
quickly as possible.
Most companies have a system whereby the carers ring their
office on arrival at the client's house, and again before they
leave. This gives an accurate record of the time spent with each
client. It has to come from the client's phone, to confirm that the
carer is there, and not elsewhere with a mobile phone.
There has been much talk recently about 15-minute calls as not
being sufficient for care needs. This can, of course, be the case,
but, sometimes, 15 minutes could be more than is needed. If you are
paying for the call, you want the visit to last as little time as
necessary. It is one of the more distressing elements of private
care that you have to judge whether genuine compassion is being
shown, or whether it is really about the care company's getting
The company needs to be monitored by the client's family or a
friend. In our case, Mum was loath to lose Marie, with whom she had
struck up a friendship. In the case of a company that we used
later, however, I was constantly seeking to have one person lead
the operation, to ensure that the routine was done the same way;
that things were put away when the carer left; and that the team
dealing with Mum should consist of a small, stable number of faces.
This was not always the case, which caused great distress.
A NUMBER of lessons can be drawn from our family's experiences.
The first is the need for the vulnerable person to have someone
acting as an advocate, to stand up for him or her when dealing with
the care company, and with social and medical services.
A distinction needs to be drawn between people who fund
themselves, and those for whom the local authority picks up the
bill. The amounts can be horrendous. The final four-visits-a-day
bill was £800 per week. Recent recommendations suggesting a cap on
care-spending by individuals would be welcomed by many.
There should also be more concern for the carers. Relatives
often say that they feel unsupported, and overwhelmed by the
pressure of looking after a member of their family, particularly if
they are trying to keep a job going at the same time - often, such
people have to give up their jobs. Research conducted by YouGov for
Carers UK in February 2013 found that 2.3 million people had given
up work to care for an elderly parent, or a disabled or ill family
member. This is said to have cost the Exchequer £5.3 billion in
lost tax revenues, on top of the additional benefit costs.
One of the problems is that the ability of families to provide
voluntary support is taken for granted. The Generation
Strain, a report published by the Institute for Public Policy
Research in April, argued that soon (by 2017 was the estimate),
there will not be enough family members to deal with all those who
PROFESSIONAL care workers do vital, skilled work, which should be
valued by society. They should not be on the minimum wage and
casual contracts: they should be salaried, with decent pay and
conditions of employment, such as holidays and sick pay. This would
change the care sector overnight. The present system of bringing in
people, giving them a little training, and exploiting them to the
point of burn-out is no way to run a system.
A wider question must be whether care can ever properly be
conducted by private-sector companies, whose concern at the end of
the day is profit, and return to shareholders. The ethos of caring
does not sit easily with their bottom-line economics. A state-run
system is unlikely to prove popular with the current Government,
however, especially against the background of continuing cuts in
public spending. More non-profit organisations and charities
operating in the sector would help.
As a whole, there needs to be a more accurate assessment of what
the care requirements of an ageing population are, and what systems
could be put in place to cope with this. It is certain that the
present system is not working.
Paul Donovan is a freelance writer with a particular
interest in social affairs.