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EHRC Inquiry in to Home Care for Older People

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Inquiry reveals failure to protect the rights of older people receiving care at home

Equality and Human Rights Commission, 20 June 2011

Older people's basic human rights are being overlooked in the provision of care at home, according to emerging findings released on 20 June 2011 by the Equality and Human Rights Commission.

The Commission is conducting a major inquiry into home care, which is investigating how well the home based care and support system in England is protecting the rights of people over 65. The full report will be published in November 2011.

In gathering evidence, it has uncovered many worrying cases, for example:

  • people being left in bed for 17 hours or more between care visits;
  • failure to wash people regularly and provide people with the support they need to eat and drink;
  • people being left in soiled beds and clothes for long periods;
  • a high staff turnover meaning some people have a huge number of different carers performing intimate tasks such as washing and dressing. In one case a woman recorded having 32 different carers over a two week period.

Major problems in the home care system that have been brought to the Commission's attention through this inquiry include:

Inadequate time to deliver care

The very brief time allocated to homecare visits – just 15 minutes in a number of cases – does not allow even basic essential tasks to be done properly. As a result people sometimes have to choose between having a cooked meal or a wash. The short visits also mean that staff have to rush tasks like washing and dressing. Older people and care staff alike have expressed dissatisfaction and frustration about this issue.

Lack of control over timing of care visits

Many older people have little or no control over what time the homecare visit happens. As a result, we have heard of people being put to bed at 5pm and not helped to get up until 10am, a period of 17 hours.

Failure to deliver adequate homecare

We have had some reports of neglect, in which people have been left in filthy nightwear and bedding after a homecare visit or without a wash or hair wash for several weeks.

Lack of staff awareness and training

Some older people have described feeling that their privacy and dignity is not respected. For example we have been told about an older person being regularly undressed by care staff in front of his bungalow window, and another person in front of family members, instead of in privacy. A thorough training process would make sure staff took the simple steps required to avoid these basic mistakes. This would have a huge impact on the day to day lives of those they care for.

High staff turnover

The high staff turnover rate impacts on older people. People have described the emotional impact of being washed and dressed by a large number of different people, and having to repeatedly disclose personal information every time a new care worker comes to the house. We will be exploring further the experiences of care workers themselves, together with the reasons for high staff turnover.

Lack of complaints and low expectations

The full extent of the potential human rights breaches is likely to be masked by the fear of complaining and the low expectations about the quality of homecare that many older people believe they are entitled to. One in five older people who responded to the call for evidence said that they would not complain because they didn't know how to, or for fear of repercussions. In addition, we are exploring what protection and support is in place for whistleblowers who want to expose poor or abusive practices.

Our evidence

The evidence for the inquiry is drawn from several sources including a general call for evidence from older people, families, care workers and NGOs; a targeted call for evidence from government (in progress), regulators and other key organisations; and surveys undertaken with local authorities and primary care trusts, and home care providers. Fifty four per cent of local authorities and 250 home care providers in England participated in the surveys. We received a total of 503 written submissions to our call for evidence.

  • 344 responses from individuals (older people, their friends and family)
  • 58 from organisations; and
  • 101 from home care staff.

Baroness Greengross, a commissioner for the Equality and Human Rights Commission, said:

'Many older people up and down the country receive good quality care from committed, respectful care workers. But our evidence suggests that in some places care workers are faced with too much to do, in too little time, sometimes without proper training. This is causing standards to slip and is placing older people's human rights to privacy, autonomy and dignity at risk, sometimes in very serious ways.'

For more press information contact the Commission's media office on 020 3117 0255, out of hours 07767 272 818.

For general enquiries please contact the Commission's national helpline: England 0845 604 6610, Scotland 0845 604 5510 or Wales 0845 604 8810.

Notes to Editors

The Commission is undertaking an inquiry into the protection and promotion of human rights of older people in England who require or receive home-based care and support. This was launched in November 2010 and is expected to be reporting before the end of 2011. View our inquiry into home care for older people.

The Commission is a statutory body established under the Equality Act 2006, which took over the responsibilities of Commission for Racial Equality, Disability Rights Commission and Equal Opportunities Commission. It is the independent advocate for equality and human rights in Britain. It aims to reduce inequality, eliminate discrimination, strengthen good relations between people, and promote and protect human rights. The Commission enforces equality legislation on age, disability, gender, race, religion or belief, sexual orientation or transgender status, and encourages compliance with the Human Rights Act. It also gives advice and guidance to businesses, the voluntary and public sectors, and to individuals.

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Older people cared for at home 'lacking basic rights'

BBC News, 20 June 2011

Care of older people in their homes is so poor their human rights are being overlooked, an inquiry by the Equality and Human Rights Commission has found.

The inquiry is investigating how well over-65s who receive homecare visits are looked after in England.

The commission says it has uncovered worrying cases of neglect and examples of lack of respect for older people's privacy and dignity.

Its full report will be published in November.

After looking at the evidence, it says there are "major problems" in the home care system.

It describes cases of people being left in bed for 17 hours, or more, between care visits and a failure to wash people regularly.

It received reports of people being left in filthy nightwear and bedding after a homecare visit, or without a wash or hair wash for several weeks.

Visits are sometimes so brief, the report says, that people have to choose between having a cooked meal or a wash.

The short visits also mean that staff have to rush tasks like washing and dressing, which frustrates both the elderly people and care staff.

No dignity

High staff turnover also has an impact on those being cared for, the commission finds.

The report said: "People have described the emotional impact of being washed and dressed by a large number of different people, and having to repeatedly disclose personal information every time a new care worker comes to the house."

 

Baroness Sally Greengross from the commission on what the inquiry found

Some older people describe feeling that their privacy and dignity were not respected when they were undressed by care staff in front of family members or in front of their bungalow window.

To gather evidence for the inquiry, the Equality and Human Rights Commission carried out surveys with NHS local authorities, primary care trusts and private home care providers.

Fifty-four per cent of local authorities completed the survey, as did 250 home care providers in England.

The commission also looked at over 500 written submissions from older people and their families, and 101 from home care staff.

One in five older people who responded to the commission's request for evidence said they would not normally complain because they did not know how to - or for fear of repercussions.

'Serious neglect'

The commission says it will explore what protection and support is in place for people who want to expose poor or abusive practices.

Peter Hay, from the Association of Directors of Adult Social Services, said "poor care is never acceptable whatever the system".

However, he pointed out that the interim report was looking at complaints, and so inevitably emphasized problems.

But he acknowledged that the problems were two-fold - "when organisations lose sight of the person they are caring for and it becomes about a task, and... how do we get older people in particular to be well-informed and powerful consumers.

"They are very passive about complaining."

He said people needed to more assertive in getting the right care they need, at the time they need it.

Michelle Mitchell, charity director at Age UK, said the findings showed "serious neglect".

"Despite government commitments made by both the previous and current government, basic rights to dignity, respect and autonomy are still being breached.

"The biggest threat to the human rights of older people receiving care at home is from cuts to adult social care budgets, and it is very unclear whether tightening eligibility criteria to care will allow local authorities to continue to meet their human rights obligations."

Care services minister Paul Burstow said: "There can be no place for poor quality care in care services, either in the home care system or in residential homes."

He added the inquiry would "help drive up standards of care and expose bad practice".

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