Home Care Agencies ? Spare A Thought For Their Problems ???

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Homecare agencies are at breaking point. Reform is long overdue.

As one council starts paying by the minute for homecare visits, adult social care urgently needs more than a quick fix.



The face of social care is changing. The steady shift away from looking after older people in residential care to supporting more of them at home is shrinking the care home sector and growing the domiciliary care market. In London, the number of homecare agencies now exceeds the number of care homes for the first time.

This would be a more welcome trend if we could have greater confidence in the quality of homecare services. Although the Care Quality Commission rates 82% of agencies in England as “good”, and a further 4% “outstanding”, there is widespread anecdotal evidence of rushed or missed visits and a constant churn of care workers. According to official estimates, 50% of the domiciliary workforce is on zero-hours contracts and annual staff turnover is 44%, with one in 10 jobs unfilled at any one time.

Care agencies say they cannot improve workers’ pay and conditions, and improve turnover, because most councils do not pay them enough to do so. The UK Homecare Association (UKHA), which represents the sector, says only one in seven councils pays care providers a contract price that is enough to run a sustainable business and meet minimum wage obligations: a price it puts at £18.93 an hour, allowing for 55p profit.

Now the association has a cause celebre. In August, Walsall council moved to a system of paying for homecare by the minute. While this is not unique – one leading national agency reckons that about one in six of its contracts is paid on this basis, using electronic monitoring of care visits – Walsall was already one of the lowest-paying councils. Its current rate is believed to be £14.33 an hour, £4.60 below the UKHA’s benchmark.

Local agencies warned that the change would imperil a fragile system. Sure enough, the regional Express & Star newspaper recently reported that the council had written to its contracted agencies saying it had 70 unallocated cases on its books, “putting at risk vulnerable service users”, and pleading with the agencies to pick them up.

The UKHA has since made a freedom of information request to Walsall, demanding the rationale for what it describes as an “irresponsible” change of payment system. Under the new approach, the association claims, homecare visits lasting longer than 20 minutes are paid by the minute, shorter “check” calls are paid a flat rate, but visits briefer than eight minutes are not paid at all. A care worker who finds that a householder is out, or that they decline a service, perhaps because they have a visitor, appears to trigger no payment.

Walsall, which is Conservative-led, says the changes were made within the terms of agencies’ existing contracts. “The underlying objective is to ensure that public funds are only spent on care that is actually delivered to service users in accordance with their assessed care needs.” Since it alerted agencies to the 70 unallocated cases, it says, the number “has now considerably reduced”. Booked calls are paid a flat rate in the event of “cancellation” by the householder with less than 24 hours’ notice.

There was general dismay at the absence of any concrete proposals on social care in last week’s Queen’s speech setting out the government’s programme. Hopes of a breakthrough had risen, with speculation that a white paper or even a bill would be announced to take forward what the prime minister had described as “a clear plan we have prepared”, but all that emerged was a vague pledge to “bring forward proposals to reform adult social care in England to ensure dignity in old age”. In December, it will be 1,000 days since we were first promised a green paper setting out options for reform.

What is happening in Walsall reminds us that if and when reform proposals do appear, they must address the broken system in its entirety and not just provide a fix to enable people needing care to avoid having to sell their homes to pay for it.
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Thank you Chris.
I just can't see how these care agencies make any money, they have so much to pay for , uniforms, thousands of disposable gloves and aprons, the office and staff, all the bills electric etc, telephone, insurance, national insurance and of course wages and fuel.

And the poor carers working all hours for minimum wage travelling all over the town often having 30 plus calls a day, 15 minute calls, what can you do in 15 minutes, a wellbeing check I think you call it.

Or a half an hour call, but you have to dash off to the next client early, no travelling time was allowed.
The carers had to use their own cars so you are putting thousands of miles on your car, tyre wear maintenance etc on minimum wage.

And the clients, there's just no quality time, no time for a friendly chat, having to get used to a new carer almost every day, there was such a high turnover of staff.

There really does need to be a big reform, bringing the dignity back, giving quality care, more time for the clients instead of rush rush rush, better wages for the carers.

I helped a friend deliver pizzas for a week, again minimum wage, but he got his petrol paid, tips and free pizzas, much better conditions.
It is hard to see how they keep in business. Are there big government incentives, extra top ups for carers?
Hello Chris,

This is of concern to me, my Dad is a Walsall resident. Although right now he does not need personal care calls, it is likely to not be too many more months before he will do. His stubbornness in accepting any help at all will lead him down that path. I had no idea that this was going on in Walsall. He certainly won't - despite it being extremely relevant to him, he will not educate himself about anything.

Thank you for posting this.

Claire
Home care agencies are very often run by a promoted carer. Many lack organisational skills, especially around finance and logistics.
I've run a small business and a national club, studied for a degree in Business Studies, and have many friends in the haulage business.
My mum's agency had carers running around like headless chickens, rather than dedicating a team of carers to one local geographical area. Hundreds of miles were being driven every week that could have been avoided by giving the manager some training and access to a haulage industry system!

Our Social Services department are equally useless at organising things. They don't have time to respond to emails but will travel many miles to have a meeting with me that takes up all afternoon.
I'd like to see a "Make Every Contact Count" policy.
At our last finance review social services sent a detailed sheet explaining we didn't need to pay but they are paying the agencies £30 an hour which I would have to pay if we had to top up the care for any reason, [which after another assesment by the OT and care agency they agreed to fund more time] however I had a sneaky look on the agency's website at jobs advertised most are advertised at over £10 an hour plus fuel and travel time if you work outside your nearest town and if your insurance premium is above a certain limit because you need buisness insurace to cover traveling to multiple places of work they will pay the excess. So they make a nice profit from social services on an hours care. I do agree though they need to rework out how they work things with travel time etc especially when they are unfamiliar with the areas and in rural areas at peak tractor time e.g harvest, silage and haymaking. The other thing I would like to see is proper training, 2 weeks shadowing and a manual handling, first aid and food hygiene is not enouhg they should have medication management, Deaf/Blind awareness, Alternative communication methods, Nutrition and dietry and so many other aspects of training that is needed to provide holistic care to individual people. They also need to identify staff who may not have what it takes, we recently had a carer who felt faint and had to sit down luckily I was around and could "help" because she saw a bruise the size of a 20p maximum. She admitted she doesn't do body fluids either they all make her faint. Hiring someone because they apply for the job and seem good on paper isn't enough, I think they should go back to how I was interviewed in a care home...formal interview then a room with staff who put me through my paces...all body fluids and then just to finish me off they hoisted me so I knew what it felt like and when I hoisted them they faked a hoist problem to see how I'd respond with the client. It seems daft but it's those things that make the difference because even if it is different carers everyday they should be so good at the job they can be trusted and able to put the client at ease straightaway.
Sall the Bibliophile wrote:
Fri Oct 25, 2019 11:41 am
At our last finance review social services sent a detailed sheet explaining we didn't need to pay but they are paying the agencies £30 an hour which I would have to pay if we had to top up the care for any reason, [which after another assesment by the OT and care agency they agreed to fund more time] however I had a sneaky look on the agency's website at jobs advertised most are advertised at over £10 an hour plus fuel and travel time if you work outside your nearest town and if your insurance premium is above a certain limit because you need buisness insurace to cover traveling to multiple places of work they will pay the excess. So they make a nice profit from social services on an hours care. I do agree though they need to rework out how they work things with travel time etc especially when they are unfamiliar with the areas and in rural areas at peak tractor time e.g harvest, silage and haymaking. The other thing I would like to see is proper training, 2 weeks shadowing and a manual handling, first aid and food hygiene is not enouhg they should have medication management, Deaf/Blind awareness, Alternative communication methods, Nutrition and dietry and so many other aspects of training that is needed to provide holistic care to individual people. They also need to identify staff who may not have what it takes, we recently had a carer who felt faint and had to sit down luckily I was around and could "help" because she saw a bruise the size of a 20p maximum. She admitted she doesn't do body fluids either they all make her faint. Hiring someone because they apply for the job and seem good on paper isn't enough, I think they should go back to how I was interviewed in a care home...formal interview then a room with staff who put me through my paces...all body fluids and then just to finish me off they hoisted me so I knew what it felt like and when I hoisted them they faked a hoist problem to see how I'd respond with the client. It seems daft but it's those things that make the difference because even if it is different carers everyday they should be so good at the job they can be trusted and able to put the client at ease straightaway.
I agree. Those working in the care sector should have full extensive training. Or be willing to listen to either the cared for person (in rare circumstances) or their carer. Let us make care great like it should be.
In my experience, care agency workers find ways to beat the system. My dad was supposed to receive one hour forty five minutes care per day. He was lucky to get 10 minutes. Quite often I would bump into his carers in the local cafe stuffing their fat faces with cake when they were supposed to be helping my parents. Even their tracking devices they could beat by sitting out in their cars during the hour they were meant to be in my dad’s. Living in a small village they’re not hard to spot on their skives.
Anna_1910123 wrote:
Wed Oct 30, 2019 11:48 am
In my experience, care agency workers find ways to beat the system. My dad was supposed to receive one hour forty five minutes care per day. He was lucky to get 10 minutes. Quite often I would bump into his carers in the local cafe stuffing their fat faces with cake when they were supposed to be helping my parents. Even their tracking devices they could beat by sitting out in their cars during the hour they were meant to be in my dad’s. Living in a small village they’re not hard to spot on their skives.
I agree. I once reported a carer to the office several times for putting my life in danger and on her phone or shirking when she was not supposed to. Can you report or not?