Local providers tell us about the challenges they face delivering home care services
Hospital discharge is a pressure point. Home care agencies told us that needs assessments conducted in hospital settings are often unrealistic. Patients can overestimate their abilities, expecting to be more able than they prove to be once they get back home.
This year, we spoke to residents receiving home care. We explored what was working well, and also the challenges, then shared our early findings.
To broaden our understanding, we also needed feedback from the various organisations involved in providing home care services. We met with the care providers at a meeting of the London Borough of Islington Home Care Providers Forum. We asked them about the challenges they faced delivering the service.
Challenges
1. Recruitment
Rapid turnover of caring staff was an issue identified by residents who shared their experiences of home care. Providers agreed that recruitment was a big challenge. A carer’s salary is lower than the salary for an equivalent supermarket role, and carers are not paid for travel time between clients. It is also difficult for providers to find carers able to work at the hours specified in care packages. A variety of reasons were given:
- Since the pandemic, most carers choose part-time work, so a full package from a single carer is not often possible.
- There is also the challenge of the hours that most carers can or want to work. Carers often have commitments, such as taking their children to school, and many want, or are only able, to work from 9.30 or 10 o'clock onwards. However, carers are needed much earlier to help the service users get out of bed, wash and have breakfast. More home care packages now specify a 7 am or 8 am start.
- In winter, carers are generally less keen to work evenings.
2. Home care packages can be difficult to bid for and deliver
Care packages are based on a care needs assessment, typically carried out by a social worker from Adult Social Services. Providers felt that early morning visits are recommended in care packages almost by default, and these decisions are not necessarily informed by close consultation with service users. This makes care packages difficult to bid for and deliver. Providers said they would welcome more involvement in the design of care packages to help ensure the packages were realistic. If, for example, early morning visits were reserved for those who really needed them to take medication and so forth, then providers would be better able to meet demand.
3. Needs assessments carried out in hospital can be unrealistic
Many service users’ home care needs are assessed when they are in hospital waiting to be discharged. Some overestimate their abilities, expecting to be more able than they prove to be once they get back home. The home environment is very different from the hospital environment and facilities at home, such as toilets, baths, showers and stairs, are less accessible than their hospital equivalents. Needs assessments conducted in hospital settings are often unrealistic, and patients’ actual care requirements may be significantly greater than those accounted for in their care or reablement packages. Providers told us that there needed to be training for professionals carrying out hospital discharge to support them to produce more realistic care packages. It was important that room to amend the packages was built in.
4. Communication with Adult Social Care can be a challenge
The lack of regular or timely communication with the Islington Council’s Adult Social Care department was a problem identified by several providers: “We send emails and emails, and there is no response”.
Successes
We also asked attendees what they were most proud of in their service. It was great to hear how the service was making such a difference for people. For example, some patients have been in hospital for six or nine months or even longer, so providing the care that then gives them back their independence has a massive impact. Providers were also proud of the way they could build a person's trust in their service, reduce hospital admissions, and bring happiness to family members by "just having someone there who can solve the problems".
Next steps for Healthwatch on home care
- Providers told us that care packages can be too rigid or unrealistic, especially around timings of visits, and that they could help shape something more deliverable if they had more involvement in the design of the packages. However, we have not spoken with hospital discharge or adult social care teams about this topic, or about their roles more broadly. We plan to do that this year.
- Hospital discharge is a pressure point, and we intend to do more work to understand it properly. We will speak to discharge teams and social workers about the challenges they face designing care packages, and where the gaps are between what’s assessed in hospital and what’s actually needed at home.
- We also plan to interview or run a focus group with paid carers to better understand their perspective on the challenges they face.
Find out more
Read the full report on the findings from the first year of our home care research, with extensive feedback from local people who rely on home care services, and our recommendations to commissioners for actions to take to improve the experience of service users
