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Indignity, a dearth of compassion, terrible suffering and utter chaos: In an investigation that'll terrify every family, we lay bare the agonising death of Britain's home care system
- The system costs UK taxpayers more than three billion pounds every year
- Daily Mail investigation reveals a catalogue of failings in home care system
- Major inquiry found some vulnerable people had 50 different carers a year
- Former Care Minister said home care is 'low paid, ill-trained and low morale'
- Paul Burstow claims the effect on elderly people who need care is 'terrible'
PUBLISHED: 00:41, 31 January 2015 | UPDATED: 01:05, 31 January 2015
Dave Watson and his wife Carole used to be great travellers — only recently they worked out they'd been to 50 countries in their 50 years of marriage, including Borneo, Thailand and Canada.
Their world, however, has shrunk considerably since Dave suffered a stroke ten years ago. Nowadays, they can be found at home most mornings — like many of us — having porridge and a cup of tea.
But unlike most of us, Dave, 76, is often forced to eat his breakfast in the bathroom — naked, while sitting on a commode.
It isn't a matter of choice. Dave, a retired water board worker, has dementia, and suffers this gross indignity because he is dependent on a care system in crisis.
Dave receives care at his Norwich home from Mears Group, an agency engaged by Norfolk County Council. In the morning he has just one carer for half an hour to do everything — hoist him out of bed and on to the commode, give him a shower, then dress and settle him in the living room.
Wasted: The home care system costs the taxpayer more than three billion pounds each year
It isn't enough. So Carole — who is 70 and just 5ft tall, while Dave weighs 12½ stone — starts the job herself. She gets her husband out of bed, she washes his bottom half and wheels him on the commode into the bathroom ready for the carer.
If no one arrives — a frequent occurrence — he sits there waiting, naked and hungry. On occasion, he's been there for up to an hour. So Carole makes his breakfast and gives it to him while he waits.
'Dave isn't happy with it — he shouldn't be eating his breakfast in the bathroom,' she says. 'The carers are all lovely, but they arrive late because they aren't given enough travel time. It isn't their fault — it's the system.'
Carole says they've seen 15 different carers since November — and her husband has had four different care companies in ten years. Each time a new face comes through the door, Carole, a retired retail manager, has to start anew the task of explaining her husband's needs — he has dementia and can't always say what he wants.
The couple don't have children, and while neighbours and other relatives do their best to help out, they are reliant on carers in the morning.
While clearly shocking, the Watsons' situation is far from unusual: as the population ages and more people need care, an overstretched system is rapidly reaching breaking point.
The system costs the taxpayer more than three billion pounds each year — and it is broken.
A Daily Mail investigation has revealed a catalogue of failings — inadequate training, call times of 15 minutes or even less in which carers must meet their clients' most basic needs; carers asked to be literally in two places at once because they are allocated insufficient travelling time.
It all adds up to a grim picture, according to the former care minister Paul Burstow. He recently headed a major inquiry into the home care provision on which more than half a million people in England and Wales rely. Some vulnerable people had up to 50 different carers coming through their doors in the course of a year, it heard.
Failing: A major inquiry concluded some vulnerable people had up to 50 different carers coming through their doors in the course of a year
It found a system which treated vulnerable people not as individuals, but as items on a production line.
'Home care is low paid, ill-trained and low-morale,' he says. 'Staff see caring as a stop-gap job, rather than something they want to pursue as a long-term career.'
The effect on the elderly and frail people who rely on carers can be terrible. He says: 'There's no continuity, no relationship there. You're just a commodity being passed from one worker to another. There's no sense that you're a human being.'
Elderly people speak of rushed visits, carers who don't arrive or even speak the same language as them. Many long to be called by their actual names as opposed to the over-familiar 'duckie' or 'lovey' — terms beloved by many in the caring professions.
They complain bitterly of a succession of strangers coming through their front doors — often charged with giving them the most intimate services.
In an Age Concern report there were complaints of being bathed at a set time whether they wanted it or not, of carers using first names or even nicknames when they preferred to be addressed formally.
Meanwhile, carers speak of schedules that demand that they must work 15-hour days, drive dangerously to get to appointments on time and even buy their own uniforms. It's hardly surprising, then, that care workers don't stay in their jobs for long — a fifth of the workforce turns over every year.
“To them you're just a commodity, not a human being” Paul Burstow, former Care Minister
It's not just undignified and demeaning, lives are being put at risk. When elderly people are relying on inexperienced staff who aren't familiar with their needs, things can end in tragedy.
On the wall of the sitting room in Glenn Millar's house in Gateshead are a row of old black and white photographs. They depict a handsome young man in Royal Navy uniform, larking about on a dockside with his mates.
The pictures are of Glenn's father, James, and the optimism of youth shines out of them. Sadly the end of James Millar's life had none of that positivity about it.
James was 77 and had moderate Alzheimer's — but he didn't let that slow him down, according to Glenn, who is 45 and works in finance. Every morning he would get up and dressed and then he'd take the Metro train down to the ex-servicemen's club in North Shields. He'd spend the day there, playing cards or bowling with his friends.
His carers were paid by Gateshead Council to pop in first thing, just to make sure he was clean and well-dressed and — crucially — to give him the warfarin medication he needed for a heart condition.
Then disaster struck. A new company took over — Merit Home Care — and a new carer arrived. He didn't know James and he hadn't been told to give him his pills. He even called his company to ask them — but didn't get clear instructions on what needed to be done.
For four days, James didn't have his warfarin. Then the carer arrived one morning to find he had collapsed from a stroke. He never recovered, and three weeks later he died. The coroner found a direct link between his death and the arrangements made by James's care company — which was under contract to Gateshead Council. Glenn doesn't blame the carer — he was young and new, he says. Instead, he blames a system which undervalues older people to the extent that it sends in staff on minimum wage who don't know their clients' needs.
'They're playing with people's lives,' he says. 'And I do believe others are still at risk. We need care workers who are better paid and better trained. My family doesn't want anybody else to have to go through what we have gone through.'
Merit Home Care told the Daily Mail it deeply regretted the circumstances leading up to Mr Millar's death. A spokesman said: 'We acknowledged at the time that there were some issues on our part. However, Mr Millar's care was assigned to an experienced care worker who was provided with full training.'
'Terrible': Former Care Minister Paul Burstow said: 'Home care is low paid, ill-trained and low-morale' (file photo)
A spokesperson for Gateshead Council said: 'Merit Homecare no longer hold any contracts with Gateshead Council. At the time private contractors were selected with considerable care. Each were judged against 18 separate standards, none of which were based on price, before even being permitted to tender for a contract. The second stage of the process was even more demanding. We monitor contractors' performance rigorously and often.'
The care industry, which provides home care under contract to local councils, says it is unhappy about the situation too. Its trade body, the United Kingdom Homecare Association (UKHCA), will publish its own research this month on what local councils are prepared to pay for care — and it will make grim reading.
In order to pay all the necessary costs — the legal minimum wage, travel expenses, overheads, training and so on — local authorities need to pay the companies at least £15.74 for every hour of care they deliver, the UKHCA says. In reality, they usually pay much less. Another survey last year found some councils were paying as little as £9 per hour.
Colin Angel, the Policy and Campaigns Director of UKHCA, says: 'Home care services have become increasingly rationed. Visit times have been cut to the bone to save councils money. It's worrying to see councils dictating low maximum prices — some are clearly exploiting their dominant purchasing power.'
“Some carers are allowed to stay only eight minutes”
Meanwhile, for those who rely on the care system for all their basic daily needs, the situation is often bleak.
Former machine tool electrician Ken Chatwood is 73, and has multiple sclerosis.
He lives in a bright, clean flat near Oswestry in Shropshire, surrounded by photographs of his family — he has two sons, a daughter and four grandchildren. Since his wife Eileen died ten years ago, he's had four different care agencies. He's very happy with the current one — but the others left much to be desired.
At one point he had no fewer than 16 carers coming through his door at different times. He had to teach them how to work the hoist in his flat while instructing them on how to ensure his delicate skin didn't get damaged. Despite that, he spent a year in hospital after poor handling caused him to develop severe pressure sores.
'I never knew who the carers coming through my door would be,' he says. 'I couldn't remember their names. I would have to tell them what to do, because they wouldn't know.'
A couple of years ago Ken got a new carer — 21-year-old Eric Evans. He's here on the day we meet — and there's clearly a fondness and a respect between care-giver and client which is so often lacking.
Back then, Eric often started work at 7am and would finish at 10pm. He wasn't paid for travelling time and once that was factored in his hourly rate was around £4 per hour — way below the National Minimum Wage.
He says there was so little time between one call and another that some of his fellow carers clocked up speeding points while trying to keep up with an impossible schedule.
Once, Eric arrived to find Ken soaking wet because his catheter had failed. He phoned his manager to say he needed to stay with him while a nurse was called — sitting in wet clothing would cause him to develop sores and could put him back in hospital. But Eric was told he had to leave: there was no one else available to cover his next call.
'They made me feel like rubbish,' says Eric, who was previously on a zero hours contract. 'And I knew if I complained, my hours could be cut.' Eric and Ken both moved to a different agency. Things are different at Home Instead — it doesn't bid for local authority contracts and its clients never see a carer they don't know. Ken is luckier than most because his care is now funded more generously by the health service, after he was assessed to have medical needs.
Home Instead's Chief Executive is Trevor Brocklebank — he started the company after struggling to find decent care for his own grandfather.
“Ten years ago, the system was already broken... It's been rolling towards a cliff edge, and in the past year or so it's fallen off” Trevor Brocklebank, Home Instead's Chief Executive
'We charge £18-£20 per hour for care so that we can get good carers and retain them,' he says. For those who rely on the care commissioned by local authorities, he continues, the situation has now become critical, with budgets so tight they often simply can't cover the costs of home care.
'Ten years ago, the system was already broken,' he says. 'It's been rolling towards a cliff edge, and in the past year or so it's fallen off.'
Home Instead has a minimum call time of one hour, while many local authorities expect carers to enter and leave their clients' homes within 15 minutes. Although these short calls are intended mainly to check someone is well or to give medication, carers sometimes have to do much more — preparing meals or helping clients to use the toilet, for instance.
And one carer, who spoke to the Mail, said she was often expected to leave her 15-minute calls after just eight minutes — because the council weren't paying for travel time.
'That to me is abuse,' Brocklebank says. 'It's totally unacceptable. I can't get dressed and have breakfast in 15 minutes — how can we expect someone with dementia to do that?'
In their defence, councils say they have been forced to cut budgets for adult care services by a quarter in just four years — at a time when demand is increasing because of an ageing population.
David Pearson is President of the Association of Directors of Adult Social Services and insists councils are as concerned as anyone else about the situation.
He says a few will deliberately set a ceiling on what they're prepared to pay, but most just want companies that will provide a decent service.
But the truth is the large majority of councils don't pay what the industry says it costs to provide that good standard of care.
And Mr Pearson says while councils will soon have to demonstrate they're paying enough for companies to meet the legal minimum wage, companies must still think hard about whether they can do the job for what they're being paid.
'It's the provider's responsibility to pay and treat staff properly,' he says. 'If people don't think there's enough money in the contracts, they shouldn't bid for the work.'
Paul Burstow, the former care minister, fears there will be more tragedies. 'We have a licensing system for bouncers,' he says. 'We have one for hairdressers. Why do we not have one for care workers?'
The system isn't just broken, he says — it's heading for disaster. 'It's amazing that we haven't had a serious scandal in the home care sector — and unless we start seriously to address the whole question of training and standards, it's only a matter of time until we do.'
Back in Norwich, Dave and Carole continue to struggle on, one day at a time.
When the Mail phoned their care agency, Mears Group, for comment on their case, the company rang the couple within hours, offering to increase the amount of support they received. But the offer depended on extra funding from the local authority, it said.
A spokesperson at Norfolk County Council, said: 'As soon as we learned of Mrs Watson's concerns this week we met with the provider to discuss these and agreed actions that we think will help better match the Watsons' needs and, in doing so, hopefully improve both Mr and Mrs Watson's quality of life.'
Meanwhile, Carole is heartbreakingly philosophical about their situation. 'I hate all of it,' she says. 'But you've just got to get on with it — haven't you?'
Until we stop viewing the elderly as second-class citizens, and accept more has to be spent on their care, for too many families this is the reality.
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