Quality of home care breaches older people’s human rights, says inquiry

Home care often breaches older people’s human rights, an inquiry by the Equality and Human Rights Commission has revealed.

The Commission’s inquiry into the home care system in England has found evidence that the poor treatment of many older people often fails to meet their basic rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want.

The final report of the inquiry, 'Close to home: older people and human rights in home care', says hundreds of thousands of older people lack protection under the Human Rights Act and questions commissioning practices that focus on a rigid list of tasks, rather than what older people actually want, and that give more weight to cost than to an acceptable quality of care.

Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. They most valued having a small number of familiar and reliable staff who took the time to talk to them and complied with their requests to do specific tasks. Home care workers said their job satisfaction came from improving the quality of older people’s lives.

But the inquiry also revealed many examples of older people’s human rights being breached, including physical or financial abuse, disregarding their privacy and dignity, failing to support them with eating or drinking, treating them as if they were invisible, and paying little attention to what they want. Some were surprised that they had any choice at all as they thought they had little say in how their care was arranged.

Ways for older people to complain about their home care are either insufficient or not working effectively. Reasons for their reluctance to make a complaint about their treatment included not wanting to get their care workers into trouble, fearing repercussions such as a worse standard of care or no care at all and preferring to make do rather than make a fuss.

The inquiry reveals the pervasive social isolation and loneliness experienced by many older people confined to their homes who lack support to get out and take part in community life. Yet evidence from the home care industry indicates that social activities are some of the first support services to be withdrawn when local authorities cut back their spending on care services. One in three local authorities had already cut back on home care spending and a further one in five planned to do so within the next year.

The low rates that some local authorities pay for home care raises serious concerns about the pay and conditions of workers. The low pay and status does not match the level of responsibility or the skills they need to provide quality home care. A high turnover of staff as a result of these factors has a negative impact on the quality of care given to older people.

The inquiry found that people over the age of 65 are getting less money towards their care than younger people with similar care needs, and are offered a more limited range of services in comparison. It also found that local authority phone contact lines can screen out older people needing home care without passing them on for a full assessment – which is unlawful.

Very few local authority contracts for home care specify that the provider must comply with the Human Rights Act which undermines the quality of care that older people are getting. The evidence given to the inquiry indicates that where human rights are embedded into the way home care is provided – from commissioning to service delivery – high quality care is delivered without necessarily increasing costs.

In response to the findings of its inquiry, the Commission says that legislation and regulation needs to be updated to reflect huge shifts in how care is provided.

It recommended closing the loophole in the Human Rights Act which would give protection to the growing number of older people receiving home care from private and voluntary sector agencies and called for the government, Care Quality Commission and local authorities to work together better to build human rights into home care and make sure that abuses are detected faster and dealt with more effectively.

Recommendations were also made for clear and robust guidance on human rights for councils so they can use the opportunities they have to promote and protect those of older people in commissioning; older people also need guidance to help them make choices about care and to explain how their human rights should be protected.

Sally Greengross, Commissioner for the Equality and Human Rights Commission, said: “It is essential that care services respect people’s basic human rights. This is not about burdensome red tape, it is about protecting people from the kind of dehumanising treatment we have uncovered. The emphasis is on saving pennies rather than providing a service which will meet the very real needs of our grandparents, our parents, and eventually all of us.

“This inquiry proposes some steps that would make sure human rights are protected in future – including changes to the law so that, at a minimum, all people getting publically funded home care are protected by the Human Rights Act. Currently this is not the case.

“Most of us will want to carry on living in our own homes in later life, even if we need help to do so. When implemented, the recommendations from this inquiry will provide secure foundations for a home care system that will let us do so safely, with dignity and independence.”