Understanding people's experiences of home care in Bexley
Around 500,000 people in England currently receive home care, but recent reports have raised significant concerns about the quality and reliability of some home care services. Hear how one local Healthwatch has worked to gain an understanding of people's experiences of home care.
According to guidance published by the National Institute for Health and Care Excellence (NICE), older people in home care should expect to feel in control and their privacy and dignity respected. However, for many people this isn’t always the case.
The University of Kent and Christchurch University, working in partnership with Healthwatch Bexley, have undertaken a significant piece of research involving 26 in-depth interviews with residents aged between 55-102. The results give a vivid picture of people’s experiences of home care:
“I feel very fortunate to have such good care. I couldn’t manage without; I would have to have gone into a home because I can’t stand at all”
Feeling satisfied with their care
People using home care placed high value on the help they receive, particularly with personal hygiene and getting dressed. They wanted to stay in their own home for as long as possible and the majority felt that home care helped them do so.
Invasion of privacy
Some people said they felt their privacy was invaded. They found experiencing changes at home frustrating, such as having care workers moving their belongings, and becoming unable to reach areas of their home due to their age and disability.
Although many people told us they were treated with dignity and respect, some felt vulnerable and that they had lost control of their bodies and personal boundaries.
Relationships with care workers
“I do find that I get very depressed, I sometimes don’t see anybody all day.”
People value friendliness, empathy, humour, experience and dedication in their care worker. Having regular visits from person also helps build a positive relationship. As lots of people receiving home care feel lonely and isolated, having a good relationship with their care worker is important for their quality of life.
People found a lack of consistency, poor attitudes and language barriers challenging. Due to lack of time, some care workers only focused on physical needs which meant meaningful activities were often ignored. People were also aware that poor quality of care could be made worse by time pressures and low staff-pay.
Inconsistency of service
“I do object when somebody comes here at half past five to get you undressed ready for bed especially in the summer.”
One of the main criticisms people had was the inconsistency of care schedules. Some people did not have care visits at times that suited them, while others said that care workers did not always come at the same time, which made it hard for them to plan their day.
Lateness, particularly at the weekends, meant that people were left waiting for the most basic help, including going to the toilet, changing incontinence pads and having meals.
Occasionally care workers would not turn up at all. One person did not have a care visit for seven days because her care worker was on holiday.
The people we spoke to wanted staff to communicate about delays with them in advance.
Lack of control
“I found it quite difficult trying to find out what was available and that would have been helpful”
Some people felt they had not been fully involved in the organisation of their care. Most believed they had a limited choice of the type and level of care they received. Changes such as a move from hospital to home care, or having a different care provider left people feeling anxious.
The people we spoke to felt they knew how to complain about poor services. However, many were reluctant to do so because they did not want to get care workers into trouble and some feared a worse consequence for themselves. For those who had voiced complaints about their care, some people were highly satisfied with the outcome, whereas others felt like their issues were neither listened to nor taken seriously.
How can services be improved?
Using the experiences from people in home care, the research team was able to identify areas where home care is not meeting the needs of both elderly and disabled groups in Bexley. Its six recommendations include reducing isolation, maintaining monitoring standards, improving choice, effectively signposting to other services, smooth transitions from hospital to home care, better communication and further research to improve services.