By Susan Adams, regional manager, CHS Healthcare
I have spent the past 20 years co-ordinating care, primarily for older people who have been admitted to hospital and cannot return to independent living at home. This work involves supporting clients and families who need to choose a care home and equally, organising the care they need in order to return to their own home.
It was typically the case that brokering care in the client’s own home was the simpler task compared with supporting people moving into a care home. This is unsurprising: moving into a care home is a major life event which involves making an important choice about which facility. Often, it is highly emotional. Brokering home care is different; putting in place the support the individual needs in order to return to their own home. The task is primarily about organising the required care. Personal preference is important, but there is not the major challenge of moving somewhere new and choosing where that should be.
It is, therefore, notable to observe that today, it is more challenging to broker home care than a care home placement. Why? It is simply due to the shortage of agencies providing home care and their lack of capacity. It is common for the co-ordinators in my teams in London to ring 20 to 30 different agencies in order to arrange care for one person.
Providing services in locations throughout England, we can also observe that the lack of care agency capacity applies in both rural and urban areas. For example, in Wiltshire, where we broker care for nearly 100 individuals each month, the challenge is geography. Clients often require frequent daily visits, each for short amounts of time. Carers are often unwilling to travel long distances for a relatively short period of provided care. This is an even greater challenge for the many carers who don’t have a car.
We are also seeing an unexpected consequence of commissioning policies. In several major cities where we work, there are four preferred care agency providers. While it is entirely appropriate to have thorough provider checks, in practice, this means the number of providers has dramatically shrunk from more than 20 to little more than the preferred four. Preferred providers have expanded, taking staff from the smaller agencies which means overall, the smaller agency based is far less responsive to changing demand. For example, last Christmas in one region in the south-west, care agencies told us they had no capacity to take on any more work whatsoever for 12 weeks. This was unprecedented and certainly resulted in further delayed discharges from hospital.
Because many people working for care agencies are on zero hours contracts, holidays are particularly problematic, when those with childcare responsibilities choose not to work. Inevitably, this coincides with Christmas pressures on the NHS and equally, the summer can be extremely challenging when family members go on holiday and their elderly relatives require additional support from care agencies.
Of course, capacity can also be a problem when people are looking for a care home, but currently shortages are at their most acute within the agencies providing care in individual’s own homes. In view of the priorities of supporting people to stay in their own homes rather than long term care whenever possible and the need to reduce delayed hospital discharges, the chronic lack of capacity in care agencies is a crisis which must be urgently addressed.