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Last Updated: Monday, 17 November 2003, 11:59 GMT
The problem with home care
by Sarah Barclay
Panorama reporter

Fran finds Doris sitting in an armchair in her front room. She's 92 and very frail.

Sarah Barclay and Joan Davies
Sarah Barclay in conversation with Joan Davies
Fran makes her tea and gets a packet of frozen bangers and mash out of the freezer and puts it in the microwave. Doris asks her to cut it up and sits eating slowly while Fran searches for an incontinence pad.

It's only when she asks Doris to stand up so she can sit on the commode that Fran realises Doris can't. She goes to the kitchen and consults the care plan which is meant to describe Doris's needs. It doesn't say anything about not standing up.

Fran phones Anchor, the agency which has sent her to look after Doris. They suggest Fran slide a clean pad on top of the wet one.

No clue

Fran quickly realised that to get through all her appointments, she was going to have to cut corners
Sarah Barclay

So easy to say. Such an intimate thing to have to do when you're faced with a frail 92 year old who has never seen you before and who you've been sent to look after with no experience and just four and a half hours training.

Later that day, Fran recorded her thoughts about her experience with Doris in one of many video diaries she recorded during the seven weeks she worked as a carer, in Liverpool and Brighton.

"It's bad enough going into someone's house and trying to help them when you've not got a clue what they need or how to do it.

"But it's even worse when you phone up the people who are supposed to be there to support you and they can't help. It just makes you feel completely useless really."

Too easy

Despite her concern, Fran is sent back to see Doris the next day, During this visit, Doris becomes so distressed when Fran tries to change her pad that she screams and wets herself and her chair.

Fran has to clean up - feeling that, yet again, she's failed someone who surely deserves better than this.

The question of whether Fran deserved better than this is also worth asking. Her payslip records that she was paid just 4.80 for each of the two half hour appointments she had with Doris that weekend.

It was easy for Fran to get a job as a domiciliary careworker - the official description for someone who looks after a person living at home, as opposed to residential care.

Much too easy considering the people Fran and thousands of other careworkers like her - 95% of them women - are now being asked to look after.

Government policy

Fran Baker and Doris Rofe
Fran Baker caring for Doris Rofe

Fran secretly recorded her experiences as a careworker and investigated what life is like for the estimated 420,000 people in England and Wales over the age of 65 who are being cared for in their own homes.

For many of them, their only daily human contact may be the person who is sent to get them up in the morning, prepare their food and put them to bed at night. Being cared for at home rather than in hospital or residential care when we get old and frail is, apparently, what most of us want.

In line with Government policy over the last decade, elderly people who get state-funded homecare are those with relatively high levels of need and it's both means-tested and rationed according to strict "eligibility" criteria.

Those who would have got it ten years ago would probably not get it now and those who get it now might not get it next year.

Fabricated

Fran was sent out alone with little or no formal training into the homes of elderly people whose needs she was not qualified to meet
Sarah Barclay

Eligibility depends as much on how much money there is as it does on actual need and homecare workers are increasingly being asked to deliver "personal care" - care which involves touching a person's body - washing, dressing, changing incontinence pads.

Even administering food and hydration through a feeding tube.

Fran started work as a carer in Liverpool at the beginning of July, working for an agency called Care Connect.

They promise: "To provide a Care Service of the highest possible standard to allow our clients to be cared for comfortably and safely with peace of mind in their own homes."

But Fran, who told Care Connect she had no previous experience as a carer, was offered a job on the basis of false references and a CV which was largely fabricated.

Cutting corners

The three days "induction training" demanded by the Government's new National Minimum Standards for Domiciliary Care, were reduced to just 70 minutes.

After that, Fran was sent out to "shadow" an experienced careworker for five and a half hours.

After her shadowing, Fran was sent out alone. Over the next three weeks she was sent to care for 51 different people: among them, Annie, an 88 year old who lives alone and whose carers do not always turn up to put her to bed or remind her to take the pills she needs for her diabetes and heart condition.

Teresa, a 91 year old with severe dementia who can only be lifted with a hoist that Fran has not been trained to use and Molly, who was left sitting in her chair all night when carers from another agency failed to turn up.

Fran quickly realised that to get through all her appointments, she was going to have to cut corners.

Call cramming

The majority of care is delivered with the best intent but very often it is too short and it is keeping people alive rather than giving them quality of life.
Bill McClimont

Because travelling time wasn't included in her schedule, the only way she could see everyone was to choose whether to leave one appointment early or arrive at the next one late.

One industry insider told us he'd even coined a phrase for this: "call-cramming"

Two thirds of domiciliary or homecare is now contracted out by local authorities to private or not for profit agencies. It's an industry where regulation is in its infancy.

From April, all agencies providing personal care are supposed to have applied to be registered with the industry's new regulator, the National Care Standards Commission.

Desperate

We asked them to tell us how many of the estimated 4,000 agencies providing domiciliary care had applied and how many were actually registered. They said they didn't have any "meaningful data."

When Fran arrived in Brighton in August, she found it just as easy to get a job with false references as it was in Merseyside.

Only one of the twelve agencies approved by Brighton & Hove City Council to provide homecare wanted previous experience as a careworker.

The others were desperate for staff and once again, Fran was sent out alone with little or no formal training into the homes of elderly people whose needs she was not qualified to meet, by agencies who have not yet been officially approved by the industry regulator.

Among them - Joan, a private client who has been promised experienced carers by Anchor, the agency she pays to look after her.

Vulnerable

When I started as a carer I had no idea that I'd be as upset by what I saw as I have been. And more than anything else, it's made me absolutely terrified of getting old.
Fran Baker

It is only when Fran - inexperienced and untrained - is shown the care plan describing Joan's needs, that she realises Joan is completely blind, partially deaf, immobile and suffering from a condition which has resulted in paralysis to her face.

Joan is understanding and kind to Fran, who is apologetic and promises to do her best. "I know you will," Joan replies, "but it just makes it tough on you and on us. It's not fair."

And there's Lilian, a confused woman of 90 who Fran is asked to fit in as an emergency because of staffing problems and who has been left waiting for her lunch.

When Fran has made lunch and is preparing to leave, she has a conversation with Lilian which reminds her just how vulnerable elderly people alone at home can be.

  • "Fran: You going to be all right?
  • Lilian: I hope so. You off now?
  • Fran:Yeah. I've got to go now. I'll see you again sometime.
  • Lilian: No more today?
  • Fran: No more today. Someone different will be along later.
  • Lilian: Who?
  • Fran: I'm not sure.
  • Lilian: When they coming?"
  • Fran: I think they will be here after five o'clock but they might be a little bit late.
  • Lilian: What time is it now?
  • Fran: Now, it's three fifteen. OK?
  • Lilian: Have to be."
Bill McClimont, chairman of the UK Homecare Association, which represents many agencies providing homecare, said: "The majority of care is delivered with the best intent but very often it is too short and it is keeping people alive rather than giving them quality of life.

Terrified

"I'd be surprised if better than thirty per cent of people are getting the kind of service we'd like to be delivering as an industry."

Fran finished working undercover at the beginning of September. In her seven weeks as a carer she had seen 106 different people and been given a disturbing glimpse into what life alone at home could be like in modern Britain. Her final video diary, recorded on September 9th says simply:

"When I started as a carer I had no idea that I'd be as upset by what I saw as I have been. And more than anything else, it's made me absolutely terrified of getting old."

Fran is 27-years-old.

SEE ALSO
A carer's diary - Merseyside
16 Nov 03 |  Panorama
A carer's diary - Brighton
16 Nov 03 |  Panorama
Your comments
16 Nov 03 |  Panorama

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