Many older people receive care and support services in their own homes. This is known as ‘domiciliary’ care. Many have to pay for some or all of their support themselves having undergone a stringent ‘needs assessment’ and a means test.
New rules will mean that more qualify for financial support. However, the proposed lifetime ‘cap’ of £86,000 only applies to costs of ‘personal care’ and will, almost certainly, be dependent on meeting a local authority ‘needs assessment’. Many will still be expected to make a large financial contribution.
Domiciliary care is expensive. Shropshire Council, for example, currently pays the outside organisations it commissions, many of them private companies, between £16.86 and £19.62 per hour. The average pay for most carers providing the service locally in 2020 was £8.84 per hour. The rates charged to those paying for their own care vary but will add up to a substantial sum for regular visits on a weekly basis.
The quality of the care provided is variable. According to the Care Quality Commission 1 in 10 providers in Shropshire require improvement or are rated as inadequate. Less than 70% of those surveyed in Shropshire said that they were ‘satisfied’ or ‘very satisfied’ with the care and support services they receive.
Continuity of care has been raised in recent interviews we have conducted. In a survey carried out by Shropshire Healthwatch 24% of respondents said they did not see the same carers regularly. Visits can last less than an hour. Those receiving care need to be fully involved in decisions about the services they receive. Greater encouragement should be given for more local not-for-profit organisations to become involved in provision.
Turnover of domiciliary carers is high nationally and locally. Many are on zero hours contracts and only a small percentage of extra government funding was allocated to support domiciliary care workers unable to work for Covid related reasons. The rural nature of a county also has an impact on the availability of staff as transport can be difficult, and staff are often not paid for time travelling between appointments. Many receive limited or no opportunities to train or develop their skills.
The government has failed to produce a realistic plan capable of delivering the adult social care that people need without imposing enormous financial costs on them or their families. The additional taxes required to fund a fully comprehensive national care service should be borne by those who can best afford to pay.