Scottish Care has today launched a new report, entitled ‘Bringing Home Care’, at the Care at Home & Housing Support Conference in Glasgow.

The report focuses on home care’s role in the preventative care agenda, how the sector has developed in recent years (including the impact of Free Personal Care), and a sets out a vision for the future of home care services.

The report seeks to demonstrate that for the care at home and housing support sector to become a sustainable, high quality form of care provision which is self-evidentially an intrinsic part of the whole, we must do a lot more to focus upon and develop some of the major contributory elements of its work.

The following areas of home care delivery are explored in the report, in relation to how they have changed over time to the present day, and what the future focus of care at home provision is likely to be:

• The role of care at home workers and services
• The development and sustainability of care at home services
• Partnerships, relationships and status
• The value placed on home care provision, and the people they support.

The report locates the tracking of these changes in a context of:

• Highlighting the loss of relational elements of the care offer and the impact this has had;
• Describing the increase in eligibility criteria and the consequential decline in overall use of care at home services;
• Focusing on the potential of the ‘preventative role’ of homecare, and
• Relating this to the ADL LifeCurve™ work of Professor Peter Gore from Newcastle University.

In doing so, it hopes to show that the future of care at home services must be developed and commissioned in a way that prioritises time-flexible, relationship-based, preventative approaches to care delivery.

You can read the report here.

Radical action is needed to reform home care services to ensure that elderly people are not being denied access to services they would previously have received.

New research by Scottish Care, the representative body for the country’s independent social care services, has found that:

• Tightened eligibility criteria means the number of people assessed as requiring Free Personal and Nursing Care has reduced, and that those who do receive it generally have higher support needs
• This means older people who would previously have received support at an earlier stage for tasks such as housework, shopping and cooking now receive either much less support or none at all
• The commissioning of home care services on a ‘time and task’ basis compromises staff’s ability to deliver personalised, high quality care and support and puts this workforce under a huge amount of pressure.

The findings come from ‘Bringing Home Care’: a new report by Scottish Care which outlines the development of home care services over the past century, the impact of Free Personal Care and other policies, and the role of home care in providing preventative care.  It also sets out a vision for the future of home care services

Speaking ahead of Scottish Care’s conference for Care at Home and Housing Support Services today, where the report will be launched, CEO Dr Donald Macaskill said:

“Whilst we fully support the existence of Free Personal and Nursing Care and value its role in supporting people with social care costs, what we have seen since its introduction in 2002 is a move towards less people receiving more care.  Whilst this reflects the reality of constrained budgets, it means that many older people are being denied the support they need to enable them to live for as long as possible in their own homes. 

“What’s more, delaying or denying someone’s access to care and support is counterproductive from a financial perspective anyway, never mind the negative impact this has on an older person’s health and wellbeing.  A lack of appropriate and timely support being provided in someone’s own home or in a care home is likely to lead to more presentations at A&E departments and hospital admissions that may have been preventable.

“That’s why, in this report and at our conference, we will be calling for a reformed approach to homecare which is preventative in nature and values relationships and spending time with people, in whatever way suits an individual’s needs.  It is only through this sort of care that individuals can be supported effectively to live at home and the strain on acute services can be relieved.”

The report also highlights that a failure to reform home care will be extremely costly, not only in financial terms but in human terms.  It found that:

• Over one third of publicly funded care packages are commissioned for visits lasting under half an hour.
• Even a 30 minute visit means that in reality, an average of only 24 minutes of care can be provided in that time.
• 90% of organisations have difficulty filling support worker vacancies
• One third of total staff leave every year
• Of the support workers who leave organisations, 41% leave within the first 12 months.

Dr Macaskill added:

“The negative consequences of limited funding and time-restrictive commissioning are already impacting extremely negatively on the existing home care workforce.

“Not only are individuals in receipt of support services being denied the holistic care they deserve, which is not rushed or time-pressured, but the workforce who deliver this are being faced with impossible decisions about what care to deliver within such restrictive time and task commissioning.  It is no wonder that this is leading to so many individuals leaving the sector or not coming into it in the first place.

 “We as a society need to better value the work that these extremely skilled and dedicated care workers undertake, and support them to deliver the high quality, relationship-based and flexible care that Scotland’s older citizens deserve.

“If urgent action isn’t taken, the reality is that there simply won’t be the workforce or services to deliver home care in the future.”

You can follow conference updates at @scottishcare and by following #bringhomecare

Mental health and older people services.

Scotland’s population projections indicate that the number of people aged 75 and over will increase by 86 per cent in just a quarter of a century to 360,000 more than today. Inevitably, this will mean a higher proportion of those with mental health needs being over the age of 65 and also a higher proportion of these individuals requiring the support of older peoples care services.

There are approximately 33,000 older people living in care homes in Scotland any night of the year, and nearly 1,000 other individuals living in care home services for adults with mental health issues. Additionally, 61,500 individuals receive support through home care services, over 50,000 who are over the age of 65. Given these figures, it is crucial that we ensure high quality mental health care and support is built into the provision of these services, which nearly 100,000 people across Scotland access.

Research undertaken over the last eighteen months by Scottish Care has focussed on discovering what it is like to work at the frontline in social care services, whether care home or care at home/housing support services. That research was published in ‘Voices from the Frontline’ (2016), ‘Voices from the Nursing Frontline’ (2016) and ‘Trees that Bend in the Wind: Exploring the Experiences of Front Line Support Workers Delivering Palliative and End of Life Care’ (2017). These reports have all served to highlight a range of particular challenges relating to both the mental health and wellbeing of those older citizens being supported but also the mental health and well-being of the workforce. These, in brief, fall into four categories:

1. Ensuring appropriate support for older people living with enduring mental health conditions who access social care services

One of the current shortcomings of mental health care and support is the way in which both formal and informal support is available to older adults when they are receiving social care services. The current infrastructure and professional relationships between care services, GP services, pharmacy services, Allied Health Professionals and primary care mean, at best, multi-disciplinary support to older adults is a postcode lottery. This has real implications for individuals living with mental health conditions who are likely to require a range of professional supports and particular expertise to enable them to live well. There are concerns of availability of support in community settings, insufficient staff awareness and training, and challenges involved in multi-disciplinary and cross-sector working – for care home and care at home services.
2. Awareness of the risk of developing mental health conditions in periods of transition, change and trauma, particularly in older age

There are particular factors relating to older people and social care which may prompt or exacerbate mental health conditions. For instance, older people are more likely to experience bereavement through the loss of friends, spouses and relations which can require mental health support. The negative mental health consequences of social isolation and loneliness are therefore more likely to be experienced by older people. Additionally individuals who go through transitions such as moving into a care home or another care setting may experience difficulties in adjusting to a loss of home or a perceived loss of identity, if adequate support is not present.

3. Transitions between adult services and older people’s services

There are risks to good mental health associated with transitions where individuals cease to be part of adult services and move to older people’s services at the age of 65. It is common for services to become less accessible or even denied, and for resource levels to be reduced at this time. This raises issues around how the human rights of older people in relation to their mental health needs and right to access essential supports are being protected and promoted. The needs of an individual are often overlooked, and replaced with a focus on age and systems. It is recognised that transition phases can lead to a breakdown in communication and quality of care and support, leading to further uncertainty and anxiety for individuals at the centre of that support.

4. Capacity of care staff to effectively support people living with mental health conditions

As the population ages and people access care and support services later due to the success of community and informal support, care staff are increasingly supporting individuals at advanced stages of life with more complex and wide-ranging needs. This increasingly includes those living with significant and varied mental health conditions. Often a care worker is the key link to other individuals involved in a person’s life and care, and the quality of relationships built mean they are often best placed to assess the health and wellbeing of the person they support. It is increasingly difficult to adequately fund specialised training for front line social care staff to provide the most appropriate interventions, particularly in the current climate of ‘time and task’ commissioning, staff shortages and continued underfunding of care.

What is Scottish Care doing?

Over the last few months Scottish Care has supported Outside the Box Consultancy to work with a small group of care home residents and individuals being supported in their own home to explore some of the mental health challenges they are facing. The results of this work will be published by Outside the Box later in the autumn. It will help to provide us with an initial picture of some of the challenges and stressors.

Over the next year Scottish Care has committed to develop work to explore the impact of mental health issues upon organisations and the staff who provide care and support to older people. We will do this in two main ways:

1.

We will undertake a process of desk research and review as well as a focused survey to:

• analyse the current level of experience, gaps and challenges re mental health and older people in care home/care at home services;
• identify mental health support issues at points of transition for those with pre-existing mental health needs;
• identify the level of unmet mental health needs in both care at home and care home contexts;
• identify learning and skills gaps in front line care home/care at home staff in relation to mental health needs.

2.

We will undertake some focus group work to explore the ways in which mental health and wellbeing issues impact upon the front line care home and care at home/housing support workforce. This will include an exploration of the personal mental health and wellbeing issues facing staff working within the sector and will build on the work which Scottish Care in conjunction with the Care Inspectorate has already started on the physical health and wellbeing of the workforce.

We would hope to be able to publish our findings by November 2017.
If you would like to know anything else about this work please contact our Policy and Research Manager, Becca Gatherum at [email protected].