The Commission's inquiry into the home care system in England reveals disturbing evidence that the poor treatment of many older people is breaching their human rights and too many are struggling to voice their concerns about their care or be listened to about what kind of support they want.

The final report of the Commission’s inquiry, 'Close to home: older people and human rights in home care', says hundreds of thousands [1] of older people lack protection under the Human Rights Act and calls for this legal loophole to be closed. It questions commissioning practices that focus on a rigid list of tasks, rather than what older people actually want, and that give more weight to cost than to an acceptable quality of care.

Around half of the older people, friends and family members who gave evidence to the inquiry expressed real satisfaction with their home care. They most valued having a small number of familiar and reliable staff who took the time to talk to them and complied with their requests to do specific tasks. Home care workers said their job satisfaction came from improving the quality of older people’s lives.

But the inquiry also revealed many examples of older people’s human rights being breached, including physical or financial abuse, disregarding their privacy and dignity, failing to support them with eating or drinking, treating them as if they were invisible, and paying little attention to what they want. Some were surprised that they had any choice at all as they thought they had little say in how their care was arranged.

For example, evidence given to the Commission included a woman being left stuck on the toilet in her bathroom, as the care worker said she was too busy completing the list of care tasks to help her; and people with dementia not being prompted to eat or their food ‘hidden’ in the fridge, so they go hungry; and a woman who asked for help with her washing up and to be assisted to walk out into her garden but was given help washing herself instead.

Ways for older people to complain about their home care are either insufficient or not working effectively. Reasons for their reluctance to make a complaint about their treatment included not wanting to get their care workers into trouble, fearing repercussions such as a worse standard of care or no care at all and preferring to make do rather than make a fuss.

The inquiry reveals the pervasive social isolation and loneliness experienced by many older people confined to their homes who lack support to get out and take part in community life. Yet evidence from the home care industry indicates that social activities are some of the first support services to be withdrawn when local authorities cut back their spending on care services.

Alarmingly, one in three local authorities had already cut back on home care spending and a further one in five planned to do so within the next year.

The low rates that some local authorities pay for home care raises serious concerns about the pay and conditions of workers, including payment of the minimum wage. The low pay and status of care workers does not match the level of responsibility or the skills they need to provide quality home care. A high turnover of staff as a result of these factors has a negative impact on the quality of care given to older people.

The inquiry found age discrimination was a significant barrier to older people getting home care. It found that people over the age of 65 are getting less money towards their care than younger people with similar care needs, and are offered a more limited range of services in comparison. It also found that local authority phone contact lines can screen out older people needing home care without passing them on for a full assessment – which is unlawful.

Very few local authority contracts for home care specify that the provider must comply with the Human Rights Act. This undermines the quality of care that older people are getting. The evidence given to the inquiry indicates that where human rights are embedded into the way home care is provided – from commissioning to service delivery – high quality care is delivered without necessarily increasing costs.

In response to the findings of its inquiry, the Commission says that legislation and regulation needs to be updated to reflect huge shifts in how care is provided [2]. Its recommendations from the inquiry fall under three broad categories: 

• Proper protection: Closing the loophole in the Human Rights Act which would give protection to the growing number of older people receiving home care from private and voluntary sector agencies. The law was changed in this way in 2008 to protect residents of care homes who are funded by the state.
• Effective monitoring: The government, Care Quality Commission and local authorities need to work together better to build human rights into home care and make sure that abuses are detected faster and dealt with more effectively.
• Clear guidance: Clear and robust guidance on human rights is needed for councils so they can use the opportunities they have to promote and protect older people's human rights in commissioning; older people also need guidance to help them make choices about care and to explain how their human rights should be protected.

Sally Greengross, Commissioner for the Equality and Human Rights Commission, said:

'It is essential that care services respect people's basic human rights. This is not about burdensome red tape, it is about protecting people from the kind of dehumanising treatment we have uncovered. The emphasis is on saving pennies rather than providing a service which will meet the very real needs of our grandparents, our parents, and eventually all of us.

'This inquiry proposes some steps that would make sure human rights are protected in future – including changes to the law so that, at a minimum, all people getting publically funded home care are protected by the Human Rights Act. Currently this is not the case.

'Most of us will want to carry on living in our own homes in later life, even if we need help to do so. When implemented, the recommendations from this inquiry will provide secure foundations for a home care system that will let us do so safely, with dignity and independence.'

[1] An estimated one in five (20 per cent) of older people living at home receive care services. In 2009-10 about 453,000 people received home care through their local authority, excluding those in receipt of direct payments.

[2] Since the Human Rights Act came into force in 2000, the home care industry has changed from having 56 per cent of care delivered by the private and voluntary sector to 84 per cent.

Article from Equality and Human Rights Commission